Evaluating a process of change in hospital environmental cleaning – the role of logic models

Alison Farrington 1, Michelle Allen 1, Lisa Hall 1, Brett Mitchell 2

On behalf of the REACH study team

Queensland University Of Technology, Kelvin Grove, QLD, Australia

Avondale College of Higher Education, Wahroonga, NSW, Australia


The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will evaluate the impact of a novel environmental cleaning bundle in 11 hospitals around Australia. In each trial site we will collect a range of data, including healthcare associated infection rates, associated costs and changes in the thoroughness of cleaning. While these data will assist in determining the overall effectiveness and cost-effectiveness of the cleaning bundle it is important to understand what aspects of the practice change process worked, under what conditions, and why.

The project team will systematically document and review the implementation process at each hospital site. To frame this process evaluation we have developed a logic model to identify what assumptions are being made and what expectations there are about how the process will work at each trial hospital.

The model outlines a proposed link between trial processes and intended trial outcomes. It shows the flow of activities and potential impact of local context and external factors in implementing change.

The process of developing a logic model – a pictorial representation of key trial inputs, outputs and outcomes – has clarified the underlying assumptions involved in improving hospital environmental cleaning. This will inform a systematic evaluation of the change process in each of the participating hospital sites, which will assist with translation of trial outcomes to other hospital settings and to the environmental services workforce.

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