Authentic Leadership Impact on Psychological Safety and Relationship Quality in the Acute Care Healthcare Setting

The quality of workplace environments is a growing concern across several industries as the impact on employee outcomes is increasingly recognized. Within healthcare the impact and importance of the workplace quality extends beyond the outcomes for the healthcare provider as this is also the healing environment for the patient. Mallibdou, Cummings, Estabrooks and Giovannetti’s (2011) findings support the established literature demonstrating provider outcomes related to the health of work environment also impact patient outcomes, both of which are multifactorial events. The quality of the nurse practice environments have been associated with adverse events including failure to rescue and death. Numerous factors influence the workplace environment and patient care delivery however a common thread for these factors lie within the relational tone of the setting. Dupree, Anderson, McEvoy and Brodman’s (2011) findings continues to support the concept that interdisciplinary relationship quality among providers is a central determinant to workplace health, patient safety and positive patient outcomes. Collaboration and interdisciplinary teaming are just two examples of the relationally-based constructs in healthcare. An additional relationally-based construct is leadership. Leadership behavior impacts the relational tone of a workplace, setting the foundation for relationship potential among providers, thereby influencing trust and the experience of psychological safety. Psychological safety is the tacit knowledge or belief that it is interpersonally safe to engage in vulnerable communication with colleagues. From the seminal work of Edmondson (1990) further studies on psychological safety in the healthcare setting have shown this to be a state conducive to such interpersonal risk-taking behaviors as speaking up or challenging a colleague without fear of retaliation. Edmondson, Bohmer and Pisano’s (2001) work supports additional findings that in the acute care setting the experience of psychological safety can reduce error rates, including medication errors, as well as improve overall quality of care. Leadership, psychological safety and relationship quality have been correlated with both provider and patient outcomes however the mechanisms by which these variables impact such outcomes is not fully understood.

This study sought to address these gaps by exploring leadership styles potential to facilitate psychological safety among nurses through the influence on relationship quality. As previously noted, Edmondson, Bohmer and Pisano’s (2001) work, and others, have demonstrated that the variables of leadership, psychological safety and relationship quality can be correlated with the provision of safe patient care, however the interplay between the variables in the day to day functioning of the unit is not fully understood. Patient and employee outcomes are multifactorial events and require contextually driven exploration to further advance the science of healthcare management and patient safety. A path analysis was used to test the hypothesized model of authentic leadership influencing team psychological safety in paths mediated by high quality relationships and workplace incivility. The findings did not fully support the hypothesized model in its entirety as a significant relationship between leadership style and psychological safety was not found. Indirect mediation effects of relationship quality on psychological safety was also not supported. However a significant relationship found between authentic leadership and high quality relationships and an inverse significant relationship with the measures of incivility.