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Journal of Research in Nursing logoLink to Journal of Research in Nursing
. 2019 Sep 24;25(1):22–34. doi: 10.1177/1744987118824621

Mediating role of the perceived benefits of using a medication safety system in the relationship between transformational leadership and the medication-error management climate

Myoung Soo Kim 1,✉, Ji Hye Seok 2, Bo Min Kim 3
PMCID: PMC7932221  PMID: 34394603

Abstract

Background

Evidence indicates that applying technology to medication safety will improve the quality of medical services and enhance the medication-error management climate. The perceived benefits of using the medication safety system are an important factor for adopting a system.

Aims

The purpose of this study was to investigate the mediating role of the perceived benefits of using a medication safety system in the relationship between transformational leadership and the medication-error management climate.

Methods

A total of 153 staff nurses from 11 secondary or tertiary hospitals in Korea were included. Descriptive statistics, t-tests, analysis of variance, Pearson correlations and multiple regression analyses were used.

Results

Transformational leadership was significantly correlated with the perceived benefits of the system use (r = .17, p = .032) and medication-error management climate (r = .55, p < .001). The perceived benefit of using the medication safety system was a mediator between transformational leadership and the medication-error management climate.

Conclusions

When chief executive officers construct and implement a medication safety system in their hospitals, transformational leadership can enhance the perceived benefits of system use, which is an important factor that contributes to a positive medication-error management climate.

Keywords: climate change, culture, error management, medical informatics, medication errors, perception

Introduction

Error management is a strategy that is used to deal with the cause of errors and tries to control negative consequences in order to prevent future errors (Frese and Keith, 2015). It provides learning opportunities for the members of an organisation to understand how to regulate and change their behaviour and is a broader concept than error prevention, which tries to reduce errors before they occur (Keith and Frese, 2005). Thus, the error management climate (EMC) is defined as the employees’ perceptions of error management practices related to communicating about errors, sharing error-related knowledge, and quickly detecting and handling errors (Van Dyck et al., 2005). Specifically, the climate related to error management contains not only the outward and visible error-handling process system but also the internalised atmosphere, compared to a culture in which this is just outward and visible (Li, 2016). This climate can be measured using questionnaires (MacDavitt et al., 2007) and it can be changed more easily than the culture (Chiang and Pepper, 2006). According to several studies, the EMC leads to higher error reporting rates due to the willingness to report errors (Castel et al., 2015), which is considered essential to patient safety (Hutchinson et al., 2009). Therefore, the most important factor for assuring medication safety is to construct a safe medication-related EMC.

Transformational leadership motivates followers to do more than is formally expected of them in order to achieve organisational goals by influencing their attitudes and beliefs (Bass, 1985). In recent psychological studies, it has been shown that a transformational leader can strengthen knowledge about and participation in safety, helping to establish a safe work environment (Jiang and Probst, 2016), and this leadership is associated with improved safety behaviours and an increased safety climate (Hoffmeister et al., 2014). Specifically, transformational leadership has received attention because it has relevance to the organisational safety climate (McFadden et al., 2009) and to continuous quality improvement initiatives (McFadden et al., 2015). The EMC is affected by nursing leadership (Fischer et al., 2018; Thompson et al., 2011), and a demonstration of leadership commitment to patient safety is important for enhancing a patient safety climate and culture in a clinical setting (Fischer et al., 2018). Furthermore, based on the fact that the leader’s vision, personality, authority and management style are highly relevant to technology-based innovations in healthcare (Chen, 2018), the transformational leadership of managers is important for enhancing the EMC.

