Staff Medical Errors Impacted by Leadership’s Commitment to Safety

Safe practices bolstered when leaders in nursing promote team safety in word and deed

Nursing team leaders can create a stronger commitment to safe practices and reduce the error rate among their team by having their own patient-safety actions mirror their spoken words, according to study results appearing online in the Journal of Applied Psychology. When nurses feel safe admitting to their supervisors that they’ve made a mistake regarding a patient, they are more likely to report the error because they do not feel trapped between adhering to safety practices and admitting mistakes in contradiction of procedures.

“Patient errors remain a major source of avoidable patient harm in the United States,” said Deirdre McCaughey, assistant professor of health policy and administration at Penn State. “The Institute of Medicine report, ‘To Err is Human: Building a Safer Health System,’ charged that avoidable medical errors in US hospitals kill at least 44,000 patients a year. Feeling comfortable reporting errors also leads to a stronger commitment to safe practices, which ultimately reduces error rate.”

McCaughey and her colleagues studied the concept of an existing conflict between the intense enforcement of safety procedures and the reporting of safety errors among care providers.

“Despite this conflict, prior research indicates that a climate of safety requires both prioritizing existing safety protocols and constructive responses to errors,” said the research team leader, Hannes Leroy of Katholieke Universiteit Leuven and the University of Calgary. “Achieving this balance highlights the importance of leadership to foster team priority of safety.”

An anonymous survey of 54 nursing teams in 4 hospitals in Belgium was conducted by researchers. For the study, the researchers considered a nursing team to be 1 head nurse and a minimum of 3 nurses who reported directly to the head nurse. The researchers sought to examine 2 major points: if the leadership actions of head nurses were aligned with the verbal procedures they had given to staff nurses, and if that connection effected nurses’ commitment to follow safe work protocols and/or their willingness to report a patient treatment error. The team examined the relationship between fostering safety and reporting patient errors 6 months later in order to determine if the relationship resulted in a reduction of patient errors.

The written surveys examined 3 main issues using a variety of statements that nurses ranked on a scale ranging from “completely disagree” to “completely agree”:

1. The behavioral integrity of head nurses was examined with such statements as, “My head nurse always practices the safety protocols he/she preaches”
2. The psychological safety felt by staff nurses was examined with such statements as, “If you make a mistake in this team, it is often held against you”
3. The priority of team safety was examined with such statements as, “In order to get the work done, one must ignore some safety aspects”

Upon analyzing the data using structural equation modeling, the researchers found that when nurse managers’ spoken expectations regarding safety aligned with their commitment to safety, their teams had a stronger commitment to acting safely while carrying out work duties. In addition, this greater emphasis on safety resulted in a greater rate of reporting errors and a reduction in patient treatment errors.

“The study offers support for the efficacy of leaders’ behavioral integrity – walking the talk, if you will – and it demonstrates the importance of leadership in promoting a work environment in which employees feel it is safe to reveal performance errors,” said McCaughey. “This benefits patients because work environments in which error is identified offer employees the opportunity to learn from those errors and, ultimately, prevent similar errors from occurring.”

Source: Penn State University.