Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48105, USA.
Infect Control Hosp Epidemiol. 2010 Sep;31(9):901-7. doi: 10.1086/655459.
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.
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.
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.
Leadership plays an important role in infection prevention activities. The behaviors of successful leaders could be adopted by others who seek to prevent HAI.
医疗保健相关感染（HAI）代价高昂，并导致大量发病。我们试图了解为什么有些医院参与 HAI 预防活动，而有些医院则不参与。由于初步数据表明医院领导层发挥了重要作用，我们试图更好地了解哪些行为是成功实施美国医院 HAI 预防实践的领导者所表现出来的。
我们报告了三阶段研究的第二和第三阶段。在第二阶段，从 700 家受邀医院中的 72%中，有 14 家美国医院是根据初步阶段的传染病预防主任完成的 HAI 预防定量调查而被选中的。在这 14 家医院的关键人员的 38 次半结构化电话访谈中收集了定性数据。在第三阶段，我们在 6 次实地考察中进行了 48 次访谈，以确定成功领导者行为的反复出现和统一主题。
我们发现，成功的领导者（1）培养了卓越的临床文化，并有效地向员工传达了这一文化；（2）专注于克服障碍，并直接处理阻碍 HAI 预防的抵触员工或流程问题；（3）激励他们的员工；（4）战略性地思考，同时在当地采取行动，这包括在关键委员会投票前进行政治活动，利用个人威望推动计划的进展，并在跨学科领域建立伙伴关系。医院流行病学家和传染病预防员在其医院的患者安全活动中通常比高级管理人员发挥更重要的领导作用。
领导力在感染预防活动中发挥着重要作用。成功领导者的行为可以被其他希望预防 HAI 的人所采用。
