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Original research
Leadership perspective on the implementation of guidelines on healthcare-associated infections
  1. Josephine Hegarty1,
  2. Siobhan Murphy1,
  3. Sile Creedon1,
  4. Teresa Wills1,
  5. Eileen Savage2,
  6. Fiona Barry3,
  7. Maura Smiddy3,
  8. Alice Coffey4,
  9. Aileen Burton2,
  10. Deirdre O'Brien5,
  11. Sinead Horgan6,
  12. Cliodhna Nibhuachalla7,
  13. Cathal Brennan2,
  14. Heloise Agreli1,
  15. Jonathan Drennan2
  1. 1 Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
  2. 2 Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
  3. 3 School of Public Health, University College Cork, Cork, Ireland
  4. 4 Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
  5. 5 Microbiology Department, Mercy University Hospital and South Infirmary Victoria University, Cork, Ireland
  6. 6 Cork University Hospital, University College Cork, Cork, Ireland
  7. 7 School of Medicine, University College Cork, Cork, Ireland
  1. Correspondence to Professor Josephine Hegarty, Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork T12 K8AF, Ireland; J.Hegarty{at}ucc.ie

Abstract

Background Leadership is a key component for infection prevention and control and plays an important role in the implementation of guidelines on healthcare-associated infections. A body of literature exists on healthcare workers’ perspectives on implementing these types of guidelines; however, there is a paucity of data on the leadership perspectives on implementation. This study aims to contribute to the evidence base of leadership perspectives.

Objective To explore the implementation of National Clinical Guidelines pertaining to methicillin-resistant Staphylococcus aureus and Clostridium difficile from the leadership angle.

Setting Healthcare organisations.

Participants Clinical and non-clinical leaders.

Design This research used a mixed-methods approach comprising qualitative individual interviews (n=16) and quantitative surveys (n=51) underpinned by the integrated Promoting Action on Research Implementation in Health Services framework.

Results Leaders recognise the value and innovation of guidelines to support clinical practice. However, they describe barriers to implementation that prevent the full uptake of guidelines, for example, guidelines may present an ideological approach to care which differs from the contextual reality of clinical practice where resources and time are not always available.

Conclusion This research highlighted that guidelines are complex interventions in complex organisations, perhaps leadership could help overcome the challenges posed by this complexity. Leadership may allow a systematic approach to all aspects of implementation despite the variety of challenges faced at different stages of implementation and sustainability of uptake of guidelines over time.

  • clinical leadership
  • medical leadership
  • health policy
  • safety
  • guidelines

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/leader-2018-000111

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Footnotes

  • Contributors JH, SM, SC, TW, ES, FB, MS, AC, AB, DOB, CB and JD made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. JH, SM, SC, TW, ES, FB, MS, AC, AB, DOB, SH, CN, CB, HA and JD were involved in drafting the manuscript or revising it critically for important intellectual content. JH, SM, SC, TW, ES, FB, MS, AC, AB, DOB, SH, CN, CB, HA and JD have given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. JH, SM, SC, TW, ES, FB, MS, AC, AB, DOB, SH, CN, CB, HA and JD have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Department of Health and the Health Research Board, Ireland (Applied Partnership Awards, APA-2017-002).

  • Disclaimer The NCEC Steering Committee had an important role in advising on access to data collection sites, provided some comments on the data collection instruments and signed off on the final report submitted on completion of the research. The funders or their employees did not have a role in the data collection or analysis processes.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Research Ethics Committee of the Cork Teaching Hospitals (CREC), Ireland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for further information can be made to the corresponding author on reasonable request.