Leadership: accepting responsibility

Leaders must declare patient safety urgent and a priority and must embrace safety as an integral part of the health care environment. Leaders need to lead with courage and take an imflinching look at their own leadership, accepting responsibility for the current state and declaring the intention to do better. Leaders must be visible to the front line and must understand the technical work of the front line, both from the perspective of process flow and from the patient-family experience. 

Facilitation A leadership role in which one guides a team of individuals toward an outcome. The facilitator should remain content neutral and accept responsibility for only the process followed to reach the outcome. 

Embracing patient safety means committing to a habit of excellence and to the creation of the same experience for patients that you would want for your child, parent, spouse, friend, loved one, and yourself It takes courage to accept responsibility for the state of things today, to declare an intent to do better, to listen to the lessons in the system and the wisdom of those on the front hue, and to take informed action for the changes that need to be made. If this were easy, it would have been done already. It is uncomfortable to objectively assess your own leadership practices and the state of safety in yom organization. 

Leaders who accept responsibility for safety take into account what is rep>orted and provide resources to the fixtnt fine to reduce risk. This is known as reciprocal accountability. It is not passive acknowledgment but active, visible leadership. 

Everyone who has ever accepted a team or committee assignment knows the frustration of fuzzy definitions of responsibilities, of individual roles, of leadership, or of the team s overall mandate. Teams lacking clarity in these critical areas tend to fall apart quickly. 

Figure 11.1 shows different kinds of decisions important to preclinical research. Clearly, IT and simulation support are completely accepted at the lowest level of this diagram as ways of predicting molecular, cellular, organ, animal, or human properties, interactions, and responses (covered elsewhere in this volume). Therefore, scientists moving into leadership roles will very often be familiar with the strengths and weaknesses of such methods. 

Some retirees react to total leisure as a selfish way to live—self-gratification without concern or compassion for others. Not so. You can adopt Plan A as your retirement lifestyle and still make contributions to the lives of others on a personal, one-on-one basis. You can continue to pay your human and social dues. Plan A just means that you refuse to have organizational connections that require responsibilities. Participate in church life, but refuse to assume a leadership role. Be a member of a fraternal organization, but refuse to accept an office. Enjoy country-club life, but back away when it comes to being on a committee. You... 

Managerial style is linked with culture, as the latter often defines, implicitly or explicitly, acceptable behaviour for a person with these responsibilities. A distinction commonly made is between managers whose primary responsibilities are operational and those who have more strategic and visionary responsibilities. Kotter (1990) describes these as managerial and leadership roles, respectively, while Bass and Avolio (1990) refer to transactional and transformational leadership. In reality most managers and leaders perform both roles but to differing degrees. 

The safety and health of employees at the workplace is the ultimate responsibility of the management of the organization. Even though it is generally accepted that all share a role in safety, the ultimate accountability lies with all levels of the leadership. With this in mind, the implementation of a safety management system with the intent of changing the safety culture can only be successful if initiated, led, and supported by all management. 

The Swiss Cheese Model of Accident Causation is a prerequisite for understanding the dynamics of the emerging risk and organizational defenses that are necessary to improve safety. Figure 4.2 illustrates the model, using its metaphor, a wedge of Swiss cheese. The model was described in detail in Chapter Three here, a metaphorical exploration of the model amplifies its implications for accepting leadership responsibility. 

Roles and Responsibilities Top management shall provide the leadership to institute and maintain effective systems for the design and redesign processes. Key points anticipate hazards and risks assess risks apply the hierarchy of controls to achieve acceptable risk levels. The following note is significant in the Roles and... 

Team Coordinator. A team coordinator shares many leadership functions with other team members. Individual team members accept specific management-type activities. The team gradually develops the ability to manage its own responsibilities. When this happens, the team coordinator is free to become involved in other activities outside the team. As close contact with individual team members becomes less and less frequent, the supervisor assumes the role of team boundary manager. 

To quote Walt Uhner, the senior Army War College faculty member responsible for the smdy, as he addressed the top Army leadership, Gentlemen, a scenario that was repeatedly described to us during our interviews for the study includes an ambitious, transitory commander, marginally skilled in the complexities of his duties, engulfed in producing statistical results, fearful of personal failure, too busy to talk with or listen to his subordinates, and determined to submit acceptably optimistic reports which reflect faultless completion of a variety of tasks at the expense of the sweat and frustrations of his subordinates (Kitfield 1995). 

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