To develop and validate an effective knowledge management framework

for the control of exogenous healthcare- associated infections (HCAIs) in facilities management cleaning services

What are the benefits of having a good practice knowledge management process framework for the control of exogenous HCAIs in facilities management cleaning services?

Scope of the Research

1.8.

In a review of 1,022 studies of investigations into outbreaks of infection by Barton (2009), it was noted that the most common sources of infectious agents are, in decreasing order:

 Medical equipment or devices,

 The hospital environment,

 The healthcare personnel.

Facilities management service delivery practices are grouped into two categories, namely “hard” and “soft” services (British Institute of Facilities Management, 2014; Barrett & Baldry, 2003). According to Alexander (2007), the range of facilities management services provided in hospital settings will normally include environmental cleaning, security,

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transportation, portering, food, linen, and sterile services. These services fall are under "soft" FM service provision. Other FM services include the maintenance of buildings and building fabric, which are in grouped in the "hard" FM category. Depending on the hospital service management strategy, the provision of cleaning services is often considered as part of domestic, hotel or housekeeping services (Department of Health, 2013e; 2004a; Codinhoto et al., 2009; Barrett & Baldry, 2003).

In the context of this research, the hospital environment means the totality of patient surroundings when in NHS hospital premises. This includes the fabric of the building and related fixtures. This research focuses on hospital environmental cleaning services.

Internal Endogenous - Nasopharynx - Genitourinary Track Infection Clinician/Medical Domain Sources of Infection Sources of Infection Infection Scope of Research (Healthcare Environment) Scope of Research (Healthcare Environment) External

External ExogenousExogenous

- Medical Personnel's - Visitors - Medical Equipment - Healthcare Environment Facilities management Domain

Figure 1.8: Sources of infection and the research domain

It is posited that knowledge infrastructure capabilities, consisting of the prevailing culture, structure and technological capabilities, together with the knowledge process elements of knowledge creation, storing, sharing and usage are essential preconditions for effective knowledge management (Judy & Ghosh, 2007; Gold et al., 2001). This research explores the interface between the knowledge management process in facilities management cleaning services and hospital knowledge infrastructure capabilities in the control of exogenous healthcare-associated infections in NHS hospitals. Based on the analysis and findings, an effective knowledge management framework will be developed to assist in the control of exogenous healthcare-associated infections (HCAIs) through facilities management cleaning service delivery in NHS hospitals. The following meanings will apply to some of the keywords used in the context of this research:

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Knowledge Creation: This encompasses all the knowledge creation and management processes that are oriented towards the acquisition of knowledge, from the sourcing of data through to its transformation into information leading to good practice knowledge to be used in the control of exogenous HCAIs.

Knowledge storing: This refers to those processes oriented towards keeping the knowledge created safe, and protected against unauthorised interference within and outside the hospital environment.

Knowledge sharing: This refers to those processes intended to make the knowledge thus created and stored appropriate, available, and accessible to the multi-professionals who are likely benefit from its use for the control of exogenous HCAI

Knowledge usage: This encompasses all the processes involved in the application and management of the knowledge that are geared towards its actual use in the most efficient manner for the control of exogenous HCAIs

Hospital Culture: By this is meant the hospital's approach towards collaboration among clinician and non-clinician employees in the control of exogenous healthcare-associated infections. It includes an understanding of the dynamism of the people factors in complying with adopted infection control policies and procedures.

Hospital Structure: This encompasses the hospital departmental structural elements that facilitate the creation and sharing of good practice knowledge across functional boundaries for the prevention and control of exogenous HCAIs.

Hospital Technology: This is used to mean processes including the specific software used by the hospital to facilitate the creation, storing, sharing and usage of good practice knowledge by clinician and non-clinician employees for the control of exogenous HCAIs.

The synthesis and review of existing literature (Table 2.4) pertinent to the research subject area will focus on work published after the publication of “The NHS Plan” (Department of Health, 2000). This is to enable the development of further insights that would help in the achievement of the overall research aim and objectives. Some of these publications include:

 Bespoke environmental audit tools developed by the Infection Control Team (ICT);

 NHS National Specification for Cleanliness – a framework for setting and measuring

performance outcomes (Association of Healthcare Cleaning Professionals, 2009; National Patient Safety Agency, 2007);

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 Bespoke facilities management audit tools for cleaners (checklist and tick box) for healthcare environmental cleanliness.

The research is limited to NHS acute and non-acute hospitals in England. The reason for this limitation is to allow for the practical adaptation of the research outcome stated in Research Objective 5 above.

Data collection for this research was limited to targeted research participants in NHS hospitals in England, including:

 Facilities managers,

 Heads of estate/facilities management, doctors,

 Domestic service managers,

 Works managers..

