From Concept to Impact: Designing the Research Inquiry – The Art of the Survey

IP LifeLine from Infection Control Today

This 6-part series will chronicle the journey of 2 infection prevention and control (IPC) leaders, Brenna Doran, PhD, MA; and Jessica Swain, MBA, MLT, as they partnered to research and shed light on the critical issue of IP staffing in the current health care landscape. From the initial spark of an idea to the publication of an impactful article, a research manuscript, and a podcast, this series will offer an insider's view of their collaborative process and the profound implications of their findings.

An IP looking at a computer screen.

(Image credit: Brayden Unger by AI)

This second article in the series will focus on the art of the survey.

The field of infection prevention has become increasingly complex, with evolving demands and persistent challenges that were magnified by the COVID-19 pandemic. Facing similar obstacles on opposite sides of the country, we recognized that this was not a regional issue, but a national one. We felt that existing staffing recommendations were inadequate and did not reflect the full scope of our work. This fueled a shared frustration that became the catalyst for our study, which started as a magazine article for Prevention Strategist and later grew into a major article in American Journal of Infection Control (AJIC), a publication we believe has helped bring greater visibility to the infection prevention workload.

To address this critical gap in the literature and move beyond frustration, we decided to survey our peers.This would allow us to collect insights from front-line infection prevention leaders to help inform how the field of infection prevention could leverage the current work environment of infection preventionists (IPs) and infection prevention departments to inform practical staffing decisions. Designing this survey required balancing curiosity with what was feasible.

In this month’s second installment of “From Concept to Impact,” titled "Designing the Research Inquiry: The Art of the Survey," we will share our journey. We will discuss how we strategically narrowed our initial 2 pages of questions and found a balance in a survey tool that could collect impactful insights without overwhelming our fellow IPs and tanking our response rate. Finally, we will share how we distributed our survey widely to capture the experiences of as many IPs as possible. This article details the collaborative process, strategic decisions, and challenges we faced in designing a survey that would ultimately contribute to a broader conversation about how infection prevention staffing is defined and resourced nationwide.

Brainstorming the Survey: Narrowing Down Questions and Direction

Our first step was to tackle the central question: What do we want to know? As researchers, we began with a long list of potential topics, requiring a balance between our curiosity and what we could reasonably accomplish. Each new idea led to another, forcing us to constantly weigh which questions would provide the most meaningful insights without overwhelming our respondents. We began by reviewing prior studies to understand what had already been explored and identify the gaps. We found that much of the existing research didn't fully account for the increased complexity of modern health care organizations. This allowed us to narrow our focus to critical but underresearched factors, such as the number of licensed hospital beds, hospital complexity, regional differences, and various staffing models. We then explored a range of free online survey tools and determined that an online survey would be the most feasible and far-reaching option for our target audience. We chose Qualtrics due to our prior experience and comfort with the platform. When crafting our questions, we included a mix of categorical and open-ended questions to gather both hard numbers and nuanced, qualitative insights.

Below is a list of common free online survey tools and some pros and cons of each as you consider what survey tool you may want to use for your research topic. (Figure 1)

(Figure 1) Free Online Surveys

(Credit: Brayden Unger)

The Survey Structure and Analysis

The survey was structured into 4 distinct sections to gather comprehensive data. The Organizational Demographics section contained a mix of open-ended and categorical questions about the organization's structure, including the number of licensed hospitals, inpatient beds, facility types, and the number of ambulatory centers covered by the IP program. (Figure 2)

(Figure 2) Survey

(Credit: Brayden Unger)

The Department-Related Staffing section focused on personnel, asking open-ended questions about the number of full-time equivalent (FTE) employees in the IP department, their average weekly hours, and the number of FTEs with dual roles. This section also explored the roles of any external support staff. The Program-Related Inquiry section included a simple "yes/no" question. (Figure 3)

(Figure 3) More survey questions

(Credit: Brayden Unger)

To analyze this mix of data, we used a variety of methods. We employed the Chi-square test to compare frequencies and examine relationships between categorical variables, such as inpatient beds and facility types. For comparing our 5 main geographic regions, we used the Kruskal-Wallis test because the data distributions were nonparametric. For our qualitative, open-ended responses, we performed a descriptive and inductive content analysis to identify and track recurring themes. Data analysis can feel overwhelming at first, but with the right resources and guidance, it becomes far more approachable. This dual approach allowed us to collect both hard numbers and valuable contextual information, resulting in a truly comprehensive survey.

Practical Advice for Survey Design

When designing a survey, think carefully about the types of questions you choose. Aim for those that will yield the most useful data, while balancing the time it will take for respondents to complete the survey.

To help you refine your choices, we recommend drafting a few variations to identify the style that is simplest for participants to answer. Remember that questions requiring a simple click take less time and energy than writing a full response. Your survey tool may provide an estimated completion time. If not, consider timing yourself to get an accurate sense of time commitment.

