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The benefits of agreeing on what matters most

Team cooperative norms mediate the effect of co-leaders’ shared goals on safety climate in neonatal intensive care units

Kuntz, Ludwig; Scholten, Nadine; Wilhelm, Hendrik; Wittland, Michael; Hillen, Hendrik Ansgar

doi: 10.1097/HMR.0000000000000220
Features: PDF Only

Background: Safety climate research suggests that a corresponding climate in work units is crucial for patient safety. Intensive care units are usually co-led by a nurse and a physician, who are responsible for aligning an interprofessional workforce and warrant a high level of safety. Yet, little is known about whether and how these interprofessional co-leaders jointly affect their unit’s safety climate.

Purpose: This empirical study aims to explain differences in the units’ safety climate as an outcome of the nurse and physician leaders’ degree of shared goals. Specifically, we examine whether the degree to which co-leaders share goals in general fosters a safety climate by pronouncing norms of interprofessional cooperation as a behavioral standard for the team members’ interactions.

Methodology/Approach: A cross-sectional design was used to gather data from 70 neonatal intensive care units (NICUs) in Germany. Survey data for our variables were collected from the unit’s leading nurse and the leading physician, as well as from the unit’s nursing and physician team members. Hypotheses testing at unit level was conducted using multivariate linear regression.

Results: Our analyses show that the extent to which nurse–physician co-leaders share goals covaries with safety climate in NICUs. This relationship is partially mediated by norms of interprofessional cooperation among NICU team members. Our final model accounts for 54% of the variability in safety climate of NICUs.

Conclusion: Increasing the extent to which co-leaders share goals is an effective lever to strengthen interprofessional cooperation and foster a safety climate among nursing and physician team members of hospital units.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Ludwig Kuntz, Dr, is Professor, Department of Business Administration and Health Care Management, University of Cologne, Germany.

Nadine Scholten, Dr, Postdoctoral Fellow, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Germany.

Hendrik Wilhelm, Dr, is Assistant Professor, Seminar for Business Administration, Corporate Development, and Organization, University of Cologne, Germany.

Michael Wittland, Dr, is Professor, Department for Nursing and Health Care, University of Applied Sciences and Arts, Hannover, Germany.

Hendrik Ansgar Hillen, MSc, is Research Associate, Department of Business Administration and Health Care Management, University of Cologne, Germany. E-mail:

This research project was supported by a grant from the UoC Forum “Managerial Risk Factors in Medicine” (funding period: 2014–2016), which was funded by the Excellence Initiative Program at the University of Cologne, endowed by the German Research Foundation.

Results from this project were previously presented at the German Conference for Health Services Research in Berlin on October 6, 2017, and at the Annual Meeting of the German Society for Neonatology and Pediatric Intensive Care Medicine in Dresden on June 9, 2017.

No conflicts of interest have been declared by any of the authors.

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

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