patient safety management was positively associated with total service quality after adjusting for the effects of control variables (β=.44, p
healthcare staff to promote patient safety [31]. Claridge et al. [32] found in-service education promotes patient safety. This study found nursing leaders not only can promote patient safety through education <strong>and</strong> training, but can impact nurses in their service quality. When nursing managers promote total quality care, through education <strong>and</strong> training, they can also enhance nursing staff’s competency <strong>and</strong> influence their service quality to the patients. This research, through statistical analysis, found a significant, positive relationship between TQM <strong>and</strong> patient safety management, which supports the theory of Claridge et al. [32] . Some scholars thought that, because frontline nursing staff provides care to the patients, the nursing managers should empower their nursing staff to provide timely care [14] . Richardson <strong>and</strong> Storr [14] thought empowerment of nursing staff by nursing leaders helps nurses provide timely care <strong>and</strong> improves service quality. Armellino et al. [11] also found that an employee empowerment <strong>and</strong> patient safety management culture are significantly positively related. This study concluded that nursing leaders’ empowering nurses is one of the factors in nursing leaders’ enhancing TQM; TQM <strong>and</strong> patient safety management are statistically positively correlated. This conclusion supported the argument that TQM <strong>and</strong> patient safety management are positively correlated. This study also found among the research samples, high TQM samples demonstrated higher service quality for high patient safety management group than low patient safety group. The finding supported the argument that “patient safety management is the moderating variable between TQM <strong>and</strong> service quality.” When nursing leaders promote TQM to impact the nursing staff’s service quality, it is suggested that they can integrate patient safety management for a more efficient outcome. Previous studies have shown that staff characteristics influence service quality. Marjorie <strong>and</strong> Cattaneo [25] found that employee characteristics (including age, position, <strong>and</strong> gender) can impact service quality. Tsai <strong>and</strong> Wu [26] indicated that nursing staff’s age affects service quality. Therefore, in testing H4, gender, age, <strong>and</strong> position are considered as control variables. Statistical analyses further validated the impact of TQM on patient safety management, with patient safety management as the moderating variable between TQM <strong>and</strong> service quality. This means that the level of the hospital’s patient safety practices will influence how TQM affects service quality. When hospitals promote greater patient safety, TQM has a larger effect on service quality. This conclusion verified our hypothesis; i.e. patient safety management <strong>and</strong> TQM are complementary. CONSLUSIONS Patient safety is a complicated phenomenon. Nursing managers should underst<strong>and</strong> the impact that patient safety management practices have on nursing care, on the healthcare environment, or even on nursing management[33]. Runciman et al. [34] conducted epidemiological research on patient safety <strong>and</strong> suggested that future research should explore how to implement patient safety practices in healthcare. The present empirical, hospital-based study linked patient safety management with TQM concepts <strong>and</strong> explored its impacts on the quality of healthcare service outcomes. This study found that patient safety management can moderate the impact of TQM on service quality. It is suggested that nursing managers, when implementing quality improvement activities to improve nursing care quality, also incorporate patient safety practices to optimize the results. REFERENCES [1]Batalden P, Davidoff F. What is “quality improvement” <strong>and</strong> how can it transform healthcare? <strong>Quality</strong> <strong>and</strong> Safety in Health Care 2007; 16: 2-3. 5
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