In 2004, the Joseph M. Juran Center conducted a research project to study rapid cycle improvement in health care. The research focused on four hospitals participating in a Safest in America and Institute for Clinical Systems Improvement initiative to eliminate ventilator-associated pneumonias (VAPs) and central line-associated bloodstream infections (BSIs) in 90 days.

Results of the study showed that hospitals were more successful in reducing VAPs than BSIs, which hospital personnel attributed to the fact that ventilators are used in ICUs, while central lines are inserted and used throughout different units in hospitals.

The research revealed that the fundamental barrier to rapid cycle improvement in infection reduction is a cultural belief that zero infections is not possible, especially not in a 90-day time frame. Related is the impression among many infection control personnel that implementing real-time root cause analysis is overly resource intensive.

According to the study, rapid change was facilitated by a culture of excellence that believes an infection-free hospital is possible, along with action-oriented problem solving with real-time root cause analysis that coordinates change efforts between the various patient safety-related committees in the hospital.

Successful implementation strategies are based on infection control best practices that are introduced through in-service training and through 10-minute training sessions on the unit at the start of a shift. Motivated nurses who are willing to enforce best practices, especially among physicians, are key to maintaining the gains. Hospital leadership must also be engaged and supportive.