Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-28T04:51:28.030Z Has data issue: false hasContentIssue false
  • English
  • Français

The Importance of Leadership in Preventing Healthcare-Associated Infection: Results of a Multisite Qualitative Study

Published online by Cambridge University Press:  02 January 2015

Sanjay Saint ,
Christine P. Kowalski ,
Jane Banaszak-Holl ,
Jane Forman ,
Laura Damschroder  and
Sarah L. Krein
Sanjay Saint*
Affiliation:
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Christine P. Kowalski
Affiliation:
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Jane Banaszak-Holl
Affiliation:
Department of Health Policy and Management, University of Michigan School of Public Health, Ann Arbor, Michigan
Jane Forman
Affiliation:
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Laura Damschroder
Affiliation:
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Sarah L. Krein*
Affiliation:
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
*
Room 7E08, 300 North Ingalls, Ann Arbor, MI 48109-0429 (saint@med.umich.edu)
Veterans Affairs Health Services Research and Development (11H), 2215 Fuller Road, Ann Arbor, MI 48105 (skrein@ umich.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Healthcare-associated infection (HAI) is costly and causes substantial morbidity. We sought to understand why some hospitals were engaged in HAI prevention activities while others were not. Because preliminary data indicated that hospital leadership played an important role, we sought better to understand which behaviors are exhibited by leaders who are successful at implementing HAI prevention practices in US hospitals.

Methods.

We report phases 2 and 3 of a 3-phase study. In phase 2, 14 purposefully sampled US hospitals were selected from among the 72% of 700 invited hospitals whose lead infection preventionist had completed a quantitative survey on HAI prevention during phase 1. Qualitative data were collected during 38 semistructured phone interviews with key personnel at the 14 hospitals. During phase 3, we conducted 48 interviews during 6 in-person site visits to identify recurrent and unifying themes that characterize behaviors of successful leaders.

Results.

We found that successful leaders (1) cultivated a culture of clinical excellence and effectively communicated it to staff; (2) focused on overcoming barriers and dealt directly with resistant staff or process issues that impeded prevention of HAI; (3) inspired their employees; and (4) thought strategically while acting locally, which involved politicking before crucial committee votes, leveraging personal prestige to move initiatives forward, and forming partnerships across disciplines. Hospital epidemiologists and infection preventionists often played more important leadership roles in their hospital's patient safety activities than did senior executives.

Conclusions.

Leadership plays an important role in infection prevention activities. The behaviors of successful leaders could be adopted by others who seek to prevent HAI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 9 , September 2010 , pp. 901 - 907
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Estimates of healthcare-associated infections. Centers for Disease Control and Prevention Web site, http://www.cdc.gov/ncidod/dhqp/hai.html. Published 2009. Accessed December 23, 2009.Google Scholar
2. Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561–566.Google Scholar
3. Pronovost, PJ, Goeschel, CA, Wachter, RM. The wisdom and justice of not paying for “preventable complications.” JAMA 2008;299:2197–2199.Google Scholar
4. Saint, S, Meddings, JA, Calfee, DP, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rules changes. Ann Intern Med 2009;150:877–885.CrossRefGoogle Scholar
5. Wald, HL, Kramer, AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA 2007;298:2782–2784.CrossRefGoogle ScholarPubMed
6. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. Executive summary: a compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S12–S21.CrossRefGoogle Scholar
7. Lo, E, Nicolle, L, Classen, D, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S41–S50.Google Scholar
8. Wong, ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:28–36.CrossRefGoogle ScholarPubMed
9. Saint, S. Prevention of intravascular catheter-associated infections. In: Shojania, KG, Duncan, JW, McDonald, KM, Wachter, RM, eds. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Agency for Healthcare Research and Quality publication no. 01-E058. Rockville, MD: Agency for Healthcare Research and Quality;2001:163–184.Google Scholar
10. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759–769.CrossRefGoogle ScholarPubMed
11. Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:1–36.Google ScholarPubMed
12. Dodek, P, Keenan, S, Cook, D, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004;141:305–313.CrossRefGoogle ScholarPubMed
13. Collard, HR, Saint, S, Matthay, MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003;138:494–501.CrossRefGoogle ScholarPubMed
14. Saint, S. Prevention of nosocomial urinary tract infections. In: Shojania, KG, Duncan, BW, McDonald, KM, Wachter, RM, eds. Making Health Care Safer: A Critical Analysis of Parient Safety Practices. Agency for Healthcare Research and Quality publication no. 01-E058. Rockville, MD: Agency for Healthcare Research and Quality;2001:149–162.Google Scholar
15. Saint, S, Kowalski, CP, Kaufman, SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243–250.Google Scholar
16. Krein, SL, Hofer, TP, Kowalski, CP, et al. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007;82:672–678.Google Scholar
17. Krein, SL, Kowalski, CP, Damschroder, L, Forman, J, Kaufman, SR, Saint, S. Preventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study. Infect Control Hosp Epidemiol 2005;29: 933–940.CrossRefGoogle Scholar
18. Krein, SL, Olmsted, RN, Hofer, TP, et al. Translating infection prevention evidence into practice using quantitative and qualitative research. Am J Infect Control 2006;34:507–512.Google Scholar
19. Collins, J. Good to Great: Why Some Companies Make the Leap and Others Don't. 1st ed. New York, NY: Harper Business, 2001.Google Scholar
20. Drucker, PF. The Effective Executive. New York, NY: Harper Collins, 1993.Google Scholar
21. Iacocca, L. Where Have All the Leaders Gone? New York, NY: Scribner, 2007.Google Scholar
22. Welch, J. Winning. New York, NY: Harper Business, 2005.Google Scholar
23. Robbins, S. Essentials of Organizational Behavior. 8th ed. Upper Saddle River, NJ: Pearson Education, 2005.Google Scholar
24. Collins, J. Good to Great and the Social Sectors: A Monograph to Accompany Good to Great. 1st ed. New York, NY: Harper Collins, 2005.Google Scholar
25. Gilmartin, MJ, D'Aunno, TA. Leadership research in healthcare: a review and roadmap. Acad Manag Ann 2008;3:387–438.Google Scholar
26. Dowton, SB. Leadership in medicine: where are the leaders? Med J Aust 2004;181:652–654.Google Scholar
27. Patton, M. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage Publications, 2002.Google Scholar
28. Sandelowski, M. Whatever happened to qualitative description? Res Nurs Health 2000;23:334–340.Google Scholar
29. Mason, J. Qualitative Researching. Thousand Oaks, CA: Sage Publications, 2002.Google Scholar
30. Creswell, J. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Approaches to Research. Upper Saddle River, NJ: Merrill/Pearson Education, 2002.Google Scholar
31. Northouse, P. Leadership: Theory and Practice. 5th ed. Thousand Oaks, CA: Sage Publications, 2010.Google Scholar
32. Xirasagar, S, Samuels, ME, Stoskopf, CH. Physician leadership styles and effectiveness: an empirical study. Med Care Res Rev 2005;62:720–740.Google Scholar
33. Taylor, CA, Taylor, JC, Stoller, JK. Exploring leadership competencies in established and aspiring physician leaders: an interview-based study. J Gen Intern Med 2008;23:748–754.CrossRefGoogle ScholarPubMed
34. Lobas, JG. Leadership in academic medicine: capabilities and conditions for organizational success. Am J Med 2006;119:617–621.Google Scholar