Advertisement

Leadership rounds to reduce health care–associated infections

Published:November 02, 2017DOI:https://doi.org/10.1016/j.ajic.2017.08.045

      Background

      Evidence-based guidelines exist to reduce health care–associated infections (HAIs). Leadership rounds are one tool leaders can use to ensure compliance with guidelines, but have not been studied specifically for the reduction of HAIs. This study examines HAI leadership rounds at one facility.

      Methods

      We explored unit-based HAI leadership rounds led by 2 hospital leaders at a large academic hospital. Leadership rounds were observed on 19 units, recorded, and coded to identify themes. Themes were linked to the Consolidated Framework for Implementation Research and used to guide interviews with frontline staff members.

      Results

      Staff members disclosed unit-specific problems and readily engaged in problem-solving with top hospital leaders. These themes appeared over 350 times within 22 rounds. Findings revealed that leaders used words that demonstrated fallibility and modeled curiosity, 2 factors associated with learning climate and psychologic safety. These 2 themes appeared 115 and 142 times, respectively. The flexible nature of the rounds appeared to be conducive for reflection and evaluation, which was coded 161 times.

      Conclusions

      Each interaction between leaders and frontline staff can foster psychologic safety, which can lead to open problem-solving to reduce barriers to implementation. Discovering specific communication and structural factors that contribute to psychologic safety may be powerful in reducing HAIs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Magill S.S.
        • Edwards J.R.
        • Bamberg W.
        • Beldavs Z.G.
        • Dumyati G.
        • Kainer M.A.
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208
      1. Centers for Medicare & Medicaid Services. Hospital value-based purchasing, quality initiatives.

      2. Wisconsin Department of Health Services. Healthcare-associated infections.

      3. U.S. Department of Veterans Affairs, Veterans Health Administration. Health, news features. Available from: https://www.hsrd.research.va.gov/news/feature/preventing_infections.cfm?ID=1229. Accessed October 18, 2017.