Most researchers predict that applying e-health technology to medication safety will improve the quality of medical services and enhance the medication EMC. E-health refers to health services facilitated by the internet or related technologies in a clinical or public health setting (Eysenbach and Köhler, 2002). A web-based patient safety reporting system can provide information about the core causes and results of medication errors (Donchin et al., 1995) and increase healthcare providers’ mindfulness regarding reporting behaviour (Sorra et al., 2008). Consequently, it will ultimately change the medication process and improve patient safety and the economic efficiency of healthcare (Riga et al., 2015). The use of a barcode system can reduce medication errors to 56% by scanning the barcodes on a patient’s wristband and on the medication before it is administered (DeYoung et al., 2009). In addition, an electronic pharmacopoeia is built into the electronic medical documentation system, which makes it possible to search for diseases and their relevant medications during nursing activities (Ehsani et al., 2013). It has been revealed that the main categories of most medication error types are contraindications, interactions, side effects and indications (De Wit et al., 2016). Ehsani et al. (2013) reported that the use of e-pharmacopoeia could prevent medication errors caused by insufficient medicine information by as much as 30.9%. Finally, e-dosage calculation systems have been useful for calculating accurate dosages by entering body weight and surface area, which has resulted in reduced errors and calculation time (Yamamoto and Kanemori, 2010). Notably, these systems have recently become more portable and available with the development of web- and mobile-based applications (Choi et al., 2015).

Unfortunately, there has been less emphasis on enhancing the medication EMC following the implementation of medication safety systems. System construction itself cannot result in an enhanced EMC (Kim, 2012). The perceived benefits of adopting a hospital-wide information system are an important factor in the continuing process of improving and implementing a system (Jung, 2006), and perception of the benefits can influence the use of a successful medication safety system and the medication EMC. Furthermore, perceived benefits can be reinforced by leadership management. According to the transformational-leadership process in the theoretical framework used for the development of the Multifactor Leadership Questionnaire, the expectation for performance is linked to the initial level of efficacy of the followers’ perceived ability and motivation (Avolio and Bass, 1999). In addition, the followers’ perceptions are enhanced through transformational leadership. A qualitative study showed that leaders played an important role in enhancing the perception of the long-term benefits, and drive for e-health success (Chen, 2018). An effective leader should manage the situation of low innovation acceptance by further developing comprehensive staff communication through their creative thinking and capability for innovation (Bonoli, 2001). Therefore, it was hypothesised that transformational leadership can influence the perceived benefits of a medication safety system and that perception of the benefits can enhance the medication EMC.

The current study’s research aims were as follows. The first was to examine whether transformational leadership affects the perceived benefits of the use of a medication safety system and the medication EMC. The second was to identify the mediating role of the perceived benefits of using a medication safety system in the relationship between transformational leadership and the medication EMC.

Method

Sample and data collection

This study used a cross-sectional descriptive design. The non-probability sampling method was used. From the address book of the Korean Nurses Association, we obtained a list of secondary and tertiary hospitals’ email addresses and telephone numbers. We sent nationwide emails to 274 hospital quality improvement department managers and received feedback from 72 hospitals. However, although the managers of the quality improvement departments in 20 hospitals wanted to participate in the research, only 11 hospitals gave permission to distribute the questionnaire. The inclusion criteria of the hospitals were (a) having one or more nurses in the quality improvement department, (b) having their own quality improvement initiatives for medication, and (c) approving participation in this study. Among these 11 hospitals, 4 had fewer than 500 beds, 3 had 500–699 beds, 3 had 700–999 beds and 1 had more than 1000 beds. The largest hospital wanted to limit the number of participants to below 25 in order to minimise nurses’ additional workloads. Therefore, 12 questionnaires were provided for hospitals with less than 500 beds, 15 questionnaires for those with 500–699 beds, 20 for hospitals with 700–999 beds, and 25 for those with more than 1000 beds considering their numbers of staff. The inclusion criteria for the registered nurses (RNs) were having at least 3 months’ clinical experience because the first 3 months are generally a job-related orientation period in Korea. The RNs of the selected wards were invited to participate in the survey after obtaining a consent form. The survey assessed demographics, the transformational leadership of the ward leader, and perceived benefits of using the system and medication EMC. Furthermore, the patient safety chief managers in each hospital were asked whether they had medication safety systems. The preliminary survey of 26 RNs was tested for validity and reliability in the Korean healthcare context. A total of 185 RNs from 11 secondary or tertiary hospitals were surveyed between 20 July 2011 and 10 August 2011. To avoid selection bias and low significance caused by a small number of participants in each hospital, self-administered questionnaires were distributed to nurses at a minimum of three units in each hospital. A total of 158 (85.4%) questionnaires were completed and returned. After excluding five questionnaires with inappropriate data, 153 questionnaires were ultimately included in the analysis.

