(This article was published in a 2022 Special Edition of Measuring Business Excellence, a peer-reviewed journal from Emerald Publishing). Medical errors have become the third leading cause of death in the USA. Two million deaths from preventable medical errors will occur annually worldwide each year. The purpose of this paper was to find themes from the literature relating leadership styles – leadership approaches in practice – with success in reducing medical errors and patient safety. The review found three leadership approaches and four leadership actions connected to successfully reducing medical errors and improving patient safety. The review concluded that leadership appeared to be the preeminent factor in reducing medical errors and improving patient safety. It also found that positive leadership approaches, regardless of the safety intervention, led to improving results and outcomes.

For more than two decades, the US government and the healthcare industry have been attempting to improve the escalating rate of preventable medical errors. Despite these efforts, medical errors are a leading cause of death in the US. Perhaps the most alarming result of medical errors is preventable deaths, estimated between 250,000 to 400, 000 annually in the US. While most healthcare organizations have adopted some strategy to improve patient safety, the efforts are largely unproductive. This report focuses on an unusual integrated healthcare system that improved and sustained patient safety for more than a decade, responding to the specific problem of strategic leader in healthcare organizations who fail to foster a safety climate and reduce medical errors. The report identifies answers to why strategic leaders failed or succeeded and what factors lead to their success or failure.

Improving patient safety — reducing medical errors — requires deep-rooted organizational change. But, organizational change is tricky; failure rates range from 60 to 90%. One evidence-based approach to changing culture — organizational culture or its byproduct, safety culture — is to couple safety culture interventions with an operational excellence strategy that addresses both the leadership and structural drivers to change. Using operational excellence principles as primary and secondary embedding mechanisms, strategic leaders can sustain and embed safety culture across the enterprise.