Imperial College London

DrMichiyoIwami

Faculty of MedicineDepartment of Infectious Disease

Research Associate
 
 
 
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Contact

 

m.iwami

 
 
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Location

 

Hammersmith HouseHammersmith Campus

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Summary

 

Publications

Publication Type
Year
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17 results found

Naylor N, Yamashita K, Iwami M, Kunisawa S, Mizuno S, Castro-Sánchez E, Imanaka Y, Ahmad R, Holmes Aet al., 2020, Code-sharing in cost-of-illness calculations: an application to antibiotic-resistant bloodstream infections, Frontiers in Public Health, Vol: 8, ISSN: 2296-2565

Background: More data-driven evidence is needed on the cost of antibiotic resistance. Both Japan and England have large surveillance and administrative datasets. Code sharing of costing models enables reduced duplication of effort in research.Objective: To estimate the burden of antibiotic-resistant Staphylococcus aureus bloodstream infections (BSIs) in Japan, utilizing code that was written to estimate the hospital burden of antibiotic-resistant Escherichia coli BSIs in England. Additionally, the process in which the code-sharing and application was performed is detailed, to aid future such use of code-sharing in health economics.Methods: National administrative data sources were linked with voluntary surveillance data within the Japan case study. R software code, which created multistate models to estimate the excess length of stay associated with different exposures of interest, was adapted from previous use and run on this dataset. Unit costs were applied to estimate healthcare system burden in 2017 international dollars (I$).Results: Clear supporting documentation alongside open-access code, licensing, and formal communication channels, helped the re-application of costing code from the English setting within the Japanese setting. From the Japanese healthcare system perspective, it was estimated that there was an excess cost of I$6,392 per S. aureus BSI, whilst oxacillin resistance was associated with an additional I$8,155.Conclusions: S. aureus resistance profiles other than methicillin may substantially impact hospital costs. The sharing of costing models within the field of antibiotic resistance is a feasible way to increase burden evidence efficiently, allowing for decision makers (with appropriate data available) to gain rapid cost-of-illness estimates.

Journal article

Kyratsis Y, Ahmad R, Iwami M, Castro-Sánchez E, Atun R, Holmes AHet al., 2019, A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?, Sociol Health Illn

Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted 'strategies of action', guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as 'pragmatic', 'sensible' and also 'legitimate'. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire.

Journal article

Kyratsis Y, Ahmad R, Iwami M, Sanchez EC, Atun R, Holmes Aet al., 2018, A multi-level analysis of infection control in English hospitals: coerced safety culture change, Publisher: OXFORD UNIV PRESS, Pages: 180-180, ISSN: 1101-1262

Conference paper

Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter J, Holmes A, Ahmad Ret al., 2018, Comparison of national strategies to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan and England, Journal of Hospital Infection, Vol: 100, Pages: 280-298, ISSN: 0195-6701

BackgroundNational responses to healthcare-associated infections vary between high-income countries but when analysed for contextual comparability, interventions can be assessed for transferability.AimTo identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England.MethodsA longitudinal analysis (2000-17), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: type - mandatory requirements, recommendations, or national campaigns; method - restrictive, persuasive, structural in nature; level of implementation - macro (national), meso (organisational), micro (individual) levels. Healthcare organisational structures and role of media were also assessed.FindingsIn England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multidisciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public.ConclusionPolicy interventions need to be relevant to local epidemiological trends, while acceptable within health system cultures and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and econom

Journal article

Castro Sanchez EM, Iwami M, Ahmad R, Atun R, Holmes Aet al., 2018, Articulating citizen participation in national antimicrobial resistance plans: a comparison of European countries, European Journal of Public Health, ISSN: 1101-1262

BackgroundNational action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions.MethodsReview and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June–September 2016). To capture geographical diversity, 11 countries were purposively sampled for content and discourse analyses using frameworks of lay participation in healthcare organization, delivery and decision-making.ResultsCountries were at different stages of NAP-AMR development (60% completed, 25% in-process, 9% no plan). The volume allocated to citizen roles in the plans ranged from 0.3 to 18%. The term ‘citizen’ was used by three countries, trailing behind ‘patients’ and ‘public’ (9/11), ‘general population’ (6/11) and ‘consumers’ (6/11). Increased citizen awareness about AMR was pursued by ∼2/3 plans. Supporting interventions included awareness campaigns (11/11), training/education (7/11) or materials during clinical encounters (4/11). Prevention of infection transmission or self-care behaviours were much less emphasized. Personal/individual and social/collective role perspectives seemed more frequently stimulated in Nordic countries.ConclusionCitizen roles in AMR plans are not fully articulated. Documents could employ direct language to emphasise social or collective responsibilities in optimal antibiotic use.