Measuring the variables

Construction of a medication safety system

Construction of a medication safety system was measured using one question for each system (i.e. the e-patient safety reporting, barcode, e-pharmacopoeia and e-dosage calculation systems), such as ‘Does your institution have an e-patient safety reporting system?’. Patient safety chief managers were asked whether they had each system because they knew the correct answer for the status of the system construction. If they answered ‘Yes, this system was constructed in my institution. Nurses use this system’, the response was scored as a ‘1’. If they answered ‘No, this system was not constructed in my institution. Nurses do not use this system’ or ‘I don’t know this system’, the response was scored as ‘0’ for each item. The sums of the variables were calculated for analytical purposes from the items that measured ‘construction of the medication safety system’. Participants at the same hospital were coded using the same scores. Technology adoption is regarded as a patient safety initiative (McFadden et al., 2009) and applying technology to medication safety has been proven to improve the quality of medical services (DeYoung et al., 2008; Ehsani et al., 2013). Therefore, it was decided to compare the importance of the medication safety system construction and perceived benefits of using the system. The range of possible scores was 0–4, where a higher score was indicative of a higher construction rate.

Transformational leadership

Transformational leadership revolutionises individuals and organisations by influencing individuals’ values and behaviours (Bass, 1985). Avolio and Bass (1999) confirmed the six-factor model of leadership using an updated version of the MLQ Form 5X. It contained six factors: charisma inspiration, intellectual stimulation, individualised consideration, contingent reward, management by exception, and laissez faire. We purchased a fixed number of Korean version copies of the Mind Garden instrument, manual and workbook (Bass and Avolio, 1999) with a licence and administered them in this study. In this study, the eight-item questionnaire for charisma inspiration was used, which was administered in the study by McFadden et al. (2009). Participants were asked ‘Please judge how frequently each statement fits your leader’. Sample items were as follows: ‘Talks about the most important issues that arise’, ‘Seeks differing perspectives when solving problems’. Charisma inspiration involves being a role model for ethical conduct and it builds identification with the leader and the followers’ articulated vision. In addition, charisma is needed to energise followers with a clear sense of purpose and to facilitate organisational change (Avolio and Bass, 1999). We employed a five-point Likert scale (from 1 = ‘not at all’ to 5 = ‘frequently, if not always’). A high score indicated that a charismatic supervisor (head nurse). Cronbach's α was .93 for the original version and .87 for this study.

Perceived benefits of using the system

Perceived benefit of system use was measured using 12 questions developed by researchers. The questions were determined to have a content validity of over .80 by two nurses with Master’s degrees who had worked at the quality improvement department for more than 5 years, and by a nursing professor. The questions about the ‘frequency of system use and perception of the effectiveness of the system use’ for the four medication safety systems (the e-patient safety reporting system, barcode system, e-pharmacopoeia and e-dosage calculation system) included three items for each of these systems. For instance, e-pharmacopoeia consisted of the following three items: ‘I use e-pharmacopoeia frequently’, ‘My colleagues use e-pharmacopoeia frequently’ and ‘Use of e-pharmacopoeia helps medication safety’. Each participant was asked to respond on a five-point Likert scale. The scores of the other three systems were calculated in the same way. In this regard, perceived benefits of system use could be assessed only in the participants whose institutions had such systems. Therefore, the sum of the perceived benefits of system use was divided by the number of established systems in their institutions. A high score indicated more positive perceived benefits of system use. If their hospital did not have any system, the data were excluded from the analysis. The reliability was .72, indicating that this instrument was suitable for a social psychological study.

