title: The effects of power, leadership and psychological safety on resident event reporting.
abstract: BACKGROUND
  Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under-reported, especially by frontline providers such as resident physicians.
  
  
  OBJECTIVE
  This study describes and tests relationships between power distance and leader inclusiveness on psychological safety and the willingness of residents to report adverse events.
  
  
  METHODS
  A total of 106 resident physicians from the departments of neurosurgery, orthopaedic surgery, emergency medicine, otolaryngology, neurology, obstetrics and gynaecology, paediatrics and general surgery in a mid-Atlantic teaching hospital were asked to complete a survey on psychological safety, perceived power distance, leader inclusiveness and intention to report adverse events.
  
  
  RESULTS
  Perceived power distance (β = -0.26, standard error [SE] 0.06, 95% confidence interval [CI] -0.37 to 0.15; p < 0.001) and leader inclusiveness (β = 0.51; SE 0.07, 95% CI 0.38-0.65; p < 0.001) both significantly predicted psychological safety, which, in turn, significantly predicted intention to report adverse events (β = 0.34; SE 0.08, 95% CI 0.18-0.49; p < 0.001). Psychological safety significantly mediated the direct relationship between power distance and intention to report adverse events (indirect effect: -0.09; SE 0.02, 95% CI -0.13 to 0.04; p < 0.001). Psychological safety also significantly mediated the direct relationship between leader inclusiveness and intention to report adverse events (indirect effect: 0.17; SE 0.02, 95% CI 0.08-0.27; p = 0.001).
  
  
  CONCLUSIONS
  Psychological safety was found to be a predictor of intention to report adverse events. Perceived power distance and leader inclusiveness both influenced the reporting of adverse events through the concept of psychological safety. Because adverse event reporting is shaped by relationships and culture external to the individual, it should be viewed as an organisational as much as a personal function. Supervisors and other leaders in health care should ensure that policies, procedures and leadership practices build psychological safety and minimise power distance between low- and high-status members in order to support greater reporting of adverse events.
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Nital P
authors.initials: NP
authors.lastname: Appelbaum
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Dow
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Mazmanian
authors.affiliation: Saint Louis University, St Louis, Missouri, USA.
authors.forename: Dustin K
authors.initials: DK
authors.lastname: Jundt
authors.affiliation: Virginia Commonwealth University Health, Richmond, Virginia, USA.
authors.forename: Eric N
authors.initials: EN
authors.lastname: Appelbaum
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007857:Leadership; D008297:Male; D019300:Medical Errors / Q000941:ethics; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D011209:Power, Psychological