How Transformational Leadership Improves Patient Safety

Transformational leadership is one of several management styles present in healthcare settings. Many consider it to be the style that best enables healthcare organizations to respond quickly to change and continuously improve. These attributes (and others) can translate to greater improvements in patient safety.

What is transformational leadership?

Transformational leadership:

• Teaches employees to think critically and take initiative.
• Motivates people to take ownership of their roles.
• Inspires staff to innovate to find better ways to achieve goals.
• Enhances well-being and morale by strengthening relationships.
• Mobilizes employees into groups to get things done.

Leaders who employ a transformative style use encouragement, support, and recognition to motivate people to perform beyond expectations. A transformative leader is a coach, mentor, and role model. Leaders employing other styles might rely on consensus, majority rule, individual decision-making, top-down authority, or no set style at all.

Transformational leadership is especially effective in health care because it emphasizes teamwork and everyone’s ability to step up as a leader when needed.

Qualities of transformational leadership that elevate patient safety

The following qualities exemplify specific ways that transformational leadership can elevate patient safety in healthcare settings:

Empowerment

Transformational leaders empower their teams by providing the resources, support, and autonomy they need to make informed decisions and take appropriate actions to protect patients.

Why it makes a difference: In an organization with a top-down leadership style where the leader must make the decisions — or even a democratic organization that uses a majority rule — critical time could be lost waiting for approval to proceed. In healthcare settings, individual clinicians must have the power to think, decide, and act on their own — sometimes within a span of minutes — to keep patients safe.

Inspiration

Transformational leaders inspire their teams to be their best selves, which can encourage them to be proactive and innovative about their approaches to patient care.

Why it makes a difference: In an organization without transformational leaders, teams may lack the drive they would gain from a leader who motivates and inspires them to follow through with rigorous safety protocols and interventions and encourage others to do the same.

Communication

Transformational leaders use effective communication skills to build trust and establish a shared vision around a culture of safety where everyone understands their role in working to protect patients.

Why it makes a difference: Without transformative leadership, which encourages good team rapport, employees might not have the practice of routinely sharing information to ensure that safety measures permeate the organization and benefit every patient.

Collaboration

Transformational leaders encourage collaboration and teamwork. By working together, healthcare teams share information, coordinate their efforts, and identify potential risks more effectively.

Why it makes a difference: In nearly every healthcare setting, teams must work together to serve patients. Rarely does a single provider or clinician handle every aspect of a patient’s care. Transformational leadership prioritizes staff collaboration to create the best outcomes.

Studies of how transformational leadership affects patient safety

Studies have documented specific improvements in patient safety and related factors in organizations using transformational leadership practices:

Improvements in patient care

• Reduced patient mortality: A study at the University of San Francisco (USF) found that the transformational leadership style led to “lower patient mortality through increased retention and expertise of staff.”
• Fewer errors: The USF study also found that trust in leadership and good manager support created by transformational leaders correlated with reduced medication errors and reduced incidence of hospital-acquired infections.
• Better patient outcomes: The USF study attributed decreased patient length of stay to several transformational leadership behaviors that led to better staff engagement and higher adherence to safe practices.
• Higher patient satisfaction: The USF study found “significant relationships” between the transformational leadership style and higher patient satisfaction in four separate studies in acute care and home healthcare settings.

Organizational improvements

• Greater staff retention: The USF study found that transformational leadership led to increased staff expertise and reduced staff turnover, suggesting that strong leaders “retain higher numbers of skilled staff.”
• Better organizational outcomes: In a study of over 500 nurses in Taiwan, researchers found that transformational leaders increased staff engagement and motivation because they were more likely to “engage in organizationally beneficial behaviors that directly or indirectly enhance[d] organizational effectiveness.”
• Enhanced staff satisfaction: The Taiwan study also found that transformational leaders increased staff engagement, enhanced staff motivation, and stepped in to “cheer up members when they experience[d] setbacks.”
• Improved organizational culture: In the Taiwan study, transformational leaders created “more opportunities to instill in members the organization’s vision and collective goals.”
• Better response to crisis and change: A report from a U.S. nonprofit addressing health equity for children and families in Ohio, Delaware, and New York listed numerous factors influencing change that all stemmed from transformational leadership, including continuous improvement, embracing old and new approaches, forming partnerships, planning strategically, and working creatively to overcome obstacles.

How engagement and connection correlate to patient safety

Despite the evidence supporting the advantages of transformational leadership over other management styles, how it works can still seem mysterious. One way to understand its beneficial effects is to examine its underlying principles in the context of Maslow’s hierarchy.

American psychologist Abraham Maslow is perhaps best known for his hierarchy of human development. In an article titled, “A Theory of Human Motivation,” Maslow presented a pyramid of human needs. He believed this hierarchy represented what every person needs to achieve fulfillment in life.

Maslow’s hierarchy of human needs

According to Maslow’s theory, everyone seeks to satisfy these needs, in order:

1. Physiological needs such as air, food, water, sleep, health, clothes, and shelter
2. Safety, including personal, physical, financial, and emotional security and well-being
3. Belongingness or love through human connections, such as family, friendships, or intimacy
4. Esteem, which can be outward (through status, recognition, attention, appreciation, admiration, or prestige) or inward (through confidence, independence, and belief in one’s abilities)
5. Self-actualization, which is contentment and fulfillment attained from putting one’s desires and abilities to full use, such as through a romantic relationship, parenthood, pursuing a goal, or utilizing and developing a talent

Later in his career, Maslow added a sixth need — self-transcendence — which he defined as a desire to “further a cause beyond the self.” To reach this step, a person must advance beyond the boundaries of the self to achieve a “peak experience.” These experiences could involve profound moments of “love, rapture, understanding, or joy.”

It is probably rare for anyone to achieve self-transcendence during a regular day at work. But examining Maslow’s pyramid illuminates why transformative leadership could have greater potential than other management styles to facilitate health outcomes that transcend expectations.

Transformative leadership aligns with Maslow’s hierarchy

Leadership styles, such as autocratic, democratic, or task-oriented, most likely satisfy the first two levels of Maslow’s pyramid. However, they may not provide a way for employees to ascend further toward their true goals and desires.

• A healthcare organization provides for basic physiological needs by paying employees a salary with which to procure food and shelter.
• Employers provide safety for employees by complying with laws and policies that ensure worker protections and safe workplaces.
• However, not all organizations provide belongingness, which is forged through human connections, teamwork, and relationships.
• And not all organizations provide esteem, which can occur through recognition, empowerment, support, and independence.
• Very few organizations enable their employees to achieve self-actualization, which only occurs when an individual achieves the previous steps.

Fulfillment of employee needs leads to better performance

With all we know about transformative leadership, we can conclude that it is a leadership style that encourages people to do and be better versions of themselves as they work closely with others. And it helps individuals work toward both their own betterment and that of their organizations.

Individual and organizational excellence in turn lead to better patient outcomes, which include maximizing patient safety and advancing patient care.

The evidence is in. The transformational leadership style can play a critical role in improving patient safety by inspiring and empowering healthcare workers to achieve excellence.