This study examines the relationship between leadership
practices and a medication safety regime (safety performance).
The unit of analysis was the medical surgical intensive care
unit in hospitals in the greater Houston, Texas area and the Registered Nurses
(RN) working in those units. Three hundred and eighty-six RNs were recruited to
participate, with 226 representing study hospitals and 149 from non-study
hospitals. They represented 13 different hospitals and 91 ICUs. Each RN was
asked to complete the Leadership Practices Inventory (Observer) for both their
ICU leader (N=355) and their hospital's leader (N=301) as they relate to patient
The study hospitals had higher unit-based leadership scores
than the non-study hospitals, in comparing unit/organizational LPI scores for both
the ICU and Hospital leadership. There were no significant differences in the total
mean score between unit based and organizational based leadership practices
(overall) toward safety. There were differences noted, however, in the leadership
practices of Challenging and Enabling with the unit based leaders scoring higher
than the organization based leaders.
The relationship between leadership at both levels (ICU and hospital) and
safety was not significant; although the researcher notes that the "small cell size in
the low and medium category may have comprised the accuracy of this finding"
(p. 78). High LPI scores were found in all levels of safety performance at both
the unit and hospital level. An inverse relationship, although not statistically
significant, was observed at both levels of leadership, and the researcher suggests
that other "factors of organizational culture may be acting as confounding
variables" (p. 81); for example, academic affiliation and profit status.
The conclusion was that leadership and safety performance vary
independently from one another and there wasn't a significant relationship
between the two at either the unit or organizational level. No significant
relationships were found between any of the five individual leadership practices
The author notes that the results might be explained by the particular
modifications made in the use of the LPI; specifically to address patient safety
rather than overall leadership practices.