Living up to safety values in health care: the effect of leader behavioral integrity on occupational safety.

While previous research has identified that leaders' safety expectations and safety actions are important in fostering occupational safety, research has yet to demonstrate the importance of leader alignment between safety expectations and actions for improving occupational safety. We build on safety climate literature and theory on behavioral integrity to better understand the relationship between the leader's behavioral integrity regarding safety and work-related injuries. In a time-lagged study of 658 nurses, we find that behavioral integrity for high safety values is positively associated with greater reporting of fewer and less severe occupational injuries. The effects of behavioral integrity regarding safety can be better understood through the mediating mechanisms of safety compliance and psychological safety toward one's supervisor. We discuss the implications of our findings for future research on safety climate.

Safety leadership: extending workplace safety climate best practices across health care workforces.

PURPOSE: Hospitals within the United States consistently have injury rates that are over twice the national employee injury rate. Hospital safety studies typically investigate care providers rather than support service employees. Compounding the lack of evidence for this understudied population is the scant evidence that is available to examine the relationship of support service employees'perceptions of safety and work-related injuries. To examine this phenomenon, the purpose of this study was to investigate support service employees' perceptions of safety leadership and social support as well as the relationship of safety perception to levels of reported injuries. DESIGN/METHODOLOGY/APPROACH: A nonexperimental survey was conducted with the data collected from hospital support service employees (n = 1,272) and examined. (1) relationships between safety leadership (supervisor and organization) and individual and unit safety perceptions; (2) the moderating effect of social support (supervisor and coworker) on individual and unit safety perceptions; and (3) the relationship of safety perception to reported injury rates. The survey items in this study were based on the items from the AHRQ Patient Safety Culture Survey and the U.S. National Health Care Surveys. FINDINGS: Safety leadership (supervisor and organization) was found to be positively related to individual safety perceptions and unit safety grade as was supervisor and coworker support. Coworker support was found to positively moderate the following relationships: supervisor safety leadership and safety perceptions, supervisor safety leadership and unit safety grade, and senior management safety leadership and safety perceptions. Positive employee safety perceptions were found to have a significant relationship with lower reported injury rates. VALUE/ORIGINALITY: These findings suggest that safety leadership from supervisors and senior management as well as coworker support has positive implications for support service employees' perceptions of safety, which, in turn, are negatively related to lower odds of reporting injuries.

Issues in researching leadership in health care organizations.

PURPOSE: We provide a review of the research in this volume and suggest avenues for future research. DESIGN/METHODOLOGY/APPROACH: Review of the research in this volume and unstructured interviews with health care executives. FINDINGS: We identified the three central themes: (1) trust in leadership, (2) leading by example, and (3) multi-level leadership. For each of these themes, we highlight the shared concerns and findings, and provide commentary about the contribution to the literature on leadership. RESEARCH IMPLICATIONS: While relation-oriented leadership is important in health care, there is a danger of too much emphasis on relations in an already caring profession. Moreover, in most health care organizations, leadership is distributed and scholars need to adopt the appropriate methods to investigate these multi-level phenomena. PRACTICAL IMPLICATIONS: In health care organizations, hands-on leadership, through role modeling, may be necessary to promote change. However, practicing what you preach is not as easy as it may seem. VALUE/ORIGINALITY: We provide a framework for understanding current research on leadership in health care organizations.

Behavioral integrity for safety, priority of safety, psychological safety, and patient safety: a team-level study.

This article clarifies how leader behavioral integrity for safety helps solve follower's double bind between adhering to safety protocols and speaking up about mistakes against protocols. Path modeling of survey data in 54 nursing teams showed that head nurse behavioral integrity for safety positively relates to both team priority of safety and psychological safety. In turn, team priority of safety and team psychological safety were, respectively, negatively and positively related with the number of treatment errors that were reported to head nurses. We further demonstrated an interaction effect between team priority of safety and psychological safety on reported errors such that the relationship between team priority of safety and the number of errors was stronger for higher levels of team psychological safety. Finally, we showed that both team priority of safety and team psychological safety mediated the relationship between leader behavioral integrity for safety and reported treatment errors. These results suggest that although adhering to safety protocols and admitting mistakes against those protocols show opposite relations to reported treatment errors, both are important to improving patient safety and both are fostered by leaders who walk their safety talk.

Racial differences in sensitivity to behavioral integrity: attitudinal consequences, in-group effects, and "trickle down" among Black and non-Black employees.

Recent research has suggested that employees are highly affected by perceptions of their managers' pattern of word-action consistency, which T. Simons (2002) called behavioral integrity (BI). The authors of the present study suggest that some employee racial groups may be more attentive to BI than others. They tested this notion using data from 1,944 employees working at 107 different hotels and found that Black employees rated their managers as demonstrating lower BI than did non-Black employees. Mediation analyses were consistent with the notion that these differences in perceived BI in turn account for cross-race differences in trust in management, interpersonal justice, commitment, satisfaction, and intent to stay. Results of hierarchical linear modeling were consistent with the idea that middle managers' perceptions of their senior managers' BI "trickle down" to affect line employee perceptions of the middle managers and that this trickle-down effect is stronger for Black employees. The authors interpret these results as indicative of heightened sensitivity to managers' BI on the part of Black employees. They also found a reverse in-group effect, in that Black employees were substantially more critical of Black managers than were non-Black employees.

Why managers should care about fairness: the effects of aggregate justice perceptions on organizational outcomes.

This work examines the aggregation of justice perceptions to the departmental level and the business-unit level, the impact of these aggregate perceptions on business-unit-level outcomes, and the usefulness of the distinction between procedural and interpersonal justice at different levels of analysis. Latent variables analyses of individual-level and department-level data from 4,539 employees in 783 departments at 97 hotel properties showed that the 2 justice types exercise unique paths of impact on employees' organizational commitment and thus on turnover intentions and discretionary service behavior. Business-unit-level analyses further demonstrate paths of association between aggregate justice perceptions, aggregate commitment levels, and the business-unit-level outcomes of employee turnover rates and customer satisfaction ratings.