Background Hand hygiene compliance can be improved by strategies fostering collaborative efforts among healthcare workers (HCWs) through change agents. However, there is limited information about how change agents shape the social networks of work teams, and how this relates to organisational culture. The objectives of this study were to describe the influence of peer-identified change agents (PICAs) and management-selected change agents (MSCAs) on hand hygiene, perception of their leadership style by peers, and the role of the organisational culture in the process of hand hygiene promotion. Methods This study, stratified in pre-, during, and post-intervention periods, was conducted between February 2017 and March 2018 in two wards at a tertiary care hospital in Malaysia. Hand hygiene promotion was facilitated either by PICAs (study arm 1) or MSCAs (study arm 2), and the two wards were randomly allocated to one of the two interventions. Outcomes were: 1) perceived leadership styles of PICAs and MSCAs by staff, vocalised during question and answer sessions; 2) the social network connectedness and communication patterns between HCWs and change agents by applying social network analysis; and 3) hand hygiene leadership attributes obtained from HCWs in the post-intervention period by questionnaires. Results Hand hygiene compliance in study arm 1 and study arm 2 improved by from 48% (95% CI: 44-53%) to 66% (63-69%), and from 50% (44-55%) to 65% (60-69%), respectively. There was no significant difference between the two arms. Healthcare workers perceived that PICAs lead by example, while MSCAs applied an authoritarian top-down leadership style. The organisational culture of both wards was hierarchical, with little social interaction, but strong team cohesion. Position and networks of both PICAs and MSCAs were similar and generally weaker compared to the leaders who were nominated by HCWs in the post-intervention period. Healthcare workers on both wards perceived authoritative leadership to be the most desirable attribute for hand hygiene improvement. Conclusion Despite experiencing successful hand hygiene improvement from PICAs, HCWs expressed a preference for the existing top-down leadership structure. This highlights the limits of applying leadership models that are not supported by the local organisational culture.

中文翻译：

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手卫生-同行识别和管理层选择的变更代理人的社交网络分析。

背景技术可以通过通过变革推动者促进医护人员（HCW）之间合作的策略来改善手部卫生状况。但是，关于变革推动者如何塑造工作团队的社交网络以及这与组织文化之间的关系的信息有限。这项研究的目的是描述同伴识别的变革代理人（PICA）和管理层选择的变革代理人（MSCA）对手卫生的影响，同行对他们领导风格的理解以及组织文化在此过程中的作用促进手部卫生。方法这项研究在干预前，干预中和干预后阶段进行了分层，于2017年2月至2018年3月在马来西亚一家三级护理医院的两个病房进行。通过PICA（研究组1）或MSCA（研究组2）促进手部卫生，并且两个病房被随机分配到两种干预措施之一。结果是：1）在问答环节中表达出员工对PICA和MSCA的领导风格的看法；2）通过应用社交网络分析，在社区医务工作者和变革推动者之间建立社交网络的连通性和沟通模式；3）在干预后的时期内，通过问卷调查从医务工作者获得的手卫生领导力属性。结果研究组1和研究组2的手卫生依从性从48％（95％CI：44-53％）提高到66％（63-69％），从50％（44-55％）提高到65％ （60-69％）。两组之间没有显着差异。医护人员认为，PICA以身作则，而MSCA采用自上而下的专制领导风格。双方病房的组织文化都是等级制的，几乎没有社会互动，但是团队凝聚力强。与干预后时期由医务工作者提名的领导人相比，PICA和MSCA的职位和网络都相似，而且总体上较弱。双方病房的医护人员都认为，权威性领导是改善手部卫生的最理想属性。结论尽管PICA成功改善了手部卫生，但HCW还是表示倾向于现有的自上而下的领导结构。这突显了当地组织文化不支持的应用领导力模型的局限性。社交互动少，但团队凝聚力强。与干预后时期由医务工作者提名的领导人相比，PICA和MSCA的职位和网络都相似，而且总体上较弱。双方病房的医护人员都认为，权威性领导是改善手部卫生的最理想属性。结论尽管PICA成功改善了手部卫生，但HCW还是表示倾向于现有的自上而下的领导结构。这突显了当地组织文化不支持的应用领导力模型的局限性。社交互动少，但团队凝聚力强。与干预后时期由医务工作者提名的领导人相比，PICA和MSCA的职位和网络都相似，而且总体上较弱。双方病房的医护人员都认为，权威性领导是改善手部卫生的最理想属性。结论尽管PICA成功改善了手部卫生，但HCW还是表示倾向于现有的自上而下的领导结构。这突显了当地组织文化不支持的应用领导力模型的局限性。双方病房的医护人员都认为，权威性领导是改善手部卫生的最理想属性。结论尽管PICA成功改善了手部卫生，但HCW还是表示倾向于现有的自上而下的领导结构。这突显了当地组织文化不支持的应用领导力模型的局限性。双方病房的医护人员都认为，权威性领导是改善手部卫生的最理想属性。结论尽管PICA成功改善了手部卫生，但HCW还是表示倾向于现有的自上而下的领导结构。这突显了当地组织文化不支持的应用领导力模型的局限性。