Patient safety in healthcare is of paramount importance in nursing practice in all kinds of healthcare settings. Leadership in nursing is important because the leader sets targets for the nursing staff and guides them on how to take specific steps to achieve the goal of delivering quality care and ensuring best possible outcomes for patients. The nursing leader has to collaborate and effectively communicate to the team the essential necessity to deliver care in a manner that ensures patient safety. The leadership style should motivate the staff to provide safe healthcare in all situations. Patient safety is defined as "the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum". It is also defined as "prevention of any injuries and damages to patients during the care process" (Hemmat, Atashzadeh-Shoorideh, Mehrabi, & Zayeri, 2015). The nurse manager plays an important role in keeping the nursing workforce focussed on improving the quality of patient care. In order to improve performance they may adopt one of the different styles of leadership. Three main styles of leadership have been analysed for their effectiveness in improving patient safety, in this paper, namely, the transformational style, the transactional style and the Laissez faire style of leadership. The impact of implementing each style on the patient safety outcomes has been discussed. Also discussed is the effect of the transformational style of leadership on the prevention of falls among patients.
One of the leadership styles that a nurse leader can adopt to improve patient safety is the transformational style. Different leadership styles differ in their approach in how the leader motivates the nursing staff to provide the best possible care to the patients. Leadership styles vary based on the approach adopted by a nurse manager.
The transformational style of leadership is associated with an increase in staff satisfaction, there is an increased commitment towards the organisation, staff scores better in well-being, there is reduced stress, thereby an increase in productivity and effective working are observed (Cope & Murray, 2017). This kind of leadership fosters an environment where the subordinates become the collaborators and therefore, this style of nursing can be more effective in delivering healthcare where efforts are being made to improve patient safety. In a study at a hospital in Ethiopia, a study was carried out to determine the preferred style of leadership in a questionnaire that asked questions about whether they preferred the transactional style of leadership over the transformational style. The transformational style of leadership helps the subordinates by showing them what can be achieved. The transformational leadership tries to motivate and inspire, The nurses who participated in the study preferred the transformational style of leadership over the transactional style of leadership and derived greater job satisfaction (Negussie & Demissie, 2013). In a similar study carried out at private hospitals at Jordan, the employees preferred the transformational style of leadership and reported better intrinsic job satisfaction (Mohammad, Al-Zeaud, & Batayne, 2011). An improvement in the area of job satisfaction is a good precursor to ensuring patient safety. It has been found that transformational leadership leads to better patient outcomes and there is a reduction in the number of adverse events when this style of leadership is adopted (Wong & Cummings, 2007). A motivated and inspired nursing workforce is more likely to strive for patient safety.
The transactional approach to leadership can work in a structured system. The transactional style of leadership involves rewarding performance in tangible or intangible forms. Examples of reward could vary from financial reward to praise during a group meeting. The style incorporates active management that involves finding fault and pointing out mistakes of the subordinates. Often transactional leadership has a favourable impact on patient safety. The transactional approach is often driven by targets and there is a risk of under reporting of mistakes made during discharge of duties. This can be detrimental to patient safety. When mistakes are perceived as opportunities to learn rather than opportunities to punish there is greater chance that the staff will adhere to ethical practice.
The Laissez faire style of leadership in nursing management the leader remains rather aloof from the group and intervenes only if there is a need. It is a passive style of management and the manager intervenes only if there is a problem. Very less supervision is exercised by the nurse managers who adopt this style. The nursing staff has to perform on their own, without any supervisory inputs. It is a good style if promotion of independent thinking is the goal, but it may lead to unwanted consequences, particularly with regard to important patient outcomes, such as patient safety. Many corrective decisions that may be required at important junctures are left to the staff. Improvement in quality happens only when lapses on the part of staff occur. Nursing managers who are new to their job or those who are awaiting a successor usually adopt this style (Bradley.edu, 2016). This style of leadership is known to promote the culture of blame since no one wants to take responsibility. When this impact is compared with that of the transformational style, the latter is much better when it comes to patient satisfaction, fewer medication errors and lower rate of hospital acquired infections are reported (Bradley.edu, 2016). In a study on the impact of leadership style on patient safety, it was inferred that the transformational style is more preferred than the Laissez faire style of leadership in nursing management (Merrill, 2015). This style of leadership is plagued by deficiencies in taking decisions and interventions are usually reactions to breach in patient safety.
Fall prevention, particularly among the frail and the elderly patients is an important aspect of patient safety. In a study on organisation of workshops to reduce the number of falls among patients in order to improve the overall quality of patient safety and care, it was observed that since the transformational leadership style was adopted, the impact on reduction was positive. As a result of participation in the workshop, the nurses were motivated and inspired to reduce the number of falls and they took all preventive steps required for the prevention of falls and reduced incidence was reported. These workshops were given by the charge nurses using the transformational style of leadership (White, 2016). Since the roles of the subordinate nurses are clearly defined, they were motivated and inspired to improve patient outcomes and reduce adverse events, on measurement of the outcome it was found that fewer falls were reported. The success in reducing falls through the transformational style of leadership occur through the intellectual stimulation, individualised consideration and through inspirational motivation of staff. The transformational style of leadership fosters a work environment that gives nurses sufficient autonomy and accountability, support, resources and opportunities that they can employ to improve upon systems to reduce the incidence of falls among the patients (Bradley.edu, how-nursing-leadership-styles-can-impact-patient-outcomes-and-organizational-performance/). Reducing incidence of falls and improved patient safety can be achieved through adoption of better leadership styles.
Therefore, in conclusion, it is important to understand the impact of leadership style on increasing patient safety in health care facilities. Nursing managers may adopt different styles of leadership. This paper analyses the transformational, transactional and the Laissez faire styles of leadership. While the Laissez faire style of leadership has been found to be less preferred due to a rather adhoc approach at solving problems. There is no element of quality control because solutions are sought only after a problem has occurred. The transactional style of leaderships is based on the reward and punishment of the nurses and the manager keeps an eye on the outcomes of the work performance of all the nurses. The transformational style of leadership is more preferred because the leader motivates and inspires and the nursing staff is keen to improve patient outcomes. In a study a workshop preceded by a program for fall prevention, the nurses were given clear goals and they succeeded in reducing the rate of falls. So, transformational style of leadership has been found to be more effective in improving patient safety.