How Do Leaders Reduce Medical Errors? Inclusion, Trust, and Psychological Safety

Background: Although psychological safety (PS) is critical for improving patient safety and reducing medical errors, little is known about how heath care systems can promote PS. Purpose: The current study examined how different factors in the work environment - such as leadership for self-worth, inclusion, and trust - may work together to foster PS and ultimately reduce medical errors. Approach: Data were collected in 2019 from 373 employees (24% response rate) in 85 hospital departments (54% response rate) in a nonprofit health care system located in the eastern United States. Constructs were measured at the department level and medical errors represented the number of errors per department. Results: Negative binomial path model results found several direct effects. Leadership for self-worth was directly associated with increasing inclusion; inclusion was directly associated with increasing trust and PS; and PS was directly associated with decreasing the number of medical errors. Indirect effects uncovered pathways by which leaders promote PS and reduce medical errors. Leadership for self-worth was associated with increased PS by enhancing inclusion. In addition, leaders who promoted employee self-worth increased department inclusion, which increased department trust, and ultimately encouraged department PS. Leadership for self-worth was associated with fewer medical errors through increasing department inclusion, trust, and PS. Practical Implications: A leader’s ability to understand employees’ unique needs, express confidence in employees’ abilities, and encourage employees’ to share their ideas, is a promising approach for creating inclusive and trusting work environments that encourage PS and ultimately help reduce medical errors.