Leadership Support, Process Standardization, and Diagnostic Process Safety in Primary Care: A Cross-Sectional…

Abstract

Šehad Draganovi&cacute; Institute of Health Management, IMC Krems University of Applied Sciences, Krems, AustriaCorrespondence: Šehad Draganovi&cacute;, Institute of Health Management, IMC Krems University of Applied Sciences, Piaristengasse 1, Krems, 3500, Austria, Email [email protected]: Failures in the follow-up of test results and referrals are recurrent contributors to diagnostic error in primary care. Leadership support for patient safety and process standardization have each been linked to patient safety, but whether their associations with diagnostic safety are additive or interdependent is unclear. This study examined both factors and their interaction in relation to staff-perceived diagnostic process safety.Methods: A cross-sectional survey was conducted in 14 of 79 invited primary health centers (18%) in Bosnia and Herzegovina (staff response rate 44%, range 14% to 82%; analytic sample 1149 of 1154 returned questionnaires). Leadership support and processes and standardization were measured with the Medical Office Survey on Patient Safety Culture, and diagnostic process safety with its four-item testing and referrals scale. Latent structural equation models with an interaction term used robust maximum likelihood and cluster-robust standard errors, followed by sensitivity analyses for clustering, interaction specification, and common method variance.Results: Leadership support (β = 0.41) and processes and standardization (β = 0.33) were each positively associated with diagnostic process safety (both p < 0.001) in all sensitivity analyses. The interaction was small (β = 0.09, p =0.008; ΔR2 = 0.007), with a leadership association of β = 0.50 at high and β = 0.32 at low (± 1 SD) processes and standardization. It was positive in every specification but not statistically significant after small-sample corrections for the 14 clusters (p =0.11 to 0.14).Conclusion: For primary care leaders, the findings suggest attending to leadership support and process standardization together, as both were independently associated with more reliable follow-up of test results and referrals. Evidence that the two reinforce each other was suggestive but not conclusive and needs confirmation in longitudinal studies with objective measures.Keywords: patient safety, diagnostic safety, test and referral follow-up, leadership support, process standardization, primary care

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BibTeX

@article{draganovic2026leadership,
  title = {{Leadership Support, Process Standardization, and Diagnostic Process Safety in Primary Care: A Cross-Sectional Study in Bosnia and Herzegovina}},
  author = {Draganović Š},
  journal = {Journal of Healthcare Leadership},
  year = {2026},
  month = nov,
  url = {https://www.dovepress.com/leadership-support-process-standardization-and-diagnostic-process-safe-peer-reviewed-fulltext-article-JHL},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Leadership Support, Process Standardization, and Diagnostic Process Safety in Primary Care: A Cross-Sectional Study in Bosnia and Herzegovina
AU  - Draganović Š
PY  - 2026
DA  - 2026/11/08
JO  - Journal of Healthcare Leadership
UR  - https://www.dovepress.com/leadership-support-process-standardization-and-diagnostic-process-safe-peer-reviewed-fulltext-article-JHL
AB  - Šehad Draganovi&cacute; Institute of Health Management, IMC Krems University of Applied Sciences, Krems, AustriaCorrespondence: Šehad Draganovi&cacute;, Institute of Health Management, IMC Krems University of Applied Sciences, Piaristengasse 1, Krems, 3500, Austria, Email [email protected]: Failures in the follow-up of test results and referrals are recurrent contributors to diagnostic error in primary care. Leadership support for patient safety and process standardization have each been linked to patient safety, but whether their associations with diagnostic safety are additive or interdependent is unclear. This study examined both factors and their interaction in relation to staff-perceived diagnostic process safety.Methods: A cross-sectional survey was conducted in 14 of 79 invited primary health centers (18%) in Bosnia and Herzegovina (staff response rate 44%, range 14% to 82%; analytic sample 1149 of 1154 returned questionnaires). Leadership support and processes and standardization were measured with the Medical Office Survey on Patient Safety Culture, and diagnostic process safety with its four-item testing and referrals scale. Latent structural equation models with an interaction term used robust maximum likelihood and cluster-robust standard errors, followed by sensitivity analyses for clustering, interaction specification, and common method variance.Results: Leadership support (β = 0.41) and processes and standardization (β = 0.33) were each positively associated with diagnostic process safety (both p < 0.001) in all sensitivity analyses. The interaction was small (β = 0.09, p =0.008; ΔR2 = 0.007), with a leadership association of β = 0.50 at high and β = 0.32 at low (± 1 SD) processes and standardization. It was positive in every specification but not statistically significant after small-sample corrections for the 14 clusters (p =0.11 to 0.14).Conclusion: For primary care leaders, the findings suggest attending to leadership support and process standardization together, as both were independently associated with more reliable follow-up of test results and referrals. Evidence that the two reinforce each other was suggestive but not conclusive and needs confirmation in longitudinal studies with objective measures.Keywords: patient safety, diagnostic safety, test and referral follow-up, leadership support, process standardization, primary care
SN  - 1179-3201
ER  -

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