The relationship between patient safety climate and occupational safety climate in healthcare – A multi-level investigation

IntroductionPatient safety climate/culture is attracting increasing research interest, but there is little research on its relation with organizational climates regarding other target domains.The aim of this study was to investigate the relationship between patient safety climate and occupational safety climate in healthcare.MethodThe climates were assessed using two questionnaires: Hospital Survey on Patient Safety Culture and Nordic Occupational Safety Climate Questionnaire. The final sample consisted of 1154 nurses, 886 assistant nurses, and 324 physicians, organized in 150 work units, within hospitals (117 units), primary healthcare (5 units) and elderly care (28 units) in western Sweden, which represented 56% of the original sample contacted.ResultsWithin each type of safety climate, two global dimensions were confirmed in a higher order factor analysis; one with an external focus relative the own unit, and one with an internal focus. Two methods were used to estimate the covariation between the global climate dimensions, in order to minimize the influence of bias from common method variance. First multilevel analysis was used for partitioning variances and covariances in a within unit part (individual level) and a between unit part (unit level). Second, a split sample technique was used to calculate unit level correlations based on aggregated observations from different respondents. Both methods showed associations similar in strength between the patient safety climate and the occupational safety climate domains.ConclusionsThe results indicated that patient safety climate and occupational safety climate are strongly positively related at the unit level, and that the same organizational processes may be important for the development of both types of organizational climate.Practical applicationsSafety improvement interventions should not be separated in different organizational processes, but be planned so that both patient safety and staff safety are considered concomitantly.     

Safety climate and firefighting: Focus group results

BackgroundFirefighting is a hazardous occupation and there have been numerous calls for fundamental changes in how fire service organizations approach safety and balance safety with other operational priorities. These calls, however, have yielded little systematic research.MethodsAs part of a larger project to develop and test a model of safety climate for the fire service, focus groups were used to identify potentially important dimensions of safety climate pertinent to firefighting.ResultsAnalyses revealed nine overarching themes. Competency/professionalism, physical/psychological readiness, and that positive traits sometimes produce negative consequences were themes at the individual level; cohesion and supervisor leadership/support at the workgroup level; and politics/bureaucracy, resources, leadership, and hiring/promotion at the organizational level. A multi-level perspective seems appropriate for examining safety climate in firefighting.ConclusionsSafety climate in firefighting appears to be multi-dimensional and some dimensions prominent in the general safety climate literature also seem relevant to firefighting. These results also suggest that the fire service may be undergoing transitions encompassing mission, personnel, and its fundamental approach to safety and risk.Practical applicationsThese results help point the way to the development of safety climate measures specific to firefighting and to interventions for improving safety performance.     

Team-Based Risk Assessment and Action Plans as Participatory Methods for Safe Patient Handling in Two Swedish Municipal Care Homes for the Elderly

Objective. We investigated the usefulness of a team-based risk assessment method in patient transfer situations in municipal care homes for the elderly. Methods. Evaluation of risk assessment and action plans carried out in 2009. Focus group interviews with care givers and one-to-one interviews with managers and occupational therapists. Results. The evaluation showed that action plans and interventions were developed for each resident with identified risk connected with movement/transfer in daily life. Twenty-six patients (28%) of a total number of 94 were assigned to the “no risk” category regarding movement/transfer situations in daily life. The other 68 patients (72%) required further interventions, which were documented in action plans. The interviews indicated that the approach of team-based risk assessment and action plans was perceived as a functional participatory method aiming to improve daily life and work. Conclusion. Systematic team-based risk assessment and action plans benefit staff as well as residents at care homes for the elderly.     

Implementation of participatory organizational change in long term care to improve safety

Introduction: Long Term Care (LTC) facilities are fast-paced, demanding environments placing workers at significant risk for injuries. Health and safety interventions to address hazards in LTC are challenging to implement. The study assessed a participatory organizational change intervention implementation and impacts. Methods: This was a mixed methods implementation study with a concurrent control, conducted from 2017 to 2019 in four non-profit LTC facilities in Ontario, Canada. Study participants were managers and frontline staff. Intervention sites implemented a participatory organizational change program, control sites distributed one-page health and safety pamphlets. Program impact data were collected via Survey (self-efficacy, control over work, pain and general health) and observation (Quick Exposure Checklist). Interviews/focus groups were used to collect program implementation data. Results: Participants described program impacts (hazard controls through equipment purchase/modification, practice changes, and education/training) and positive changes in culture, communication and collaboration. There was a statistically significant difference in manager self-efficacy for musculoskeletal disorder (MSD) hazards between the control and intervention sites over time but no other statistical differences were found. Key program implementation challenges included LTC hazards, staff shortage/turnover, safety culture, staff time to participate, and communication. Facilitators included frontline staff involvement during implementation, management support, focusing on a single unit, training, and involving an external program facilitator. Conclusion: A participatory program can have positive impacts on identifying and reducing MSD hazards. Key to success is involving frontline staff in identifying hazards and creating solutions and management encouragement on a unit working together. High turnover rates, staffing shortages, and time constraints were barriers as they are for all organizational change efforts in LTC. The implementation findings are likely applicable in any jurisdiction. Practical Application: Implementing a participatory organizational change program to reduce MSD hazards is feasible in LTC and can improve communication and aid in identification and control of hazards.     

