A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes
AbstractThe purpose of this study was to use the Leader-Member Exchange (LMX) perspective to examine the association of leadership with safety climate and adverse care outcomes. LMX posits that leaders engage in differentiated dyadic relationships with staff (members) and the quality of these relationships is an important predictor of employee attitudes, beliefs, and thus outcomes. Data for this multi-level cross-sectional study were obtained from 34 unit directors and their associated staff members (n=711) in a large academic medical center. Measures were the Agency for Healthcare Research Hospital Survey on Patient Safety Culture (safety climate), Leader-Member Exchange tool (differentiated relationship), staff characteristics and unit level data (characteristics and adverse outcomes) obtained from hospital information systems.Differentiated relationships were found between nursing leaders and their respective staff (p<.0001). LMX scores demonstrated significant variability both within (p<.0001) and among units (p=.004). Positive associations were observed with each safety climate dimension and LMX (p<.0001). Furthermore, a multivariate model of supervisor expectations and actions promoting safety (p<.0001), organizational learning-continuous improvement (p=0.54), unit teamwork (p=.001), and feedback and communication about error (p =.001) together predicted LMX. Significant differences in safety climate (p=.002) were found between units with high and low LMX scores in multivariate analysis, irrespective of patient care mix. Supervisor expectations and actions promoting safety (p<.001), organizational learning-continuous improvement (p=.034), communication openness (p=.027), feedback and communication about error (p=.012), and nonpunitive response to error (p=.005) were significant in univariate analysis. No associations were found between safety climate, staff member/unit level characteristics, LMX scores or adverse outcomes or for any interrelationships of these variables. These findings indicate high quality LMX relationships were associated with positive staff perceptions of safety behaviors. The observation of positive findings in all patient care units demonstrates LMX's potential applicability to broadly impact safety climate. High scoring units can be identified and used as exemplars. Future studies should test this concept in additional settings to confirm findings and examine how to develop and use LMX as a model to improve staff attitudes, safety behaviors, and patient care outcomes.
TypeUniversity of Pittsburgh ETD
Thompson, Debra Newmeyer (2010) A Multi-Level Study of Nurse Leaders, Safety Climate and Care Outcomes. Doctoral Dissertation, University of Pittsburgh.