PhD Defense Carien Alingh

The results of this study show that managers combine two management approaches which do both in their own way contribute to nurses’ safety-related attitudes and behaviour as well as patient safety. A control-based safety management approach, in which managers monitor and control healthcare professionals’ compliance with (safety) rules, is interpreted by nurses as signalling the importance of patient safety issues. In contrast, a commitment-based management approach, in which managers clearly prioritise patient safety, create awareness of safety risks and encourage healthcare professionals to take initiative on improving patient safety, contributes to creating an environment where nurses feel psychologically safe to take interpersonal risks. If nurses feel psychologically safe, they will be more willing to speak up about patient safety concerns. Furthermore, this study shows that nurses who perceive more commitment-based management and simultaneously experience that patient safety is highly valued within their department, do more frequently offer suggestions for patient safety improvement.

How control- and commitment-based safety management combine depends, among other things, on the position of a manager within the managerial hierarchy, the specific situation that a manager faces and the influence of external stakeholders such as the healthcare inspectorate and health insurers. Safety management requires synergies: synergy of the safety management approaches as well as synergy of all of the internal and external stakeholders involved in patient safety management.