[Case Study] CityCenter and Cosmopolitan Construction Projects, Las Vegas, Nevada: Lessons learned from the use of multiple sources and mixed methods in a safety needs assessment

Problem

The present study describes a response to eight tragic deaths over an eighteen month times span on a fast track construction project on the largest commercial development project in U.S. history.

Methods

Four versions of a survey were distributed to workers, foremen, superintendents, and senior management. In addition to standard Likert-scale safety climate scale items, an open-ended item was included at the end of the survey.

Results

Safety climate perceptions differed by job level. Specifically, management perceived a more positive safety climate as compared to workers. Content analysis of the open-ended item was used to identify important safety and health concerns which might have been overlooked with the qualitative portion of the survey.

Discussion

The surveys were conducted to understand workforce issues of concern with the aim of improving site safety conditions. Such efforts can require minimal investment of resources and time and result in critical feedback for developing interventions affecting organizational structure, management processes, and communication.

Summary

The most important lesson learned was that gauging differences in perception about site safety can provide critical feedback at all levels of a construction organization.

Impact on the Industry

Implementation of multi-level organizational perception surveys can identify major safety issues of concern. Feedback, if acted upon, can potentially result in fewer injuries and fatal events.     

Modeling attitudes and perceptions as predictors for changing safety margins during organizational change

This study describes the relations between different dimensions of leadership commitment, safety climate and attitudes toward change, and how these affect employee perceptions of safety during organizational change in a high risk environment. We collected data from a European national air navigation services provider during a volatile 3-year corporatization process that ended in the sudden collapse of a deliberate change implementation project. Surprisingly, despite visible signs of internal and external stress caused by the volatile and disruptive change process, we did not observe any change in the traditional safety metrics of incident and accident reporting during the study. The study is based on a large survey (n = 422) of individual attitudes and perceptions of safety climate, perception of leadership commitment to safety, attitudes to organizational change, and perception of safety. The data support the claim that perception of safety at least, in part, depends on individual perceptions of the leadership’s commitment to safety, and the safety climate in place at a given point in time. The model shows how employee perceptions of the leadership’s commitment to safety and safety climate are related to both attitudes toward change, and to perceived safety.     

企业安全文化管理技术体系理论与实践探讨

为推动企业安全文化建设,实现不同群体行为安全整体协同发展,应用协同理论、自适应性管理及行为安全等方法,架构了企业安全文化管理技术体系。该技术体系强调安全文化整体提升需要外部推动力(企业例行的安全管理制度)及内部自驱力(员工安全文化自律提升)协同发展,最终实现由外部推动力向内部自驱力的转化。将构建的技术体系引入试点矿进行有效性验证,并运行2个周期。运行评估结果表明,试点矿不同群体对安全文化意识均呈整体提升,增长幅度比较大的是高层管理者(55.13%),其次是中层管理者(4.74%),一线员工层(4.48%)、培训层(3.69%)。     

Investigating ethnic minorities' perceptions of safety climate in the construction industry

IntroductionAn increasing number of ethnic minorities (EMs) have been employed in the construction industry to alleviate severe labor shortages in many countries. Unfortunately, statistics show that EMs have higher fatal and non-fatal occupational injury rates than their local counterparts. However, EMs are often underrepresented in safety climate (SC) research as they are difficult to reach and gauge their perception. A positive relationship has been widely found between SC and safety performance. Understanding the safety perceptions of EMs helps to reduce injuries and improve their safety performance.MethodBased on a sample of 320 EMs from 20 companies in the construction industry, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the SC factors of EMs, and validate the extracted factors, respectively. Multivariate analysis of variance was undertaken to examine mean differences in perceptions of SC by personal characteristics.ResultsThree SC factors for EMs encapsulating 16 variables were identified through EFA. The hypothesized CFA model for a three-factor structure derived from EFA showed a satisfactory goodness-of-fit, composite reliability, and construct validity.ConclusionsThree SC factors were identified, namely: (a) safety management commitment, safety resources, and safety communication; (b) employee's involvement and workmate's influence; and (c) perception of safety rules, procedures and risks. The perceptions of SC differed significantly by nationality, marital status, the number of family members supported, and drinking habit.Practical applicationsThis study reveals the perception of EMs toward SC. The findings highlight the areas for safety improvement and provide leading indicators for safety performance of EMs. The findings are also enlightening for countries with a number of EMs, such as the United Sates, the United Kingdom, Australia, Singapore, and the Middle East.     

