“Pixie dust”: The moderating effect of reflexivity on patient safety culture and quality patient care

Susan Brandis (Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia) (School of Business, Griffith University, Gold Coast, Australia)
Stephanie Schleimer (Department of International Business and Asian Studies, Griffith University, Brisbane, Australia)
John Rice (Department of Business, University of New England, Armidale, Australia)

Journal of Health Organization and Management

ISSN: 1477-7266

Publication date: 8 August 2019



Creating a culture of patient safety and developing a skilled workforce are major challenges for health managers. However, there is limited information to guide managers as to how patient safety culture can be improved. The purpose of this paper is to explore the concept of reflexivity and develop a model for magnifying the effect of patient safety culture and demonstrating a link to improved perceptions of quality of care.


This research employed a correlational case study design with empirical hypothesis testing of quantitative scores derived from validated survey items. Staff perceptions of patient safety, reflexivity and quality of patient care were obtained via a survey in 2015 and analysed using inferential statistics. The final sample included 227 health service staff from clinical and non-clinical designations working in a large Australian tertiary hospital and health service delivering acute and sub-acute health care.


Both patient safety culture and reflexivity are positively correlated with perceived quality of patient care at the p<0.01 level. The moderating role of reflexivity on the relationship between patient safety culture and quality of care outcomes was significant and positive at the p<0.005 level.

Practical implications

Improving reflexivity in a health workforce positively moderates the effect of patient safety culture on perceptions of patient quality of care. The role of reflexivity therefore has implications for future pre-professional curriculum content and post-graduate licencing and registration requirements.


Much has been published on reflection. This paper considers the role of reflexivity, a much less understood but equally important construct in the field of patient safety.



Brandis, S., Schleimer, S. and Rice, J. (2019), "“Pixie dust”: The moderating effect of reflexivity on patient safety culture and quality patient care", Journal of Health Organization and Management, Vol. 33 No. 5, pp. 635-646. https://doi.org/10.1108/JHOM-03-2018-0092



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