Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
University of Wisconsin School of Pharmacy, Madison, WI.
Am J Infect Control. 2018 Mar;46(3):303-310. doi: 10.1016/j.ajic.2017.08.045. Epub 2017 Nov 2.
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.
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.
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.
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.
现已有循证指南来减少医疗保健相关感染（HAIs）。领导层查房是领导者可以用来确保指南得到遵守的一种工具，但尚未专门针对减少 HAI 进行研究。本研究检查了一家机构的 HAI 领导层查房。
我们探索了由 2 位医院领导在一家大型学术医院进行的基于单元的 HAI 领导层查房。对 19 个病房进行了观察、记录和编码，以确定主题。主题与实施研究综合框架相关联，并用于指导与一线工作人员的访谈。
工作人员披露了特定于单位的问题，并与医院高层领导一起积极解决问题。这些主题在 22 轮查房中出现了 350 多次。研究结果表明，领导者使用了表现出易错性和好奇心的词语，这两个因素与学习氛围和心理安全有关。这两个主题分别出现了 115 次和 142 次。查房的灵活性质似乎有利于反思和评估，这一过程被编码了 161 次。
领导者与一线工作人员之间的每一次互动都可以促进心理安全，从而促进开放的问题解决，以减少实施的障碍。发现有助于心理安全的特定沟通和结构因素可能在减少 HAI 方面具有强大的作用。