Effects of safety climate on safety norm violations: exploring the mediating role of attitudinal ambivalence toward personal protective equipment

Problem

Research on the role of organizational and psychosocial factors in influencing risk behaviors and the likelihood of injury at work showed that safety climate also has great impact on workers’ behavior. However, the mechanisms through which this impact operates are still partially unclear.

Method

In order to explore the role that attitudinal ambivalence toward wearing PPE might play in mediating the impact of safety climate on safety norm violations, a questionnaire was administered to 345 Italian workers.

Results

Three dimensions of safety climate (i.e., company safety concern, senior managers’ safety concern, supervisors’ attitudes towards safety) were found to be positively associated with the individual ambivalence level, whereas the fourth one (i.e., work pressure) was negatively correlated with it. In turn, low levels of ambivalence were associated with a lower tendency to break the safety norms, even though the perception of a good safety climate also maintained a direct effect on unsafe behaviors.

Impact on industry

Designers of training program for the prevention of work related injuries must pay great attention to the psycho-social factors (such as the effects of the safety climate perception by employees on their attitudes and behaviors), and include specific contents into the prevention programs in order to improve workers compliance with safety norms.     

Development of the German version of the Hospital Survey on Patient Safety Culture: Dimensionality and psychometric properties

Despite the importance of safety climate assessment in healthcare, the psychometric properties of existing safety climate surveys have seldom been tested. We developed a German version of the HSOPSC and investigated its dimensionality and predictive validity. In adapting the survey we differentiated between the two management levels (hospital, unit) by duplicating dimensions of the HSOPSC. Based on a sample of n = 568, confirmatory and exploratory factor analyses (CFA, EFA) were applied. Relationships between safety climate and outcome variables were investigated by regression analyses. CFA did not replicate the proposed factor structure, supporting evidence from other European countries. EFAs revealed eight factors (instead of twelve proposed for the original instrument) and allowed for differentiating between management levels (hospital, unit). For physicians and nurses, different predictors were identified for overall safety climate perception. Further cross-cultural investigations of dimensionality are necessary for international comparisons of safety climate in healthcare. Our results highlight the importance of capturing the impact of different management levels, especially in large hospitals, and differences between professional groups in order to design interventions accordingly.     

Safety compliance and safety climate: A repeated cross-sectional study in the oil and gas industry

IntroductionViolations of safety rules and procedures are commonly identified as a causal factor in accidents in the oil and gas industry. Extensive knowledge on effective management practices related to improved compliance with safety procedures is therefore needed. Previous studies of the causal relationship between safety climate and safety compliance demonstrate that the propensity to act in accordance with prevailing rules and procedures is influenced to a large degree by workers' safety climate. Commonly, the climate measures employed differ from one study to another and identical measures of safety climate are seldom tested repeatedly over extended periods of time. This research gap is addressed in the present study.MethodThe study is based on a survey conducted four times among sharp-end workers of the Norwegian oil and gas industry (N = 31,350). This is done by performing multiple tests (regression analysis) over a period of 7 years of the causal relationship between safety climate and safety compliance. The safety climate measure employed is identical across the 7-year period.ConclusionsTaking all periods together, the employed safety climate model explained roughly 27% of the variance in safety compliance. The causal relationship was found to be stable across the period, thereby increasing the reliability and the predictive validity of the factor structure. The safety climate factor that had the most powerful effect on safety compliance was work pressure.Practical applicationsThe factor structure employed shows high predictive validity and should therefore be relevant to organizations seeking to improve safety in the petroleum sector. The findings should also be relevant to other high-hazard industries where safety rules and procedures constitute a central part of the approach to managing safety.     

