Quality and safety

Quality and safety are the core principles in health care that must be driven by information. This assessment task
is designed to help you build skills in finding and understanding research evidence which can be used to improve
nursing practice.
Assignment question:Read the article Patient safety: a literature review on the impact of nursing empowerment,
leadership and collaboration (Richardson & Storr, 2010) and answer the following questions:
1.What impact can teamwork have on patient safety?
2.What role does nursing leadership play in the delivery of safe patient care?
3.What challenges are outlined in the delivery of safe patient care?
4.Why is it important for nurses to lead improvements in the delivery of safe patient care?

  1. What impact can teamwork have on patient safety?
    Numerous studies have shown that teamwork can significantly improve patient safety.
    Thus interdisciplinary teamwork is essential in mitigating clinical errors as it is usually
    predicated on the ability of each individual team member’s ability to anticipate the actions of
    others, adjust to the dynamic teamwork needs and most importantly, having a common
    understanding with regards to how a procedure should be conducted (Goh, Chan, & Kuziemsky,
    2013). Teamwork has been proved to have the ability to reduce errors and subsequently leading
    to improved patient safety largely due to the adaptability of teams. Adaptability of teams enables
    team members to spot and recognize deviations from an expected procedure or correct actions
    and subsequently make the correct adjustments (Henderson, 2013). Team adaptability can help
    teams adjust their strategies based on the demand of a particular task, hence enabling optimal
    utilization of available resources rather than promote strict adherence to bureaucratic procedures
    that can spawn errors in time sensitive and high pressure environments. Consequently, it has
    been proved to lead to improved patient safety (Manser, 2009). Thus adaptability within
    members of medical teams is a critical skill that is largely underpinned by the sophistication and
    interdependency that exists between such teams. Although medical teams are largely
    multidisciplinary and hence adaptable, they are highly intricate due to the idiosyncrasies
    emanating from patient care and staffing changes within a team environment. Teamwork can
    also improve patient safety due to improved performance monitoring. Additionally, teams
    present a high performance monitoring environment especially given that team members are able

to monitor the actions of colleagues thus helping to minimize possible deviations that can cause
errors and hence poor patient safety (Goh, Chan, & Kuziemsky, 2013). By helping members to
be each other’s pair of eyes or ears and collaborative monitoring of each other’s actions, spotting

mistakes, slips and procedural lapses before or as soon as they occur, teams play a critical role in
patient safety. Goh, Chan & Kuziemsky (2013) opine that although performance monitoring has
been proved to be an effective strategy in stemming lapses and errors, its success largely depends
on the ability of the nurse leaders to clarify its purpose. Hence its purpose should be
improvement of patient safety rather than documentation of staff errors. As such, it must focus
on continuous improvement of processes and procedures rather than perpetuation or facilitation
of punitive administrative actions. Teams help to drastically reduce preventable adverse
outcomes and mistakes that often result from trivial errors (Welp & Manser, 2016). Through
reduction of trivial mistakes, the unanticipated adverse outcome is timely averted. Thus effective
teams usually allow members to monitor each other’s actions thereby helping to identify and
correct trivial errors that can result to significant adverse outcomes. Moreover, the common
awareness that exists within teams allows members to probe and detect procedural deficiencies
while facilitating distribution of responsibilities whenever possible. It’ is this sense of shared
awareness that necessitates error detection that subsequently averts adverse outcomes. Medical
teams have the ability to improve patient safety since team members can act as backup for fellow
members. Back-up behavior is critical in error reduction especially when combined with shared
awareness (Goh, Chan & Kuziemsky, 2013). Through shared awareness, team members are able
to know when and who should step in as there is a clear line of delegation and task prioritization.
Studies have shown that even minimal shifts in workloads have the potential to significantly
reduce errors, misses or lapses (Welp & Manser, 2016). Backup behavior is critical as it is
premised on the principle that all human beings are susceptible to errors and hence the need for
shared responsibility.


  1. What role does nursing leadership play in the delivery of safe patient care?
    Nursing leadership plays a pivotal role in the delivery of safe patient care. Firstly, nurse leaders
    play a key role in influencing and managing factors that are essential toward improvement in
    patient safety. They participate in the development of innovative strategies that are critical in the
    attainment of a safe and sustainable healthcare environment that is free from errors
    (Richardson& Storr, 2010). Numerous studies have indicated that nursing leadership has a direct
    influence on nursing turnover and the level of staff satisfaction (Vogelsmeier et al., 2010). These
    two factors play an important role in improving patient safety. Still, given the multidisciplinary
    healthcare environment, nurse leaders’ contribution to the multidisciplinary healthcare
    environment cannot be overstated. Their collaboration with other medical professionals has been
    shown to improve patient outcomes. Furthermore, it established that effective nurse leadership
    was necessary for optimal performance of nurse teams. It also showed that nurse teams
    performed optimally under the leadership of nurse managers who acted as role models for team
    members, thereby resulting to high team performance and perpetuation of a safety culture.
    Consequently, this resulted into high quality healthcare outcomes. Furthermore, through their
    involvement in different aspects of clinical governance such as facilitation of clinical audits
    among nursing staff members, they are able to influence the safety quality in a healthcare
    environment. Besides, nurse leaders exercise leadership and oversight role over the nursing staff,
    which constitutes the largest staff groups in the healthcare system (Vogelsmeier et al., 2010).
    Despite their accountability role, nursing leaders also bring a nursing focus and perspective into
    the healthcare management environment.


