Skip to main content

Taking the Lead in Patient Safety: How Healthcare Leaders Influence Behavior and Create Culture

Taking the Lead in Patient Safety: How Healthcare Leaders Influence Behavior and Create Culture

Thomas R. Krause, John Hidley, Diane C. Pinakiewicz (Foreword by)

ISBN: 978-0-470-43658-5 November 2008 287 Pages




  • Written by industry professionals: a workplace safety specialist in conjunction with a practicing physician and medical manager.
  • Provides recommendations for assessing hospital safety practices as well as specific suggestions for behavioural interventions.
  • Brings a systematic approach to healthcare safety, identifying common problems through illustrative case studies and offering solutions.
  • Offers several different perspectives including patient safety, doctor safety, and administrator safety.
Foreword by Diane C. Pinakiewicz, M.B.A.



Think leadership.

Think systems.

Think strategy.

Think culture.

Think behavior.

About this book.

1. What Determines Patient Safety?

Why make safety happen?

What stands in the way of improved healthcare safety?

Whose job is it to take the lead?

2. Blueprint for Healthcare Safety Excellence.

The working interface: Where exposure to hazard can occur.

Healthcare safety-enabling elements.

Organizational sustaining systems.

Organizational culture.

The charge of the safety leader.

3. Nine Dimensions of Organizational Culture.

Measuring culture with the Organizational Culture Diagnostic Instrument.

Organizational dimensions: The four pillars of culture.

Team dimensions.

Safety-specific dimensions.

Why do some organizations change more readily than others?

4. Qualities of a Great Safety Leader.

The Safety Leadership Model.

Measuring leadership with the Leadership Diagnostic Instrument (LDI).

Personal safety ethic.

Leadership style.

5. Leadership Best Practices.



Action orientation.



Recognition and feedback.


Measuring leadership best practices with the LDI.

6. Changing Behavior with Applied Behavior Analysis.

What is behavior change?

Antecedents, behaviors, and consequences.

ABC analysis.

Putting the tools to work in your organization.

7. Protecting Your Decision Making from Cognitive Bias.

Tragedy on Mount Everest.

Cognitive bias and healthcare safety.

Biases of data selection.

Biases of data use.

Case study: Cognitive bias in manufacturing.

Putting your cognitive bias knowledge to work.

8. Designing Your Safety Improvement Intervention.

The Leading with Safety process.

Phase I: The Patient Safety Academy.

Step 1: Gain leadership alignment on patient safety as a strategic priority.

Step 2: Develop a patient safety vision.

Step 3: Perform a current state analysis.

Step 4: Develop a high-level intervention plan for phase II.

9. Launching Culture Change for Patient and Employee Safety.

Phase II: Achieving safety throughout the organization.

Step 5: Engage the organization in the Leading with Safety process.

Step 6: Realign systems, both enabling and sustaining.

Step 7: Establish a system for behavior observation, feedback, and problem solving.

Step 8: Sustain the Leading with Safety process or continual improvement.

Case history: Exemplar HealthNet.

Leadership Coaching.

10. NASA After Columbia: Lessons for Healthcare.

NASA’s approach to culture and climate transformation.

Assessing NASA’s existing culture and climate.

BST’s NASA intervention.

Results at NASA.

Lessons for healthcare.



?This is an easy read, but that does not detract from the useful examples of safety awareness. The two authors make the case that emphasis on promoting safety should be for the benefit of staff as well as patients.? ( Nursing Standard , October 2009)