The purpose of this study is to investigate the existence of a patient safety chain for hospitals. Drawing on high reliability organization theory, multifactor leadership theory and total quality management literature, we develop and test a model for improving patient safety – a critical issue facing hospitals today. Specifically, we hypothesize that improving patient safety begins at the highest level of the organization with a transformational leadership style. This leads to a sequence of linkages whereby transformational leadership has an important relationship with creating a culture of safety, which in turn is associated with the adoption of patient safety initiatives, and ultimately with positive improvements in patient safety outcomes. Using data from a nationwide survey of over 200 hospitals, we use structural equation modeling to provide empirical support for the effectiveness of this patient safety chain model. The results have major implications for enhancing operations in hospital settings.

Healthcare operates in a complex professional service environment that faces challenges in delivering high quality and affordable care e a set of goals that some healthcare professionals believe are incongruous. To consider opportunities to achieve these important outcomes, this study examines the relationships among comprehensive lean orientation, internal integration, patient safety, and financial performance. This study draws on the professional services operations (PSOs) literature stream to explain and offer a means of addressing the complexity of healthcare delivery. Grounded in dynamic capabilities, this study develops a model for improving financial performance and patient safety in hospitals. Using structural equation modeling, the model is tested with survey data from 211 acute care hospitals in the USA that are matched with data from two other sources e objective patient safety data from the Centers for Medicare and Medicaid Services and objective net income data from the American Hospital Directory. Results indicate that although a comprehensive lean orientation has a direct and positive impact on patient safety, it impacts financial performance indirectly through internal integration. The results have major implications for enhancing patient safety and financial performance in healthcare service organizations, and improving operations in PSOs more broadly.

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The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

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