Contagious charisma: the flow of charisma from leader to followers and the role of followers' self-monitoring.

Charisma, the captivating attribute that endows an individual with the power to inspire and influence others, is frequently associated with possessing an attractive personality, effective communication skills, and the capacity to draw people in and lead them. The concept of the trickle-down effect in leadership theory suggests that the characteristics of a leader's style including perceptions, emotions, attitudes, and behaviors, have the potential to be "contagious" and spread to their followers. Nevertheless, it is unclear whether and when a leader's charisma may be transferred to followers, as charisma is predominantly a trait associated with the leader. Integrating insights from the social learning, emotional contagion, and self-concept theories, we propose that charisma can cascade downward from the leader to followers and that this effect is contingent on the individual follower's level of self-monitoring. Measuring a sample of 127 followers and 15 leaders in a large organization at two time points, we found that throughout time the leader's charisma indeed cascaded down to followers, i.e., followers of a charismatic leader were perceived as more charismatic throughout time. However, this effect was prominent only for low-monitoring followers. Novel insights into the flow-down effect of charisma, avenues for future research, and practical implications are discussed.

Resident physicians' advice seeking and error making: A social networks approach.

BACKGROUND: Resident physicians are especially at risk of being involved in medical errors because they bear tremendous responsibility for patient care yet are still in the process of learning and mastering their profession. To increase knowledge and gain information, they create a professional-instrumental network, that is, the deliberate initiation of advice ties with senior physicians. PURPOSE: We aim to explore whether and how residents' networking with senior physicians is associated with their error rates. Specifically, we aim to identify whether the centralities of residents (advice seekers) and senior physicians (advice givers) in the social network are associated with residents' error rates. METHODOLOGY: We surveyed 142 resident physicians working in 22 wards in two general hospitals about whom and how frequently they consult using a sociometric technique. Information about errors made in a 3-month period was collected independently. RESULTS: Residents made less errors when they sought advice from few senior physicians but consulted more frequently with focal senior physicians (those whom many other advice seekers frequently consult). However, when residents sought advice from many senior physicians, their frequency of consultation with focal senior physicians was not associated with their number of errors. These effects were more pronounced for residents at the beginning of their residency period. CONCLUSIONS: Results of this study provide evidence of a specific association between resident physicians' consultation patterns and their error rates. PRACTICE IMPLICATIONS: Results inform ward managers about ways to leverage opportunities and remove constraints for residents to ask for advice and for focal physicians to provide it.

The dual effects of leading for safety: The mediating role of employee regulatory focus.

This study examined the underlying mechanisms through which transformational and transactional leadership influence employee safety behaviors. Linking leadership theory with self-regulatory focus (SRF) theory, we examined a model of dual effects of leadership on safety initiative and safety compliance behaviors as mediated by promotion and prevention self-regulations. We conducted an experimental study (N = 107), an online study (N = 99) and a field study (N = 798 employees and 49 managers). Results demonstrated that followers' situational promotion focus mediated the positive relationship between transformational leadership and safety initiative behaviors. Through all 3 studies, transactional active leadership was positively associated with followers' situational prevention focus, however, the association between followers' prevention focus and safety compliance behaviors was inconsistent, showing the expected mediation relationships in the experimental setting, but not in the online and field studies. We discuss theoretical and practical implications of the findings.

A longitudinal study of an intervention to improve road safety climate: climate as an organizational boundary spanner.

This study presents and tests an intervention to enhance organizational climate and expands existing conceptualization of organizational climate to include its influence on employee behaviors outside the organization's physical boundaries. In addition, by integrating the literatures of climate and work-family interface, the study explored climate spillover and crossover from work to the home domain. Focusing on an applied practical problem within organizations, we investigated the example of road safety climate and employees' and their families' driving, using a longitudinal study design of road safety intervention versus control groups. Results demonstrated that the intervention increased road safety climate and decreased the number of traffic violation tickets and that road safety climate mediated the relationship between the intervention and the number of traffic violation tickets. Road safety climate spilled over to the family domain but did not cross over to influence family members' driving.

