Transformational Leadership & Social Capital as Determinants of Patient Safety: a Parsonian Approach

BACKGROUND: Health and safety, especially quality of care and patient safety, are central concerns in healthcare. In the past, researchers concentrated on special measures to promote safety. Fewer studies focused on general prerequisites of safety management. Drawing on Parson's adaptation (A), goal attainment (G), integration (I), and latent pattern maintenance (L) (AGIL)-scheme, we argue that safety management needs two components to succeed: an integrated group (I-factor) and leaders with goals and the ability to align the group to these goals (G-factor). Both factors together form the GI-factor. METHODS: Based on a 2008 survey of medical directors of German hospitals (N = 551) we administered a social capital scale (proxy for integration) and a transformational leadership scale (proxy for goal attainment). Both concepts - social capital and transformational leadership - are widely deployed in health care settings and acknowledged to impact patient safety. Via median-splits, we created three groups with low (G&I low), medium (G low/I high and vice versa) and high (G&I high) GI-factor. Survey data were aligned with 2012-2019 quality reports in a longitudinal study to test if hospitals with a low GI-factor had more quality deficiencies. RESULTS: There were continuous differences between the share of quality deficiencies and the GI level. A high GI-factor was associated with significantly lower share of quality deficiencies. A significant correlation with reported quality deficiencies in inpatient German health care was evident for multiple aspects of quality deficiencies. The results persisted when controlled for other organizational characteristics. CONCLUSIONS: It seems evident that healthcare organizations have to meet two conditions to build up long-term patient safety: (1) goal setting and attaining, and (2) social integration. It is important for hospital managers to sustainably ensure better health care by building up the social infrastructure for health and safety. KEY MESSAGES: • Hospitals with a high GI-factor (i.e., exhibiting both strong goal attainment and social integration) were associated with significantly lower quality defects in inpatient care. • To sustain patient safety, healthcare organizations need to keep a focus on organizational influencing factors in hospital management.