Medication EMC

Medication EMC was measured using the Korean version of the EMC questionnaire (Van Dyck et al., 2005). In a previous study (Kim, 2012), two bilingual professionals conducted translation and reverse translation using a synthesis of the translations of the EMC questionnaire to assess semantic equivalence. After modifying the wording from error to medication error, content validity was determined to be above .80 by two experts. The original instrument consisted of 16 items with 4 categories: ‘learn from errors’, ‘thinking about errors’, ‘errors competence’ and ‘errors communication’. Errors in each item were replaced by medication errors. A five-point Likert scale from 1 (‘not at all’) to 5 (‘frequently, if not always’) was used. A higher score indicated a positive medication EMC. The previously reported Cronbach's α of this instrument was .89 (Kim, 2012), and it was .88 for this study.

Statistical analysis

IBM SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA) was used for all statistical analyses.

Descriptive statistics, t-tests and analyses of variance were used to describe the participants’ characteristics and to examine the medication EMC according to the participants’ characteristics.

The relationships between transformational leadership, perceived benefits of system use and medication EMC were assessed using Pearson correlation coefficients.

A three-way regression analysis was employed. The first regression analysis examined whether transformational leadership was a meaningful predictor for the perceived benefits of system use. The second regression analysis investigated whether transformational leadership was a meaningful predictor of the medication EMC. The third regression analysis was used to examine whether the perceived benefits of system use was a controlling variable and whether the medication EMC was an independent variable. We considered perception of system use as a mediator if there was no meaningful relationship or there was a weak direct effect of the independent variable.

Ethical considerations

This study was conducted after it had been reviewed and approved by the Institutional Review Board number 5. On the first page of the survey, the purpose, voluntary participation, confidentiality of the information and procedures of the study were explained. After the questionnaires were distributed to the participants, written consent was obtained from them. The respondents placed the completed sealed questionnaires in a box located at the nurses’ station on each floor and research assistants directly collected the questionnaires.

Results

Participants’ demographics and hospital-related characteristics

Almost all participants (98.7%, n = 151) were female; only two were male. The mean age was 30.10 years (SD = 8.09). We observed a higher average rating for the medication EMC among participants with a higher educational status (F = 7.00, p = .001) and those who worked in hospitals with more beds (F = 15.62, p < .001) (Table 1).

Table 1.

Demographic and hospital-related characteristics of participants (n = 153).

Characteristics Categories n (%) Medication-error management climate (M ± SD) t or F(p)
Gender Male 2 (1.3) 0.33 ± 0.47 −1.52
Female 151 (98.7) 1.75 ± 1.31 (.130)
Age (years) 22–29 94 (61.4) 1.76 ± 1.31 1.18
(M ± SD=30.10 ± 8.09) 30–39 42 (27.5) 1.83 ± 1.32 (.318)
40–49 11 (7.2) 1.68 ± 1.39
≥50 6 (3.9) 0.76 ± 0.99
Marital status Married 42 (27.5) 1.77 ± 1.47 0.22
Single 111 (72.5) 1.72 ± 1.26 (.827)
Educational 3 years at college 83 (54.2) 1.39 ± 0.26a 7.00
status BSN 63 (41.2) 2.10 ± 1.31b (.001)
MSN or higher 7 (4.6) 2.46 ± 0.67
Total clinical <5 102 (66.7) 1.65 ± 1.37 0.55
 experience (years) 5–10 18 (11.8) 1.97 ± 1.38 (.647)
(M ± SD=6.20 ± 7.64) 10–15 19 (12.4) 1.74 ± 1.02
≥15 14 (9.2) 2.02 ± 1.20
Clinical experience <3 95 (62.1) 1.67 ± 1.30 0.40
 in current position 3–5 34 (22.2) 1.77 ± 1.31 (.809)
 (years) 5–10 15 (9.8) 2.09 ± 1.49
(M ± SD=3.43 ± 4.80) 10–15 4 (2.6) 1.40 ± 0.57
≥15 5 (3.3) 1.73 ± 1.68
Number of beds <300 3 (2.0) 1.53 ± 1.35 15.62
300–500 43 (28.1) 0.91 ± 1.09 (<.001)
500–700 53 (34.6) 1.55 ± 1.29
700–1000 35 (22.9) 2.27 ± 1.01
≥1000 19 (12.4) 3.12 ± 0.71
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BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing. Note: a<b

Medication EMC according to the system construction

As shown in Table 2, the group that had constructed an e-dosage calculation system scored 4.03 ± 0.58 points, whereas the other group that had not constructed an e-dosage calculation system had a score of 3.76 ± 0.56 points on the ‘learn from medication errors’ subsection (t = −2.85, p = .005).

