Leadership dynamics in health care crises: The impact of initiating structure and consideration behaviors on safety climate in public hospitals.

Abstract

Background: Health care crises underscore the critical need to maintain a robust safety climate to prevent medical errors and improve patient outcomes. Leadership behaviors, particularly initiating structure and consideration, are vital in shaping safety climate. However, inconsistent findings have raised questions regarding the effectiveness of these behaviors in crisis contexts.

Purpose: This study examines how the initiating structure and consideration behaviors of clinical leaders influence safety climate during crises and explores the moderating role of leaders' affectivity in these relationships.

Methodology/approach: Empirical data were collected from 108 dyads of clinical leaders and their direct reports across 21 public hospitals in Thailand at three intervals over one year. The study employed growth modeling using random coefficient models to analyze the impact of leadership behaviors on safety climate, accounting for the nonindependence of observations over time and variations in leader affectivity.

Findings: The results show that the positive impact of consideration behaviors on safety climate diminishes during crises, whereas initiating structure plays a crucial role in enhancing safety climate by providing clarity and stability. Additionally, leaders' positive affectivity enhances the impact of consideration behaviors on safety climate, although this effect weakens as the crisis intensifies.

Practice implications: These findings highlight the need for clinical leaders to balance initiating structure with consideration to enhance safety climate during crises, while leveraging positive affectivity to integrate new information to stabilize safety practices and develop effective contingency responses to immediate needs.