Getting to Zero: Goal Commitment to Reduce Blood Stream Infections

Med Care Res Rev. 2016 Aug;73(4):458-77. doi: 10.1177/1077558715616028. Epub 2015 Nov 20.


While preventing health care-associated infections (HAIs) can save lives and reduce health care costs, efforts designed to eliminate HAIs have had mixed results. Variability in contextual factors such as work culture and management practices has been suggested as a potential explanation for inconsistent results across organizations and interventions. We examine goal-setting as a factor contributing to program outcomes in eight hospitals focused on preventing central line-associated bloodstream infections (CLABSIs). We conducted qualitative case studies to compare higher- and lower-performing hospitals, and explored differences in contextual factors that might contribute to performance variation. We present a goal commitment framework that characterizes factors associated with successful CLABSI program outcomes. Across 194 key informant interviews, internal and external moderators and characteristics of the goal itself differentiated actors' goal commitment at higher- versus lower-performing hospitals. Our findings have implications for organizations struggling to prevent HAIs, as well as informing the broader goal commitment literature.

Keywords: CLABSI; HAI prevention; blood stream infections; case study methods; goal-setting theory; health services research; qualitative methods.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attitude of Health Personnel
  • Catheter-Related Infections / prevention & control*
  • Cross Infection / prevention & control*
  • Humans
  • Interviews as Topic
  • Organizational Objectives*
  • Patient Care Team
  • Peer Group
  • Program Evaluation
  • Self Efficacy