A parsonian approach to patient safety

transformational leadership and social capital as preconditions for clinical risk management—the Gi factor

Holger Pfaff*, Jeffrey Braithwaite

*Corresponding author for this work

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The purpose of this study is to investigate the role of the combination of transformational leadership and social capital in safety capacity building. Drawing on the A-G-I-L concept of Talcott Parsons, we test a model for patient safety. The hypothesis is, that good safety management needs a combination of goal attainment (G) and integration (I), here called the GI factor. We tested this hypothesis by using transformational leadership as a surrogate for goal attainment and social capital as a surrogate for integration in a study of the perceptions of chief medical officers in 551 German hospitals. We conducted a cross-sectional hospital survey combined with secondary data analysis in all German hospitals with at least one internal medicine unit and one surgery unit (N = 1224 hospitals) in the year 2008 with a response rate of 45% (N = 551). The regression model explained 17.9% of the variance in perceived clinical risk management. We found that if both requirements for goal-oriented collective action—transformational leadership and social capital—are met, good safety management is more likely. The tentative conclusion is that it takes transformative leaders and cohesive followers together as a social basis to improve safety in hospitals.

Original languageEnglish
Article number3989
Pages (from-to)1-13
Number of pages13
JournalInternational Journal of Environmental Research and Public Health
Issue number11
Publication statusPublished - 4 Jun 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • AGIL scheme
  • Clinical risk management
  • Germany
  • Hospital
  • Parsons
  • Patient safety culture
  • Social capital
  • Transformational leadership

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