Table 2.

Medication-error management climate according to construction of medication safety system (n = 153).

Systems Construction n (%) Medication-error management climate (M ± SD)
Learn from MEs Thinking about MEs MEs competence MEs communication Total
E-patient Have 126 (82.4) 3.95 ± 0.59 3.98 ± 0.55 3.87 ± 0.61 3.77 ± 0.53 3.90 ± 0.44
Safety Do not have 27 (17.7) 3.80 ± 0.58 3.94 ± 0.50 3.84 ± 0.57 3.87 ± 0.36 3.87 ± 0.40
Reporting t(p) −1.26 (.211) −0.35 (.725) −0.26 (.794) 0.94 (.348) −0.36 (.720)
Barcode Have 47 (30.7) 3.89 ± 0.58 3.97 ± 0.48 3.93 ± 0.64 3.79 ± 0.46 3.90 ± 0.38
Do not have 106 (69.3) 3.94 ± 0.59 3.97 ± 0.56 3.84 ± 0.59 3.79 ± 0.52 3.89 ± 0.45
t(p) 0.44 (.663) −0.01 (.993) −0.85 (.399) 0.01 (.995) −0.08 (.940)
E- Have 126 (82.4) 3.95 ± 0.59 3.98 ± 0.55 3.87 ± 0.61 3.77 ± 0.53 3.90 ± 0.44
pharmacopoeia Do not have 27 (17.7) 3.80 ± 0.58 3.94 ± 0.50 3.84 ± 0.57 3.87 ± 0.36 3.87 ± 0.40
t(p) −1.26 (.211) −0.35 (.725) −0.26 (.794) 0.94 (.348) −0.36 (.720)
E-dosage Have 61 (39.9) 4.03 ± 0.58 4.03 ± 0.53 3.91 ± 0.63 3.79 ± 0.51 3.95 ± 0.43
 calculation Do not have 92 (60.1) 3.76 ± 0.56 3.89 ± 0.53 3.80 ± 0.56 3.79 ± 0.49 3.81 ± 0.42
t(p) −2.85 (.005) −1.67 (.097) −1.16 (.248) 0.07 (.946) −1.91 (.059)
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ME = medication errors.

Correlations between the transformational leadership, perceived benefits of system use and medication EMC

We found transformational leadership was positively associated with the perceived benefits of system use (r = .17, p = .032) and medication EMC (r = .55, p < .001). Perceived benefits of system use also exhibited a statistically significant positive correlation with the medication EMC (r = .18, p = .027) (Table 3).

Table 3.

Correlations among research variables (n = 153).

Variables 1)
 2)
 3)
r(p)
1) Transformational leadership 1.00
2) Perceived benefits of using a system .17 (.032) 1.00
3) Medication-error management climate .55 (<.001) .18 (.027) 1.00
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Mediating effects of perceived benefits of system use on the relationship between transformational leadership and medication EMC

The first equation showed that transformational leadership was a significant predictor of perceived benefits of system use (β = .17, p < .05, R2 = .02). The second equation indicated that transformational leadership had a significant direct effect on the medication-EMC (β = .55, p < .001, R2 = .30). In the final model, the results were compared with the second model by β and R2. When the perceived benefits of system use were included, the β of the medication EMC decreased from .55 (p < .001) to .53 (p < .001) (Figure 1).

Figure 1.

Figure 1.

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Mediating effects of perceived benefits of using a medication safety system in the relationship between transformational leadership and medication-error management climate.

