Patient safety and human factors: human factors - leadership

Definition: “Leadership is the process of influencing people towards achievement of organizational goals” (Naylor 2004, p.354).
 
Leadership matters. It can enhance effective safety management at all levels of an organisation.
 
Recent studies of organisational culture and patient safety have emphasised the critical role of senior leadership (McKee et al. 2010). In a study examining factors affecting patient safety in eight acute trusts, staff perceived that senior leadership behaviours had a galvanising effect and were important in "signalling patient safety and staff well-being priorities" (Charles et al. 2011, p.61).
 
Effective leadership is characterised by active engagement for both patients and staff and this has been shown to have a direct bearing on safer patient care (West and Dawson 2012). Examples of how senior staff can demonstrate the importance of patient safety include: leadership "walkrounds" (Thomas et al. 2005; Patient Safety First 2009) and as role models (Laschinger and Leiter 2006).
 
The Royal College of Nursing (RCN) has promoted the pivotal supervisory role of the ward sister/team leader for the same reasons (RCN 2011). The approach is corroborated by the findings and recommendations of the King's Fund review, that the role of team leaders in the acute and community settings enhances "staff-well being and delivers high-quality patient care" (King's Fund 2012, p.vi).

Nursing staff play an important part as clinical leaders in that they make sense of patient safety problems as well as mobilising resources and designing and implementing solutions (Charles et al 2011). Richardson and Storr's review highlighted the significance of nurse leadership but also the gap in our understanding of "how nurses develop the leadership and authority that will enable them to impact on the prevention of error..." (Richardson and Storr 2010, p.20).
 
For ideas about how to reduce risks to do with leadership go to our Action on leadership page.

References

These resources were last accessed on 21 November 2012. Some of them are in PDF format - see how to access PDF files.

Charles K et al. (2011) A quest for patient-safe culture: contextual influences on patient safety performance, Journal of Health Services Research and Policy, 16 (Suppl. 1) April, pp.57-64.

King's Fund (2012) Leadership and engagement for improvement in the NHS. Together we can. Report from the King's Fund Leadership Review 2012, London: King’s Fund.

Laschinger HKS and Leiter MP (2006) The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement, Journal of Nursing Administration, 36(5) May, pp.259-67.

McKee L et al. (2010) Understanding the dynamics of organisational culture change: creating safe places for patients and staff, National Institute for Health Research Health Services and Delivery Research Programme (HS&DR project 08/1501/092), University of Southampton NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) website.

Naylor J (2004) Management (2nd. ed.), New York: Prentice Hall.

Patient Safety First (2009) Leadership for patient safety: supplement 1. Patient safety walkrounds (PDF 377.9KB), London: Patient Safety First.

RCN (2011) Making the business case for ward sisters/team leaders to be supervisory to practice (PDF 2.2MB), London: RCN. 

Richardson A and Storr J (2010) Patient safety: a literature review on the impact of nursing empowerment, leadership and collaboration, International Nursing Review, 57(1) March, pp.12-21 + erratum p.158.

Thomas EJ et al. (2005) The effect of executive walk rounds on nurse safety climate attitudes: a randomised trial of clinical units, BMC Health Services Research 5(28).