Journal List > Korean J Adult Nurs > v.25(6) > 1094502

Kim: Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse

Abstract

Purpose

The objective of this study was to identify the moderating and mediating effects of transformational-leadership in the relationship between medication error management climate and error reporting intention.

Methods

Participants in this study were 118 nurses from 11 hospitals in Korea. The scales of medication error management climate, transformational-leadership and error reporting intention of nurses were used in this study. Descriptive statistics, t-test, ANOVA, partial Pearson correlation coefficient, and stepwise multiple regression were used for data analysis.

Results

Higher transformational leadership group members had higher error management climate (t=3.88~4.64, p<.001) and higher intention to error reporting (t=2.49, p=.014). There were significant positive correlations between subcategories of medication error management climate and transformational leadership (r=.37~.51, p<.001). But error reporting intention was related to the transformational leadership (r=.28 p=.002), two subcategories such as 'learn from error' (r=.26, p=.004) and 'medication error competence' (r=.25, p=.008) of medication error management climate. Transformational-leadership was a moderator and a mediator between medication error management climate and error reporting intention.

Conclusion

Based on the results of this study, transformational-leadership promotion training program to construct medication error management climate and to improve error reporting intention should be needed.

REFERENCES

Ajzen I.., Madden T. J.1986. Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology. 22:453–474.
crossref
Avolio B. J.1994. The “natural” leader: Some antecedents to transformational leadership. International Journal of Public Administration. 17:1559–1581.
Barling J.., Loughlin C.., Kelloway E. K.2002. Development and test of a model linking safety-specific transformational leadership and occupational safety. Journal of Applied Psychology. 87:488–496.
crossref
Bass B. M.., Avolio B. J.2000. MLQ Multifactor leadership questionnaire. Redwood City: Mind Garden.
Chiang H. Y.., Lin S. Y.., Hsu S. C.., Ma S. C.2010. Factors determining hospital nurses' failures in reporting medication errors in Taiwan. Nursing Outlook. 58:17–25. http://dx.doi.org/10.1016/j.outlook.2009.06.001.
crossref
Cho J.., Park I.., Michel J. W.2011. How does leadership affect information systems success? The role of transformational leadership. Information & Management. 48:270–277. http://dx.doi.org/10.1016/j.im.2011.07.003.
crossref
Feng J. Y.., Wu Y. W. B.2005. Nurses' intention to report child abuse in Taiwan: A test of the theory of planned behavior. Research in Nursing and Health. 28:337–347.
crossref
Flin R.2007. Measuring safety culture in healthcare: A case for accurate diagnosis. Safety Science. 45:653–667. http://dx.doi.org/10.1016/j.ssci.2007.04.003.
crossref
Ha N. S.., Choi J.., Yoon Y. M.2002. The relationship between transformational leadership of nurse managers and autonomy, empowerment of nurses. Journal of Korean Academy of Nursing Administration. 8:249–259.
Hartnell N.., MacKinnon B. M.., Sketris I.., Fleming M.2012. Identifying, understanding and overcoming barriers to medication error reporting in hospitals: A focus group study. BMJ Quality & Safety. 21:361–368.
crossref
Helmreich R. L.., Davies J. M.1996. Human factors in the operating room: Interpersonal determinants of safety efficiency and morale. Bailliere's Clinical Aneaesthesiology. 10:277–295.
Kagan I.., Barnoy S.2008. Factors associated with reporting of medication errors by Israeli nurse. Journal of Nursing Care Quality. 23:353–361. http://dx.doi.org/10.1097/01.NCQ.0000336674.10348.09.
