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Followership characteristics among infection preventionists in U.S. hospitals: Results of a national survey

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Abstract

Infection prevention practices vary across U.S. hospitals. Although the importance of leadership in infection prevention has been described, little is known about how followership influences such efforts. Our national survey found that hospitals with truly exemplary followers in infection control roles may be more likely to use recommended prevention practices.

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... 15,16 Several studies have demonstrated the importance of leadership, clinical champions, and truly exemplary followers in adopting, implementing, and sustaining infection prevention efforts. [17][18][19][20][21][22] Additionally, the importance of 2 foundational domains-culture and the learning system-in fostering safe and reliable health care operations have been highlighted. 23 A key component of the culture domain is psychological safety, defined as the degree to which people view the environment as conducive to interpersonally risky behaviors like speaking up if they witness an error or asking for help if they have concerns about an order. ...
... 18,19 It has also been demonstrated that hospitals with exemplary followers were more likely to regularly use urinary catheter reminders or stop-orders and/or nurse-initiated catheter discontinuation for CAUTI prevention, and subglottic drainage via endotracheal tubes for VAP prevention. 21 It is not surprising that high levels of psychological safety are associated with frequent use of socioadaptive safety interventions such as nurse-initiated urinary catheter discontinuation or ventilator sedation vacation. These practices require communication between nurses, respiratory therapists and physicians, efforts by bedside staff to engage patient and family requests, and the willingness to speak up and challenge entrenched customs and practices. ...
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Background: Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals. Methods: We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about hospital and infection control program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety. Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices. Results: Survey response rate was 59%. High psychological safety was reported in approximately 38% of responding hospitals, and was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; P = .002) for catheter-associated urinary tract infection prevention, and regularly using sedation vacation (odds ratio, 1.93; P = .04) for ventilator-associated pneumonia prevention. Conclusions: We provide a snapshot of psychological safety in US hospitals and how this characteristic influences the use of select HAI prevention practices. A culture of psychological safety should be considered an integral part of HAI prevention efforts.
... This unlocks the gate for A Literature Review of Followership as Independent and Dependent Variables and the Meaning leadership study to acknowledge the useful opportunities of problems and theories from a follower's viewpoint [11]. Although followership as part of organizational studies has been recognized and has made valuable contributions [22], even the research trends of the last decade published in research articles, proceedings, master's theses and even doctoral dissertations have also begun to discuss membership in various fields, ranging from education [23][24][25][26][27][28], industry and companies [29][30][31][32][33][34][35][36][37], military field [33,[38][39][40][41][42][43][44][45][46], military field [47,48], hospitality industry [15], bidang industri perhotelan [32], public administration [49], management systems and business [50], banking, telecommunications and transportation [39], and other fields. However, reviews that try to find out the highest average score of followership from various research documents and implied scores are still very minimal and have not even been published in reputable journals. ...
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This article is a literature review. This study aims to critically as well as comprehensively analyze engagement as an independent (X) and dependent (Y) variable. There are 15 articles that were reviewed with quantitative criteria and influence. The outcomes of this investigation found that the average followership score in the role of the X variable was 0.3957, in the 3rd class interval, which was between 0.323 – 0.414 with a fairly low category. While the average follow-up score as the Y variable is 0.385833, which is in the 4th class interval, which is between 0.379 - 0.501 in the high category. Based on the findings, the authors conclude that (1) followers as variable X have characteristics that are proactive, critical of the situation that occurs in their organization, dare to express their views, and criticize the leadership for the good and success of the organization to which they are affiliated, scores that are in the low enough category range indicate to the reader that follower participation has not received attention from the leader to be given more space to contribute or because followers are generally the party being thought of, they think they don't need to think because someone has already thought about it, (2) follower, as a Y variable is characterized by that followers, are the party who thought so that he only needs to be obedient, committed, perform well so that the leader provides opportunities to continue to grow with his organization and continue to develop his competence to complete his duties through training designed by the leade.
... Two studies, examining these concepts within healthcare, found a positive correlation between followership style and organizational performance. Greene et al., based on US national survey data, examined the association between the followership styles of infection prevention staff across US hospitals and the hospital infection practices [13]. The authors found an association between followership styles characterized by higher active engagement and critical thinking when compared against observance with hospital infection policies. ...
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Introduction: Research in healthcare leadership has focused on leaders. In contrast, organizational success may be more influenced by followers. Kelley described five followership styles based on two characteristics: active engagement and independent critical thinking. We examined the literature on the association between followership style and workplace outcomes. Methods: Articles from MEDLINE, CINAHL, and EMBASE were searched. Given the paucity of studies, we expanded our search to non-healthcare databases. Two reviewers identified all studies examining followership styles and their association with job satisfaction and/or performance outcomes. Included studies were evaluated using the GRADE approach. Results: We identified one article on followership for every sixty articles on leadership in the medical literature. Fourteen observational studies on followership were included in our analysis. Outcomes ranged from the individual to the organizational level. No synthesized analysis was possible due to heterogeneity. Followership styles with greater active engagement and independent critical thinking were associated with increased job satisfaction, decreased burnout, and workplace performance metrics. Conclusions: There is a dearth of studies on followership. The literature suggests that followership characterized by greater independence is associated with positive outcomes. Given the importance of teamwork in the critical care environment, we should prioritize understanding of this important variable.
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Aim: To explore the followership styles and their associations with nurses' sociodemographic profiles in Saudi Arabia. Background: In Saudi Arabia, nurses' role is seen as less important and passive. However, whether they were actually passive followers has not been examined. No previous research has examined nurses' followership styles in Saudi Arabia. Methods: This cross-sectional study used a convenience sample of nurses. The Kelley followership questionnaire-revised was used to determine the prevalence of the five followership styles. Participants' demographic characteristics, which included age, gender, nationality, education level, years of experience, and role, were collected to investigate their associations with followership styles. An online survey was designed and distributed using SurveyMonkey®. Data were analyzed with logistic regression and expressed as odds ratios. Results: This study included 355 nurses. Findings revealed that the predominant followership style was exemplary (74%), followed by the pragmatist (19%), conformist (4%), and passive styles (3%). Logistic regression analysis revealed that expatriates, higher education, and a leader role had an independent association with an exemplary followership style. Male gender was associated with a passive style. Younger age, male gender, Saudi Arabian nationality, undergraduate qualification, no previous leadership experience, a follower role, and fewer years of experience increased the odds of having a pragmatist style. Conclusion and implications: Followership styles were influenced by sociodemographic and work-related factors. Young nurses with less experience tend to be pragmatist followers. Nursing managers should integrate followership styles when planning leadership and team development courses to ensure maximum team effectiveness as leadership and followership are interdependent.
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