Aim  The overall aim of this study was to examine nurses’ and patients’ perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals. Background  This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals. Methods  Web‐based surveys and mailed questionnaires were used in 2008–2009 to collect data from patients (n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership (n = 1151), job satisfaction (n = 2707) and patient safety culture (n = 925) in the selected hospitals. Results  Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care. Conclusions  Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards. Implications for nursing management  Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular.

Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.

Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.

The complexities of healthcare demand new leadership approaches to achieve organizational goals while developing and sustaining healthy work environments. The nurse manager is the defining role, crucial to achievement of workplace outcomes. Preparing nurses for this dynamic, complex role is often dependent on didactic education or on-the-job training that falls short of true leadership development. The authors describe an innovative approach to the development of successful nursing leaders across an integrated healthcare system.