Kim C. H.., Kim M.2009. Defining reported errors on web-based reporting system using ICPS from nine units in a Korean university hospital. Asian Nursing Research. 3:167–176.
crossref
Kim M. S.2010. The effectiveness of error reporting promoting strategy on nurse's attitude, patient safety culture, intention to report and reporting rate. Journal of Korean Academy of Nursing. 40:172–181. http://dx.doi.org/10.4040/jkan.2010.40.2.172.
crossref
Kim M. S.2012. Medication error management climate and perception for system use according to construction of medication error prevention system. Journal of Korean Academy of Nursing. 42:568–578. http://dx.doi.org/10.4040/jkan.2012.42.4.568.
crossref
Koerner J.., Wesley M. L.2008. Organizational culture: The silent political force. Nursing Administration Quarterly. 32:49–56. http://dx.doi.org/10.1097/01.NAQ.0000305947.69311.a0.
Künzle B.., Kolbe M.., Grote G.2010. Ensuring patient safety through leadership behaviour: A literature review. Safety Science. 48:1–17. http://dx.doi.org/10.1016/j.ssci.2009.06.004.
Lee E. O.., Im N. Y.., Park H. Y.., Lee I. S.., Kim J. I.., Bae J. I., et al. 2009. Nursing research and statistical analysis. Paju: Soomoonsa.
McFadden K. L.., Henagan S. C.., Gowen C. R.2009. The patient safety chain: Transformational leadership's effect on patient safety culture, initiatives, and outcomes. Journal of Operations Management. 27:390–404.
crossref
Noble D. J.., Pronovost P. J.2010. Underreporting of patient safety incidents reduces health care's ability to quantify and accurately measure harm reduction. Journal of Patient Safety. 6:247–250. http://dx.doi.org/10.1097/PTS.0b013e3181fd1697.
crossref
Salas E.., Fowlkes J. E.., Stout R. J.., Milanovich D. M.., Prince C.1999. Does CRM training improve teamwork skills in the cockpit? Two evaluation studies. Human Factors. 41:326–343.
crossref
Schein E. H.1996. Organizational culture and leadership. San Francisco: Jossey-Bass Publishers.
Singer S. J.., Gaba D. M.., Geppert J. J.., Sinaiko A. D.., Howard S. K.., Park K. C.2003. The culture of safety: Results of an organization-wide survey in 15 California hospitals. Quality and Safety in Health Care. 12:112–118. http://dx.doi.org/10.1136/qhc.12.2.112.
crossref
Squires M.., Tourangeau A.., Spence Laschinger H. K.., Doran D.2010. The link between leadership and safety outcomes in hospitals. Journal of Nursing Management. 18:914–925. http://dx.doi.org/10.1111/j.1365-2834.2010.01181.x.
crossref
Tabachnick B. G.., Fidell L. S.2012. Using multivariate statistics. 6th ed.Needham heights, MA: Allyn & Bacon, Boston.
Thompson D. N.., Hoffman L. A.., Sereika S. M.., Lorenz H. L.., Wolf G. A.., Burns H. K., et al. 2011. A relational leadership perspective on unit-level safety climate. Journal of Nursing Administration. 41:479–487. http://dx.doi.org/10.1097/NNA.0b013e3182346e31.
crossref
Throckmorton T.., Etchegaray J.2007. Factors affecting incident reporting by registered nurses: The relationship of perceptions of the environment for reporting errors, knowledge of the nursing practice act, and demographics on intent to report errors. Journal of Perianesthesia Nursing. 22:400–412. http://dx.doi.org/10.1016/j.jopan.2007.09.006.
crossref
van Dyck C.., Frese M.., Baer M.., Sonnentag S.2005. Organizational error management culture and its impact on performance: A two-study replication. Journal of Applied Psychology. 90:1228–1240. http://dx.doi.org/10.1037/0021-9010.90.6.1228.
crossref
Vogelsmeier A. A.., Scott-Cawiezell J. R.., Pepper G. A.2011. Medication reconciliation in nursing homes: Thematic differences between RN and LPN staff. Journal of Gerontological Nursing. 37:56–63. http://dx.doi.org/10.3928/00989134-20111103-05.
crossref
Zohar D.., Tenne-Gazit O.2008. Transformational leadership and group interaction as climate antecedents: A social network analysis. Journal of Applied Psychology. 93:744–757. http://dx.doi.org/10.1037/0021-9010.93.4.744.
crossref

