Senior executive meetings with frontline healthcare staff may contribute to patient safety by elevating critical problems and encouraging open dialogue that can solve problems and sustain best practices for reducing healthcare-associated infections (HAIs), according to a new study in the American Journal of Infection Control (AJIC).
The study identifies key structural characteristics and leader communication tactics that can be employed in healthcare facilities through such leadership rounds (LRs), including engaging with staff honestly and transparently while asking probing questions that encourage a free flow of information. These behaviors empower staff to express themselves with leadership, a form of psychologic safety, and reduce barriers to moving HAI prevention theory into practice within a complex setting.
“By fostering an open culture, health leaders are able to problem solve with frontline staff to determine barriers to implementation,” said Mary Jo Knobloch, PhD, MPH, the study’s lead author. “This presents the opportunity to move evidence to practice and better protect patients from harm.”
The research team explored unit-based HAI leadership rounds led by two hospital leaders within University of Wisconsin Health, University Hospital and the American Family Children’s Hospital in Madison, Wisconsin. The study population included hospital executive leaders, infection preventionists, and frontline staff. LRs and key informant interviews were conducted across 19 units, amounting to 22 recorded observations over a period of seven months.
Among the findings:
• LRs revealed more than 350 instances where staff appeared to disclose issues and problems related to HAI prevention in their units and engage in problem solving. These observations reveal that each interaction between leaders and frontline staff can generate psychologic safety, or the belief that a person can feel free to take a risk when expressing themselves to leaders or managers in a workplace.
• Several leader-related themes also emerged throughout observations. All interviewees commented that both leaders were good listeners and complemented each other in communication styles, and felt that they were good at allowing the staff to be the experts in the day-to-day work that they do. Participating frontline staff identified these leadership attributes as positive, and were deemed as integral to the success of the LRs.
• Tellingly, interviewees overwhelmingly expressed discomfort with leaders comparing units to other units, as they were concerned about unfair comparisons considering the unique set of circumstances and unique patient populations between units. Participants also expressed concerns that HAI LRs may be too open-ended, and that expectations were not made clear – staff wanted to know where LRs were leading, and they tended to be unclear about the impact of HAI LRs. However, they did indicate that LRs has an impact on the culture of the institution overall.
• Most interviewees agreed that the short duration of the LRs was a positive aspect, and many indicated that the location on the busy unit – rather than a conference room – was preferable, as they felt it important for leaders to witness the “busyness” of the unit.
LRs have historically proven to connect senior leaders with frontline patient safety issues and advance a culture of safety, but this study is the first to explore the connection between the use of LRs for reducing HAIs.
“As healthcare-associated infections continue to affect 1 in 25 hospitalized patients, it is critical that every facility engage with unit-level care providers to understand why infections occur and what can be done to prevent them in the future,” said 2018 APIC president Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “This research shows that healthcare leaders can and should be actively listening to frontline staff through HAI leadership rounds, problem-solving with them in real-time on ways to integrate best practices into daily unit operations.”
“Leadership rounds to reduce health care-associated infections,” by Mary Jo Knobloch, Betty Chewning, Jackson Musuuza, Susan Rees, Christopher Green, Erin Patterson, and Nasia Safdar, appears in the American Journal of Infection Control, Volume 46, Issue 3 (March 2018).