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The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.

Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.

The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.

Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.

This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

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.

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.

Purpose – Patient safety and adverse events continue to present significant challenges to the US health care delivery system. Mandated reporting of adverse events can be a mechanism to “coerce” hospitals to identify, evaluate, and ultimately improve the quality and safety of patient care. The objective of this study is to determine if the coercion of mandated reporting impacts hospital patient safety scores.

Methods – We utilize the US News and World Report 2012–2013 Best Hospital Rankings which includes patient safety data from US teaching hospitals. The dependent variable is a composite measure of six indicators of patient safety during and after surgery. The independent variable is state mandated reporting of hospital adverse events. Three control variables are included: Magnet accreditation status, surgical volume, and the percentage of surgical admissions.

Findings – Using ordered logistic regression (n = 670 hospitals) we find a positive, but not significant, relationship between state mandated reporting and better patient safety scores.

Implications – This finding suggests that regulatory policy may not actually prompt performance improvement, and our data point to the need for further study of both formal and informal processes to manage patient safety within the hospital.

Originality – While increased reporting of adverse events has been linked to hospitals providing safer care, no research to date has examined whether or not state-level mandates actually lead to improvements in patient safety.

The purpose of this study is to increase knowledge and understanding of the relationship between full-time-culture and the outcome for quality and safety of care.

The paper is a literature review with a qualitatively oriented thematic analysis concerning quality or safety outcomes for patients, or patients and staff when introducing a full-time culture.

Identified factors that could have a positive or negative impact on quality and patient safety when introducing full-time culture were length of shift, fatigue/burnout, autonomy/empowerment and system/structure. Working shifts over 12 h or more than 40 h a week is associated with increased adverse events and errors, lower quality patient care, less attention to safety concerns and more care left undone. Long shifts give healthcare personnel more flexibility and better quality-time off, but there is also an association between long shifts and fatigue or burnout. Having a choice and flexibility around shift patterns is a predictor of increased wellbeing and health.

A major challenge across healthcare services is having enough qualified personnel to handle the increasing number of patients. One of the measures to get enough qualified personnel for the expected tasks is to increase the number of full-time employees and move towards a full-time culture. It is argued that full-time culture will have a positive effect on work environment, efficiency and quality due to a better allocation of work tasks, predictable work schedule, reduced sick leave, and continuity in treatment and care. There is limited research on how the introduction of full-time culture will affect the quality and safety for patients and staff, and few studies have been focusing on the relationship between longer shift, work schedule, and quality and safety of care.

Early writings about teamwork in healthcare emphasized that healthcare providers needed to evolve from a team of experts into an expert team. This is no longer enough. As patients, accreditation bodies, and regulators increasingly demand that care is coordinated, safe, of high quality, and efficient, it is clear that healthcare organizations increasingly must function and learn not only as expert teams but also as expert multiteam systems (MTSs).

In this chapter, we offer a portrait of the robust, and albeit complex, multiteam structures that many healthcare systems are developing in order to adapt to rapid changes in regulatory and financial pressures while simultaneously improving patient safety, quality, and performance.

The notion of continuous improvement rooted in continuous learning has been embraced as a battle cry from the boardroom to the bedside, and the MTS concept offers a meaningful lens through which we can begin to understand, study, and improve these complex organizational systems dedicated to tackling some of the most important goals of our time.

Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided.

Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis.

Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way.

The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital’s context can significantly contribute to positive outcomes in terms of quality and patient safety improvements.

This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

High patient satisfaction is not simply a customer service goal; it is an important dimension of quality and part of financial incentives and public reporting requirements. However, patient experience is often siloed within health system organizational charts and considered separately from quality and safety initiatives, instead of being seen predominantly as a “customer service” initiative. Representatives from 52 health care systems across the United States completed an online survey to explore both the processes and infrastructure hospitals employ to improve patient experience, and the metrics hospitals use to assess the quality of patient experience beyond patient satisfaction survey data. When asked about performance metrics beyond satisfaction, most hospitals or systems noted other metrics of the entire patient experience such as the rate of complaints or grievances and direct feedback from patient and family advisors. Additionally, respondents suggested that a broader definition of “quality of the patient experience” may be appropriate to encompass measures of access, clinical processes, and quality of care and patient safety outcomes. Almost all respondents that we surveyed listed metrics from these less traditional categories, indicating that performance improvement within the patient experience domain in these organizations is linked with other areas of hospital performance that rely on the same metrics, such as clinical quality and patient safety.