A quest for quality care: Exploration of a model of leadership relationships, work engagement, and patient outcomes Translated title: 寻求优质护理:领导关系、工作投入和患者结果的模型探索

Abstract

Aim

To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes.

Design

A cross‐sectional survey design.

Methods

Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM).

Results

The final model was an excellent fit to the data (χ ² (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = −0.14, p < 0.05) and better patient satisfaction (β = −0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader–member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether.

Conclusion

Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes.

Impact

This investigation into a real‐world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.

摘要

目标

探讨共鸣式领导、领导交流关系和组织支持认知对工作投入和患者结果的影响。

设计

横断面调查设计。

方法

在2016年6月至7月从新西兰252名护士和文书人员以及机构患者安全(跌倒率)和患者满意度(亲友测试)中采集数据。使用结构方程建模(SEM)对数据进行分析。

结果

最终模型与数据拟合良好(χ ² (22,  N = 252) = 39.048,  p = 0.014)。共鸣式领导与工作关系、对单位护理质量的认知(β=0.28, p < 0.001)具有显著地积极作用,并降低跌倒率(β=‐0.14, p < 0.05)以及提升患者的满意度(β=‐0.41, p < 0.001)。共鸣式领导对患者满意度具有直接影响作用(β = 0.20,  p < 0.01)。组织支持认知(β = 0.40,  p < 0.001)和领导‐成员之间的交流(β = 0.46,  p < 0.001)是工作投入的前因变量。同时,工作投入是护士对单位护理质量认知的前因变量(β = 0.21,  p < 0.001)。在存在社会交流的场所中,工作参与起到中介作用。另外三个中介因素与工作参与不相关。

结论

现有的文献调查了工作投入的驱动因素和影响,侧重于员工的结果而非患者的结果。研究发现确定了可改善员工体验、提高患者安全性并最终提升患者满意度的可变因素。共鸣式领导是一种关系型领导方式,是优质护理的核心前因变量,对员工体验和患者结果具有积极的影响作用。

影响

这项对于护士领导者实际问题的调查也证实组织对工作投入的关注并非绝对必要。共鸣式领导能改善员工的工作体验、提高患者安全性和提升患者满意度。护士领导者应在实践中衡量、培养和发展他们的共鸣式领导能力。