An educational intervention to enhance nurse leaders' perceptions of patient safety culture

Health Serv Res. 2005 Aug;40(4):997-1020. doi: 10.1111/j.1475-6773.2005.00401.x.


Objective: To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.

Study setting: Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control).

Study design: A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.

Extraction methods: Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.

Principal findings: A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554.

Conclusions: Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Canada
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Inservice Training*
  • Leadership
  • Male
  • Medical Errors / prevention & control
  • Middle Aged
  • Nursing Staff, Hospital / education*
  • Nursing Staff, Hospital / organization & administration
  • Organizational Culture
  • Quality Assurance, Health Care / methods
  • Regression Analysis
  • Safety Management / organization & administration*