key: cord-0886640-25sz76ip authors: Gaughan, Alice A.; Walker, Daniel M.; DePuccio, Matthew J.; MacEwan, Sarah R.; McAlearney, Ann Scheck title: Rewarding and Recognizing Frontline Staff for Success in Infection Prevention date: 2020-06-30 journal: Am J Infect Control DOI: 10.1016/j.ajic.2020.06.208 sha: 8c32c7e6f5f8c2ce4e9f56c51eedae6ff973e05c doc_id: 886640 cord_uid: 25sz76ip Management practices help support efforts to prevent healthcare-associated infections (HAIs). Providing rewards and recognition to frontline staff is one management practice found to be in use by hospitals that are higher-performers in HAI prevention. Using data from interviews with hospital managers and frontline staff at 18 US hospitals, our study identifies how managers can use reward and recognition programs as motivational tools to sustain frontline HAI prevention efforts. Management practices help support efforts to prevent healthcare-associated infections (HAIs). Providing rewards and recognition to frontline staff is one management practice found to be in use by hospitals that are higher-performers in HAI prevention. Using data from interviews with hospital managers and frontline staff at 18 US hospitals, our study identifies how managers can use reward and recognition programs as motivational tools to sustain frontline HAI prevention efforts. Healthcare-associated infections (HAIs) cause patient morbidity and mortality that is often preventable. 1 Clinical practices are critical to the prevention of HAIs, but are implemented with varying effectiveness, 2 suggesting that management practices also influence infection prevention efforts. 3 Hospitals that are higher performers with respect to HAI prevention have reportedly adopted management strategies to support these initiatives, including providing rewards and recognition to frontline staff around their efforts to prevent HAIs. 3 Previous research indicates that reward and recognition programs that acknowledge healthcare workers' accomplishments can make workers feel more appreciated, mitigate fatigue, 4 and provide motivation to deliver better patient care. 3 Understanding the characteristics of reward and recognition programs in the context of HAI prevention can potentially inform how this management practice can support frontline staff in these efforts. To characterize the types of reward and recognition programs that hospitals have deployed to acknowledge effective HAI prevention efforts on the frontline, we examined these types of programs as part of a larger study of management practices that support HAI prevention. 5 We conducted site visits to US hospitals from September 2017 to November 2019 to learn about management practices that contribute to successful prevention of HAIs. The study was focused on catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs), but also considered general infection prevention efforts. The study sample was comprised of 18 hospitals from 10 states. We recruited hospitals that varied with respect to their CLABSI and CAUTI infection rates compared to the national average (i.e., Better, Worse, or Average) based on 2016 data from Hospital Compare. We also considered variability among hospitals on the basis of geographic region and organizational characteristics (e.g., size). Hospital characteristics are presented in Table 1 . Across sites we held in-person one-on-one or group interviews with 318 key informants who were either unit managers or frontline nursing staff. The total number of key informants at each hospital is provided in Interview transcripts were analyzed using a deductive dominant thematic analysis, 6 allowing for categorization of data based on general themes derived from the interview guides, as well as identification of emergent themes. This approach allowed for comparison of themes across sites and enabled us to characterize meaningful rewards for success in infection prevention. Table 2 . Methods of motivating frontline staff with rewards and recognition for infection prevention efforts Rewards "Yeah, so we just had a party, a big party…we had like a huge banner made that we hung outside. We made poster boards, and we ordered a cake. And we invited other units to come and celebrate our success." "Every nurse is getting a goody bag that says, 'You're a lifesaver.' " [with lifesaver candies inside.] "Last year we had trophies made up for different CAUTIs and CLABSIs and people who met those goals or exceeded them got little trophies to display on their unit. And candy." Recognition "A lot of individual recognition like, so-and-so had no infections…and that is recognized at huddle in front of your peers." "…trauma, neuro [neurology] ICU because they were, I'd say, 190 days or something like that without an infection. We announced it at bed huddle and everyone was made to feel a part." "Recognition, and there's hospital-wide emails you know. They'll have all the units on there and the amount of days they have gone and things like that. A lot of times we will get signs on the door that says you've gone 100 days." "They post newsletters and it might even be on the internet and that kind of thing. Everybody sees that throughout the organization…and they [frontline staff] are very proud of it." Perspectives of frontline staff Rewards "Our unit was recently awarded because it has been two years since our last CAUTI and three years since our last CLABSI. We had a big cake party and a big picture of us, a video of us." "We actually all got new scrub jackets and that was like the best ever. I think it motivates us as a unit." "We were CLABSI-free for a year and we had like, they brought in, they catered food and we had like a little party after a year. Oh, I mean we don't say no to food so, we liked it." "They did ice cream one time and pizza for so many months of not having CAUTIs or CLABSIs. Which is nice because we are nurses and we always like food." Recognition "We send a weekly email. We do actually give acknowledgement of people who have done, you know, 100% or something with their documentation." "Well our manager always sends us kudos when we don't have any hospitalacquired [infections] . When everything is going smooth, she always sends us an email saying great job-you guys did really good." With any heightened focus on maximizing clinical efforts, it may be easy to let recognition of frontline staff fall by the wayside. Yet to sustain workforce morale and calm anxiety that staff are likely experiencing in such times of crisis, 10 managers must make efforts to clearly communicate they value frontline staff and their extraordinary efforts. 8, 9 Further, to accommodate social distancing, this recognition may need to shift to modes such as emails and other types of efforts rather than in-person approaches. It is thus perhaps more important now than ever for hospitals to support their frontline staff and communicate that they are appreciated for their hard work. Our findings are subject to several limitations. First, as our work was qualitative and largely exploratory, our intent was not to establish causality, but to provide insight into reward and recognition practices that were perceived to be positive by the frontline staff we interviewed. In addition, as our study took place prior to the emergence of COVID-19, we are unable to examine how rewards and recognition practices may need to be modified due to the unique circumstances of this pandemic. In future work it will be of interest to learn how managers' use of rewards and recognition continued or was altered during the pandemic, especially given the unique circumstances of COVID-19. Providing motivation and encouragement to frontline staff can support efforts to prevent HAIs. Hospitals can take inspiration from these existing strategies to provide meaningful rewards and recognition for frontline efforts, especially as they face the extraordinary challenges of the COVID-19 pandemic. The preventable proportion of healthcare-associated infections 2005-2016: Systematic review and meta-analysis The ability of intensive care units to maintain zero central line-associated bloodstream infections Preventing central line-associated bloodstream infections: A qualitative study of management practices Compassion practices, nurse wellbeing, and ambulatory patient experience ratings Searching for management approaches to reduce HAI transmission (SMART): A study protocol Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study COVID-19: Protecting health-care workers Supporting clinicians during the COVID-19 pandemic Surge priority planning COVID-19: Critical care staffing and nursing considerations Resources/Resources/Surge-Priority-Planning-COVID-19-Critical-Care-Staffingand-Nursing-Considerations Supporting the health care workforce during the COVID-19 global epidemic The authors thank [blinded for submission], all affiliated with the authors' organization, for their assistance with this project. They also are grateful to the hospital managers, directors, and frontline staff who participated in this study.