Research on quality improvement work in health care, safety improvements in hospitals, the importance of teamwork in a critical care setting, and the role of leadership in healthcare priority setting has yielded fairly consistent findings over the past decade. The objective of this paper is to emphasize the localness of psychological safety in hospitals, the delivery of safe patient care, the leaders' role in quality-improvement efforts, and the involvement of clinicians in management.
JEL Codes: H51,H75, 111
Keywords: leadership; healthcare; patient safety; hospital; management
The mainstay of the paper is formed by an analysis of improvements in patient safety in hospitals, leaders' role in promoting patient safety, effective priority setting practices in health care facilities, the increasing interest in safety culture in health care, and the development of appropriate interventions to improve patients' safety. The theory that I shall seek to elaborate here puts considerable emphasis on pervasive barriers embedded in healthcare's organizational systems, effective methods for improving patient safety, the increasing complexity of healthcare services, and the role of leadership in health services priority setting. Applying new conceptual and methodological approaches, this study advances to the next level research on the positive role that a TFL style may have in creating and promoting a culture of safety within an HRO, the cohesiveness and cooperation necessary for successful organizational change, the processes by which clinicians become formal managers, and hospital managers' differentiated responsibilities. The analysis presented in this paper contributes to research on health care team effectiveness, efforts to improve interpersonal communication in health care environ- ments, practices that foster and nurture the development of clinical managers, and the complex environments in health care organizations.
2. Leaders' Role in Promoting Patient Safety
Learning-oriented leadership is behaviors designed to frame tasks as learning situations (Bacalu, 2013) aiming at improving interpersonal risk taking and organizational effectiveness. Effective team-based (Cremers, 2013), learningoriented should require training managers to exercise learning-oriented behaviors and to lead as teams. Leaders can create the psychological and organizational conditions (Hunter, 2013a) that support team learning. Team training may improve the ability of groups of managers to overcome barriers (Yuan, 2013) to effective team-based learning-oriented safety leadership. No training program can guarantee that a management group (Nicoläescu, 2013a) will succeed in creating a learning environment on behalf of patient safety. (Singer et al., 2011) Leaders need to develop processes to understand and engage the community and patients. (Reeleder et al., 2006) Leadership is often understood as motivating (Nicoläescu, 2013b) or influencing others to produce change. Experience alone is not the only prerequisite for improving management skills. Entering into management is a significant transition from clinical work, where tasks and routines are usually standardized. Clinicians who enter management through path dependent routes might be less prepared for the inherent challenges in the new position. Clinical managers would benefit from early advice on how to delegate effectively. Path dependency and social pressure influence clinicians' decisions to enter into management positions. (Spehar, Frich, and Kjekshus, 2012)
High reliability organizations (HROs) refer to organizations or systems that operate in complex and hazardous conditions (Prager, 2013), achieving nearly error-free performance. HRO status can be achieved through a systematic process linked to top leadership. The patient safety chain can provide an impetus for healthcare organizations to achieve high reliability organization (HRO) status. …