Identifying Leadership Practices for Success in Healthcare‐Associated Infection Prevention

Research Objective Hospitals face policy pressure to reduce health care–associated infections (HAIs) as part of the Hospital‐Acquired Condition (HAC) Reduction Program that financially penalizes hospitals in the lowest quartile of HAIs. While clinical approaches to reducing HAIs are well established, management practices supporting the clinical efforts are less clear. To address this gap, this study aims to identify and describe organizational approaches to facilitate HAI prevention. Study Design We conducted site visits at seventeen U.S. hospitals between 2017 and 2019 to interview hospital staff about management practices in place to facilitate prevention of HAIs. Using a semistructured interview guide, we asked questions primarily focused on preventing central line–associated bloodstream infections (CLABSIs) and catheter‐associated urinary tract infections (CAUTIs). Interview transcripts were coded and analyzed using a deductive dominant thematic analysis, allowing for categorization of data as well as identification of emergent themes. This approach allowed for comparison of themes across sites in order to characterize management practices important for infection prevention. Population Studied Using a purposive sampling approach, hospitals were invited to participate in this study. To ensure geographic variability, we attempted to recruit “pairs” of higher‐ and lower‐performing hospitals within regions, and considered variability on the basis of different organizational characteristics (ie, size and number of ICUs). Hospital performance was evaluated by comparing CLABSI and CAUTI rates to the national benchmarks acquired from 2017 to 2018 Hospital Compare data. At each site, a total of 450 people including hospital administrators, clinical leadership, infection preventionists, and frontline staff were interviewed about their experience with infection prevention. Principal Findings Across hospitals and across interviewees, three themes emerged as critical for management approaches to preventing HAIs: (1) leadership support; (2) meaningful rewards; and (3) goal setting. Specific tactics used by leadership included providing both financial and human resources to support infection prevention; engaging with frontline staff; maintaining visibility on units; and participating in a tiered huddle system. Leaders used several methods to recognize success in infection prevention. Rewards included positive feedback from leadership shared in person and in newsletters and emails; celebrations on units; positive recognition during huddles and staff meetings; and tangible rewards. Goals set by leaders were recognized by staff at all levels, were often reiterated at staff meetings, and reinforced with visual reminders demonstrating progress displayed on bulletin boards in break rooms. Conclusions Hospitals have limited evidence to base management approaches to preventing HAIs. Our findings identified three mechanisms through which hospitals can support HAI prevention: leadership support, meaningful rewards, and goal setting. Implications for Policy or Practice Our findings persisted throughout levels of an organization, from the frontline to executive leaders. This prevalence suggests that management approaches to preventing HAIs should include all members of an organization and develop specific strategies that embrace the unique position of different organizational members. Additionally, our findings have important implications for the HAC Reduction Program: The evidence that incentives can motivate HAI prevention efforts suggests that the effectiveness of the policy may benefit from inclusion of inducements along with the existing penalties. Primary Funding Source The study was funded by the Agency for Healthcare Research and Quality.