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Positive Patient Outcomes

“A successful leader shares his or her personal vision and demonstrates commitment to achieving it” (Mohr, Abelson and Barach, 2002: 70).  Effective leaders integrate vision, values, purpose, systems thinking and mental models throughout the organization.   In recent years, leadership has emerged as a critical theme to enhancing patient safety outcomes in healthcare organizations (Mohr, Abelson and Barach, 2002 ).   

The purpose of this paper is to 1) provide an overview of the theoretical and empirical evidence of the positive relationship between effective leadership and patient safety outcomes; 2) describe and critically analyze a related situation; and, 3) discuss implications for nurse managers.

Theoretical and Empirical Background

Trends affecting nurse staffing: Today's worry with cost shifting and reduction undermines the services the patients receive as well as the work done by the nurses. The health care reforms are trying all their best in improving the services offered to patients.  One of the reforms proposed, is the one on increasing the number of nurses to be more than that of the patients. This is done so as to curb the shortage that has for a long time now affected many hospitals. The best way of improving health care is by having a higher number of physicians to that of the patients. This is one of the best competitions that hospitals can have in order to improve their results in terms of the health care services offered. For this change to take place, the physician team must be highly concerned with the health of their patients as well as saving their lives(Hughes, 2008). The out comes of the changes should also be evaluated so as to rate the services.        

There are many recommended methodologies in literature  which state  out the  actions healthcare leaders can board to improve patient safety  and patients outcomes in their organizations.  Although they vary in techniques, there exist re -occurring themes such as aligning activities with goals, performance measurement and stakeholder engagement.  In reference to this, it is true to say that strong leadership has positively influenced patient safety outcomes.

Patient outcomes

The numbers of nurses determine the number of patients visiting that certain hospital. Every patient  demand having qualified personnel treating them. A reassessment was done and proved that deaths that occur during treatment season in hospital with a strong empowered team are lesser than in hospital with a lesser team. With a higher number of the nursing team, cases of emergency are well taken care of this ensures that lives that are in danger are saved easily and faster .This encourage the patients to visit such hospitals to receive treatment . This is because they are assured that their lives are safe (Morath, 2006). In cases of operations or heart attacks, the hospitals that are well known to be having qualified personnel are given the first priority by many.

Nurse outcomes

People enjoy working in a conducive environment. Conducive environment stands for a place where there is  peace in the  mind.  The services offered by the nurses are highly affected by the type of work they do. If a certain nurse is overworked, she may get neglecting some patients or doing her work in a hurry so as to manage to finish her work by the expected time.  Moral degradation of the nurses from other health officials, may also contribute to them being psyche less. This may affect their productivity rate. They may end up not attending to the patients well. Thus this calls for the medical teams to work as one so as to achieve the aimed goal.

Organizational outcomes

Nurses may gain a reputable name for the hospital or tarnish it before people. Their services matter. If a patient goes to seek  for medical assistance and gets  mishandled; there is a higher possibility of him not coming to the hospital again. Having an overloaded team of nurses, affects the services provided to patients (Wong and Cummings , 2007). Some of the nurses may not enjoy having overtimes due to the stresses they have faced through the day or night.  This may highly affect the patients and mostly the in patients. They may lack people to attend to them. Thus having their life’s at risk.

Staff Mix

According to study that was carried out by the University of Toronto Canada in Ontario, we can say that having a team of physicians, who can mix their skills performance, is more effective. This study shows that organization registering a higher number of nurses with mixed skills, have a positive out come of patient. This practice, has improved services offered to patients  . It has also reduced the costs incurred by the organizations  (Botwinick,2006).  . This practice is believed to be performed by 30%- 70% nurses in the NHS (UK). In a research conducted it has proved that patients are satisfied by the practice as it proved to be friendly on their side by reducing the cost of  medical treatment.

Nurses –patient ratio

California was the first country to implement the policy since 2005. It calls for one nurse two patients. The California nurses association claims that the reform has reduced the rate of overworked nurses and motivated the nurses to deliver quality health care.  Advocates argue out that this exercise has ensured that a nurse has   manageable number of patients. Jan Emerson thought that this reform was tough for hospitals to manage. For this reason she challenged it and preferred the hospitals to retain the old method.  She thought the acquiescence the hospitals were called in to be was more than expensive for them to handle.

In a research carried out in 2008 by the Massachusetts Nurses Association, showed that 305 of the patients acknowledged the new reform. DeAnn McEwen, who is a member of the nurses association in California and a Rn , thinks that the reform has brought a change in number of the nurses who used to resign from their jobs due to un favourable working conditions(RNAO, 2007).. She also says that hospitals have changed from the old mentality of the number of nurses required. This was what caused by  over working the nurses who in-turn delivered poor services

Description and Analysis of a Management / Leadership Situation

At a large urban teaching hospital, a “Good  Catch” program for incident reporting was established based on a recommendation by a nurse manager.   Through her experience, she felt that staff were often fearful for reporting adverse events and as a result don't often report them.   She wanted to create an environment where clinicians and other healthcare professionals felt safe reporting errors in an effort to learn from them and improve patient safety.  After extensive research, and speaking with colleagues from other organizations, she developed a proposal for the “Good Catch” program and presented it to senior management, including the CEO who strongly supported it – CEO support is a critical component to improving patient safety outcomes according to McFadden et al (2009). 

