Once consigned to silos themselves, infection preventionists are increasingly out on the floors and inviting their administrators to join them in “leadership rounds.”
Engaging hospital leadership is seen as a key step in continuing to raise the profile for IPs and show the power of infection prevention in an era of reduced reimbursement.
As part of this effort, the Association for Professionals in Infection Control and Epidemiology (APIC) has sent out a survey to hospital administrators and healthcare leaders.
“We are in the process of reaching out to C-suite leaders and querying them about their view of IPs and infection prevention,” says Janet Haas, RN, CIC, FAPIC, president of APIC.
“We think that will be very useful in defining the current state. This is to make sure that people who are in administrative roles are aware of our profession and the value that we bring.”
Haas, director of epidemiology at Lenox Hill Hospital in New York City, points to a recently published study1 on the benefits of infection control leadership rounds as a good example of administrative engagement by IPs.
A key lever with healthcare leadership is the Centers for Medicare & Medicaid Services ongoing programs like pay for performance and value-based purchasing, which include fiscal penalties and incentives for protecting patients from hospital-acquired infections (HAIs).
“Certainly, CMS reimbursement gets the attention of the leadership,” she says. “If their hospital is failing in that area, they are failing. They are being held accountable in ways that they weren’t prior to pay for performance.”
The aforementioned study on leadership rounds showed initial success in reducing catheter-associated urinary tract infections (CAUTIs) and has since been expanded to focus on other HAIs.
Somewhat modeled on the walk-through approach used in automobile manufacturing, the leadership rounds program was initiated at the University of Wisconsin (UW) Hospitals and Clinics in Madison. The senior vice president of medical affairs and the vice president of nursing “had a goal of visiting units regularly to determine whether evidence-based and best practices are being routinely integrated into [care].” They ask the workers about barriers or obstacles they face in delivering optimal care and preventing infections.
In the study, the leaders on rounds showed traits of both “curiosity” and “fallibility,” making staff more comfortable in addressing infection control challenges. Interestingly, there was no script prompting this action, says lead author of the paper, Mary Jo Knobloch, PhD, MPH, a research health scientist in the UW School of Medicine and Public Health.
Those “leadership traits are important for staff members to really be open and candid,” she says. “The two leaders I studied were not coached, instructed — nor was there a script they followed. They were both natural leaders in this sense.”
Psychologic Safety
Another aspect is the “psychologic safety” of workers in interacting with leaders, she says. This “is defined as the belief that a person can feel free and take a risk when expressing themselves without concern about retaliation or other negative consequences.”
Having a somewhat similar program at her facility, Haas says the IP role is critical in terms of creating a safe zone for workers to speak up.
“Psychologic safety can be a real issue, especially in the beginning when the staff members don’t know what to expect,” she says. “All of a sudden, leadership is on their unit.”
While Knobloch’s program brings a relatively small number or workers into the rounds, Haas says the whole unit is invited when leadership visits at Lenox Hill Hospital.
“Everybody is there, so it is an even greater sort of risk in terms of psychologic safety for the workers,” she says. “We start out with some templated language that explains this is a learning experience — not a blame game. At first, it requires a brave soul speaking up, and seeing that the sky isn’t falling on them.”
The critical communication channel is between the IP and the administration, so that expectations and ground rules are clear before rounds begin, she says.
“The risk is having a communication disconnect between the IP and the top leadership,” Haas says. “If you think you have that kind of buy-in and you don’t, that could be problematic. The goal is problem-solving without blame.”
One aspect of the rounds that caused some worker discomfort was the possibility of leaders comparing infection rates and other factors between units that have different patient populations and acuity levels, Knobloch says.
“Staff members did express some concern about units being compared to other units, and I brought this issue forward to the two leaders during the quality improvement phase of the study,” she says. “I hope to continue to study leadership in the context of implementing evidence-based practices to prevent healthcare-associated infections.”
While leadership rounds certainly could foster a better work culture of open communication and transparency, there is a need for more evidence to sell the approach strictly by the data.
“The interesting thing about this is that there is nothing high-tech here,” says Haas. “It’s not like you have to buy some new equipment or make a huge capital investment to make this happen. Also, you get some secondary gains from this, including the engagement of employees. Everyone is trying to improve employee engagement.”
IPs considering initiating a leadership rounds program may want to start small on particular units or targeting single infections, she says. There is a message here for leaders as well.
“Top-level leadership can seem divorced from the actual work that is being done at the front lines,” Haas says. “Getting out and seeing what the situations are, how busy it is, [and] how challenging it can be is helpful so you don’t lose that connection with the front line.”
- Knobloch MJ, Chewning B, Musuuza J, et al. Leadership rounds to reduce health care-associated infections. AJIC 2018;46(3):303-310.