Resident physicians' clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature.

Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores the relationships between residents' error rates and three clinical training methods (1) progressive independence or level of autonomy, (2) consulting the physician on call, and (3) familiarity with up-to-date medical literature, and whether these relationships vary among the specialties of surgery and internal medicine and between novice and experienced residents. 142 Residents in 22 medical departments from two hospitals participated in the study. Results of hierarchical linear model analysis indicated that lower levels of autonomy, higher levels of consultation with the physician on call, and higher levels of familiarity with up-to-date medical literature were associated with lower levels of resident's error rates. The associations varied between internal and surgery specializations and novice and experienced residents. In conclusion, the study results suggested that the implicit curriculum that residents should be afforded autonomy and progressive independence with nominal supervision in accordance with their relevant skills and experience must be applied cautiously depending on specialization and experience. In addition, it is necessary to create a supportive and judgment free climate within the department that may reduce a resident's hesitation to consult the attending physician.

Antecedents of willingness to report medical treatment errors in health care organizations: a multilevel theoretical framework.

BACKGROUND: To avoid errors and improve patient safety and quality of care, health care organizations need to identify the sources of failures and facilitate implementation of corrective actions. Hence, health care organizations try to collect reports and data about errors by investing enormous resources in reporting systems. However, despite health care organizations' declared goal of increasing the voluntary reporting of errors and although the Patient Safety and Quality Improvement Act of 2005 (S.544, Public Law 109-41) legalizes efforts to secure reporters from specific liabilities, the problem of underreporting of adverse events by staff members remains. PURPOSE: The purpose of the paper is to develop a theory-based model and a set of propositions to understand the antecedents of staff members' willingness to report errors based on a literature synthesis. The model aims to explore a complex system of considerations employees use when deciding whether to report their errors or be silent about them. The model integrates the influences of three types of organizational climates (psychological safety, psychological contracts, and safety climate) and individual perceptions of the applicability of the organization's procedures and proposes their mutual influence on willingness to report errors and, as a consequence, patient safety. PRACTICE IMPLICATIONS: The model suggests that managers should try to control and influence both the way employees perceive procedure applicability and organizational context-i.e., psychological safety, no-blame contracts, and safety climate-to increase reporting and improve patient safety.

Active learning: when is more better? The case of resident physicians' medical errors.

An active learning climate facilitates new knowledge acquisition by encouraging employees to ask questions, seek feedback, reflect on potential results, explore, and experiment. These activities, however, also increase a learner's chances of erring. In high-reliability organizations, any error is unacceptable and may well be life threatening. The authors use the example of resident physicians to suggest that by adjusting the conditions of priority of safety and managerial safety practices, organizations can balance these potentially conflicting activities. Participants in the study were 123 residents from 25 medical wards. Results demonstrated that the positive linear relationship between priority of safety and safety performance, demonstrated in earlier studies, existed only when the active learning climate was low. When the active learning climate was high, results demonstrated a U-shaped curvilinear relationship between priority of safety and number of errors. In addition, high managerial safety practices mitigated the number of errors as a result of the active learning climate.

Goal orientations in negotiations: the influence of goal orientations on fixed-pie perceptions and bargaining outcomes.

As is the case for other achievement situations, people may approach negotiations emphasizing outcome and/or process goals. This paper examines the effects of process goal orientation (PGO) and outcome goal orientation (OGO) on individuals' fixed-pie perceptions and the negotiation of joint outcomes. Process and outcome goal orientations are associated with different personal beliefs about the world. We hypothesized that persons who are primarily oriented toward outcome goals, based on their fixed-entity perception of the world, would mainly concentrate on the final results or on the outcomes of the negotiation. They would tend to perceive negotiations as fixed, zero-sum, competitive situations, which have to be "won" by one of the parties at the expense of the other. On the other hand, we predicted that people who are strongly process-oriented, based on their malleable-entity perception of the world, would focus mainly on formulating and mastering the best strategies that lead to successful resolution of the negotiation. They would perceive positions to be "malleable" and, hence, would tend to perceive the negotiation as a non zero-sum situation. Additionally, the interaction between the two types of goal orientations and its effect on the parties' joint negotiation outcomes was examined. Results of two empirical studies indicated that OGO was significantly positively associated with fixed-pie bias (Study 1). The significant interaction between PGO and OGO (Study 2) demonstrated that a strong OGO combined with a strong PGO led to the best joint negotiation outcomes. Implications for goal orientation and negotiation theories are discussed.

