title: Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study.
abstract: Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention.
  
  
  
  A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders.
  
  
  
  In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05).
  
  
  
  The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes.
authors.affiliation: The Danish Clinical Registries, Aarhus, Denmark Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Aalborg University Hospital-Psychiatric Hospital, Aalborg, Denmark.
authors.forename: Solvejg
authors.initials: S
authors.lastname: Kristensen
authors.affiliation: Department of Biostatics, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Karl Bang
authors.initials: KB
authors.lastname: Christensen
authors.affiliation: Aalborg University Hospital-Psychiatric Hospital, Aalborg, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Jaquet
authors.affiliation: Aalborg University Hospital-Psychiatric Hospital, Aalborg, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Møller Beck
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Svend
authors.initials: S
authors.lastname: Sabroe
authors.affiliation: The Danish Clinical Registries, Aarhus, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Paul
authors.initials: P
authors.lastname: Bartels
authors.affiliation: Aalborg University Hospital-Psychiatric Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Mainz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007857:Leadership; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety; D017751:Safety Management / Q000458:organization & administration*
keywords: PSYCHIATRY; intervention; leadership; patient safety culture