Leadership for Quality & Safety in Health Care


Clinical workers, physicians, and health practitioners are now being held responsible for improving the quality and safety of patients. There are different ways that can be used in measuring the quality of health care. Workers in Health Care agree with the necessity to improve the quality of health care in order to prevent the risk of harm that can be prevented. While this is becoming a major issue around the world, the aim is to make reforms in the health care sector by designing a system that will enable physicians to monitor, measure and also act on data. However, the reforms are anticipated to be slow in implementation. The issue of quality is becoming a major concern to the National Health Service and that led to a study that identified measurement and the role of information towards supporting quality improvement. Consequently, those concerned with the information should be informed about the opportunities and challenges associated with the information. Those concerned include stakeholders such as clinicians, practitioners, board members and the policy makers. Being aware of the opportunities and challenges will help define the right meaning of quality in terms of how information can be used appropriately or misused. It also helps when making decisions regarding the quality measures to be used. In classwork, topics on quality, patient safety, governance frameworks and other strategies that can be employed in Health Care were taught. Therefore, several main approaches commonly used in addressing quality of care and patient safety were examined and analyzed. Thus the paper will discuss various approaches studied and their applications in respective areas of practice.

Establishment of culture of safety as an approach to improve quality and patient safety

Quality and safety in health care can also be enhanced by establishing a culture of safety among the management team and clinicians. It was noted that patients continue to die as a result of medical errors despite the efforts and many strategies being put up in order to prevent them. Though many safety measures taken lead to some improvement, the measure was only short lived, but the objective was to establish a culture that will continue engaging in quality and safety of patients. This measure believed in teamwork and a structure that will lead to a reduction in medical errors in future to impact on the effectiveness of clinicians, good outcomes and patient safety (Halligan & Zecevic, 2011).

Teams Strategies and Tools to Enhance Performance and Patient Safety was then established and implemented in order to train teams to bring about changes in organizational culture while at times solving specific problems. According to Lily & Catherine, the framework has been put into effect in 14 hospitals, 2 long term health facilities, out patients in North Shore and about 32150 members of the were able to get trained. Successful outcomes were observed in the institutions in which the framework was implemented thus resulted to the quick spread of the strategy (Honoré et al., 2011).

A study was conducted among registered nurses in China hospitals through the use of self-designed questionnaires. About 217 nurses supported the culture of safety regarding various areas including process of changing shifts, cooperation of staffs and hospital leadership’s attention to the patients. When a new culture of incorporating punishment was established, the study found out that nurses developed fear to report some error when made, most cases of errors by nurses were never identified and also found that the hospitals did not have committees to handle safety issues (Jeong, Yeon & Ock, 2012).

Leadership for quality and safety in Health Care

Leadership can be used for improving quality and safety in health care. Statistics show that around 44000 to 98000 Americans die each day due to medical errors. Innovative developments have thus been made in order to reduce the levels of harm caused due to human error. (Baker & Denis, 2011).  

According to Botwinick, Bisognano and Haraden (2012), the following steps can be used by leaders towards improving quality and safety in health care. Step one involved addressing strategic options, culture and infrastructure. As a senior leader, various options can usually be developed when making decisions so that in case one system fails then another way can be used for backup. The leaders as the team managers are usually of great influence to the staff, therefore they may be able to establish a patient safety culture in the institution (Botwinick, Bisognano & Haraden, 2012).

Step two involves engaging key stakeholders. Health care institutions are made up of stakeholders such as policy makers, clinicians, and the board of managers which equally have the right to know whatever happens in the institution. They should be involved in coming up with quality and safety measures of patients. Each stakeholder should be aware of the areas that concern them in order to gauge the opportunities and challenges to be faced (Botwinick, Bisognano & Haraden, 2012).

Step three involves communicating and building awareness. On this part, the senior leaders require to use faster and efficient means of communication in order to keep the staffs up-to-date. In cases where urgent meetings and discussions will be required to come up with solutions to quality and safety of patients, the senior leaders require a faster means of communication to workers in all departments (Botwinick, Bisognano & Haraden, 2012).