      4. Agency for Healthcare Research and Quality. Healthcare-associated infections.

        • Dixon-Woods M.
        • Leslie M.
        • Tarrant C.
        • Bion J.
        Explaining matching Michigan: an ethnographic study of a patient safety program.
        Implement Sci. 2013; 8: 70
        • Aarons G.A.
        • Green A.E.
        • Trott E.
        • Willging C.E.
        • Torres E.M.
        • Ehrhart M.G.
        • et al.
        The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: a mixed-method study.
        Adm Policy Ment Health. 2016; 43: 991-1008
        • Harvey G.
        • Fitzgerald L.
        • Fielden S.
        • McBride A.
        • Waterman H.
        • Bamford D.
        • et al.
        The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy.
        Implement Sci. 2011; 6: 96
        • Weiner B.J.
        A theory of organizational readiness for change.
        Implement Sci. 2009; 4: 67
        • Aarons G.A.
        • Ehrhart M.G.
        • Farahnak L.R.
        • Hurlburt M.S.
        Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.
        Implement Sci. 2015; 10: 11
        • Saint S.
        • Kowalski C.P.
        • Banaszak-Holl J.
        • Forman J.
        • Damschroder L.
        • Krein S.L.
        The importance of leadership in preventing healthcare-associated infection: results of a multisite qualitative study.
        Infect Control Hosp Epidemiol. 2010; 31: 901-907
        • Frankel A.
        • Graydon-Baker E.
        • Neppl C.
        • Simmonds T.
        • Gustafson M.
        • Gandhi T.K.
        Patient safety leadership walkrounds.
        Jt Comm J Qual Saf. 2003; 29: 16-26
        • Peters T.W.
        In search of excellence.
        Warner Books, New York (NY)1982
        • Ono T.
        Toyota production system: beyond large-scale production.
        Productivity Press, Cambridge (MA)1988
        • Purvis S.
        • Gion T.
        • Kennedy G.
        • Rees S.
        • Safdar N.
        • VanDenBergh S.
        • et al.
        Catheter-associated urinary tract infection: a successful prevention effort employing a multipronged initiative at an academic medical center.
        J Nurs Care Qual. 2014; 29: 141-148
        • Purvis S.
        • Kennedy G.D.
        • Knobloch M.J.
        • Marver A.
        • Marx J.
        • Rees S.
        • et al.
        Incorporation of leadership rounds in CAUTI Prevention Efforts.
        J Nurs Care Qual. 2017; 32: 318-323
        • Henderson D.M.
        • Staiger T.O.
        • Peterson G.N.
        • Sinanan M.N.
        • Angiulo C.L.
        • Makarewicz V.A.
        • et al.
        A collaborative, systems-level approach to eliminating healthcare-associated MRSA, central-line-associated bloodstream infections, ventilator-associated pneumonia, and respiratory virus infections.
        J Healthc Qual. 2012; 34 (quiz 48-9): 39-47
        • Huis A.
        • Hulscher M.
        • Adang E.
        • Grol R.
        • van Achterberg T.
        • Schoonhoven L.
        Cost-effectiveness of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: a cluster randomised trial.
        Int J Nurs Stud. 2013; 50: 518-526
        • McAlearney A.S.
        • Hefner J.
        • Robbins J.
        • Garman A.N.
        The role of leadership in eliminating health care-associated infections: a qualitative study of eight hospitals.
        Adv Health Care Manag. 2013; 14: 69-94
        • Welsh C.A.
        • Flanagan M.E.
        • Hoke S.C.
        • Doebbeling B.N.
        • Herwaldt L.
        Reducing health care-associated infections (HAIs): lessons learned from a national collaborative of regional HAI programs.
        Am J Infect Control. 2012; 40: 29-34
        • Damschroder L.J.
        • Aron D.C.
        • Keith R.E.
        • Kirsh S.R.
        • Alexander J.A.
        • Lowery J.C.
        Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.
        Implement Sci. 2009; 4: 50
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Birt L.
        • Scott S.
        • Cavers D.
        • Campbell C.
        • Walter F.
        Member checking: a tool to enhance trustworthiness or merely a nod to validation.
        Qual Health Res. 2016; (June 22; [Epub ahead of print].)
        • Frankel A.
        • Grillo S.P.
        • Baker E.G.
        • Huber C.N.
        • Abookire S.
        • Grenham M.
        • et al.
        Patient safety leadership walkrounds at partners healthcare: learning from implementation.
        Jt Comm J Qual Patient Saf. 2005; 31: 423-437
        • Frankel A.
        • Grillo S.P.
        • Pittman M.
        • Thomas E.J.
        • Horowitz L.
        • Page M.
        • et al.
        Revealing and resolving patient safety defects: the impact of leadership walkrounds on frontline caregiver assessments of patient safety.
        Health Serv Res. 2008; 43: 2050-2066
        • Burgess L.H.
        • Cohen M.R.
        • Denham C.R.
        A new leadership role for pharmacists: a prescription for change.
        J Patient Saf. 2010; 6: 31-37
        • Gandhi T.K.
        • Graydon-Baker E.
        • Huber C.N.
        • Whittemore A.D.
        • Gustafson M.
        Closing the loop: follow-up and feedback in a patient safety program.
        Jt Comm J Qual Patient Saf. 2005; 31: 614-621
        • Girerd-Genessay I.
        • Michel P.
        [Should we establish patient safety leadership walkrounds? A systematic review].
        Rev Epidemiol Sante Publique. 2015; 63: 315-323
        • Martin G.
        • Ozieranski P.
        • Willars J.
        • Charles K.
        • Minion J.
        • McKee L.
        • et al.
        Walkrounds in practice: corrupting or enhancing a quality improvement intervention? a qualitative study.
        Jt Comm J Qual Patient Saf. 2014; 40: 303-310
        • Morello R.T.
        • Lowthian J.A.
        • Barker A.L.
        • McGinnes R.
        • Dunt D.
        • Brand C.
        Strategies for improving patient safety culture in hospitals: a systematic review.
        BMJ Qual Saf. 2013; 22: 11-18
        • Schwendimann R.
        • Milne J.
        • Frush K.
        • Ausserhofer D.
        • Frankel A.
        • Sexton J.B.
        A closer look at associations between hospital leadership walkrounds and patient safety climate and risk reduction: a cross-sectional study.
        Am J Med Qual. 2013; 28: 414-421
        • Sexton J.B.
        • Sharek P.J.
        • Thomas E.J.
        • Gould J.B.
        • Nisbet C.C.
        • Amspoker A.B.
        • et al.
        Exposure to leadership walkrounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout.
        BMJ Qual Saf. 2014; 23: 814-822
        • Singer S.J.
        • Tucker A.L.
        The evolving literature on safety walkrounds: emerging themes and practical messages.
        BMJ Qual Saf. 2014; 23: 789-800
        • van Dusseldorp L.
        • Hamers H.
        • van Achterberg T.
        • Schoonhoven L.
        Patient safety policy in long-term care: a research protocol to assess executive walkrounds to improve management of early warning signs for patient safety.
        JMIR Res Protoc. 2014; 3: e36
        • Leonard M.W.
        • Frankel A.S.
        Role of effective teamwork and communication in delivering safe, high-quality care.
        Mt Sinai J Med. 2011; 78: 820-826
        • Edmondson A.C.
        Psychological safety and learning behavior in work teams.
        Adm Sci Q. 1999; 44: 350-383
        • Appelbaum N.P.
        • Dow A.
        • Mazmanian P.E.
        • Jundt D.K.
        • Appelbaum E.N.
        The effects of power, leadership and psychological safety on resident event reporting.
        Med Educ. 2016; 50: 343-350
        • Saint S.
        • Howell J.D.
        • Krein S.L.
        Implementation science: how to jump-start infection prevention.
        Infect Control Hosp Epidemiol. 2010; 31: S14-S17
        • Aranzamendez G.
        • James D.
        • Toms R.
        Finding antecedents of psychological safety: a step toward quality improvement.
        Nurs Forum. 2015; 50: 171-178
        • Zhou Q.
        • Pan W.
        A cross-level examination of the process linking transformational leadership and creativity: the role of psychological safety climate.
        Human Performance. 2015; 28: 405-424
        • Nembhard I.M.
        Learning and improving in quality improvement collaboratives: which collaborative features do participants value most?.
        Health Serv Res. 2009; 44: 359-378
        • Nembhard I.M.
        • Cherian P.
        • Bradley E.H.
        Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement.
        Med Care Res Rev. 2014; 71: 450-471
        • Aarons G.A.
        • Ehrhart M.G.
        • Torres E.M.
        • Finn N.K.
        • Roesch S.C.
        Validation of the implementation leadership scale (ILS) in substance use disorder treatment organizations.
        J Subst Abuse Treat. 2016; 68: 31-35