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"THE ROLE OF TRANSFORMATIONAL LEADERSHIP IN THE RISK

MANAGEMENT OF PATIENT SAFETY"

Conference Paper · December 2018

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 1

"THE ROLE OF TRANSFORMATIONAL LEADERSHIP IN THE RISK

MANAGEMENT OF PATIENT SAFETY”

M. Husni Tamrin1, Moeheriono2

1,2
Department of Public Administration, Hang Tuah University, Surabaya, Indonesia
email: 1m.husnitamrin@hangtuah.ac.id, 2 moeheriono_msi@yahoo.com

Keywords : Transformational Leadership, Risk Management, and Patient Safety

Abstract : Changes and dynamics in the healthcare industry tend to fluctuate dynamically and experience rapid
changes, and require strong executive leadership manner (Transformational Leadership). This issue
relates with the health industry that needs a high supervision of the leader so that employees do not make
mistakes and create a maximum customer satisfaction for patient safety. For this reason, leaders are
needed who can manage the risks and minimize them which disserve the patient.

The role of transformational leadership must have: (1) Idealized Influence, a behavior that produces
respect and subordinate trust. (2) Inspirational Motivation, a behavior that always provides challenges for
the job of staff and takes into account the meaning of the work itself. (3) Intellectual Stimulation,
practicing the innovation based on the development of science and being able to transform it into a
productive performance. (4) Individualized Consideration, reflecting his/herself as a caring person in
understanding and following up complaints, ideas, expectations, and any staff input.

Introduction Transformational leadership is

formed by two words, namely leadership
Current transformational leadership
and transformational. The term
is always present and responds to the
“transformational” comes from the word
challenges of an era which is filled with
“to transform,” which means transforming
the changing of human needs and the
or transforming something into a different
changing of science. The era is not the era
form, for example, transforming the vision
when man accepts everything that befall
into reality, or transforming potential into
him (surrender). But the era, where human
actual. Transformational, therefore,
beings can criticize and demand their right
contains the meaning of traits that can
and it is worthy to be accepted in
transform something into another form,
humanity. Transformational leadership is
such as converting potential energy into
not only based on the need for self-esteem,
actual energy or achievement motive into
but it raises the leader's awareness to do
real achievement.
the best in accordance with management
and leadership development that Patient Safety has become a global
appreciates human, performance, and issue in health services. Patient safety in a
organization. hospital is a system whereby hospitals

make patients safer and more comfortable.
One of the most important concepts about
patient safety is leadership thinking, a
move to optimize patient safety
movements in hospitals. The leaders
create a culture in every thought, word and
deed. Leadership can affect the quality
standard of patient safety services if the
leadership itself can’t manage the patient's
risk management properly.
Transformational leadership
According to Covey (1989) and
Peters (1992), a transformational leader
has a clear vision and a holistic picture of
how the organization of the future when
all its goals and objectives have been
achieved. This affirms that
transformational leaders priorities on the
goals on the future, whether the vision is
visionary in the sense of being recognized
by everyone as a great and fundamental
vision. A transformational leader views
organizational values as noble values that
need to be designed and defined by all
staff so that they have a sense of
ownership and commitment to their
implementation. Sergiovanni (1992),
argues that the symbolic meaning of a
transformational leader's actions is more
2
concerned with actual action. The basic
values are the most important and upheld
the leader is everything that can be used as
a reference to be the basic values of
organization which is upheld by all staff.
It is the leader's task to transform the value
of the organization to realize the vision of
the organization. A transformational is a
person who has diagnostic skills, always
takes the time and devotes attention in
solving problems from various aspects.
Bass and Aviola (1994), there are four
dimensions in transformational leadership
with the following concepts:
1. Idealized Influence, which is described
as a behavior that generates the respect
and confidence (trust) of the person that
he leads. Idealized influence implies in
sharing the risk through the consideration
of the needs of staff above personal needs
and moral ethically.
2. Inspirational Motivation is reflected in
behaviors that always provide challenges
for the work of staff and pay attention to
the meaning of work for staff. Leaders
demonstrate commitment to
organizational goals through staff
observable behavior. The leader is a
motivator who is eager to continue to
 3

