Leadership Styles and Patient Safety: Impact on Outcomes

This essay explores the critical role of leadership styles in influencing patient safety within healthcare settings, particularly focusing on the impact of nurse leaders. It examines three primary leadership styles: transformational, transactional, and laissez-faire, analyzing their respective effects on patient outcomes, including medication errors, patient falls, and hospital-acquired infections. The essay highlights that transformational leadership, characterized by inspiring and motivating followers, is strongly associated with improved safety and reduced adverse events, such as lower mortality rates and fewer medication errors. Conversely, it finds that laissez-faire leadership, with its lack of direction and supervision, negatively impacts patient safety. Transactional leadership's effectiveness is also considered, with the understanding that it can be beneficial when leaders set clear expectations and monitor performance to ensure adherence to safety guidelines. The conclusion emphasizes the importance of nurse leaders selecting the most appropriate leadership style to foster a culture of safety, ultimately improving patient care.

Running head: LEADERSHIP STYLES AND PATIENT SAFETY
Leadership Styles and Patient Safety
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LEADERSHIP STYLES AND PATIENT SAFETY 2
Leadership Styles and Patient Safety
Nurses play a major role in the health setting and the manner in which they are managed
by their leaders affects their performance and patient outcomes. The nurse leaders have the
responsibility of establishing a culture of patient safety and this is greatly influenced by the kind
of leadership style they choose. Effective nurse managers ensure that the best resources and
manpower are sufficiently utilized in order to realize optimal patient outcomes and quality of
care. They use appropriate leadership styles to do so and also to attract and retain the top-
performing nurses. There are various leadership styles that have a major impact on patient safety
such as transactional, transformational, democratic, laissez-faire and authoritarianstyles (Frankel
& PGCMS, 2017). This essay will focus on transformational, transactional and laissez-faire
types of leadership and the various ways they affect patient safety in healthcare.
Patient safety is an important principle in healthcare and it refers to the reduction of risk
of medical errors and negative effects to patients. It is a discipline that emphasizes mainly on
safety in healthcare which is achieved through reduction, prevention and reporting of
unnecessary errors that lead to adverse effects (World Health Organization, 2016). This is greatly
influenced by the type of leadership style used by nurse leaders who are in a better position to
control the healthcare environment. Generally, all leadership styles have their own place and a
good leader ought to know the most appropriate one to be implemented at a particular situation.
The chosen style has an impact on the nurses’ performance and this can be seen through patient
satisfaction and safety, the levels of medication and recording errors, patient falls, hospital-
acquired infedtions and patient mortality rates (Wong, 2015).

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According to James McGregor Burns, transformational leaders engage with their
subordinates in a manner that both the leaders and followers boost one another to greater levels
of morality and motivation (Fischer, 016). Therefore, transformational leadership can be defined
as a style in which the leader’s conduct inspires and transforms the followers. Leadership is by
example. The leaders are proactive and motivate their followers to strive for greater
performance. The followers feel encouraged to perform beyond the levels of expectations and to
put the good of the organization before their self-interests. This style embraces inspirational
motivation which entails the provision of a vision for the future by the leader to their followers
and motivating them to exceed the levels of expectations. Additionally, it includes intellectual
stimulation which replaces the conventional assumptions and beliefs with a novel culture. The
leader is always concerned with the skills and needs of each of their followers and this can be
termed as individualized consideration (Yoder-Wise, 2014).
Transactional leadership is a style whereby the leader encourages compliance with rules
amongst their followers using rewards and punishments. Those who follow the set rules and
instructions and manage to achieve the set goals are rewarded appropriately. Conversely, those
that fail to obey and achieve the set goals are punished. This style majorly focuses on supervision
of followers, ensuring that the organization runs effectively and improving group achievements.
The leader pays attention to the followers’ performance in order to find deviations or fault.
Transactional leadership is suitable in times of crisis and emergency cases and also when highly
detailed tasks need to be done in a specific manner (Lorber, Treven & Mumel, 2016).
In laissez-faire leadership, the leader gives little or no instructions or supervision and
takes a hands-off approach. They prefer to let their followers do what they have to do on their

LEADERSHIP STYLES AND PATIENT SAFETY 4
own, probably believing that they will perform without guidance. Although it promotes
independence, this style can have many adverse effects. First, crucial decisions are not made on
time and positive changes rarely take place in the organization. Quality improvements are made
only when the situation demands so. This approach is often used by inexperienced or new leaders
who are still learning or by transitional leaders who believe that things will be dealt with by their
incoming replacements (Lorber, Treven & Mumel, 2016).
The above leadership styles have different impacts on patient safety. To begin with,
transformational leadership has been greatly associated with improved safety and reduced
adverse effects in the healthcare setting. When this approach is used, things are done more
carefully as followers are determined to go beyond the usual level of expectations. In a number
of studies previously conducted, it has been related to reduced patient mortality rates as well as
reduced medication errors (Vaismoradi,Griffiths, Turunen & Jordan, 2016). The style has also
been related to reduced patient falls. Additionally, studies have reported that this style is related
to fewer cases of hospital-acquired infections. Patients tend to receive quality carein a safe
climate. It has also been identified with increased patient satisfaction in the home health care and
acute care settings. Since the leader leads by example and motivates followers to exceed their
expected levels of performance, there is reduced staff turnover trends as compared to other
styles. Generally, it has been considered to be a style that has positive contributions to a safer
climate in healthcare (Hutchinson& Jackson, 2013).
On the other hand, the laissez-faire style of leadership has been seen to have a negative
effect on unit socialization as it cultivates a culture of blame among the followers. Subsequently,
this has a negative effect on patient safety. Due to the lack of directions and supervision, there

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are several cases of medication errors, patient falls and hospital-acquired infections (Merril,
2015). Transactional leadership has its focus on the reward system of nursing tasks instead of the
holistic nature of organizing, facilitating and communicating evidence-based care. The focus
shifts from patient safety and outcomes and followers are determined to complete the assigned
tasks and acquire the conceptualized reward. This style may put the patient’s safety at risk and its
effectiveness has not been proven in the provision of quality care. Besides this, the positive
effects of transactional leadership are short-lived and the leader only intervenes when something
goes wrong (Wong, Cummings & Ducharme, 2013). However, in a case where the transactional
leader sets clear expectations for their subordinates, this style plays a significant role in engaging
the nurses in patient safety efforts. It also helps to ensure that the followers adhere to the set
safety policies since obedience calls for a reward. An effective transactional leader is vigilant
and monitors performance to ensure that there are no conditions that endanger the patient’s
safety (Grossman & Valiga, 2016).
In conclusion, the essay has discussed on the transformational, transactional and laissez-
faire types of leadership and the various ways they affect patient safety in healthcare. In this
case, it is the role of nurse leaders to ensure that patient safety is upheld. To this end, they need
to choose the most suitable style of leadership and as evidently seen, transformational leadership
is the most effective. The transformational leadership conduct of nurse leaders will encourage the
staff’s attitude towards safety guidelines and this will influence their compliance with patient
safety practices. In return, there will be reduced patient mortality, erroneous medication, patient
falls and hospital-acquired infections. On the other hand, laissez-faire style of leadership has a
negative effect on patient safety. Transactional leadership can promote patient safety if

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appropriately used and when the leaders are vigilant and strict enough to ensure that safety
guidelines are adhered to. A good leader should know when to use a certain leadership style by
first assessing the situation and then determining the best style.

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References
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