A Parsonian Approach to Patient Safety: Transformational Leadership and Social Capital as Preconditions for Clinical Risk Management—the GI Factor

Abstract

The purpose of this study is to investigate the role of the combination of transformational leadership and social capital in safety capacity building. Drawing on the A-G-I-L concept of Talcott Parsons, we test a model for patient safety. The hypothesis is, that good safety management needs a combination of goal attainment (G) and integration (I), here called the GI factor. We tested this hypothesis by using transformational leadership as a surrogate for goal attainment and social capital as a surrogate for integration in a study of the perceptions of chief medical officers in 551 German hospitals. We conducted a cross-sectional hospital survey combined with secondary data analysis in all German hospitals with at least one internal medicine unit and one surgery unit (N = 1224 hospitals) in the year 2008 with a response rate of 45% (N = 551). The regression model explained 17.9% of the variance in perceived clinical risk management. We found that if both requirements for goal-oriented collective action—transformational leadership and social capital—are met, good safety management is more likely. The tentative conclusion is that it takes transformative leaders and cohesive followers together as a social basis to improve safety in hospitals.

Patient safety and leadership style in the government general hospitals in Kuwait: a multi-method study

“…This is because transformational leaders strengthen the commitment of followers towards the organisation’s goals in preference to immediate personal gain. Maintenance of high safety performance is commonly attributed to teamwork and shared goals that emphasise the safety climate and effective transformational leadership can elicit safety performance beyond expectation by exceeding the rise in individual safety performance and by reinforcing the followers’ obligation to the department's and organisation’s goals (Pfaff and Braithwaite, 2020).…”

“…This was clearly exemplified in our study; the hospital rated good in reporting practices (hospital A ; Table 3) had the highest number of reported incidents (Table 2), whereas the hospital having the lowest mean scores for poor reporting practices (hospital C ) also had the lowest number of reported incidents. Secondly, the literature discusses the negative relationship between patient safety and hospital size (number of beds) (Pfaff and Braithwaite, 2020). Given the relatively large size of the hospitals in this study, some of the findings could be explained within this context.…”

Is Organizational Communication Climate a Precondition for Patient-Centered Care? Insights from a Key Informant Survey of Various Health and Social Care Organizations

“…In hospitals, communication takes place between various professional groups and between several and alternating individuals. This might be a disadvantage to build a positive, open communication climate based on social capital, that enables social cooperation, psychological safety, and trustful debates over problems at work [12,13], characterized by an understanding of roles and responsibilities, agreement on the approach to care, absence of power dynamics, proper communication patterns, and constant exchange of information [14]. Similarly, hospitals have more pronounced hierarchies due to the diversity of professional groups and areas of responsibility.…”

“…Organizational communication climate is an atmosphere and an expression of social interaction, harmony, and inclusion, and not only cooperation or an exchange of information between organizational members [11]. It is based on high social capital and enables social cooperation, psychological safety, and trustful debates over problems at work [12,13]. A positive organizational communication climate is, for example, characterized by an understanding of roles and responsibilities, agreement on the approach to care, absence of power dynamics, proper communication patterns, and constant exchange of information [14].…”

Social determinants of the impact of hospital management boards on quality management: a study of 109 European hospitals using a parsonian approach

“…Based on the GI model of system performance [ 9 , 10 ], we define the GI factor as follows: The GI factor is given in a group if two conditions are met: (1) strong actions of the group to attain specific goals (G factor) and (2) a high degree of social integration within the group (I factor). Top management teams with the GI factor have a sense of unity and purpose, which makes them impactful.…”