Table 3 Example for identifying and defining the nonlinear phases of policy D&I across contexts (Recommendation 3)

Example scenario

Hospital leaders identify a high number of hospital-acquired infections in their patient population. Hospital leaders identify poor hand hygiene as a root cause of elevated infection rates and decide to adopt the Center for Disease Control’s Clean Hands Count campaign as a hospital policy. The hospital emails staff about the new policy, places soap and hand sanitizer in every patient room and hallway, displays posters reminding staff to clean their hands before and after entering each patient’s room, and incorporates hand hygiene education into staff meetings and provider rounds. Observers record hospital staff’s handwashing behavior and monitor the rate of hospital-acquired infections over time.

EPIS framework application steps

1. Organize documented policy dissemination and implementation activities by time-bound EPIS phases.

  • Exploration: Hospital leaders examined the need for change by reviewing data on hospital-acquired infection rates, identify hand hygiene as a problem, and hospital leaders decided to adopt the Clean Hands Count campaign as hospital policy.

  • Preparation: Hospital leaders designed implementation strategies to facilitate adoption of the Clean Hands Count initiative.

  • Implementation: Policy notices, hand hygiene supplies placement, and educational and reminder strategies were used. Observers monitored fidelity to the hospital policy and corresponding implementation strategies.

  • Sustainment: Over time, if infection rates decrease and employees continue hand hygiene protocols, the hospital may enter sustainment, whereby hand hygiene becomes part of the hospital’s culture and workflows.

2. Use mixed-methods approaches to investigate the contextual factors that propel the hospital to the next phase or influence them to revisit activities from past phases.

  • Examine how the hospital leaders maintain focus on hospital acquired infection rates or if leadership changes impacted this policy focus over time.

  • Examine any resource changes or competing demands that amplified or diminished focus on this policy over time.