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Recent studies of organisational culture and patient safety emphasise the role of senior leadership. They can support learning and communicate the importance of safety over other organisational goals.

Effective leaders show active engagement with patients and staff and this has a bearing on safer patient care (2). Nursing staff play an important part as clinical leaders. They make sense of patient safety problems, mobilise resources and put solutions in place.

Richardson and Storr's review highlights the significance of nurse leadership. But we lack insight into "how nurses develop the leadership and authority that will enable them to impact on the prevention of error..." (3). The Royal College of Nursing (RCN) promotes the pivotal supervisory role of the ward sister/team leader (4). 

Tools and interventions: Patient Safety Leadership Walkrounds

"Patient Safety Leadership Walkrounds" can influence the safety culture. Senior managers and board members can show their commitment to safety by visiting workplaces. Visits connect management with the realities of the frontline. They provide opportunities to address safety issues. Walkrounds are not one off events but form part of a cycle of improvement. They need planning preparation and follow up. 


1. McKee et al (2010) Understanding the dynamics of organisational culture change: creating safe places for patients and staff. National Institute for Health Research Service Delivery and Organisation programme.

2. West and Dawson (2012) 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.

3. 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. 

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