Parte cuantitativa

In terms of the data obtained from all sources, common themes relating to how authentic leadership practices impacted patient safety culture were identified. So far as the Hospital Survey on Patient Safety Culture (HSOPSC) was concerned, moderate to strong positive correlations were identified between all four components of leadership studied with the overall grade given by the nursing staff on the unit’s patient safety (CultMeaE) and the overall safety culture measure (Culttot) (r = .43 to .71 for CultMeaE) and (r = .46 to .65 for Culttot)

respectively.

On evaluation, LeadB1 was most relevant to the ethical behaviours and self-awareness of front-line leadership. LeadB2 assessed the leadership’s extent of transparency and balanced processing. LeadB3 and LeadB4 both evaluated the nurse perceived ethical and moral conduct of front-line leadership. As stated previously in Chapter 3, the HSOPSC was designed to measure group culture within a unit. Notably, correlations made that were based on the

measurement of group culture were also reflected in the individual responses of the participants. All 12 dimensions of the HSOPSC were identified within the features of the key categories impacted by leadership and subsequently impacted the nurse’s “identification of self”. Key categories include: emotions, actions/operations, outcomes impact, perceptions, and influences. Specific attributes of leadership reflective in the variables LeadB1-B4 are again reflective in the psychological and external components of the “identification of self”. Therefore, the same

conclusions can be drawn so far as the nurses’ commitment to a patient safety culture based on leadership’s impact on their professional development (as recognized both through the

quantitative and qualitative data). Within all elements of data collection and analysis, the first hypothesis was confirmed, namely that authentic leadership practice was identified as a positive correlative factor to patient safety culture. These findings support earlier work within the arena of authentic leadership and areas of work life, psychological capital and trust (Walumbwa et al., 2011; Wong & Giallonardo, 2013).

Further significance in findings was identified in respect to theorized authentic

leadership attributes and current leadership practice within the department. As noted within the data from the Authentic Leadership Questionnaire (ALQ), the lowest raw score was acquired from the ethical/moral component of leadership. This notion of limited ‘moral courage’ was supported by the comments obtained in the qualitative section of this study. One nurse’s telling example summed up the need for enhanced moral/ethical leadership: She noted “certain areas have become status quo and are no longer concerning to management when they are actually potentially dangerous situations such as patient volumes”. The perceived moral decision making - or minimal presence of it - by front-line leadership was regarded by nurse participants as dangerous to patients in particular and unethical. Quantitatively, the positive correlation of this leadership attribute with patient safety culture was identified. It can therefore be concluded, that an ethical/moral component of leadership indirectly impacts the patient safety culture.

According to the nurse participants in this study, potentially it is the most problematic element to maintain as a front-line leader within this environment. This notion is supported throughout literature sources on ethics and leadership (Donlevy & Walker, 2011; Tuana, 2014). Leadership can struggle with the concept of ‘moral courage’ as identified as an area of potential inadequacy

of the current leadership represented in this study. In support of authentic leadership practice, this inadequacy was identified by leadership within the questionnaire response, possibly through self-awareness.

Notably, the highest score associated with the leader’s perception of their authentic leadership practice was in regard to their ability to be self-aware. This perception of self-

awareness was not echoed in the nurses’ perception or culture of the unit. It was assumed, based on the findings, that front-line leadership was limited in their scope of self-awareness rather than the alternative (in which they were aware but uninterested in improving the culture). This assumption of limited scope is based on the organization’s emphasis on and foundation for learning through a learning organization model plus the requirement by Accreditation Canada

for the organization to sustain a patient safety culture. The assumption is also supported through previous research with similar findings related to the inconsistencies of leadership and

followership perceptions of the leader’s characteristics and the identification that follower ratings are more valid in predicting leadership effectiveness than the leader’s themselves (see for

example Agnew & Flin, 2013; Kim & Yukl, 1995; McGuire & Kennerly, 2006).

Attribution theory, in which the judgement of a leader is not “simply based on what the leader has done but also what the follower attributed to the leader” (Gardner et al., 2005, p.348) is a concept of significance in relation to this identified awareness. Attribution theory is significant in relation to the concepts discussed in the paragraph above and potential impacts on the follower in regard to their perceptions of the leaders. In support of the premise made above, it is also recognized that this theory supports the need for self-awareness and greater

understanding by leaders of the notion that followers assign their own meanings to the actions and/or achievements of leaders. In regard to the findings from this study, it was identified within

the core theory (and supported by statistical analysis) that the nurses perceived the leaders to be lacking in self-awareness. Specifically, leadership appeared to lack the ability to demonstrate insight regarding how the enactment of their leadership impacted others. Whilst it can be argued that any quest for such self-understandings by leaders is a most challenging one, this inability limited a perception of the authenticity in their leadership practice and the ability to foster positive self-development as identified within the context of “identification of self”.

The core theory model, ALQ raw scores, and statistical inter-correlations demonstrated both the necessity of self-awareness and authentic leadership practice for a positive patient safety culture and the significant impact this had on the individual and team within the unit. It is also recognized that the leadership’s perception of their own attributes (based on the one respondent) did not coincide with the nurses’ perception and overall culture of the unit (from the standpoint of nurse participants) further demonstrating the influence of the front line staff on the culture and the need for this type of mixed-methods study.

To identify why these leadership attributes impacted patient safety culture, triangulation was performed between the document perusal of the defined culture of the organization,

components of the HSOPSC, and the core theory model. Subject matter related to the need for shared values and beliefs around what is important and how things operate and the interaction of all of this with the work unit and organizational system was identified within both the qualitative and quantitative components of this study. Findings included the positive correlations between the leadership attributes and culture measures and key categories within the core theory model. Behavioural norms in regard to patient safety were created within the ethos of nurses’ personal and professional development and reflected in their commitment to the patient safety culture. Based on numbers alone, these organization members are part of the largest group within the unit

and therefore have a great influence in shaping and maintaining the culture in which they work. It was identified through this study that their influence as nurses was mediated by the impact of leadership on all aspects of their identification of self.