Discussion

Transformational leadership is directly related to the patient safety climate and patient safety initiatives (McFadden et al., 2009); however, a limited number of studies have examined the importance of the perceived benefit of using a medication safety system. Medication-related safety and quality improvement are recognised as priorities for healthcare organisations (Ehsani et al., 2013), and hospitals have tried to build several medication safety systems (Kim, 2012). For the successful adoption of a medication safety system, it is important to demonstrate how members perceive the benefits of such a system and how frequently they use it. Therefore, based on the current study’s results, we will focus on the relationships among the variables and the perceived benefits of using a medication safety system, and suggest several strategies for developing the perceived benefits.

We identified the medication EMC according to the participants’ demographics and hospital-related characteristics. Staff nurses with Master’s and Doctoral degrees who administered medication had higher medication EMC scores than the others. This finding is inconsistent with a previous study, which determined that educational status was not a significant factor for changing the EMC (Yom and Choi, 2005). However, educational status can be a determining factor for the medication EMC if graduate coursework provides guidance on improving patient safety. According to one study, the safety teamwork climate can be changed by educational interventions (Bleakley et al., 2012). It is essential to encourage nursing staff to pursue higher educational development and to engage with training programmes for the medication EMC.

Notably, the medication EMC was different depending on the number of beds in the hospital. In Korea, a larger number of beds indicates that the hospital has a better infrastructure for improving patient safety, such as more nurses in the quality improvement department (Korea Institute for Healthcare Accreditation, 2016). Hospital infrastructure is one of the major factors for patient safety and it affects the EMC (Raftopoulos and Pavlakis, 2013). Staff in hospitals that have more beds could be trained to think about and learn from errors via a quality improvement programme that is managed by more nurses as part of the infrastructure, and they may have higher error management competence and easier communication.

It is noteworthy that there were no significant differences in the medication EMC according to the construction of the medication safety system, except for the e-dosage calculation system. This result shows that the construction of a medication safety system itself is not an antecedent of active system use or the medication EMC. In addition, it is inconsistent with the published research in which it was found that the construction of a system caused a positive perception of system use (Khajouei et al., 2011). Organisational support that provides time for training to learn and practice on the system is crucial for the successful adoption of a hospital information system (Khalifa and Alswailem, 2015). However, a study has demonstrated that many staff nurses did not know whether their institutions had constructed the medication safety system (Kim, 2012), and it was shown that organisational efforts for patient safety initiatives were insufficient. Therefore, an organisation should create patient safety initiatives to enhance communication and collaborative practice when constructing the system. Also, nurses should be involved in the design of e-health technology because involving users when developing new technology helps to identify the challenges associated with delivery of the service and to instruct the design of a new health service for meeting the needs of users (Garne Holm et al., 2017).

Nurses with a higher perception of their leader’s transformational leadership showed a higher medication EMC in the correlation and regression analyses. This finding is similar to previous studies that have shown a positive correlation between transformational leadership and the EMC (McFadden et al., 2009; Hoffmeister et al., 2014). Furthermore, according to one study, if nurses perceived their leader to be transformational, they felt the leadership was more effective and that it improved their job satisfaction and organisational commitment (Kang, 2006). Nursing performance and the responsibility of staff nurses are improved in a setting of optimal transformational leadership (Wang et al., 2012). In addition, because patient safety-related nursing activities were affected by leadership, a greater responsibility for medication safety and a more positive climate would be observed in this setting (Lin et al., 2015). Therefore, it is likely that nurses will feel a strong sense of responsibility and be absorbed in the medication EMC because of strongly perceived transformational leadership.

Finally, the perceived benefits of system use exerted a mediating effect on the relationship between transformational leadership and the medication EMC. This result is supported by a previous study that showed transformational leadership can affect how individuals interpret the challenge in their jobs and careers (Wang and Lee, 2009). Leadership can help to change staff’s meaning and view of their jobs, which benefits not just the individual but the organisation as well (Avolio and Bass, 1999). Many research studies have demonstrated that the user’s perception of an information system's usefulness and easiness are the biggest factors for its successful adoption and implementation (Farzandipur et al., 2016; Yusof et al., 2007). Moreover, strong leadership, such as that found in transformational leaders, also motivates followers to reach their potential. Specifically, leaders’ charisma engenders greater levels of cooperation among followers because it appeals to the relational concerns of the followers (De Cremer and Van Knippenberg, 2002). Consequently, the participants’ responses and perceived effectiveness of using the system formed by their transformational leader can drastically improve their medication EMC.

