RESUMO
OBJECTIVE: This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. BACKGROUND: Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. METHODS: Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. RESULTS: Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. CONCLUSION: The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors.
Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Liderança , Recursos Humanos de Enfermagem Hospitalar/psicologia , Gestão da Segurança/organização & administração , Centros Médicos Acadêmicos , Adulto , Estudos Transversais , Unidades Hospitalares , Humanos , Pessoa de Meia-Idade , Pesquisa em Administração de Enfermagem , Cultura OrganizacionalAssuntos
Competência Clínica , Enfermagem em Emergência/educação , Medicina Baseada em Evidências/métodos , Relações Enfermeiro-Paciente , Processo de Enfermagem/normas , Serviço Hospitalar de Emergência , Humanos , Processo de Enfermagem/tendências , Aprendizagem Baseada em Problemas/métodos , Qualidade da Assistência à Saúde , Sensibilidade e EspecificidadeAssuntos
Comunicação , Papel do Profissional de Enfermagem , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Gestão da Segurança/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Relações Interprofissionais , Liderança , Erros Médicos/métodos , Erros Médicos/enfermagem , Erros Médicos/prevenção & controle , Estados UnidosRESUMO
Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.
