Consensus achievement of leadership, organisational and individual factors that influence safety climate: Implications for nursing management

Abstract

Aim:To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects.Background: Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods:A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys.Results: Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions:Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management:Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. K E Y W O R D SDelphi survey, nursing, patient safety, safety climate, transformational leadership | INTRODUCTIONHuman suffering caused by preventable medical error has taken a significant toll on patients, families and the second victims, health care organisations and clinicians (James, 2013). As care providers and consumers have become increasingly aware of the high rates of preventable patient deaths worldwide, the global health care community has called for transformational improvement in patient care quality and safety. To achieve this goal, an understanding of specifically how nurse leaders improve patient safety is essential. According to Wong (2015: p. 276), "the development and testing of robust conceptualisations of leadership that clearly describe leadership behaviours and identify the | BACKGROUNDTransformational leadership has a salient role in the safety chain by developing cultures of safety in the patient care environment (Buckner et al., 2014). This leadership style is associated with im- Despite a growing body of evidence related to TFL and its influence on patient safety outcomes (Merrill, 2015;Ross, 2011;Weng et al., 2015), further research is needed to explain how, why, or when these factors affect the safety chain by testing mediating and moderating effects (McFadden et al., 2014;Wong, 2015). A mediator specifies how the relationship between TFL and SC occurs, while a moderator interacts with TFL to vary the strength of the relationship with SC (Baron & Kenny, 1986). The framework validated by this study serves as an organising tool for this testing.The review of current evidence and prop...

Patient participation in patient safety-An exploration of promoting factors

“…These traits can lead to situations in which patient safety is a rare subject of communication between patients and professionals in everyday clinical practice (Martin, Navne, & Lipzak, ). For this reason, nurse leaders have a critical role in developing the structure for supporting PP in PS (Fisher, Jones, & Verran, ; Jangland et al, ; Thornton et al, ). If patient safety issues are not customarily addressed in the wards, patients are unsure of their roles and expected actions (Ocloo & Matthews, ).…”

“…If patient safety issues are not customarily addressed in the wards, patients are unsure of their roles and expected actions (Ocloo & Matthews, ). Fischer et al () concluded that leadership's commitment to safety, support of employees, and resilience, as well as safety education and training are principal factors influencing patient safety.…”

“…Patient participation and patients’ views on PS are important for efficient identification of effective interventions for promotion of safe care (Ringdahl, Chaboyer, Ulin, Bucknall, & Oxelmark, ). Improving safety requires an organisational culture that enables and prioritizes safety and, above all, a commitment to safety at all organisational levels from frontline workers to managers and executives (Fisher, Jones, & Verran, ; Thornton et al, ). A robust safety culture also requires active leadership.…”

The relationship between nurse manager's transformational leadership style and medication safety

“…Transformational leadership styles have been found to contribute positively to the safety climate, whereas laissez‐faire leadership styles (a lack of leadership or no leadership) were shown to contribute negatively by promoting a culture of blame and socialising nurses into a negative safety climate . Specifically, the proactive, trustworthy and bi‐directional communication with staff by a transformational nurse leader positively influences a safety climate .…”

Factors contributing to voluntariness of incident reporting among hospital nurses

“…From the individual perspective, fear of blame, knowledge of human factor safety, workload, job satisfaction and behavioural engagement in care quality were respectively noted as contributing to nurses' intention of reporting (Chiang et al, 2010;Pfeiffer, Manser, & Wehner, 2010;Vrbnjak, Denieffe, O'Gorman, & Pajnkihar, 2016). Based on organizational culture and citizenship standpoints, the frontline medical staff's specific behaviours (i.e., nurse's incident reporting and nursing-based safety practices) are affected by individual and organizational factors that might have mediator or moderator effects on the above behaviours (Fischer, Jones, & Verran, 2018). However, little attention has been paid to this complex interaction and its effect on nurses' VIR.…”