Exploring leadership within a systems approach to reduce health care-associated infections: A scoping review of one work system model.

BACKGROUND: Despite efforts to prevent health care-associated infections (HAIs), these infections continue to challenge health care systems. The Centers for Disease Control and Prevention emphasizes implementation of evidence-based practices. Within the complex health care environment, sustained implementation calls for work systems that harness expertise of interprofessional teams, which, in turn, calls for suitable executive, mid-level, and local leadership. The purpose of this review is to highlight the need to study leadership when using a systems approach to reduce HAIs.

METHODS: This is a scoping review of HAI studies that used a systems engineering model called the Systems Engineering Initiative for Patient Safety model. We examined if and how leadership was addressed within 1 systems approach.

RESULTS: We found 15 studies using the Systems Engineering Initiative for Patient Safety model and, of these, leadership was directly mentioned in 3 studies. In the remaining studies, reference to leadership may be inferred by use of terms such as teamwork, managerial oversight, climate and culture, staffing support, and institutional/administrative support.

CONCLUSIONS: Research is needed to bring recognition of the role of leadership within a work systems approach to reducing HAIs. We need further examination of leadership attributes and communication behaviors that allow staff to diffuse and sustain best practices to prevent HAIs.