Walk the talk: leaders' enacted priority of safety, incident reporting, and error management.

PURPOSE The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). DESIGN/METHODOLOGY/APPROACH Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. FINDINGS As hypothesized, leaders' enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders' enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders' role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. RESEARCH IMPLICATIONS We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. PRACTICAL IMPLICATIONS Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. VALUE/ORIGINALITY Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.