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Because the indirect associations between ‘‘managementsupport for patient safety’’ and ‘‘trust inmanagement’’ were more prominent than the directassociation, developing a culture of patient safetymightrequire concentrated efforts by hospital leaders to fostervarious aspects of safety communication, such asan open and blame-free environment, to support opensafety communication.15,16 This might include regularsafety meetings, where hospital leaders and frontlinestaff can collaborate on patient safety issues. Atthe unit level, proactive learning activities, such as executiveor leadership WRs, are promising approachesto improve safety communication regarding risks andsafety concerns and to solve systemic problems.33 Duringtheir regular WRs to discuss safety issues, hospitalleaders can create a dialogue with frontline staff toimprove care processes in general.34 Findings fromprevious studies indicate that unit participation inWRsis associated with a positive safety climate, safety riskreduction, and feedback about WR actions.10,33 Thissubstantiates findings regarding the positive effectsofWRs on unit teams’ safety behaviors and emphasizesthe value of leaders’ direct unit-level engagement.16
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