Regular “leadership rounds” where senior hospital managers meet frontline nursing staff to discuss infection control, can help improve practice and boost patient safety, according to a new US study.
The study, published in the American Journal of Infection Control, found these short meetings led by senior managers and attended by nurse managers, clinical nurse specialists and some frontline nurses enabled and encouraged concerns to be raised and problems solved.
“Health leaders are able to problem solve with frontline staff to determine barriers to implementation”
Mary Jo Knobloch
Researchers from the University of Wisconsin looked in detail at the way leadership rounds focusing on healthcare-associated infections (HAIs) worked in practice at two hospitals, observing the sessions and interviewing a range of staff that took part.
In all, they observed and recorded 22 leadership rounds led by two senior managers at University Hospital and the American Family Children’s Hospital – both part of University of Wisconsin Health.
The rounds were initially established by the group’s associate chief nursing officer and associate chief medical officer to tackle a rise in urinary tract infections linked to catheters. However, the sessions were expanded to encompass two other types of infection causing concern – infections linked to central lines and cases of the superbug C. difficile.
The timing and location of these gatherings was flexible but they generally took place during a day shift on an inpatient unit and typically included the nurse manager, clinical nurse specialist, infection control specialists and certain frontline nurses, who were invited to attend by email.
“HAI leadership rounds are typically 30 minutes in duration; some are conducted while all participants are standing in a busy unit hallway and some are conducted in a conference room or a breakroom,” said the study authors.
“This research shows that healthcare leaders can and should be actively listening to frontline staff”
There was no formal agenda but the meetings usually started with leaders and infection prevention staff reviewing the unit’s infection data. Leaders then discussed ways to ensure infection guidelines and protocols were followed and any issues getting in the way.
“This discussion is most often prompted by leaders asking about what seems to be working and what is not working, unit barriers, and how they as leaders can potentially assist in overcoming the barriers,” stated the study paper.
The researchers observed rounds across 19 units over a period of seven months and also interviewed nurses and others about the process and what they got out of it.
Over the course of 22 rounds, they recorded more than 350 instances where staff raised issues and problems relating to infection control in their units and discussed ways to solve these problems.
Meanwhile, they also recorded 161 instances of “reflecting and evaluating” – described as “time spent during the conversations that appeared to allow everyone to reflect on what was going on, evaluate the problems, and talk about solutions”.
“They felt it was important for leaders to witness the ‘busyness’ of the unit”
They concluded the “flexible nature” of the rounds and the way senior managers communicated fostered a sense of “psychologic safety”, where staff felt able to express themselves openly and honestly about the challenges they encountered, which helped ensure infection control issues were addressed.
“By fostering an open culture, health leaders are able to problem solve with frontline staff to determine barriers to implementation,” said lead author Mary Jo Knobloch. “This presents the opportunity to move evidence to practice and better protect patients from harm.”
Keys to success included the fact that the leaders involved were described as “good listeners” by nurses. “Staff felt that both leaders were good at allowing the staff to be the experts in the day-to-day work they do,” said the study paper.
Nursing staff said they appreciated the chance to have direct contact with senior management.
“I think there’s genuine understanding and empathy for the challenges that we have…it’s been really a great way to have a discussion about some of the initiatives we are executing that require their attention and potential support,” said one quoted in the paper.
Another described the leaders as “very receptive in wanting to hear what the bedside nurse had to say”.
“It’s been really a great way to have a discussion about some of the initiatives we are executing”
Nurses also liked the fact the meetings were short and many said they preferred the rounds to take place on the unit itself, rather than going into a meeting room. “They felt it was important for leaders to witness the ‘busyness’ of the unit,” said the paper.
However, one clear message to emerge was that nurses were not happy when leaders compared their unit with others. “Participants were concerned about unfair comparisons, that each unit has a unique set of circumstances and a unique patient population,” said the study paper.
Some nurses also expressed concern the rounds were “too open-ended” and that expectations of staff were unclear as was the impact of such meetings.
“There was overwhelming support for the visibility that leadership rounds bring to the unit staff, the attention these unit-based visits bring to the issue of reducing HAIs, and the feeling that leaders really do care about what staff members are doing day to day,” said the paper. “However, unit staff did not really know the impact on reducing HAIs for the institution.”
Nevertheless, nurses did feel leadership rounds had a made difference to the overall culture of their organisation, the paper added.
Janet Haas, president of the Association for Professionals in Infection Control and Epidemiology, which publishes the journal the paper featured in, said it was vital to engage with frontline staff to understand why infections occurred and what could be done to prevent them.
“This research shows that healthcare leaders can and should be actively listening to frontline staff through HAI leadership rounds, problem-solving with them in real-time on ways to integrate best practices into daily unit operations,” she said.