Key Topics Patient safety Industries Healthcare Industry University Hospitals

Managers as role models: Patient safety in hospitals and clinics

Managers in clinics and hospitals play a crucial role in risk management, as they make a significant contribution to creating a culture of safety. Their work and actions not only have a direct impact on employees, but also on the establishment and implementation of specific measures that affect patient safety. Our expert Anja Pope, Senior Consultant at GRB, explains what is important in our safety clip.

A key aspect of their role is to establish a culture of open communication. Errors and near-misses should be reported so that systematic learning is possible. This is the only way to derive targeted measures that minimise the recurrence of errors.

The manager's reaction has a major impact

The influence of leadership is particularly evident in the direct reaction to the employee. Imagine you are an assistant doctor, a nurse or an MTLA in the laboratory and you report a specific risk to your manager. This could be an accidental error (mix-up of medication, documentation in the wrong file), an error that you have noticed (dosage error in the order, mixed-up "stickers" on blood tubes) or an overall unsafe process (inconsistent procedure for team time-out, lack of information in handovers).

You recognise the need for action and report this to your manager in confidence. These are possible reactions by the manager with negative effects on the safety culture:

Assigning blame, possibly even in front of others ("This must not happen to you" or "Who did this?")
Ignoring your safety concerns ("Nothing has ever happened before")
Punishments (social rejection, stigmatisation, negative performance reviews)

These behaviours result in the manager setting a negative example, which has various consequences for employees, the team and ultimately the organisation:

Fear and insecurity in the employee or team
Demotivation, loss of commitment, frustration
Loss of trust in the manager
Decreasing willingness to report mistakes
Learning from mistakes is hardly possible
Risks remain and jeopardise patients

In practice, it has been shown that such negative experiences remain in the collective memory of a team for a very long time and influence employee behaviour even years later. For example, employees report such experiences when asked about the reasons for low CIRS reporting rates. It is not uncommon for them to say that sanctions were imposed following a report or that they were instructed to seek a direct dialogue next time instead of reporting in CIRS. This often influences the reporting behaviour of the department concerned for years to come. This also shows that dealing with such an incident and clarifying communication are important. After all, negative experiences have a long-lasting effect and the consequences do not disappear automatically.

Positive contributions to patient safety

However, managers can make a significant contribution to strengthening patient safety through different, positive behaviour. One part of the safety culture is psychological safety. This describes a group feeling, not an individual opinion. Teams that feel psychologically safe are more innovative, achieve better results and higher quality. The openness to report and analyse mistakes is a matter of course for them, even if it is not always easy.

By having the courage to talk about their own mistakes and being transparent about how they learn from them and show appreciation to all others who behave in the same way, managers can promote psychological safety in their team.

Possible reactions of the manager with positive effects in the above-mentioned case:

Recognition and gratitude ("Thank you for reporting this. That's exactly the attitude we need.")
Taking up the issue ("That's an important tip. I'll look into it ...")
Involving the employee in solving the problem ("Analyse together what happened and find out how we can avoid it in future.")

Another crucial aspect: It is also important that managers sanction clear violations of rules by employees. Deliberately omitting control steps during onboarding "because it's always correct anyway" or ticking off the emergency equipment checklist without checking it first is harmful behaviour that managers should address directly and stop.

Management

Other management tools also support the goal of patient safety. These include, for example:

The influence of the quantity and qualifications of employees
The organisation of processes such as handovers, ward rounds, team time-outs, etc.
The establishment of current, well-founded and practicable standards
The provision of suitable tools and aids

Overall, it is clear that leadership is an elementary component in promoting patient safety. On the one hand via the central contribution to psychological safety in the team, and on the other via the actions of management.

Patient safety as part of leadership skills in hospitals

This requires a great deal of reflection and a clear attitude. This makes it all the more important to empower hospital managers so that they can fulfil this responsible task. The inclusion of patient safety in management development in hospitals is an important and often neglected aspect.

Training courses and seminars should give managers the opportunity to expand their knowledge of patient safety for specific target groups. They can only fulfil their responsible role in risk management effectively if they have fully understood it.

In workshops, managers can solve their problems in analysing risks and selecting and implementing suitable measures under moderated guidance. Ideally, this is done in an interdisciplinary management team.

At the same time, they can be offered professional business coaching in which they can reflect on their behaviour in their role in a protected manner. On the one hand, this serves to ensure the success of the implementation of measures, especially in complex situations, and on the other, it creates the basis for continuously scrutinising one's own impact on the psychological safety of the team. Coaching offers a protected space in which managers can speak freely and constructively about their challenges and thoughts without fear of negative consequences. This promotes an open and trusting atmosphere, which also has a positive effect on the team.

Author: Anja Pope

Literature:

Bresser, J. (2024): "Just Culture in Hospitals: Shaping the Future with New Leadership Approaches in the Medical Sector." Springer
Edmondson, A: (2024). "Valuable Mistakes - Right Kind of Wrong: The Practical Science of Smart Failure (M. Kauschke, transl.)." Vahlen.
Töpfer, R. (2014): "Systemisches Coaching als erfolgreiches Mittel im Risikomanagement für Ärzte und Kliniken" in: Merkle (ed.): "Risikomanagement und Fehlervermeidung im Krankenhaus", Springer