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      Linking transformational leadership, patient safety culture and work engagement in home care services

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          To assess the relationship between transformational leadership, job demands, job resources, patient safety culture and work engagement in home care services.


          Cross‐sectional survey.


          Healthcare professionals in Norwegian home care services participated in the study ( N = 139). Multiple regression analyses with patient safety culture and work engagement as outcomes and transformational leadership, job demands, job resources as predictors were conducted.


          The transformational leadership model explained 35.7% of the variance in patient safety culture. Adding job demands and resources and work engagement to the model increased the explained variance to 53.5%. The job resource “skill utilization” was the strongest predictor of work engagement. The full model with all predictor variables explained 28.2% of work engagement.


          Transformational leadership has a significant impact on patient safety culture and work engagement in home care services. Employees' perceptions of job demands, available resources and engagement also affect patient safety culture.

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          Most cited references 20

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          Safety at work: a meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes.

          In this article, we develop and meta-analytically test the relationship between job demands and resources and burnout, engagement, and safety outcomes in the workplace. In a meta-analysis of 203 independent samples (N = 186,440), we found support for a health impairment process and for a motivational process as mechanisms through which job demands and resources relate to safety outcomes. In particular, we found that job demands such as risks and hazards and complexity impair employees' health and positively relate to burnout. Likewise, we found support for job resources such as knowledge, autonomy, and a supportive environment motivating employees and positively relating to engagement. Job demands were found to hinder an employee with a negative relationship to engagement, whereas job resources were found to negatively relate to burnout. Finally, we found that burnout was negatively related to working safely but that engagement motivated employees and was positively related to working safely. Across industries, risks and hazards was the most consistent job demand and a supportive environment was the most consistent job resource in terms of explaining variance in burnout, engagement, and safety outcomes. The type of job demand that explained the most variance differed by industry, whereas a supportive environment remained consistent in explaining the most variance in all industries.
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            What is patient safety culture? A review of the literature.

            To organize the properties of safety culture addressed by many studies and to develop a conceptual culture of safety model.
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              The relationship between nursing leadership and patient outcomes: a systematic review update.

              Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes. © 2013 John Wiley & Sons Ltd.

                Author and article information

                Nurs Open
                Nurs Open
                Nursing Open
                John Wiley and Sons Inc. (Hoboken )
                08 October 2019
                January 2020
                : 7
                : 1 ( doiID: 10.1002/nop2.v7.1 )
                : 256-264
                [ 1 ] SHARE – Centre for Resilience in Healthcare Faculty of Health Sciences University of Stavanger Stavanger Norway
                Author notes
                [* ] Correspondence

                Eline Ree, SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger N‐4036, Norway.

                Email: eline.ree@

                © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 0, Tables: 5, Pages: 9, Words: 6914
                Funded by: Norges Forskningsråd , open-funder-registry 10.13039/501100005416;
                Award ID: 256681/H10
                Funded by: University of Stavanger
                Research Article
                Research Articles
                Custom metadata
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.3 mode:remove_FC converted:18.12.2019


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