Leadership for reducing medical errors via organizational culture: a literature review

Abstract

Purpose Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The purpose of this paper is to find themes from the literature relating leadership styles – leadership approaches in practice – with success in reducing medical errors and patient safety. Design/methodology/approach This review analyzed primary and secondary sources based on a search for the terms leadership OR leadership style AND medical errors OR patient safety using five high-quality health-care-specific databases: Healthcare Administration Database from Proquest, LLC, Emerald Insight from Emerald Publishing Limited, ScienceDirect from Elsevier, Ovid from Ovid Technologies and MEDLINE with Full-Text from Elton B. Stevens Company. After narrowing, the review considered 21 sources that met the criteria. Findings The review found three leadership approaches and four leadership actions connected to successfully reducing medical errors and improving patient safety. Transformational, authentic and shared leadership produced successful outcomes. The review also found four leadership actions – regular checks on the front line and promoting teamwork, psychological safety and open communication – associated with successful outcomes. The review concluded that leadership appeared to be the preeminent factor in reducing medical errors and improving patient safety. It also found that positive leadership approaches, regardless of the safety intervention, led to improving results and outcomes. Research limitations/implications This review was limited in three ways. First, the review only included sources from the USA, the UK, Canada and Australia. While those countries have similar public-private health-care systems and similar socioeconomics, the problem of medical errors is global (Rodziewicz and Hipskind, 2019). Other leadership approaches or actions may have correlated to reducing medical errors by broadening the geographic selection parameters. Future research could remove geographic restrictions for selection. Second, the author has a bias toward leadership as distinctive from management. There may be additional insights gleaned from expanding the search terms to include management concepts. Third, the author is a management consultant to organizations seeking to improve health-care safety. The author’s bias against limited action as opposed to strategic leadership interventions is profound and significant. This bias may generalize the problem more than necessary. Practical implications There are three direct practical implications from this review. The limitations of this review bound these implications. First, organizations might assess strategic and operational leaders to determine their competencies for positive leadership. Second, organizations just beginning to frame or reframe a safety strategy can perhaps combine safety and leadership interventions for better outcomes. Third, organizations could screen applicants to assess team membership and team leadership orientation and competencies. Originality/value This review is valuable to practitioners who are interested in conceptual relationships between leadership approaches, safety culture and reducing medical errors. The originality of this research is limited to that of any literature review. It summarizes the main themes in the selected literature. The review provides a basis for future considerations centered on dual organizational interventions for leadership and safety.