Enacting Practice Changes during COVID-19

Recognizing the challenges of putting outbreak response policies into practice, SHEA adapted its ORTP implementation tool kit to help facilities implement changes during COVID-19.
The COVID-19 pandemic has caused facilities to rapidly adopt new practices. These changes at times have been different than previously recommended practices, or those suggested by professional societies, agencies, or other trusted voices.
While the existence of sound recommendations contributes to the health and safety of personnel and patients, recommendations need to be translated into real-world settings, especially in the midst of turbulent conditions and the rapid pace of a pandemic.

Practice Changes during COVID-19

Internal and External Factors

Internal and external factors at individual, organizational, and societal levels have upended assumptions typically used to justify changes to policies and practices in healthcare facilities. For instance, rather than basing a practice change on published recommendations derived from accumulated evidence, healthcare facilities in the midst of the COVID-19 pandemic have had to make practice changes rapidly due to sudden resource constraints. Competing interpretations of what is needed to manage the crisis made by influential authorities, and a list of unknowns about the virus and disease, further complicate the picture.[ii],[iii] This diagram (pdf) illustrates the internal and external factors that have influenced practice changes for healthcare personnel and patient safety during the COVID-19 pandemic.

SHEA created this COVID-19 implementation tool kit to help decision makers navigate these obstacles and get on the path for successful uptake of practices and policies needed for healthcare personnel and patient safety and risk mitigation.

[i],[i]Banach, D., Johnston, B., Al-Zubeidi, D., Bartlett, A., Bleasdale, S., Deloney, V., Trivedi, K. (2017). Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals. Infection Control & Hospital Epidemiology, 38(12), 1393-1419. doi:10.1017/ice.2017.212

[ii] SHEA/CDC Outbreak Response Training Program Implementation Tool Kit: https://ortp.guidelinecentral.com/implementation/

[iii] Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2010;38(1):4-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025110/

[iv] Adapted from GTO model. Barbee A., Christensen B., Antle B., Wandersman A., Cahn K. Successful adoption and implementation of a comprehensive casework practice model in a public child welfare agency: Application of the Getting to Outcomes (GTO) model. Children and Youth Services Review. Volume 33, Issue 5, May 2011, Pages 622-633. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2010.11.008

[v] Wandersman, A., Snell-Johns, J., Lentz, B., Fetterman, D., Keener, D., & Livet, M. (2005). The principles of empowerment evaluation. New York: Guilford Press. (2005).

[vi] CDC’s Replicating Effective Practices (REP) for Healthcare Interventions: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-2-42