In the development of the program, key stakeholders, including nurses, physicians, allied health professionals and technicians, were engaged by the proponent nurse manager to ensure support for the program.  Stakeholder engagement, according to IHI helps leaders improve patient safety outcomes (Botwinick, Bisognano%uFF0CHaraden, 2006). 

To increase awareness of the program, the nurse management marketed the new program through presentations, posters and in-services.  This communication blitz provided strong, clear and visible attention to safety – actions that IOM and IHI believe will assist in leaders in improving patient safety outcomes (Mohr, Abelson and Barach, 2002; Botwinick, Bisognano%uFF0CHaraden, 2006; Anderson et al, 2003). 

The program itself is an incident reporting recognition program where near misses, errors that were caught before they reached the patient, if reported are rewarded through recognition in the organization newsletter and an opportunity to win a small reward.  The program provided a non-punitive system for reporting, analyzing errors and measuring performance which are essential to improving patient outcomes according to IHI and IOM (Mohr, Abelson and Barach, 2002; Botwinick, Bisognano%uFF0CHaraden, 2006). The success of this program could not have occurred without the senior leadership nor the nurse managers/leaders in the organization who championed this program and promoted it to all staff. 

One nurse manager commented on the importance of this initiative to contributing to a culture of safety by creating a safe environment to report errors.  She believed that the senior management team played an essential role in rolling out this program.  And reported that she and other nurse managers she knows discusses these near misses in their regular meetings and discuss what could have been done differently.  She believes that this program supports a safety culture and ultimately improved patient safety outcomes. 

This program resulted in an increase in reporting by 26% exceeding the corporate goal of 10% within the first year of implementation.  This is a notable accomplishment as reporting of errors contributes to a patient safety culture and allows for system and process improvements resulting from learnings from the reported errors and subsequently positive patient safety outcomes. 

Implications for Nurse Leaders and Managers

“Nurses are critical to the surveillance and coordination that reduce…adverse outcomes” (Hughes, 2008: 4).  Nurse leaders are well positioned to drive and implement patient safety initiatives and positive outcomes because of their central role in the healthcare system (Thompson, Navarra and Antonson 2005) and their proximity to patients (Richardson and Storr, 2010).

Thompson, Navarra and Anton (2005) identified four domains to drive patient safety: leadership competencies (strong leadership skills with a focus on patient safety), culture (a commitment to improve patient safety across all levels of the organization), shared leadership (non-hierarchical structure that creates an environment of interdependence and values and respects all staff) and external partnerships (developing strong partnerships external of the organization to advance the patient safety agenda).  A nurse leader who has competencies in all four domains not only influences patient safety strategy.   A strong nurse manager possesses the competences to coordinate and advance patient safety initiatives, establish a patient safety culture, integrate shared leadership, and develop both internal and external relationships to further the patient safety agenda. 

Chief Nursing Officers (CNO) tend to be more familiar with patient safety and quality improvement reports compared to CEOs and board members who were more familiar with integrating quality planning.  As a result, CNOs are in a unique position to become boardroom champions of patient safety and quality improvement (Mastal, Joshi and Schulke, 2007).   The researchers conducted 73 structured interviews with CNOs, CEOs and board chairs and single face-to-face focus groups with CNOs.

Historically, nursing's patient safety responsibility has often been viewed narrowly i.e. avoiding medication errors and patient fall prevention.  Although these aspects of safety continue to be important within the nursing scope of practice, the breadth and depth of patient safety are much greater.  “The most critical contribution of nursing to patient safety, in any setting, is the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing, and across the care delivered by others in the setting” (Hughes, 2008: 3).  

Nurse leaders and managers must take an active role in promoting patient safety to influence positive patient safety outcomes.  Championing initiatives and mentoring nurses are two examples of how this can be accomplished.  Mastal, Joshi and Schulke (2007) believe that nurse leaders must provide the drive for patient safety because of their clinical and operational expertise.  They further believe that they need to share their vision for optimal patient care with executives and board members who may not have had direct care experience themselves.  CNOs should be designing and supporting quality improvement initiatives that improve patient safety outcomes as they are defining nursing care across the organization.  Unfortunately, they often face barriers as board members may not have an understanding of patient safety and quality of care in general.  While, challenging, it provides CNOs an opportunity to influence board members regarding patient safety measures and outcomes (Mastal, Joshi and Schulke, 2007).

The evidence supporting the influence of nursing leadership on patient safety is limited and quantifying the relationship between the two elements by analyzing the direct impact of nursing leadership on patient safety outcomes is still in the early stages of development.  Further investment and research into this area is highly recommended.  There needs to be an understanding of how nurses develop leadership and authority for them to impact patient safety.  Without this research, there will be limited success in ensuring that nursing leadership is fully integrated within the patient safety realm (Richardson and Storr, 2010; Wong and Cummings, 2007;  Hughes, 2008).


Effective leaders are essential for improving patient safety outcomes.  Leadership practices that facilitated improved patient safety included open communication, formalization, decision making participation, and relationship-oriented leadership.

There is some empirical research that demonstrates the link between leadership and patient safety outcomes.  There are also many recommended approaches for leaders to improve patient safety that exist in literature.  Nurse leaders and managers play a critical role in advancing the patient safety agenda.  They have the clinical and operational experience to inform patient safety culture and initiatives that will contribute to positive patient outcomes.  However, research into how nursing leadership specifically impacts patient safety is warranted is limited and further research should be conducted in this area.  Overall, however, there appears to be a general consensus from literature and from the field that effective leadership does positively influence patient outcomes.

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