How to manipulate friends and influence practice: Application of complexity science leads to quality improvement in laboratory sample submissions

We sought to reduce healthcare-associated infections (HCAIs) through the application of complexity science. To confirm incidental findings that altering the structure of microbiology reports with targeted education led to better utilisation of laboratory resources, while participating in efforts to reduce HCAI. We adopted a different approach to laboratory result authorisation, using narrative to engage the clinicians and induce behavioural change. Subsequent educational opportunities emphasised key messages. Positive urine means calculated by the analysis tool numbered 2179/month throughout the study period. Negative urines started at 5576/month, reduced to 5134/month in November 2014 and to 4602/month in April 2016, coinciding with our changes. Opportunity costs were saved. The changes in both policy and reporting were contemporaneous with a decline in negative samples. There were no significant changes in the number of positive specimens. The efficiency and effectiveness of the laboratory was improved and resources released: ￡145,000 ($182,000) for a resident population of 384,000. This suggests an annual release of about ￡25 million ($31 million) may be possible in the UK and ￡122 million ($155 million) in the USA