Servant leadership and patient safety culture in Ethiopian public hospitals: a qualitative study

Healthcare systems continue to grapple with preventable patient safety challenges that require leadership interventions across all levels of operation. Servant leadership has emerged as a promising style for cultivating an organizational culture that promotes patient safety improvement within healthcare settings. This study explored how healthcare managers' servant leadership behaviors contribute to nurturing an organizational culture that boosts patient safety performance in public healthcare settings.

We conducted a multicenter qualitative case study to explore how healthcare managers' servant leadership nurtures a culture of patient safety in outpatient care settings of three large public sector hospitals in Addis Ababa, Ethiopia. Data were collected using in-depth interviews with 23 healthcare professionals (November 2023-March 2024) and onsite observations to generate rich, contextual insights about the research phenomenon. Template analysis, guided by the Ability‒Motivation‒Opportunity (AMO) framework, was used to explore the relationships between servant leadership and patient safety culture.

The research participants articulated their positive views about the patient safety practices of the respective public hospital outpatient care settings. The study produced key themes across the ability (supporting professional development, commitment to continuous learning), motivation (fostering a culture of service, providing incentives and rewards), and opportunity (promoting empowerment, leadership support, effective communication systems, resource allocation efforts, alignment of policies and systems) dimensions of human resources management.

Our study provides a comprehensive understanding of the leadership-safety culture phenomenon in Ethiopian public healthcare. The study critically unpacks how healthcare managers' servant leadership behaviors catalyze the cultivation of a patient safety culture through enhancing staff ability (e.g. continuous learning), inspiring motivation (e.g. service culture), and creating opportunities (e.g. resource provision) for engagement in safety-related initiatives. Integrating servant leadership with the AMO framework offers a powerful approach to nurturing an organizational culture that measurably enhances patient safety performance.