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01.12.2019 | Research article | Ausgabe 1/2019 Open Access

BMC Health Services Research 1/2019

Managing creativity and compliance in the pursuit of patient safety

BMC Health Services Research > Ausgabe 1/2019
Sharon H. Kim, Sallie J. Weaver, Ting Yang, Michael A. Rosen
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-019-3935-2) contains supplementary material, which is available to authorized users.
Sharon H. Kim and Sallie J. Weaver contributed equally to this work.



Are creativity and compliance mutually exclusive? In clinical settings, this question is increasingly relevant. Hospitals and clinics seek the creative input of their employees to help solve persistent patient safety issues, such as the prevention of bloodstream infections, while simultaneously striving for greater adherence to evidence-based guidelines and protocols. Extant research provides few answers about how creativity works in such contexts.


Cross-sectional survey data were collected from employees in 24 different U.S.-based outpatient hemodialysis clinics. Linear mixed-effects models were utilized to test study hypotheses. Professional status, clinic climate variables, and interaction terms were modeled as fixed effects, with a random effect for clinic included in all models.


Our results show that high status employees contributed more creative patient safety improvement ideas compared to low status employees. However, when high status employees were part of clinics with a stronger safety climate of compliance, they contributed fewer creative ideas compared to their counterparts working in clinics with a reduced compliance orientation. We also predicted low status employees working in less punitive clinics would contribute more creative ideas, but this hypothesis was not fully supported.


This study suggests that in hospitals and clinics that rely on strict protocols and formal hierarchies to meet their goals, the factors that promote creativity may be distinctively context-dependent. Implications for theory, practice, as well as future directions for research examining creativity in healthcare and safety critical contexts are discussed.
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