Journal article

Castro Sanchez EM, Iwami M, Ahmad R, Holmes Aet al., 2017, Articulating citizen participation in national policies for addressing antimicrobial resistance in European countries - an updated analysis, ECCMID 2017, Publisher: European Society of Clinical Microbiology and Infectious Diseases

Conference paper

Iwami M, Ahmad R, Castro Sanchez E, Birgand G, Johnson AP, Holmes AHet al., 2017, Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multi-level qualitative analysis., BMJ Open, Vol: 7, ISSN: 2044-6055

Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design: A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level: a) documentary review of 14 hospitals to determine the capacity to report on performance; b) qualitative interviews with three senior managers from five hospitals and direct observation of hospital wards to identify gaps in use of these indicators to improve IPC management and practice.Setting: Two acute English National Health Service (NHS) trusts and one NHS foundation trust (14 hospitals).Participants: Three senior managers from five hospitals for qualitative interviews.Primary and secondary outcome measures: As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. Secondary outcome measure includes the assessment of gaps across national and local levels by comparing the RAG rating results.ResultsNational regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.ConclusionsFor effective patient safety and infection prevention in English hospitals, ro

Journal article

Castro Sanchez EM, Iwami M, Ahmad R, Holmes Aet al., 2016, Application of novel outcome evaluation criteria to UK social marketing campaigns focused on infections, FIS/HIS 2016

Conference paper

Castro Sanchez EM, Kyratsis Y, Iwami M, Rawson T, Holmes Aet al., 2016, Serious electronic games as behavioural change interventions in healthcare- associated infections and infection prevention and control: scoping review of the literature and future directions., Antimicrobial Resistance and Infection Control, Vol: 5, ISSN: 2047-2994

Background: The uptake of improvement initiatives in infection prevention and control (IPC) has often provenchallenging. Innovative interventions such as ‘serious games’ have been proposed in other areas to educate andhelp clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of seriousgames in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games inIPC to support healthcare workers’ behaviour change and best practice learning; and b) to identify gaps across theformulation and evaluation of serious games in IPC.Methods: A scoping study was conducted using the methodological framework developed by Arksey andO’Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus,Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analyticframework of intervention formulation and evaluation.Results: Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and fourfinally selected. Studies focused on intervention inception and development rather than implementation. Expertinvolvement in game design was reported in 2/4 studies. Potential game users were not included in needsassessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported.Conclusions: The growing interest in serious games for health has not been coupled with adequate evaluation ofprocesses, outcomes and contexts involved. Explanations about the mechanisms by which game components mayfacilitate behaviour change are lacking, further hindering adoption.

Journal article

Ahmad R, Iwami M, Castro-Sanchez E, Husson F, Taiyari K, Zingg W, Holmes Aet al., 2015, Defining the user role in infection control, Journal of Hospital Infection, Vol: 92, Pages: 321-327, ISSN: 1532-2939

BackgroundHealth policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices.AimTo understand how users define their own role in patient safety, specifically in infection control.MethodsThrough group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis.FindingsUsers considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high (‘red’ flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, ‘Have you washed your hands?’ConclusionThis in-depth qualitative analysis of views from a relatively informed user sample shows ‘what matters’, and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.

Journal article

Kyratsis Y, Ahmad R, Hatzaras K, Iwami M, Holmes AHet al., 2014, Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care., Health Services and Delivery Research, Vol: 2, ISSN: 2050-4357

Background: Although innovation can improve patient care, implementing new ideas is often challenging.Previous research found that professional attitudes, shaped in part by health policies and organisationalcultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little abouthow evidence is empirically accessed and used by organisational decision-makers when innovationsare introduced.Aims and objectives: We aimed to investigate the use of different sources and types of evidence ininnovation decisions to answer the following questions: how do managers make sense of evidence? Whatrole does evidence play in management decision-making when adopting and implementing innovations inhealth care? How do wider contextual conditions and intraorganisational capacity influence research useand application by health-care managers?Methods: Our research design comprised multiple case studies with mixed methods. We investigatedtechnology adoption and implementation in nine acute-care organisations across England. We employedstructured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting wasinfection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinicaland clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technologyexamples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejectedor discontinued.Findings: (1) Access to, and use of, evidence types and sources varied greatly by profession. Cliniciansreported a strong preference for science-based, peer-reviewed, published evidence. All groups called uponexperiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sourcesand types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-levelsources, and local implementation trials. (2) A sizeable proportion of professionals from all g

Journal article

Meads GD, Griffiths FE, Goode SD, Iwami Met al., 2007, Lessons from local engagement in Latin American health systems, HEALTH EXPECTATIONS, Vol: 10, Pages: 407-418, ISSN: 1369-6513

Journal article

Meads G, Wild A, Griffiths F, Iwami M, Moore Pet al., 2006, The management of new primary care organizations: an international perspective., Health Serv Manage Res, Vol: 19, Pages: 166-173, ISSN: 0951-4848

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

Journal article

Meads G, Iwami M, Wild A, 2005, Transferable learning from international primary care developments, INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Vol: 20, Pages: 253-267, ISSN: 0749-6753

Journal article

Iwami M, 2003, A CLAS act?, JOURNAL OF PUBLIC HEALTH MEDICINE, Vol: 25, Pages: 274-275, ISSN: 0957-4832

Journal article

Iwami M, Petchey R, 2002, A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru, JOURNAL OF PUBLIC HEALTH MEDICINE, Vol: 24, Pages: 246-251, ISSN: 0957-4832

Journal article

Iwami M, Petchey R, 2002, A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration., J Public Health Med, Vol: 24, Pages: 246-251, ISSN: 0957-4832

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

Journal article

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