Electronic Thesis and Dissertation Repository

Degree

Doctor of Education

Program

Education

Supervisor(s)

Dr. Pam Bishop

Abstract

Within the complex and often changing Canadian landscape of healthcare, patient safety remains at the forefront of hospital corporate priorities and strategic plans. Drawing data from an emergency department in one Ontario-based hospital that was supported by 180 nursing staff and a three-member front-line leadership team (two coordinators and a manager), this study provides further insight into aspects of how safe patient care can be provided. An exploratory mixed-methods case study was used to understand how and why leadership attributes impact a patient safety culture and patient safety outcomes in a learning organization. It was hypothesized that nursing staff who report to front-line leadership who demonstrate authentic leadership attributes, work within a department that evidences a heightened patient safety culture. It was also hypothesized that nursing staff who report to front-line leadership who demonstrate authentic leadership attributes, experience less adverse events or ‘near misses’ in relation to patient safety issues and thereby work in an organizational context of improving patient safety outcomes.

The conceptual framework utilized was based on learning organization theory and authentic leadership theory. Measurements used included the Hospital Survey on Patient Safety Culture (HSOPSC) (N=47) for nursing staff and the Authentic Leadership Questionnaire (ALQ) (N=1) for leadership. The HSOPSC was divided into two safety culture measures, four leadership measures, and two patient outcome measures. Inter-correlation matrices were performed for all measure-to-measure and item-to-item correlations to examine the relationship between individual leadership attributes, unit specific patient safety culture, and patient safety outcomes. To obtain a deeper understanding of nurses’ perception of formal leadership and patient safety, an interview process was performed with a select number of nursing staff (N=2). Data from the correlational analysis, constant comparative analysis as well as the ALQ, the hospital’s Adverse Events Management System (AEMS), and organizational documents were used for triangulation purposes.

Findings showed a significant relationship between authentic leadership attributes and a heightened patient safety culture as well as a significant relationship between authentic leadership attributes and adverse events or ‘near misses’ related to patient care. It was further identified that nurses embrace front-line leadership which demonstrate attributes based on authentic leadership practice. As well, interviews and survey data revealed that front-line leadership’s intentions and actions impacted the nurses’ abilities to learn and develop professionally and provide an environment and care needed for patient safety. With ongoing financial constraints, competing organizational priorities, and the quest for quality and safety in patient care, this study helped identify leadership attributes that not only promote but have a favourable impact on patient safety culture and patient safety outcomes in a hospital-based learning organization.


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