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How Hospital Leaders Contribute to Patient Safety Through the Development of Trust

Auer, Corinne MScN, RN; Schwendimann, René PhD, RN; Koch, Roswitha MCommH, RN; De Geest, Sabina PhD, RN, FAAN, FRCN; Ausserhofer, Dietmar PhD, RN

Journal of Nursing Administration: January 2014 - Volume 44 - Issue 1 - p 23–29
doi: 10.1097/NNA.0000000000000017

Objective: The aim of this study was to explore the associations between hospital management support for patient safety, registered nurses’ trust in hospital management, and their overall perception of patient safety, considering aspects of safety communication as possible mediating variables.

Background: Limited research exists regarding how key elements of a patient safety culture, that is, leadership, safety communication, and trust, are interrelated.

Methods: This study used cross-sectional nurse survey data from 1,633 registered nurses working in 35 acute care hospitals participating in the Swiss arm of the RN4CAST (Nurse Forecasting in Europe) study.

Results: A path analysis revealed that the indirect associations between “management support for patient safety” and “overall perception of patient safety” were more prominent than the direct association.

Conclusion: Our findings confirm that safety communication plays a partially mediating role between “management support for patient safety” and nursing professionals’ assessments of patient safety. This suggests that hospital leader-unit exchanges might improve patient safety.

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Author Affiliations: Clinical Nurse Specialist (Ms Auer), Triemli City Hospital, Zurich; Nurse Scientist (Drs Schwendimann and Ausserhofer) and Professor and Chair (Dr De Geest), Institute of Nursing Science, University of Basel, Basel; Chief of Nursing Development (Ms Koch), Swiss Nursing Association/SBK-ASI, Bern, Switzerland.

The authors declare no conflicts of interest.

Correspondence: Dr Schwendimann, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland (

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