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Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse

Myoung Soo Kim
Korean Journal of Adult Nursing 2013;25(6):633-643.
Published online: December 18, 2012

Department of Nursing, Pukyong National University, Busan, Korea

Corresponding author: Kim, Myoung Soo Department of Nursing, Pukyong National University, 599-1 Daeyeon 3-dong, Nam-gu, Busan 608-737, Korea. Tel: +82-51-629-5782, Fax: +82-51-629-7906, E-mail: kanosa@pknu.ac.kr

© 2012 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The objective of this study was to identify the moderating and mediating effects of transformational-leadership in the relationship between medication error management climate and error reporting intention.
  • Methods
    Participants in this study were 118 nurses from 11 hospitals in Korea. The scales of medication error management climate, transformational-leadership and error reporting intention of nurses were used in this study. Descriptive statistics, t-test, ANOVA, partial Pearson correlation coefficient, and stepwise multiple regression were used for data analysis.
  • Results
    Higher transformational leadership group members had higher error management climate (t=3.88~4.64, p<.001) and higher intention to error reporting (t=2.49, p=.014). There were significant positive correlations between subcategories of medication error management climate and transformational leadership (r=.37~.51, p<.001). But error reporting intention was related to the transformational leadership (r=.28 p=.002), two subcategories such as 'learn from error' (r=.26, p=.004) and 'medication error competence' (r=.25, p=.008) of medication error management climate. Transformational-leadership was a moderator and a mediator between medication error management climate and error reporting intention.
  • Conclusion
    Based on the results of this study, transformational-leadership promotion training program to construct medication error management climate and to improve error reporting intention should be needed.
  • Key Words: Leadership; Organizational cultures; Medical errors; Safety management
Table 1.
Demographic Characteristics of the Participants (N=118)
Characteristics Categories n (%) or M±SD Transformational leadership t or F (p)
M±SD
Gender Male 1 (0.8) - -
Female 117 (99.2)    
Age (year)   26.32±6.87    
22~29 81 (68.6) 6.92±1.16 0.23 (.796)
30~39 29 (24.6) 7.06±1.73  
≥40 8 (6.8) 6.73±1.53  
Marital status Married 30 (25.4) 7.15±1.61 0.97 (.335)
Single 88 (74.6) 6.87±1.23  
Educational status College 57 (48.3) 6.71±1.29 3.87 (.024)
University 56 (47.5) 7.06±1.11  
Master's degree 5 (4.2) 8.30±1.34  
Total clinical   5.89±7.17    
experience (year) ＜1 21 (17.8) 6.85±1.48 0.51 (.770)
1~＜3 36 (30.5) 7.11±1.15  
3~＜5 21 (17.8) 6.78±1.12  
5~＜10 15 (12.7) 6.98±1.27  
10~＜15 15 (12.7) 7.18±1.79  
≥15 10 (8.5) 6.49±1.57  
Number of beds ＜500 29 (24.6) 7.11±1.15 1.90 (.133)
≥500~＜700 38 (32.2) 6.78±1.12  
≥700~＜1,000 32 (27.1) 6.98±1.27  
≥1,000 19 (16.1) 7.18±1.79  
Table 2.
The Differences between Lower and Higher Transformational Leadership Group (N=118)
Variables (No. items) Transformational leadership t (p)
Total Lower group (n=59) Higher group (n=59)
M±SD M±SD M±SD
Error management climate (16) 3.88±0.43 3.67±0.37 4.08±0.39 5.84 (＜.001)
   Learn from error (4) 3.92±0.56 3.72±048 4.11±0.58 3.88 (＜.001)
   Thinking about error (4) 3.96±0.54 3.75±0.49 4.18±0.50 4.64 (＜.001)
   Medication error competence (3) 3.83±0.60 3.59±0.58 4.07±0.53 4.63 (＜.001)
   Medication error communication (5) 3.76±0.48 3.59±0.44 3.94±0.46 4.19 (＜.001)
Intention to error reporting (3) 66.98±21.05 62.26±19.22 71.69±21.89 2.49 (.014)
Table 3.
Correlation among Variables (N=118)
Variables / categories 1 2 3 4 5 6
r (p) r (p) r (p) r (p) r (p) r (p)
1. Transformational leadership 1.00          
   Error management climate            
     2. Learn from error .42 (＜.001) 1.00        
     3. Thinking about error .38 (＜.001) .55 (＜.001) 1.00      
     4. Medication error competence .43 (＜.001) .28 (.002) .51 (＜.001) 1.00    
     5. Medication error communication .37 (＜.001) .50 (＜.001) .50 (＜.001) .39 (＜.001) 1.00  
6. Total error management climate .51 (＜.001) .77 (＜.001) .86 (＜.001) .68 (＜.001) .76 (＜.001) 1.00
7. Intention to error reporting .28 (.002) .26 (.004) .15 (.102) .25 (.008) .18 (.050) .2 27 (.004)
Table 4.
Moderating Effects of Transformational Leadership in the Relationship between Error Management Climate and Error Reporting Intention (N=118)
Independent variables Step 1 Step 2 Step 3
β t (p) β t (p) β t (p)
Error management climate (A) -.28 3.18 (.002) -.17 -1.64 (.103) -.13 -1.23 (.221)
Transformational leadership (B)     -.21 -2.01 (.047) -.21 -2.05 (.043)
A ∗ B         .22 2.50 (.014)
Adjusted R2 .07 .10 .14
F (p) 10.08 (.002) 7.20 (.001) 7.10 (＜.001)
Table 5.
Mediating Effects of Transformational Leadership in the Relationship between Error Management Climate and Erro Reporting Intention (N=118
Variables β R2 Additional R2 Mediating effect
        Yes
Equation A : Error management climate → Transformational leadership .54∗∗∗ .28    
Equation B : Error management climate → Error reporting intention .28∗∗ .07    
Equation C : Transformational leadership → Error reporting intention .30∗∗ .09    
                     Error management climate → Error reporting intention .17   .02  

∗∗ p＜.01, ∗∗∗p＜.001.

