טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentLivne Yael
SubjectLeadership and Safety Climate in Healthcare
Organizations: A Conceptual Framework for
Predicting and Measuring Patient Safety
Climate among Hospital Nurses
DepartmentDepartment of Industrial Engineering and Management
Supervisor Professor Emeritus Dov Zohar
Full Thesis text - in Hebrew Full thesis text - Hebrew Version


Abstract

Disappointing results of current patient safety efforts indicate that technical and administrative change must be augmented by more global organizational change. One of the best researched organizational attributes is the climate, which emerges from convergent assessments of employees regarding management priorities and commitments to various organizational goals. The present study outlines a conceptual framework that considers healthcare climate as a compounded construct. Then it tests one of its elements, the nursing sub-climate, in terms of relationships between the hospital and individual units’ nursing climates, interactions of climate metrics (level and strength), and climate as a leading indicator of patient safety. In addition, the study examines group-level antecedents for climate, i.e. supervisor's leadership style as well as commitment to the hospital and to the nursing profession. A total of 955 nurses in 69 inpatient units in three tertiary care hospitals completed the Nursing Climate Scale, constituting a 72% response rate. Six months later, patient safety data were collected for each unit, using check-list items identifying medication- and emergency-safety practices, averaged across five random sampling rounds in each unit. Head nurses' leadership style was assessed by their subordinates, using the Multi-factor Leadership Questionnaire. Organizational and professional commitments were measured by self-reports. Results indicate that both unit-level and hospital-level climates predict patient-safety outcomes. A significant interaction shows that best safety conditions are obtained when unit-level and hospital-level climates are high, and that high unit-level climate compensates for the detrimental effect of poor hospital-level climate. Furthermore, climate strength moderates the effect of climate level on outcomes; i.e. climate level better predicts patient safety outcomes with increasing consensus among unit nurses. The results also demonstrate the advantage of proactive over passive leadership and of leader's high work commitment in enhancing patient safety climate level and strength. These data support the diagnostic value of multi-level, profession-based climate surveys in identifying units where the likelihood of adverse events is greater or lower than the overall average. They encourage continued development of climate sub-scales according to the framework of the healthcare climate model (e.g. Physicians sub-climate). Moreover, they emphasize the important leadership role of unit head nurses and call for the adoption of leadership development programs as a means for improving patient safety outcomes.