In order to better enhance the perceived benefits of system use that is influenced by transformational leadership and affects the medication EMC, we drew several strategies from the literature related to patient safety. The first strategy for enhancing the perceived benefits is to develop safety-specific transformational leadership. Safety-specific transformational leadership relates to the number of occupational injuries through the effects on the perceived safety climate (Barling et al., 2002) and this has been applied to the clinical setting. It impacts on the followers’ safety-related emotional motivation and enhances perception and behaviours involved in patient safety (Shen et al., 2017). Second, because chief managers in quality improvement departments also keep their members informed about the organisation’s adoption and implementation of a medication safety system, it is necessary to run in-hospital patient safety campaigns for the organisational members that include information about the effectiveness, costs and benefits of using a medication safety system. This can generate enthusiasm and focus among leaders and frontline staff (Ozieranski et al., 2014). Finally, a collaborative alliance for medication safety among hospitals will improve the perceived positive benefits of system use. As the various economic statuses and the chief executive’s volition in each hospital lead to a different level of adoption of medication safety systems, communication and collaboration can help to enhance the perceived benefits of a medication safety system. Specifically, a nationwide patient safety system, such as the medication-error reporting system, has not yet been built in Korea, and hospitals’ patient safety-related affairs are rarely shared between sectors (Kim, 2012). Therefore, a collaborative effort, which has been proven to lead to a transformation of the healthcare safety culture (Apold et al., 2006), would be helpful for improving the perceived benefits.

This study has several limitations. The first is the gap between actual system use and the perceived benefits of the system use. Because actual system use was not measured, the assumption that the perceived benefits of system use are based on actual system use is spurious. Therefore, further measurement of the actual use of medication safety systems would rectify this limitation. Second, because of the cross-sectional study design, the generalisation of the findings to other settings is limited.

Conclusions

Transformational leadership is expected to improve the perceived benefits of system use and enhance a positive view of the medication EMC. This suggests that it is necessary for organisation administrators or chief executives to make an effort and train themselves to improve the perceived positive benefits of the use of a medication safety system. Furthermore, when constructing and implementing a medication safety system in hospitals, transformational leadership may enhance the perceived benefits of system use as an important factor to obtain a positive medication EMC.

Key points for policy, practice and/or research

  • Demographics such as nurses’ educational status or hospital-related characteristics such as infrastructure for improving patient safety can be determining factors for medication EMC.

  • The participants’ perceived benefits of using the system formed by their transformational leader can drastically improve their medication EMC.

  • Because the construction of a medication safety system itself is not an antecedent of active system use or the medication EMC, organisations should make an effort to enhance the perceived benefits of system use when constructing a medication safety system.

  • For the successful adoption and implementation of a medication safety system, it is necessary to develop positive perceived benefits of system use by developing safety-specific transformational leadership, running in-hospital patient safety campaigns and building a collaborative alliance for medication safety among hospitals.

Biography

Myoung Soo Kim, was a staff nurse in the Pusan National University Hospital from 1999 to 2006. She was an Assistant Professor in Ulsan College from 2006 to 2010. Now, she is a Professor at Pukyong National University.

Ji Hye Seok, graduated from Pukyong National University. She is a Civil Servant at Songpa-gu Public Healthcare Center in Seoul.

Bo Min Kim, graduated from Pukyong National University. She is a Staff Nurse in Bong Seng Memorial Hospital.

Contributor Information

Myoung Soo Kim, Professor, Department of Nursing, Pukyong National University, Busan, Republic of Korea.

Ji Hye Seok, Pukyong National University, Busan, Republic of Korea.

Authors' note

Ji Hye Seok is now affiliated with the Department of Health Promotion, Songpa-gu Public Healthcare Center, Seoul, Republic of Korea.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethics

This study was conducted after it was reviewed and approved by the Institutional Review Board (Institutional Review Board: PKNU-5).

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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