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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)
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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

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