Larry Hirschhorn

Evidence-Based Practice to Reduce Central Line Infections

BACKGROUND In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP). METHODS Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database. RESULTS Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p < .05). At the project midpoint (3 quarters of 2004), adherence to evidence-based practices increased from 30% to nearly 95%. DISCUSSION The direct role of hospital leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.

New productive forces and the contradictions of contemporary capitalism

ConclusionThe analysis that we have put forward is necessarily incomplete without developing its implications for political practice. However, considerations of space prevent us from elaborating on this aspect of our argument here. It is also the case that our ideas on politics are less coherent and developed than the theoretical perspective that we have outlined. This seems inevitable, since political thinking must be a collective project; political programs written by isolated individuals always sound hollow and abstract.Yet there are a few broad political implications of our analysis that are important to state here. The first is that any emancipatory politics in the present must begin with the realities of contemporary society, rather than from Marxist categories that have been rendered obsolete by the passing of accumulationist capitalism. While this point might seem obvious, it bears restating since so much current Marxist writing fails to grasp this idea. Second, while some might read our argument as an optimistic alternative to those theorists (Piccone, Lasch, Jacoby) who despair of the existence of emancipatory possibilities in the present, that is not our intention. For us, optimism and pessimism are not the important categories. In fact, our analysis incorporates the most pessimistic possible scenarios, since continued social stalemate in the face of post-industrial transition can unleash awesomely powerful pressures for individual and social regression. The point is rather that we have sought to develop an analysis that is genuinely dialectical — recognizing in this historical moment the interlocking processes of decay and development.

The Post-Industrial Economy: Labour, Skills and the New Mode of Production

The rise of services signifies the emergence of a new mode of production, through which services, manufacturing and the relationship between the two are transformed. Firms are developing high value-added production systems, by focusing on quality rather than cost, by vertically disintegrating production to limit their exposure, by training and retraining a core group of employees and by relying on temporary workers to complete rime-delimited projects. Presenting several examples of this new mode of production, the article outlines the new firms human resources and training policies and examines the brooder obstacles to its development.

Post-industrial life: A US perspective

Abstract Adulthood is no longer the relatively static plateau of personal development. Increasing freedom of choice between life and work, and within work itself, produces greater responsibilities and an increase in psychological stress. The family, the school, and various other social institutions are losing their rigid control over an individuals life course. Developmental adulthood is now emerging, as the categories of youth and adolescence emerged in the 19th century. If changes in the fields of culture, work, and social scheduling are out of step, problems of marriage breakdown, decreased economic growth, or personal aimlessness will result. Even if the changes are in harmony, a time-sensitive social policy will be necessary to bridge the growing gap between individual decisions and aggregate flows of people, resources, and jobs.

The Destruction of a Synagogue Community: Polarization in a Postindustrial World

Examining a case study of a consultation to a synagogue community, this article describes how the community polarized around its Rabbis support for the Palestinian rebellion in the Gaza Strip and the West Bank. By studying both the processes of polarization and the dynamics of the consultation, the article explores how a polarized community can destroy the real and psychological public space that it needs to heal its divisions and proposes that consultants can help a polarized community revitalize its public space by providing structure and boundaries inside the consultation process itself; by facilitating conversation so that substantive differences can be explored, and by interpreting the consulting process so that unconscious fantasies and unverbalized feelings can be examined. The article suggests that as we enter into a multicultural world where identities are negotiated, we need to develop a consulting technology that can help communities tolerate, protect, and sustain the many identities embedded in the texture of community life.

Campaigns, deals, systems and science: designing the innovative organization

To link invention to innovation more effectively, companies must integrate processes of creation with processes of selection. It is suggested that, senior managers must create a balance between four kinds of ideal-typical games or milieus: the science game based on the lone genius, the game of the deal maker, the game of the campaign, and the game of using the program, system, or technique. American companies focus excessively on the first two. This drives a wedge between the individual and the organization, creating a climate in which innovation is a form of delinquency, leaders and followers undermine each other, and rational techniques are used to mask non-rational processes. To overcome these obstacles to innovation, senior managers can undertake sensibly two developmental initiatives. The first involves understanding and supporting the companys core competence as a way of building up its technical and marketing culture. The second involves using techniques and programs for the rational part of the decision process, but making public the rationale and personal responsibility for the necessarily nonrational dimensions of the decisions and actions.<<ETX>>