Because the indirect associations between ‘‘management
support for patient safety’’ and ‘‘trust in
management’’ were more prominent than the direct
association, developing a culture of patient safetymight
require concentrated efforts by hospital leaders to foster
various aspects of safety communication, such as
an open and blame-free environment, to support open
safety communication.15,16 This might include regular
safety meetings, where hospital leaders and frontline
staff can collaborate on patient safety issues. At
the unit level, proactive learning activities, such as executive
or leadership WRs, are promising approaches
to improve safety communication regarding risks and
safety concerns and to solve systemic problems.33 During
their regular WRs to discuss safety issues, hospital
leaders can create a dialogue with frontline staff to
improve care processes in general.34 Findings from
previous studies indicate that unit participation inWRs
is associated with a positive safety climate, safety risk
reduction, and feedback about WR actions.10,33 This
substantiates findings regarding the positive effects
ofWRs on unit teams’ safety behaviors and emphasizes
the value of leaders’ direct unit-level engagement.16