Underlying influence of perception of management leadership on patient safety climate in healthcare organizations - A mediation analysis approach

Int J Qual Health Care. 2017 Feb 1;29(1):111-116. doi: 10.1093/intqhc/mzw145.


Objective: We aim to draw insights on how medical staff's perception of management leadership affects safety climate with key safety related dimensions-teamwork climate, job satisfaction and working conditions.

Design/setting: A cross-sectional survey using Safety Attitude Questionnaire (SAQ) was performed in a medical center in Taichung City, Taiwan. The relationships among the dimensions in SAQ were then analyzed by structural equation modeling with a mediation analysis.

Participants: 2205 physicians and nurses of the medical center participated in the survey. Because not all questions in the survey are suitable for entire hospital staff, only the valid responses (n = 1596, response rate of 72%) were extracted for analysis.

Main outcome measure(s): Key measures are the direct and indirect effects of teamwork climate, job satisfaction, perception of management leadership, and working conditions on safety climate.

Results: Outcomes show that effect of perception of management leadership on safety climate is significant (standardized indirect effect of 0.892 with P-value 0.002) and fully mediated by other dimensions, where 66.9% is mediated through teamwork climate, 24.1% through working conditions and 9.0% through job satisfaction.

Conclusions: Our findings point to the importance of management leadership and the mechanism of its influence on safety climate. To improve safety climate, the implication is that commitment by management on leading safety improvement needs to be demonstrated when it implements daily supportive actions for other safety dimensions. For future improvement, development of a management system that can facilitate two-way trust between management and staff over the long term is recommended.

Keywords: management leadership; mediation effect; patient safety; quality improvement.

MeSH terms

  • Attitude of Health Personnel
  • Cross-Sectional Studies
  • Hospitals, Teaching
  • Job Satisfaction
  • Leadership*
  • Medical Staff, Hospital / psychology
  • Nursing Staff, Hospital / psychology
  • Patient Safety*
  • Safety Management / organization & administration*
  • Surveys and Questionnaires
  • Taiwan