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...