The objective of the present study was to explore how infection rates in study hospitals were affected by an intervention in six intervention hospitals in Gujarat, India. Infection control practices, human resource management, infrastructure, supplies and associated health system factors were investigated.
Methods

This study was conducted within a controlled, interrupted time series study where a reduction in infection rates was observed. The intervention was a process called Appreciative Inquiry (AI), an organisational change agent which focuses on positive aspects (what is done well) where hospital personnel were brought together to share experiences and agree on action plans for improving infection control. Three to six months after the intervention, 31 in-depth interviews were conducted. Monthly observation check lists were also used to investigate the perceived influence of AI and underlying health system factors.

AI was perceived as having a positive influence on team relationships; improving communication across the power hierarchy of hospitals; fostering trust and cooperation with inclusion of the marginalized and non-technical staff in the team; and developing better understanding of one's own role and those of the others. The intervention did not lead to changes in human resource policies, financial and information systems or leadership and governance. Pre-existing factors such as power and autonomy of leaders, the leader's motivation for change, leadership styles and a background of organizational reform such as accreditation influenced the AI process.

Infection control is a complex phenomenon both being influenced by and influencing health systems. Organizational factors such as distribution of power across staff hierarchy, inclusive decision making and problem solving seem to influence team performance. Social factors such as status of women, and caste and social hierarchies influence team relationships in health care settings. Appreciative inquiry as an organizational change method has the potential to change infection control behaviours of health care teams by not only targeting health systems but the underlying organizational and social factors thereby strengthening teams and staff morale.It is a means for developing a shared ideology and values for improved service delivery, thereby setting-up an organisational 'work culture'. Enabling environments such as accreditation appear to put organizations into a receptive, high alert, active mode.