Safety self-efficacy and safety performance: potential antecedents and the moderation effect of standardization.

PURPOSE: The purpose of this paper is to suggest a new safety self-efficacy construct and to explore its antecedents and interaction with standardization to influence in-patient safety. DESIGN/METHODOLOGY/APPROACH: The paper used a survey of 161 nurses using a self-administered questionnaire over a 14-day period in two large Israeli general hospitals. Nurses answered questions relating to four safety self-efficacy antecedents: enactive mastery experiences; managers as safety role models; verbal persuasion; and safety priority, that relate to the perceived level of standardization and safety self-efficacy. Confirmatory factor analysis was used to assess the scale's construct validity. Regression models were used to test hypotheses regarding the antecedents and influence of safety self-efficacy. FINDINGS: Results indicate that: managers as safety role models; distributing safety information; and priority given to safety, contributed to safety self-efficacy. Additionally, standardization moderated the effects of safety self-efficacy and patient safety such that safety self-efficacy was positively associated with patient safety when standardization was low rather than high. Hospital managers should be aware of individual motivations as safety self-efficacy when evaluating the potential influence of standardization on patient safety. ORIGINALITY/VALUE: Theoretically, the study introduces a new safety self-efficacy concept, and captures its antecedents and influence on safety performance. Also, the study suggests safety self-efficacy as a boundary condition for the influence of standardization on safety performance. Implementing standardization in healthcare is problematic because not all processes can be standardized. In this case, self-efficacy plays an important role in securing patient safety. Hence, safety self-efficacy may serve as a "substitute-for-standardization," by promoting staff behaviors that affect patient safety.

The moderate success of quality of care improvement efforts: three observations on the situation.

Why is the health care system still unable to achieve a breakthrough in its quality performance? This commentary offers three observations on the problem of the moderate success of quality of care improvement efforts. We based our discussion on theoretical models from management theory and research. We conclude that health care organizations invest efforts in quality improvement initiatives; however, there is a potential in improving the fit between these efforts and the specific problems these organizations face.

Readiness to report medical treatment errors: the effects of safety procedures, safety information, and priority of safety.

BACKGROUND: Medical error reporting is an essential component of patient safety enhancement. However, increasingly, the literature points to a problem of underreporting of treatment errors, mainly as a result of the fear of malpractice lawsuits and limited formal data collection systems. Few studies, if any, have examined the influence of informal aspects of the organization, such as safety climate, on employees' willingness to report errors. OBJECTIVES: This study investigated the relationship between safety climate aspects and personnel readiness to report treatment errors in different hospital departments. METHOD: The model was tested in 3 hospitals (n = 632 in 44 medical departments of 3 types; internal medicine, surgery, and intensive care). Three safety climate aspects were measured using questionnaires: the way employees perceive the safety procedures, the safety information flow within their department, and the relative priorities given to safety in the department. Readiness to report was measured by tallying each department's annual number of treatment errors reported to the hospitals' risk management systems. RESULTS: Negative binomial regression analysis indicated that the more personnel perceive procedures as suitable and safety information as available, the higher was their willingness to report treatment errors. These relationships significantly differed depending on the department type. CONCLUSIONS: Hospitals should take into account the perceptions of personnel regarding safety procedures and information and understand that these perceptions operate differently in different department types in their effect on the staff's willingness to report treatment errors.