Comparing safety climate factors as predictors of work-related driving behavior

INTRODUCTION: Research suggests safety climate (SC) is a strong predictor of safety-related outcomes in organizations. This study explores the relationship between six SC dimensions and four aspects of work-related driving. METHOD: The SC factors measured were "communication and procedures," "work pressures," "relationships," "safety rules," "driver training," and "management commitment." The aspects of self-reported occupational driving measured were traffic violations, driver error, driving while distracted, and pre-trip vehicle maintenance. RESULTS: Hierarchical regression analyses revealed that the SC factors accounted for significant amounts of variance in all four aspects of work-related driving, over and above the control factors of age, sex, and work-related driving exposure. However, further investigation indicated certain SC factors (particularly safety rules, communication, and management commitment) were more strongly related to specific aspects of work-related driving behavior than others. Together, the SC factors were better able to predict self-reported distraction from the road than the other aspects of driving behavior measured. Implications for occupational safety, particularly for the management of work-related drivers are discussed.     

Transport company safety climate—The impact on truck driver behavior and crash involvement

Objective: The present study investigated the relationships between safety climate and driving behavior and crash involvement.

Methods: A total of 339 company-employed truck drivers completed a questionnaire that measured their perceptions of safety climate, crash record, speed choice, and aberrant driving behaviors (errors, lapses, and violations).

Results: Although there was no direct relationship between the drivers' perceptions of safety climate and crash involvement, safety climate was a significant predictor of engagement in risky driving behaviors, which were in turn predictive of crash involvement.

Conclusions: This research shows that safety climate may offer an important starting point for interventions aimed at reducing risky driving behavior and thus fewer vehicle collisions.     

Attitude to safety rules and reflexivity as determinants of safety climate

IntroductionWe present two studies that focus on the relationship between safety rules and the safety climate. It is expected that a reasoned acceptance, namely one based on an understanding of the bases for the rules and a collective management of the rules, should benefit the climate. Method: In an initial study (N = 202) employees replied to a questionnaire that measured the safety climate, the level of the relationship with the safety rules, and the understanding of their bases. The results highlighted the fact that a reasoned acceptance of the rules is associated with an understanding of their bases and predicts the level of safety. In a second study (N = 258) employees replied to a questionnaire measuring team reflexivity, the safety climate, and the level of relationship with the safety rules. We observed that collective management of the rules mediated the relation between team reflexivity and the safety climate. Results: The results are discussed from the point of view of their practical implications. Developing safety climate requires that operators are trained to understand the basis of safety rules and team reflexivity.     

建设工程项目安全管理概念技能探究

在建设工程项目中,为提高安全水平,需要营造良好的安全氛围。安全氛围是抽象化概念,这就要求项目管理团队首先对安全管理进行概念化。研究目的在于探索项目管理人员的概念技能构成维度,分析维度间关系以及对安全管理水平提升的作用机理。因此,运用问卷调查收集相关数据,然后对有效数据进行因子分析,得到概念技能对于建设工程项目安全至关重要的两个维度:项目愿景,项目范围与整合。基于两个重要维度,初步建立理论模型并采用SEM分析论证概念技能对建设工程安全管理的作用机理。研究结果表明,概念技能可以帮助项目管理人员实施安全管理工作,安全管理工作的顺利实施又会提升现场的安全氛围。     

Exploratory study on safety climate in Chinese manufacturing enterprises

This study was conducted in eastern cities of China; 1060 employees were sampled from 144 enterprises located in East China, and 796 (75.1%) responded validly. The level of safety climate of Chinese manufacturing enterprises as well as the differences in safety climate between large enterprises and small and medium-sized enterprises (SMEs) were examined. This study revealed that the safety climate level that the employees’ perceived was rather low in Chinese manufacturing enterprises, and differences in terms of mean scores of total safety climate, factors composing the safety climate, and items to measure this climate between large enterprises and SMEs were statistically significant (at p < 0.05). Among all the factors, the largest difference between large enterprises and SMEs was the employees’ perception of safety training, followed by management support. It suggests that SMEs should pay more attention to safety training and management support to improve the safety climate.     