In summary, the scope of the research includes:

 A synthesis and review of existing policies, guidance documents and strategies in the area of HCAIs published further to the Department of Health publication of “The NHS

Plan” (Department of Health, 2000);

 The identification and assessment of existing procurement strategies including Service Level Agreements (SLAs) in hospital facilities cleaning service delivery;

 An evaluation of the efficacy of good practice guidance documents which have been

adopted/adapted, including bespoke initiatives from available policies, guidelines and specifications used in the creation, storing, sharing, and usage of good practice knowledge. These will be evaluated within the context of the prevailing hospital culture, structure and technological capabilities in FM cleaning service delivery;

 Developing an effective knowledge management framework for facilities management

cleaning service delivery for the control of exogenous HCAIs.

Anticipated Contribution to Knowledge

1.9.

Facilities management cleaning service delivery practice relative to the cleanliness of hospital environment is acknowledged to be crucial in the prevention of exogenous HCAIs (Dancer, S., 2009; Department of Health, 2004a, 2016). While a “clean hospital environment” is capable of preventing and suppressing infections, an infected environment could contribute to the prevalence of disease or death (Selanders, 1998; Osváth, 1970). It is anticipated that findings from the research will:

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 Enhance the understanding of and optimise contemporary good practice knowledge management process elements adapted/adopted for the creation, storing, sharing and usage of good practice knowledge in hospital cleaning service delivery.

 Provide a basis for a targeted approach within the hospital structure, prevailing culture and technological knowledge infrastructure capabilities for the curtailment of infections that are linked to exogenous sources.

 Provide a guide for future cleaning-related initiatives using the framework developed that is understandable, usable and adaptable for the control of exogenous HCAIs in FM cleaning services.

The anticipated outcome of the research will also provide facilities managers with an understanding of knowledge management processes from a range of different perspectives, expectations and preferences to underpin a targeted and sustainable approach to the management of exogenous HCAIs in NHS hospitals.

This research is not intended to be based onthe development of a theory. It is rather focused on contributing to the existing body of knowledge within the research subject domain.

Research Methodology

1.10.

This research was conducted within the paradigm of an interpretivist philosophical stance (see Section 4.3.5. ). A sequential explanatory approach based on a mix of methods was adopted for data collection, employing both quantitative and qualitative techniques. In keeping with this approach, quantitative data was collected using a questionnaire survey before qualitative face-to-face interviews were conducted. The quantitative data gathered from the research questionnaires was first analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) Software. This method of data analysis helps to show the relationships, differences, and trends in the collected data. The qualitative data gathered from the face-to- face interviews with the research participants (See 1.8), was analysed using a qualitative data analysis software program (CAQDAS) and Microsoft Excel. This program for the analysis of data from qualitative sources is popularly known as NVivo. The data was transcribed, coded and analysed thematically using NVivo 10. The methodology adopted for this research is discussed in Chapter 4.

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Structure of the Thesis

1.11.

This thesis comprises three sections and is further divided into nine distinct chapters as illustrated in Figure 1.9.

Chapter One Chapter Two Chapter Three

Chapter Nine

Conclusion and Recommendation Research aim and Objectives

Introduction Literature Review Research Methodology Chapter Seven Discussion of Findings Chapter Eight Conceptual Framework Validation Chapter Six

Findings and Analysis of face-to-face

Interviews

Chapter Five

Findings and Analysis of Questionnaire

Survey

Chapter Four

Conceptual Framework

Figure 1.9: Structure of the thesis

Section one: This phase is made up of the introduction chapter (1) and the literature review chapter (2), which focuses on the synthesis and review of literature in the areas of healthcare- associated infections, knowledge management, facilities management and healthcare facilities management. Chapter 2 also includes a discussion of the pilot study involving semi-structured interviews with clinician and non-clinician (facility management team) members of the infection control team in NHS hospitals in England, which identified further insights into the phenomena to be investigated.

Section two: This phase of the thesis comprises the methodology chapter (3). This chapter provides a rationale and justification for the research methodology adopted.

Section three: This phase of the thesis includes chapters 4 - 9. The findings of the questionnaire survey and the face-to-face interviews are presented and analysed in Chapters 5 and 6 respectively. Chapter 7 synthesises and discusses the findings from the data collection tools, which include the literature, the questionnaire survey and the face-to-face interviews. Chapter 8 presents the development of the effective knowledge management conceptual framework. Finally, Chapter 9 presents the validation of this framework as well as how the research contributes to the existing body of knowledge in the area and limitations of the

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research. Recommendations for further studies are also presented in this chapter. Figure 1.9 presents the structure of the thesis in visual form.

Summary

1.12.

This chapter provides an overview of the research, starting with an introduction to the research and its background and concluding with the structure of the thesis. The contending phenomenon leading to the justification of the research was identified. This resulted in the identification of a need for an effective knowledge management framework in facilities management cleaning services for the control of exogenous healthcare-associated infections in NHS hospitals. The chapter also outlines the research methodology and the structure of the thesis.

The next chapter presents a comprehensive synthesis and review of relevant literature pertinent to the research domain, thereby providing a theoretical background to the research.

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