تأثیر رهبری تحول گرا بر رضایت شغلی و نتایج ایمنی بیمار Effect of transformational leadership on job satisfaction and patient safety outcomes

Introduction Safety and quality of patient care is recognized as a priority for health care organizations worldwide. However, large studies across North America and Europe have shown that health care systems are prone to error and that the risk of adverse events is significant (de Vries, Ramrattan, Smorenburg, Gouma, & Boermeester, 2008; Kohn, Corrigan, & Donaldson, 1999). Adverse patient outcomes or events are defined as unintended injuries or complications caused by health care management rather than the patient’s underlying disease process, resulting in prolonged hospital stay, disability, or death (Baker et al., 2004). The Institute of Medicine (IOM) landmark report, To Err is Human, estimates that up to 98,000 patients die, and more than 1 million are injured each year in the United States as a result of preventable medical errors (Kohn et al., 1999). Equally alarming, the Canadian Institute for Health Information (CIHI) estimates that in more than 138,000 hospitalizations in Canada in 2014 to 2015, about 30,000—or one in every 18 patients suffered preventable harm that compromised their care (CIHI, 2016). Research has shown that the economic costs of adverse events are also significant, and the burden in developed countries remains high. For instance, the cost of adverse events to the Canadian health care system was estimated at $1.1 billion in 2009 to 2010 (Etchells et al., 2012). Analogous costs have been reported in the United States. Despite progress in the past 15 years after the IOM report, patient safety remains an important public health challenge (Pronovost, Cleeman, Wright, & Srinivasan, 2016). Studies indicate that alarmingly high rates of adverse events in hospitals are a result of preventable incidents, some of which are likely because of nursingrelated factors (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; IOM, 2004). Researchers have linked patient safety outcomes to the quality of nursing work environments and lack of effective leadership (Aiken et al., 2002; IOM, 2004). In the organizational literature, relational leadership styles (i.e., transformational leadership) have been linked to reduced adverse patient outcomes (Cummings et al., 2010). Few studies, however, have investigated the mechanisms through which leadership influences employee behavior and subsequent implications on patient safety outcomes (Wong, Cummings, & Ducharme, 2013). In the context of the foregoing, one of the biggest knowledge gaps is how nursing leadership and workplace factors influence health care quality and safety outcomes. Thus, the purpose of this study was to test a model linking transformational leadership and structural empowerment to nurses’ job satisfaction and prevalence of adverse events in acute care settings. In this study, the researchers examined how transformational leadership influenced patient safety outcomes and job satisfaction through the mediator, structural empowerment. Transformational leadership is a behavior-based approach to obtain performance beyond basic expectations of workers and to strive for excellence (Bass & Avolio, 1994). Studies have shown that transformational leadership is key in creating supportive work environments in which nurses are structurally empowered to provide optimal patient care (Cummings et al., 2010). Several authors (Gabel, 2013; IOM, 2004) have suggested that transformational leadership styles seem particularly relevant in current turbulent and stressful health care work environments. Applying the concept of transformational leadership to this issue may provide insight into the ways in which leadership can influence patient outcomes.