Leadership and Patient Safety


We often hear about the need for leadership in health care practice.  Yet for many, the word leader is just another buzzword.  We often think leaders are born not made, and leadership is for others with important titles, nice offices and assistants at the door.

Our experiences with the Dorothy Wylie Nursing and Health Leaders Institute, now in its 10th year with over 2300 alumni, provide us with a different mental model.  We believe that building leadership skills and developing leadership competence and confidence is important for every health professional.  We believe leadership makes a profound difference in the quality of care patients receive. We believe that health professionals who see themselves as leaders will make a difference in every patient and family interaction.

The Leadership Institute uses Kouzes and Posner’s 5 Practices as the basis of its development programs, the keys to leadership that health professionals need to understand, value and acquire.  The 5 Practices are: Model the Way; Inspire Shared Vision; Challenge the Process; Enable Others to Act and Encourage the Heart.

Good leadership is an essential ingredient in creating high quality workplaces for health professionals and safe care places for patients.  Strong leadership benefits patients in a number of ways.  Leaders who model the way by focusing their attention on high quality care and patient safety will create a workplace where safety consciousness is the norm.  It takes leaders promoting it, and encouraging and rewarding health professionals who improve it, to make awareness of patient safety part of the fabric of patient care units.

The key to understanding the role of leadership – despite the models of generals, presidents prime ministers, and sports heroes ingrained in our consciousness – is that leaders are not just the people at the top.  Leadership in the workplace needs to be much more broadly defined.  It’s not an instinct some of us have and others don’t.   It should be an expected part of every professional role.  We have to find the level at which every health professional is comfortable leading, and then we need to grow and stretch that mark.

Professionals who feel like leaders are more likely to have the courage to stand up in an unsafe situation or take a risk and challenge the status quo when they think there is a safety risk to patients.  Leadership is too important to be left to develop by chance as professionals gain experience.  Instead, leadership must be an integral part of education and training and an expectation in the jobs professionals do from the beginning of their careers.

Here are some important steps for developing leaders:

  • Begin leadership development at the undergraduate level.  Start from the notion that every student is a potential leader by virtue of being in a program that leads to being a health professional.
  • Introduce leadership concepts in lectures across the curriculum, and encourage students to use them in group projects, then emphasize them during fieldwork with mentoring and coaching to expand development.
  • Explore leadership expectations during the job interview process.  Employers can pose a scenario requiring leadership and ask what the candidate would do.  Candidates should ask what the employer will do to support them in developing leadership skills.
  • The message that leadership comes from everywhere should be part of new employee orientation.  Leadership can be encouraged throughout course work and experiences can be tailored to enable professionals to take the lead, with mentoring and coaching from managers and clinical specialists.
  • In practice opportunities can be provided for direct care professionals to strengthen their leadership skills (e.g., coaching them on participating effectively in multidisciplinary rounds).
  • Formal and informal opportunities can be created for every professional to lead a care team, a research project and other professional activities.
  • Managers, advanced practice specialists and clinical educators can support leadership development as part of daily interactions and through the performance management process.
  • Experimentation and risk-taking should be recognized and rewarded (e.g., staff members who take calculated risks and make difficult decisions when help is unavailable).
  • Managers can identify and appreciate the things people are doing to promote patient safety and provide meaningful recognition and rewards.
  • Leaders can remember that an important part of leadership is modeling behaviour to encourage leadership in others.
  • Organizations can develop a formal mentorship program that engages senior staff and proven leadership skills to set the bar and coach newer staff.

Beverley Simpson, Julia Scott, Judith Skelton Green

**The paper was adapted from an interview with us that appeared in the Canadian Health Services Research Foundation’s Stories for Safety.