Step four involves the leader’s responsibility in overseeing and communicating system-level aims. As leaders of the team, the senior leaders should lead the rest of the members in coming up with a system that will help reduce the medical errors. They are also in charge of supervising and communicating the next steps of the system performance (Botwinick, Bisognano & Haraden, 2012).

Step five involves keeping track and measuring performance with time and strengthening analysis. Being the overseers of the system’s performance, senior leaders should always keep a record of performance for purposes of checking system’s efficiency in health care, aside from supporting the examination towards reducing harm to patients (Botwinick, Bisognano & Haraden, 2012).

The sixth step involves supporting the patients, staffs and the families that are victims of medical errors. In order to achieve the expected results of the system, leaders should give their support towards the staff and patients while those families affected by cases of medical errors done to one of their patients could be given some financial help to make them feel supported (Botwinick, Bisognano & Haraden, 2012).

Step seven involves the alignment of system wide activities with incentives. This can be an appropriate way of encouraging the staff to get involved in activities to improve quality and safe health care. It can also be another way of ensuring that the system’s goals are reached by promoting attention of clinicians to care of patients as they desire to get the incentives (Botwinick, Bisognano & Haraden, 2012).

The final step involves redesigning the systems and improving reliability. As the senior leaders keep track of the system’s performance, they will be able to determine when efficiency starts declining thus detecting the need for a system design. This also helps improve the reliability of the institution by patients with regards to the improved quality and safety of patients (Botwinick, Bisognano & Haraden, 2012).

Assessment of competencies among healthcare professionals

Health care professional competencies should be checked across the institution. To begin with, the senior leaders require training in quality and safety in health care. The medical staff and clinician should also be assessed to check for competencies in patient safety. For example, a systematic review can be conducted from time to time to check the staff levels of competencies. Questionnaires can be used to check for skills and knowledge while other options of tests can be used to check for clinicians’ attitude towards the safety of patients.  At times, a new tool installed in the institution may be used to study the non-technical skills of nurses (Okuyama, Martowirono & Bijnen, 2011).

“New” and distributed leadership or “old” and hierarchical leadership

There are either “new” and distributed ways of leadership or “old” and hierarchical ways of leadership used in quality and safety in health care. A study was conducted among the United Kingdom’s National Health Services. The method used involved interviewing the stakeholders involved in quality and safety as either policy makers, managers or the clinical staff. The interview covered around 107 stakeholders and the goal was to assess the strategic level of stakeholders; whether they supported implementation of “new” and distributed leadership or “old” and hierarchical leadership in health care. (McKee et al., 2013).

According to academic literature, the participants were able to differentiate the two ways of leadership distinctively. The “old” and hierarchical leadership ways, also identified as the concentrated leadership, were associated with specific positions of leadership, whereas the “new” and distributed ways were associated with the skills across several levels of institution. This clearly showed the role of the new leadership which emphasized that staffs in all departments were equally important and responsible in quality and safety of patients. Distributed leadership would end up bringing conflicts at the national level and mixtures of messages and consequently resulting to demands and expectations that are conflicting (McKee et al., 2013).

            There was an argument that the hierarchical leadership should also be inflicted in the health care in order to avoid the confusion in undertaking responsibility. Hierarchical leadership is associated with a given rank of positions therefore creating focus and expertise in the management team. Academic descriptions and policies will help know how the workers perform their duties thus assist in determining the powers to be handed to each worker (McKee et al., 2013).

Governing patient safety

In governing safety of patients, there were lessons learnt from an evaluation done using mixed methods in implementation of medication safety scorecards at the ward level in two English NHS. The study involved using mixed methods that were controlled before and after the design. The wards were officially investigated on the indicators of safety of medications. In the phase of obtaining feedback, the scorecard used was taken forward to the intervention wards at a 7- week sequence. Alongside that, 49 members of staff, including clinicians, were also interviewed regarding the implementation of score cards (Ramsay et al., 2013).