Table 1.
Demographic Characteristics of the Participants (N=118)
Characteristics Categories n (%) or M±SD Transformational leadership t or F (p)
M±SD
Gender Male 1 (0.8) - -
Female 117 (99.2)    
Age (year)   26.32±6.87    
22~29 81 (68.6) 6.92±1.16 0.23 (.796)
30~39 29 (24.6) 7.06±1.73  
≥40 8 (6.8) 6.73±1.53  
Marital status Married 30 (25.4) 7.15±1.61 0.97 (.335)
Single 88 (74.6) 6.87±1.23  
Educational status College 57 (48.3) 6.71±1.29 3.87 (.024)
University 56 (47.5) 7.06±1.11  
Master's degree 5 (4.2) 8.30±1.34  
Total clinical   5.89±7.17    
experience (year) <1 21 (17.8) 6.85±1.48 0.51 (.770)
1~<3 36 (30.5) 7.11±1.15  
3~<5 21 (17.8) 6.78±1.12  
5~<10 15 (12.7) 6.98±1.27  
10~<15 15 (12.7) 7.18±1.79  
≥15 10 (8.5) 6.49±1.57  
Number of beds <500 29 (24.6) 7.11±1.15 1.90 (.133)
≥500~<700 38 (32.2) 6.78±1.12  
≥700~<1,000 32 (27.1) 6.98±1.27  
≥1,000 19 (16.1) 7.18±1.79  
Table 2.
The Differences between Lower and Higher Transformational Leadership Group (N=118)
Variables (No. items) Transformational leadership t (p)
Total Lower group (n=59) Higher group (n=59)
M±SD M±SD M±SD
Error management climate (16) 3.88±0.43 3.67±0.37 4.08±0.39 5.84 (<.001)
   Learn from error (4) 3.92±0.56 3.72±048 4.11±0.58 3.88 (<.001)
   Thinking about error (4) 3.96±0.54 3.75±0.49 4.18±0.50 4.64 (<.001)
   Medication error competence (3) 3.83±0.60 3.59±0.58 4.07±0.53 4.63 (<.001)
   Medication error communication (5) 3.76±0.48 3.59±0.44 3.94±0.46 4.19 (<.001)
Intention to error reporting (3) 66.98±21.05 62.26±19.22 71.69±21.89 2.49 (.014)
Table 3.
Correlation among Variables (N=118)
Variables / categories 1 2 3 4 5 6
r (p) r (p) r (p) r (p) r (p) r (p)
1. Transformational leadership 1.00          
   Error management climate            
     2. Learn from error .42 (<.001) 1.00        
     3. Thinking about error .38 (<.001) .55 (<.001) 1.00      
     4. Medication error competence .43 (<.001) .28 (.002) .51 (<.001) 1.00    
     5. Medication error communication .37 (<.001) .50 (<.001) .50 (<.001) .39 (<.001) 1.00  
6. Total error management climate .51 (<.001) .77 (<.001) .86 (<.001) .68 (<.001) .76 (<.001) 1.00
7. Intention to error reporting .28 (.002) .26 (.004) .15 (.102) .25 (.008) .18 (.050) .2 27 (.004)
Table 4.
Moderating Effects of Transformational Leadership in the Relationship between Error Management Climate and Error Reporting Intention (N=118)
Independent variables Step 1 Step 2 Step 3
β t (p) β t (p) β t (p)
Error management climate (A) -.28 3.18 (.002) -.17 -1.64 (.103) -.13 -1.23 (.221)
Transformational leadership (B)     -.21 -2.01 (.047) -.21 -2.05 (.043)
A ∗ B         .22 2.50 (.014)
Adjusted R2 .07 .10 .14
F (p) 10.08 (.002) 7.20 (.001) 7.10 (<.001)
Table 5.
Mediating Effects of Transformational Leadership in the Relationship between Error Management Climate and Erro Reporting Intention (N=118
Variables β R2 Additional R2 Mediating effect
        Yes
Equation A : Error management climate → Transformational leadership .54∗∗∗ .28    
Equation B : Error management climate → Error reporting intention .28∗∗ .07    
Equation C : Transformational leadership → Error reporting intention .30∗∗ .09    
                     Error management climate → Error reporting intention .17   .02  

∗∗ p<.01, ∗∗∗p<.001.

TOOLS
Similar articles