  1. What challenges are outlined in the delivery of safe patient care?
    Richardson & Storr (2010) have enumerated a number of challenges that impedes the delivery of
    safety patient care. These challenges include:
    Nurses’ misunderstanding with regards to their role in the delivery of a safety patient care
    Nurses misconstrue their role in the delivery of safety patient care as simply intervention based,
    and limited to intervention actions that encompass double checking of procedures particularly
    where they perceive that an immediate benefit of satisfaction will accrue due to their personal
    role in mitigating a hazardous act. Thus, nurses do not perceive their role as proactive and
    analytical, and that which is focused at finding solutions to systemic healthcare problems
    (Richardson & Storr, 2010, p.19). This suggests a lack of understanding among nurses with
    regards to their role in the delivery of safety patient care.
    Lack of a systems approach in the evaluation of failures and misunderstanding on how
    diverse disciplinary procedures integrate into the healthcare safety system.
    Richardson & Storr (2010) suggests that the way to address this challenge is to embrace a
    systems approach in the evaluation of failures and a comprehensive evaluation of how different
    disciplinary procedures can be incorporated into the healthcare safety system ( p.19).
    Ineffective communication in multi-disciplinary teams and lack of feedback among
    healthcare professionals who undertake ‘hands on care’. This is particularly a great challenge
    since numerous studies have established a correlation between poor communication and medical
    failures. Still, another related challenge is the lack of participation by nurses in the development
    of a culture of safe patient care (Richardson & Storr, 2010, p.19). In order to achieve a safe

healthcare environment, they recommend improved communication and feedback. Additionally,
they recommend the incorporation of ‘hands ‘on healthcare professionals in the development of a
safety patient care culture.
Lack of teamwork and leadership skills
Richardson & Storr (2010) suggests that lack of non-technical skills among ‘hands on’
professionals such as nurses and surgeons is a great challenge toward achieving a safe patient
care culture. Furthermore, they underscore the importance of teamwork and leadership in
enhancing safety in healthcare (p.19).
Disparate perceptions on the meaning of patient safety among nurse leaders
Richardson & Storr (2010) suggests that top healthcare managers such as nurse executives and
Board chairs have differing opinions on what constitutes patient safety, although he states that
Chief Nurse Officers (CNOs) demonstrated a greater understanding of patient safety (p.19).

  1. Why is it important for nurses to lead improvements in the delivery of safe patient care?
    It is important that nurses should play a lead role in the improvement of the safe patient
    care as they have a unique patient centered perspective of the healthcare system (Brady &
    Cummings, 2010). Their focus and direct involvement in the delivery of primary care gives them
    a unique view of the healthcare environment. Besides, due to their involvement in
    multidisciplinary teams, nurses tend to have a more holistic approach to patient care. This
    holistic approach makes them better placed to make improvement suggestions that are focused
    on the safety of care (Reichenpfader et al., 2015). Besides, their participation in primary care
    makes them better placed to make informed contributions that will ensure patient safety during

primary care. Additionally, nurse leaders are accountable for the largest healthcare group hence
their involvement would ensure that the improvements actually lead to widespread safety across
the healthcare system (Mendes & de Jesus José, 2014). Still, while executing their oversight role,
nurse managers interact with patients, and hence they can help in the creation of a culture that
promotes openness, transparency and accountability. Lastly, nurse leaders play an important role
of empowering nurses and this can help in establishment of an organizational culture of safety.



Brady Germain, P., & Cummings, G. G. (2010, May). The influence of nursing leadership on
nurse performance: A systematic literature review. Journal of Nursing Management.
Goh, S. C., Chan, C., & Kuziemsky, C. (2013). Teamwork, organizational learning, patient
safety and job outcomes. International Journal of Health Care Quality Assurance, 26(5),
Manser, T. (2009, February). Teamwork and patient safety in dynamic domains of healthcare: A
review of the literature. Acta Anaesthesiologica Scandinavica.
Mendes, L., & de Jesus José, G. F. (2014). Influence of leadership on quality nursing care.
International Journal of Health Care Quality Assurance, 27(5), 439-450.

Richardson, A., & Storr, J. (2010). Patient safety: a literature [corrected] review on the impact of
nursing empowerment, leadership and collaboration. International Nursing
Review, 57(1), 12–21.
Vogelsmeier, A., Scott-Cawiezell, J., Miller, B., & Griffith, S. (2010). Influencing leadership
perceptions of patient safety through just culture training. Journal of Nursing Care
Quality, 25(4), 288–294.
Welp, A., & Manser, T. (2016). Integrating teamwork, clinician occupational well-being and