Results showed that about 18.7 % of patients’ documentations on allergy were not completed, 53.4 % had experienced omission of drugs in 24 hours before, 22.5% of skipped doses were categorized as critical, 22.1% either had an un functioning ID wristband or no ID wristband whereas 45.3% patients had unlabeled drugs stored in their lockers. The results also revealed that the implemented scorecards did not achieve any kind of improvement in safety of patients in the wards. (Ramsay et al., 2013).

Quality improvement learning collaboratives in public health

A multisite case study was used to determine the learning collaborative for improvement of quality in public health. The method used involved evaluation of a subset of collaborative and the local health departments that participated in various targeted areas. Data was collected when semistructured-interviews were conducted and from observations made in meetings of mini collaborative. By use of data techniques, the data were coded according to themes and the other connections between the themes apart from the final reviews of documentations (Aarons, Hurlburt, & Horwitz, 2011).

The results were in support of the theory used in the case study; the factors leading to successful improvement of quality in health care. They include, early planning, the role played by senior leaders, choice of departments, technical help, implementing practices that are based on evidence, use of improved models and methods of evaluation, availability of resources, the target selected and experience in the application of quality improvement. Though there is no sufficient evidence proving successful use of minicollaboratives to improve quality where minicollaboratives had been put to practice, it still appears that they will have an impact by catalyzing the improvements of quality in health care (Aarons, Hurlburt, & Horwitz, 2011).

Clinical Governance policies

In line with ensuring improvements in quality and safety of patients, clinical governance is a system that ensures that the National Health Services continuously improve the quality of service in clinical care. A review of the past published clinical governance was analyzed while websites and journals were also searched systematically. This was done in order to study the emerging issues of clinical governance, to identify the current best practices used and evaluate their implications to the boards that wish to promote an approach of clinical governance in health services (Greenfield et al., 2011).

The issues identified to be key in effective clinical governance include; creation of links between clinical governance of health services and the overall corporate governance, use of clinical governance as a focus of promoting quality and patient safety to ensure continued improvements in services, creating structures of clinical governance to improve safety and quality and management of risks, developing strategies to ensure effectiveness in exchanging data, use of knowledge and expertise by clinicians and lastly establishing an approach (patient-centered) to delivery of services (Greenfield et al., 2011).

Tools used for assessing organizational culture for quality and safety improvement

A national survey of tools and tool use should also be conducted in order to assess for organizational culture for improvement of quality and patient safety. A research conducted by Mannion, Konteh and Davies was based on the internationally grown interest on organizational culture as a primary issue in improvement of health care. It not only drew the need to study how National Health Service manage organizational culture but also the need to know what tools can be used to assess organizational culture in use (Groene et al., 2013).

The method used in the research involved posting questionnaires to 275 different English National Health Services to get feedback on clinical governance. The institutions responded positively with about 77 percent rate of response. About a third of the institutions were using assessment instruments as tools of assessing clinical governance which is a more advantaged way due to ease of use. (Groene et al., 2013).


In conclusion to the discussions, it is evident that leadership can be steered into different ways of promoting quality and safety of patients to reduce medical errors and to prevent preventable harm. Regarding leadership, senior leaders can take the issue of quality and safety of patients as a strategic issue. This reveals that through the aid of leaders in supervision and putting up of other safety measures the levels of harm can be able to be reduced. In the study about old and new leadership methods, the participants of the interview agreed that the most effective type of leadership to improve quality and patient safety would be the one that combines both concentrated and distributed leadership. Governing patient safety revealed how clinicians only got interested in implementing the scorecard of feedback due to the longer durations of study, errors, lack of capacity to be engaged in learning preferences and the leadership in the wards. It was noted that scorecards demanding evidence of feedback would be the best to implement inwards to enable engagement of clinicians in practices of safety of patients. The development of quality scorecards should therefore accommodate the evidence showing the efficiency of the scorecard and how the overall implementation will suit the patients for quality and safety. On the other hand, effective clinical governance should involve support and active participation of executes and board members in promoting clinical governance as a way of ensuring improvement in quality of services in health care. Finally, installation of new tools in the hospitals can also be used to measure professional incompetency through checking lack of technical skills.



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