Jenny Firth‐Cozens

Leadership and the quality of care.

The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena.

Organisational trust: the keystone to patient safety

Trust is an essential part of health care—not only between clinicians and patients but also between staff and management. Research shows us that trust has a beneficial impact on many aspects of working life, including job satisfaction and organisational effectiveness, and both these factors have been shown to affect the quality of patient care. In addition, trust will now be the keystone for any system developed for services to learn from untoward incidents, such as the Reporting and Learning System of the National Patient Safety Agency in the UK. This type of trust is complex and is explored in terms of what staff need from management and the potential conflicts that might be involved in developing trust in a healthcare organisation. This paper looks at the societal and emotional context of health care today and at research from other organisations which shows the factors that must be in place to establish trust. It reviews the attributes of leaders who are seen as trustworthy, and looks at how all this can be used to increase the reporting of and learning from error.

Evaluating the culture of safety

Leaders need to stay close to the action if their organisations are to be not just seen as safe, but actually to be safer Where once poor patient safety was deemed to be the result of individuals and technical inadequacy, ways of improving safety increasingly focus on the interaction of technology, human resources and organisations, together with the value systems or culture which lie behind them.1 In this issue of QSHC Pronovost et al 2 describe the development of a scale from a tool which looked at cockpit management attitudes, with questions focusing very much on the leader’s role in the enhancement of a safety culture. They found that staff saw their supervisors as having a greater commitment to safety than the more senior leaders. Their emphasis on views of leadership—including management—is important. Leadership …

Total Quality Management in Health Care

following criterion: 8% complete audit, 7% full audit, 31% partial audit, 13% potential audit, 15% planned audit, and 22% planning audit. At that time 4% were performing no audit, but this has subsequently been reduced to 0%. Our two new categories are compatible with the system described by Derry et al and we hope they will prove useful to others. We agree that the usefulness of this systematic coding system will be to provide information on the progress of audit in the county and to identify those practices in need of help in pursuing their audits. We use the coding method to help us to focus our activities more effectively in facilitating the development of medical audit in Wiltshire and not in a point scoring or punitive fashion.