Finally, once you feel confident with your question types and wording, consider asking a few colleagues to review or take a sample survey. You may be surprised how terminology that is standard to you may not be common in other areas. Ensuring your survey uses terms and language that are generalizable to your chosen participant pool is a critical final step. (Figure 4)

(Figure 4) Survey questions and pros and cons of each.

(Credit: Brayden Unger)

Anticipating Survey Impact and Overcoming Hurdles

What began as a hope for academic insights evolved into a vision for driving practical and policy changes, and this broader vision was the primary driver of our survey design. We specifically designed questions that would provide the most insight into the current realities of IP programs and their alignment with the increased complexity of modern health care organizations. For instance, we focused on gathering data about organizational demographics and detailed staffing metrics. This deliberate effort to collect actionable data could be used to strengthen national tools, such as the APIC Staffing calculator,¹ to better reflect the current challenges faced by IPs today.

Equally important were the decisions about what not to include. While questions related to budget allocations or clinical outcomes were tempting, we recognized that adding them would complicate the survey and likely reduce participation. By focusing on a smaller set of high-yield variables, we struck a balance between research depth and feasibility.

Rolling out our survey presented a series of challenges we had to overcome to ensure the integrity and representation of our data. While our initial distribution via professional networks was encouraging, we quickly realized we lacked a nationwide reach, as illustrated by gaps in the Midwest and Southern regions. To overcome this hurdle, we launched a targeted outreach strategy that involved sending our survey directly to Association for Professionals in Infection Control and Epidemiology (APIC) chapter presidents in those states, which helped us achieve responses from nearly every state. (Figure 5)

(Figure 5 LinkedIn Post

Once the responses were collected, we faced the critical task of managing and preparing the data for analysis. Of the 128 total responses, we carefully reviewed each submission, excluding 15 due to duplication, missing data, or misclassification. This left us with 98 responses from acute care facilities that met the study's inclusion criteria. A final challenge involved managing the small dataset from critical access hospitals. Due to their limited representation, we made the decision to exclude this data from the analysis to avoid introducing skewed results. By proactively addressing these challenges, we were able to successfully gather reliable and representative data for our research.

Key Findings

Our analysis uncovered several key findings about IP staffing. First, we discovered a significant relationship between the number of IP FTEs and both the number of licensed inpatient beds and the facility’s geographic region. Second, our research also revealed that IPs are consistently overworked, with participants reporting an average of 43.6 hours per week, which is well above a standard 40-hour workweek. This highlights that IP departments across various health care settings are generally understaffed. Finally, we found that the practice of cross-sharing IP FTEs becomes more common as the complexity of health care services increases, with these professionals most frequently supporting the Quality department.

Based on our findings, we concluded that IPs are regularly working more than a standard week, and their staffing levels are directly impacted by the number of inpatient beds, hospital complexity, and geographic location. Looking ahead, we believe that artificial intelligence (AI)-driven tools could offer a transformative solution by dynamically adjusting staffing models in real-time to meet fluctuating workloads.

In Closing

In this installment, we shared our journey of designing and executing a national survey to inform a broader conversation about IP staffing. Through a collaborative process, we strategically narrowed our focus to collect high-yield data, leveraged an online survey tool for broad distribution, and selected question types that balanced our need for both quantitative data and qualitative insights. In doing so, we successfully navigated the challenges of survey design and rollout, including overcoming geographic limitations in our responses and making difficult decisions about data inclusion to ensure the integrity of our findings. The many conversations, shared insights, and strategic decisions made throughout this collaborative phase were crucial to transforming our initial academic curiosity into a data-driven resource that will inform policy and practical changes across the country.

References

R. Bartles, A. Dickson, O. Babade. A systematic approach to quantifying infection prevention staffing and coverage needs Am J Infect Control, 46 (2018), pp. 487-491. https://apic.org/apic-staffing-calculator/

To read more about our publications and work on this topic:

• "Post-COVID Learnings from an Infection Prevention Staffing Survey" Brenna Doran and Jessica Swain Prevention Strategist, Spring 2024.

This article offers key insights from a survey on infection prevention staffing in the post-COVID era.

Prevention Strategist (APIQ) - Spring 2024 - Post-COVID Learnings From an Infection Prevention Staffing Survey

• "Quantifying the Progressing Landscape of Infection Preventionists: A Survey-Based Analysis of Workload and Resource Needs" Brenna Doran, Jessica Swain, and Shanina Knighton American Journal of Infection Control, 2025.

Dive deeper into the research that quantifies the workload and resource needs of infection preventionists today.

https://www.sciencedirect.com/science/article/pii/S019665532500104X

• "Burnout, Beds, and Budgets: The Hidden Reality of IP Staffing" (Podcast Episode No. 46) Hosted by Nikki Shore and Jessica Swain American Journal of Infection Control: Science Into Practice Podcast, May 10, 2025.

Listen to this podcast for a candid discussion on the challenges and realities of infection prevention staffing, including burnout and budget constraints.

https://ajicscienceintopractice.org/episode/46-burnout-beds-and-budgets-the-hidden-reality-of-ip-staffing/