When nurses feel safe admitting a mistake regarding patient care to their supervisors, they are more likely to report the error, according to a Belgian study. That sort of work environment ultimately leads to a stronger commitment to safe practices and a reduction in the error rate, reported an international team of researchers.
In addition, when nurse leaders’ safety actions mirror their spoken words, unit nurses do not feel caught between adhering to safety protocols and speaking up about mistakes against protocols.
The researchers examined the notion that care providers may experience a conflict between the strong enforcement of safety procedures and the reporting of safety/patient errors. "Prior research indicates that a climate of safety requires both prioritizing existing safety protocols and constructive responses to errors," Hannes Leroy, PhD, of Katholieke Universiteit Leuven in Belgium and the University of Calgary, and the study’s lead investigator, said in a news release. "Achieving this balance highlights the importance of leadership to foster team priority of safety."
Study methodology
The researchers surveyed 54 nursing teams in four hospitals in Belgium to determine whether the leadership actions of nurse managers were aligned with the verbal expectations they had given to staff nurses and examine the effect of that congruence on nurse/employee commitment to follow safe work protocols and willingness to report a patient treatment error.
Six months later, the team examined the relationship between fostering safety and reporting patient errors to determine whether that association was related to a reduction in errors regarding patients.
In their study, the researchers defined a team as a nurse manager and a minimum of three nurses who reported directly to the nurse manager. They distributed paper surveys to nurses and nurse managers within the different nursing departments, and asked the nurses to deposit the surveys in a sealed box or envelope to assure anonymity.
The surveys examined the behavioral integrity of nurse managers, the psychological safety felt by staff nurses and team priority of safety using a variety of statements that participants ranked on a scale ranging from "completely disagree" to "completely agree."
To examine the behavioral integrity of nurse managers, the surveys included statements such as "My head nurse always practices the safety protocols he/she preaches." To examine the psychological safety felt by staff nurses, the surveys included statements such as "If you make a mistake in this team, it is often held against you." To examine team priority of safety, the surveys included statements such as "In order to get the work done, one must ignore some safety aspects."
The researchers found that when nurse managers’ spoken expectations regarding safety aligned with their apparent commitment to safety, their teams had a stronger commitment to acting safely while carrying out work duties and a greater rate of reporting errors. In addition, this greater emphasis on safety resulted in a reduction in patient treatment errors.
"The study offers support for the efficacy of leaders’ behavioral integrity — walking the talk, if you will — and it demonstrates the importance of leadership in promoting a work environment in which employees feel it is safe to reveal performance errors," said Deirdre McCaughey, PhD, a study investigator and assistant professor of health policy and administration at Penn State University.
"This benefits patients because work environments in which error is identified offer employees the opportunity to learn from those and, ultimately, prevent similar errors from occurring."
According to Leroy, the researchers’ findings suggest that by staying true to the safety values they espouse, leaders can start to solve the managerial dilemma of providing clear safety directives while encouraging employees to report errors.
That conclusion is important, he said, because "the results of our study indicate that combination of both a high priority of safety and a psychologically safe working environment predicts the number of reported patient errors in hospitals," Leroy said.
The study is scheduled for publication in the Journal of Applied Psychology. The study abstract is available at http://psycnet.apa.org/psycinfo/2012-25105-001/.
In addition, when nurse leaders’ safety actions mirror their spoken words, unit nurses do not feel caught between adhering to safety protocols and speaking up about mistakes against protocols.
The researchers examined the notion that care providers may experience a conflict between the strong enforcement of safety procedures and the reporting of safety/patient errors. "Prior research indicates that a climate of safety requires both prioritizing existing safety protocols and constructive responses to errors," Hannes Leroy, PhD, of Katholieke Universiteit Leuven in Belgium and the University of Calgary, and the study’s lead investigator, said in a news release. "Achieving this balance highlights the importance of leadership to foster team priority of safety."
Study methodology
The researchers surveyed 54 nursing teams in four hospitals in Belgium to determine whether the leadership actions of nurse managers were aligned with the verbal expectations they had given to staff nurses and examine the effect of that congruence on nurse/employee commitment to follow safe work protocols and willingness to report a patient treatment error.
Six months later, the team examined the relationship between fostering safety and reporting patient errors to determine whether that association was related to a reduction in errors regarding patients.
In their study, the researchers defined a team as a nurse manager and a minimum of three nurses who reported directly to the nurse manager. They distributed paper surveys to nurses and nurse managers within the different nursing departments, and asked the nurses to deposit the surveys in a sealed box or envelope to assure anonymity.
The surveys examined the behavioral integrity of nurse managers, the psychological safety felt by staff nurses and team priority of safety using a variety of statements that participants ranked on a scale ranging from "completely disagree" to "completely agree."
To examine the behavioral integrity of nurse managers, the surveys included statements such as "My head nurse always practices the safety protocols he/she preaches." To examine the psychological safety felt by staff nurses, the surveys included statements such as "If you make a mistake in this team, it is often held against you." To examine team priority of safety, the surveys included statements such as "In order to get the work done, one must ignore some safety aspects."
The researchers found that when nurse managers’ spoken expectations regarding safety aligned with their apparent commitment to safety, their teams had a stronger commitment to acting safely while carrying out work duties and a greater rate of reporting errors. In addition, this greater emphasis on safety resulted in a reduction in patient treatment errors.
"The study offers support for the efficacy of leaders’ behavioral integrity — walking the talk, if you will — and it demonstrates the importance of leadership in promoting a work environment in which employees feel it is safe to reveal performance errors," said Deirdre McCaughey, PhD, a study investigator and assistant professor of health policy and administration at Penn State University.
"This benefits patients because work environments in which error is identified offer employees the opportunity to learn from those and, ultimately, prevent similar errors from occurring."
According to Leroy, the researchers’ findings suggest that by staying true to the safety values they espouse, leaders can start to solve the managerial dilemma of providing clear safety directives while encouraging employees to report errors.
That conclusion is important, he said, because "the results of our study indicate that combination of both a high priority of safety and a psychologically safe working environment predicts the number of reported patient errors in hospitals," Leroy said.
The study is scheduled for publication in the Journal of Applied Psychology. The study abstract is available at http://psycnet.apa.org/psycinfo/2012-25105-001/.
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