Leading Quality and Safety on the Frontline – A Case Study of Department Leaders in Nursing Homes

Malin Rosell Magerøy,1 Geir Sverre Braut,2,3 Carl Macrae,1,4 Robyn Clay-Williams,5 Jeffrey Braithwaite,5 Siri Wiig1 1SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway; 2Department of Research, Stavanger University Hospital, Stavanger, Norway; 3Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway; 4Centre for Health, Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK; 5Australian Institute of Health Innovation. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, AustraliaCorrespondence: Malin Rosell Magerøy, SHARE- Centre for Resilience in Healthcare, Faculty of Health Science, University of Stavanger, Stavanger, Norway, Tel +47 47385445, Email malin.r.mageroy@uis.noPurpose: The role of healthcare leaders is becoming increasingly complex, and carries great responsibility for patients, employees, and the quality of service delivery. This study explored the barriers and enablers that department leaders in nursing homes encounter when managing the dual responsibilities in Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS).Methodology: Case study design with data collected through semi structured interviews with 16 department leaders in five Norwegian municipalities. We analyzed the data using qualitative content analysis.Results: Data analysis resulted in four themes explaining what department leaders in nursing homes experience as barriers and enablers when handling the dual responsibility of HSE and QPS: Temporal capacity: The importance of having enough time to create a health-promoting work environment that ensures patient safety. Relational capacity: Relationships have an impact on work process and outcomes. Professional competence: Competence affects patient safety and leadership strategies. Organizational structure: Organizational frameworks influence how the dual responsibilities are handled.Conclusion: Evidence from this study showed that external contextual factors (eg, legislations and finances) and internal factors (eg, relationships and expectations) are experienced as barriers and enablers when department leaders are enacting the dual responsibility of HSE and QPS. Of these, relationships were found to be the most significant contributor.Keywords: leadership, patient safety, quality, human factors, staff safety