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      Korean J Adult Nurs. 2013;25(6):633-643.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.633
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      Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse
      Korean J Adult Nurs. 2013;25(6):633-643.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.633
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      Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse
      Role of Transformational-leadership in the Relationship between Medication Error Management Climate and Error Reporting Intention of Nurse

      Demographic Characteristics of the Participants (N=118)

      Characteristics Categories n (%) or M±SD Transformational leadership t or F (p)
      M±SD
      Gender Male 1 (0.8) - -
      Female 117 (99.2)    
      Age (year)   26.32±6.87    
      22~29 81 (68.6) 6.92±1.16 0.23 (.796)
      30~39 29 (24.6) 7.06±1.73  
      ≥40 8 (6.8) 6.73±1.53  
      Marital status Married 30 (25.4) 7.15±1.61 0.97 (.335)
      Single 88 (74.6) 6.87±1.23  
      Educational status College 57 (48.3) 6.71±1.29 3.87 (.024)
      University 56 (47.5) 7.06±1.11  
      Master's degree 5 (4.2) 8.30±1.34  
      Total clinical   5.89±7.17    
      experience (year) ＜1 21 (17.8) 6.85±1.48 0.51 (.770)
      1~＜3 36 (30.5) 7.11±1.15  
      3~＜5 21 (17.8) 6.78±1.12  
      5~＜10 15 (12.7) 6.98±1.27  
      10~＜15 15 (12.7) 7.18±1.79  
      ≥15 10 (8.5) 6.49±1.57  
      Number of beds ＜500 29 (24.6) 7.11±1.15 1.90 (.133)
      ≥500~＜700 38 (32.2) 6.78±1.12  
      ≥700~＜1,000 32 (27.1) 6.98±1.27  
      ≥1,000 19 (16.1) 7.18±1.79  

      The Differences between Lower and Higher Transformational Leadership Group (N=118)

      Variables (No. items) Transformational leadership t (p)
      Total Lower group (n=59) Higher group (n=59)
      M±SD M±SD M±SD
      Error management climate (16) 3.88±0.43 3.67±0.37 4.08±0.39 5.84 (＜.001)
         Learn from error (4) 3.92±0.56 3.72±048 4.11±0.58 3.88 (＜.001)
         Thinking about error (4) 3.96±0.54 3.75±0.49 4.18±0.50 4.64 (＜.001)
         Medication error competence (3) 3.83±0.60 3.59±0.58 4.07±0.53 4.63 (＜.001)
         Medication error communication (5) 3.76±0.48 3.59±0.44 3.94±0.46 4.19 (＜.001)
      Intention to error reporting (3) 66.98±21.05 62.26±19.22 71.69±21.89 2.49 (.014)

      Correlation among Variables (N=118)

      Variables / categories 1 2 3 4 5 6
      r (p) r (p) r (p) r (p) r (p) r (p)
      1. Transformational leadership 1.00          
         Error management climate            
           2. Learn from error .42 (＜.001) 1.00        
           3. Thinking about error .38 (＜.001) .55 (＜.001) 1.00      
           4. Medication error competence .43 (＜.001) .28 (.002) .51 (＜.001) 1.00    
           5. Medication error communication .37 (＜.001) .50 (＜.001) .50 (＜.001) .39 (＜.001) 1.00  
      6. Total error management climate .51 (＜.001) .77 (＜.001) .86 (＜.001) .68 (＜.001) .76 (＜.001) 1.00
      7. Intention to error reporting .28 (.002) .26 (.004) .15 (.102) .25 (.008) .18 (.050) .2 27 (.004)

      Moderating Effects of Transformational Leadership in the Relationship between Error Management Climate and Error Reporting Intention (N=118)

      Independent variables Step 1 Step 2 Step 3
      β t (p) β t (p) β t (p)
      Error management climate (A) -.28 3.18 (.002) -.17 -1.64 (.103) -.13 -1.23 (.221)
      Transformational leadership (B)     -.21 -2.01 (.047) -.21 -2.05 (.043)
      A ∗ B         .22 2.50 (.014)
      Adjusted R2 .07 .10 .14
      F (p) 10.08 (.002) 7.20 (.001) 7.10 (＜.001)

      Mediating Effects of Transformational Leadership in the Relationship between Error Management Climate and Erro Reporting Intention (N=118

      Variables β R2 Additional R2 Mediating effect
              Yes
      Equation A : Error management climate → Transformational leadership .54∗∗∗ .28    
      Equation B : Error management climate → Error reporting intention .28∗∗ .07    
      Equation C : Transformational leadership → Error reporting intention .30∗∗ .09    
                           Error management climate → Error reporting intention .17   .02  

      ∗∗ p＜.01, ∗∗∗p＜.001.
      Table 1. Demographic Characteristics of the Participants (N=118)

      Table 2. The Differences between Lower and Higher Transformational Leadership Group (N=118)

      Table 3. Correlation among Variables (N=118)

      Table 4. Moderating Effects of Transformational Leadership in the Relationship between Error Management Climate and Error Reporting Intention (N=118)

      Table 5. Mediating Effects of Transformational Leadership in the Relationship between Error Management Climate and Erro Reporting Intention (N=118

      ∗∗ p＜.01, ∗∗∗p＜.001.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      Table 5.

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