arouse the enthusiasm and optimism of the The leader is a person who is aware of the
staff. principles of organizational development
and staff performance so that he develops
3. Intellectual Stimulation, the leader who
his leadership aspect through staff
practices innovations. The attitudes and
motivation. Leaders should be able to call
behaviors of a leadership is based on
for higher ideals and moral values such as
developing science and intellectually able
independence, justice, and humanity, not
to apply it in the form of productive
based on emotions, such as greed,
performance. As the intellectual people,
jealousy, or hatred.
leaders constantly explore new ideas and
creative solutions from staff and do not Transformational leaders are
forget to always encourage staff to learn leaders who have far-reaching insights and
and practice new approaches in doing their improve the organization not for
work. temporary goal but for the future.
Therefore, transformational leaders are
4. Individualized Consideration, the leader
leaders who can be regarded as visionary
reflects himself as a caring person in
leaders. The transformational leader is the
listening and following up on complaints,
agent of change and acts as a catalyst,
ideas, expectations, and any feedback
which gives the role of changing on the
from the staff.
system towards the better. The catalyst is
Transformational leadership can be another term for transformational leaders
viewed as macro and micro. Micro- because it plays a role in improving all
transformational leadership is a process of available human resources. Trying to give
affecting the individual, while macro is a reaction that raises the spirit and power
the process of mobilizing the power to quickly as much as possible, always
change the social system and reform appear as a pioneer and creator of change.
institutional organization. Burns (1978),
describes transformational leadership is a
process that basically "leaders and
followers mutually raise themselves to a
higher level of morality and motivation."
 4

The Risk Management in Patient Safety effects of risk and accepting some or all of
the consequences of certain risks, those
The organization should prioritize
are aimed to patient safety.
the patient safety principle, to identify and
control all strategic and operational risks. Integrated risk management is the
This covers all areas of both managerial process of identifying, assessing,
and functional areas, service areas, service analyzing and managing all potential risks
stations, and clinical areas. Hospitals and patient safety incident. Integrated risk
should ensure the system in order to management is applied to all types of
control and reduce risk. Risk management hospital services at every level. If the risk
is a proactive approach in identifying, is properly assessed, this process will help
assessing and prioritizing risks, which hospitals, owners, leaders and
aims to eliminate or minimize its impact. practitioners to determine priorities and
Hospital risk management is an activity of improvement in decision making to
identification and evaluation to reduce the achieve the optimal balance between risk,
risk of injury and deprivation on the profit and cost.
patients, hospital employees, visitors and In general, integrated risk management
the organizations (The Joint Commission means:
on Accreditation of Healthcare
1. To ensure that hospitals apply the same
Organizations / JCAHO).
system to manage all the risk management
Risk management is closely linked functions, such as patient safety,
to the implementation of hospital patient occupational health and safety,
safety and affects the achievement of complaints, clinical litigation, employee
hospital quality objectives. Risk litigation, financial and environmental
management is a process of identifying, risks.
measuring risks, and forming strategies for
2. If it is considered for improvement,
managing them through available
modernization, clinical governance, and
resources. The strategies that can be used,
the risk management become the key
namely transferring risk to others,
components for each project design.
avoiding risks, reducing the adverse