Night club patrons who feel safe will return: Evidence to encourage management to address club violence

IntroductionThere is substantial evidence that heavy drinking is associated with aggression and violence. Most managers of drinking establishments are required to maintain a security staff to deal with disruptive patrons who threaten an organization's business or legal status. However, managers may focus little on minor instances of aggression even though these may escalate into more serious events. We hypothesize that proactive security efforts may positively affect patrons' perceptions of nighttime safety and influence their decisions to return to the club, thereby affecting the club's bottom line.MethodData for this study were collected from entry and exit surveys with 1714 attendees at 70 electronic music dance events at 10 clubs in the San Francisco Bay Area (2010–2012). Participants were asked to report on observations and experiences with aggressive behavior while in the club, their overall perception of club safety, and their plans to return to the same club in the next 30 days. Mediational multiple regression analysis was used to relate observations of club security to perceptions of personal safety and plans to return to the club.ResultsReported observations of an active club security staff were positively related to perceptions of personal safety. Safety perceptions, in turn, were significantly related to plans to return to the club. The indirect path between perceptions of security and plans to return was significant as well.ConclusionsThe results suggest that an active security presence inside clubs can encourage club attendance by providing an environment where minor altercations are minimized, contributing to the perception of club safety.Practical ApplicationsEvidence that proactive security efforts appear to increase return customers might motivate managers to implement better security policies.     

Association between safety leading indicators and safety climate levels

ObjectivesThe aim of this study was to evaluate the association of leading indicators for occupational health and safety, particularly safety inspections and non-compliances, with safety climate levels.MethodsNordic Occupational Safety Climate Assessment Questionnaire was employed to evaluate safety climate in cross-sectional design. The geographically diverse population of the inspection body made it possible to conduct the survey across 10 provinces in Iran. 89 completed questionnaires were obtained with a response rate of 47%. Except for management safety justice, the internal consistency of other six dimensions was found to be acceptable (α ≥ 0.7).ResultsMean scores of dimensions ranged from 3.50 in trust in the efficacy of safety systems (SD = 0.38) to 2.98 in workers' safety priority and risk non-acceptance (SD = 0.47). Tukey HSD tests indicated a statistically significant difference of mean scores among groups undergoing different number of safety inspections and those receiving different number of non-compliances (p < 0.05), with no significant differences based on safety training man-hours and sessions (p > 0.05). Spearman's rank-order correlation showed no relationship between work experience and number of non-compliances (correlation coefficient = − 0.04, p > 0.05) and between safety training man-hours and number of non-compliances (correlation coefficient = − 0.15, p > 0.05).ConclusionsOur results indicate that safety climate levels are influenced by number of safety inspections and the resultant non-compliances.Practical applicationsFindings suggest that safety non-compliances detected as a result of conducting safety inspections could be used to monitor the safety climate state. Establishing plans to conduct scheduled safety inspections and recording findings in the form of safety non-compliance and monitoring their trend could be used to monitor levels of safety climate.     

Validation of the group nuclear safety climate questionnaire

IntroductionGroup safety climate is a leading indicator of safety performance in high reliability organizations. Zohar and Luria (2005) developed a Group Safety Climate scale (ZGSC) and found it to have a single factor.MethodThe ZGSC scale was used as a basis in this study with the researchers rewording almost half of the items on this scale, changing the referents from the leader to the group, and trying to validate a two-factor scale. The sample was composed of 566 employees in 50 groups from a Spanish nuclear power plant. Item analysis, reliability, correlations, aggregation indexes and CFA were performed.ResultsResults revealed that the construct was shared by each unit, and our reworded Group Safety Climate (GSC) scale showed a one-factor structure and correlated to organizational safety climate, formalized procedures, safety behavior, and time pressure.“Impact on IndustryThis validation of the one-factor structure of the Zohar and Luria (2005) scale could strengthen and spread this scale and measure group safety climate more effectively.     

Development of a multilevel health and safety climate survey tool within a mining setting

IntroductionThis study aimed to design, implement and evaluate the reliability and validity of a multifactorial and multilevel health and safety climate survey (HSCS) tool with utility in the Australian mining setting.MethodsAn 84-item questionnaire was developed and pilot tested on a sample of 302 Australian miners across two open cut sites.ResultsA 67-item, 10 factor solution was obtained via exploratory factor analysis (EFA) representing prioritization and attitudes to health and safety across multiple domains and organizational levels. Each factor demonstrated a high level of internal reliability, and a series of ANOVAs determined a high level of consistency in responses across the workforce, and generally irrespective of age, experience or job category. Participants tended to hold favorable views of occupational health and safety (OH&S) climate at the management, supervisor, workgroup and individual level.ConclusionThe survey tool demonstrated reliability and validity for use within an open cut Australian mining setting and supports a multilevel, industry specific approach to OH&S climate. Findings suggested a need for mining companies to maintain high OH&S standards to minimize risks to employee health and safety. Future research is required to determine the ability of this measure to predict OH&S outcomes and its utility within other mine settings.Practical applicationsAs this tool integrates health and safety, it may have benefits for assessment, monitoring and evaluation in the industry, and improving the understanding of how health and safety climate interact at multiple levels to influence OH&S outcomes.