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Leadership, safety climate, and continuous quality improvement: Impact on process quality and patient safety

McFadden, Kathleen L.; Stock, Gregory N.; Gowen, Charles R. III

doi: 10.1097/HMR.0000000000000006

Background: Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals.

Purpose: We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures.

Methodology/Approach: The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services.

Findings: The results provide empirical evidence that a safety climate, which is connected to the chief executive officer’s transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes.

Practical Implications: The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

Kathleen L. McFadden, PhD, is Professor of Operations Management, Department of Operations Management and Information Systems, Northern Illinois University, DeKalb. E-mail:

Gregory N. Stock, PhD, is Professor and Co-Director, Bachelor of Innovation Programs, College of Business, University of Colorado at Colorado Springs.

Charles R. Gowen III, PhD, is Professor of Management, Department of Management, Northern Illinois University, DeKalb.

This research has approval from the institutional review board for human subjects’ research.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins