Leadership Styles, Safety Culture Elements, and Serious Safety Events: An Empirical Investigation within a Healthcare System


Author/Creator ORCID




Hood College Department of Education


Organizational Leadership

Citation of Original Publication


Attribution-NonCommercial-ShareAlike 3.0 United States


Patient safety in healthcare is a societal concern. In 2016, researchers at Johns Hopkins Hospital identified medical errors as the third leading cause of death in the United States, citing over 400,000 potential deaths annually (Bernstein, n.d.; Makary, 2016). While there is debate on the number of deaths related to medical errors, this remains a problem in the United States, and there is an opportunity for better tracking (Allen & Pierce, 2016). The purpose of this cross-sectional, non-experimental study was two-fold: (1) to determine if leadership style impacts serious safety events (SSE) and (2) if a safety culture mediates this relationship. This study examined leadership styles of leaders in three hospitals in a health system located in the Mid-Atlantic region of the United States through the MLQ self-assessment survey. The findings of this study found Transactional leadership was associated with fewer serious safety events, and safety culture teamwork did not mediate this relationship. Transformational leadership was associated with more serious safety events and also was not mediated by safety culture teamwork. While this was an unexpected finding, literature does support the attributes of transactional leadership being associated with positive task performance, whereas transformational leadership is associated with contextual performance. The findings of this study will contribute to the development of leadership training programs in the health system to develop safety leaders at three levels including executive leaders, management, and supervisory leadership. The concept of shared leadership also emerged in the study as an implication for practice. There is also an opportunity to study the impact of staff turnover and temporary staff on safety culture and serious safety events.