3. To combine the sources of information
related to the risk and safety, for example,
"reactive data" such as patient safety
incidents, clinical litigation demands,
occupational health and safety complaints,
incidents, "proactive data" such as the
outcome of risk assessment;
consistent approach in training,
management, analysis and investigation of
all potential risks and actual events.
4. To apply consistent approach and
incorporate risk assessments of the risk
types at the hospital at each level.
5. To integrate all the risks into risk
assessment programs and risk registers.
6. To use the information obtained
through risk assessment and incidents to
construct the future activities and strategic
planning.
7. To identify business risks in identifying
situations that may cause financial injury,
demands or losses. Identification will help
the actions that occured on
management toward its risk.
5
Patient Safety
Patient Safety is a system that makes
patient care more secure, includes risk
assessment, identification and risk
management of patients, incident
reporting and analysis, learning ability and
using
the follow-up, and the implementation of
solution to minimize the risks and prevent
injuries caused by errors resulting from
carry out an action or no action.
Furthermore, Patient Safety Incident is
called incidents, are any unintentional
events and conditions that result in
preventable injury to the patient.
(Permenkes, No. 11/2017).
Currently, an important and global
issue in health care is patient safety. This
issue is practically re-talked in the 2000s,
since the report and the Institute of
Medicine (IOM) published a report: to err
is human, building a safer health system.
Patient safety is a new discipline in health
services that prioritizes reporting, analysis,
the and prevention of medical errors that often
cause Unexpected Event (KTD) in health
services.
The existence of hospitals as a
health service in the future will depend on
the response to the patient's needs.
 6

Providing excellent service to the patients Conclusion

is a key in achieving success. Hospitals as
The Role of Transformational Leadership
health-care establishments that deal
in Patient Safety is:
directly with patients should prioritize
safety, quality, anti-discriminatory and 1. Leaders should encourage and ensure

effective health services by prioritizing the the implementation of an integrated

interests of patients in accordance with patient safety program within the

hospital service standards (Hospital Law organization through the implementation

No.44 / 2009, article 29 b). Patient as a of "Seven Steps to the Safety of Hospital

user of health services has the right to Patients".

obtain self-safety during hospitalization 2. The Leader can ensure the ongoing

(Hospital Law No.44 / 2009, article 32 n). proactive program for the identification of
the patient's safety risk and the program of
Safety is a global issue and
suppressing or reducing incidents.
summarized in five important hospital
3. Leaders should encourage and foster
related issues: (1) patient safety, (2) the
communication and coordination between
safety of workers or health workers, (3)
units and individuals with regard to
the safety of buildings and equipment in
decision making on patient safety.
hospitals that can affect patient safety and
4. Leaders allocate powerful resources to
personnel, (4) green productivity
measure, assess, and improve hospital
impacting on environmental pollution and
performance and improve patient safety.
(5) hospital business safety related to
5. Leaders measure and assess the
hospital survival. Five aspects of safety
effectiveness of its contribution in
are important to be implemented, but it
improving hospital performance and
must be admitted that the activities of
patient safety.
hospital institutions can run well if there is
6. Leaders have strategic vision and plan
a patient.
in facing global issues and the speed of
technological information change (IT),
which is engulfing all over the world.
 7

One of the important concepts of

patient safety is leadership thinking, a step
to optimize patient safety movement in a
hospital, by establishing cooperation
between all policy makers in the hospital.
In applying transformational leadership of
patient safety, a leader must constantly
strive to prevent harm or injury to the
patient or employees.

References

Bass, B.M. and Avolio, B.J., (1994),

Improving Organizational Effectiveness
Through Transformational Leadership,
Sage, Thousand Oaks.

Burns, James MacGregor. 1978. .

Leadership, New York: Harper dan Row
.
Covey, Steven R, 1989, Seven Habits of
Highly Effective People: Powerful Lessons
in Personal Change, New York: Simon
and Schuster

Peraturan Menteri Kesehatan, Nomor. 11

tahun 2017, tentang Keselamatan Pasien,
Jakarta, Kemenkes.

Sergiovanni, T.J. 1992. Moral leadership.

San Fransisco: Jossey-Bass. Publishers
Undang-Undang, Nomor. 44 tahun 2009,
tentang Rumah Sakit, Jakarta.

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