Synergies for Safety : A theoretical-empirical study into different safety management approaches for hospital care

Several studies have shown that it is not self-evident that hospitalised patients are safeguarded from (preventable) adverse events that cause temporary or permanent harm to them. As a result, growing attention has been devoted to patient safety. Notwithstanding the widely agreed necessity to improve the safety in care delivery, no clear consensus exists on how to effectively manage patient safety. Therefore, this dissertation aims to provide insight into how hospital managers manage patient safety, why they choose a specific safety management approach, and how different management approaches affect healthcare professionals’ safety-related attitudes and behaviour as well as patient safety performance.

To answer the research questions, both qualitative and quantitative research methods were used. First, semi-structured interviews were conducted with managers working at different hierarchical levels within the hospitals. The interviews resulted in a conceptualisation of control- and commitment-based safety management approaches. This conceptualisation formed the basis for developing and testing a questionnaire to measure nurses’ perceptions of the management approaches used by their direct supervisor: the ConCom Safety Management Scale. Subsequently, a cross-sectional survey study was conducted among nurses and nurse managers working in the clinical hospital wards of 17 Dutch hospitals to gain insight into the effects of both management approaches on nurses’ safety-related attitudes, behaviours and patient safety performance.

The results show that patient safety management is a multidimensional construct, consisting of two separate but closely related approaches towards workforce management. In a control-based safety management approach, managers stress the importance of following safety rules, monitor compliance and provide employees with feedback. In a commitment-based safety management approach, managers clearly prioritise patient safety by exhibiting role modelling behaviour, they show determination to ensuring safe care delivery, encourage employees to participate in safety improvement initiatives and create awareness on safety issues. How managers combine control- and commitment-based safety management is influenced by specific contextual features, characteristics of the safety issues at hand and personal preferences of the manager. Both management approaches in their own way contribute to nurses’ safety-related attitudes and behavior. Hence, it is important that managers combine control- and commitment-based management practices with regard to patient safety management and that they adjust their safety management approach to the specific situation they are facing.