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.     

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.     

Enhancing safety competencies of young adults: A randomized field trial (RCT)

IntroductionYoung workers are exposed to various occupational hazards, often with limited experience and skills. In this study, we investigated the effects of the Attitude to Work Program on the safety competencies of young workers. Based on the social cognitive theory, the intervention was developed to help young people adopt an active role in preventing occupational hazards and overcoming barriers to safe work.MethodThe program was implemented in eight upper secondary-level vocational schools in Finland during 2015. A total of 464 students participated in the cluster randomized field trial. Those in the intervention group (n = 229) participated in the Attitude to Work Program. During the program, students identified and practiced behavioral strategies to prevent occupational hazards. Students in the control condition (n = 235) received written material about the same safety-related topics.ResultsThe short-term follow-up showed that the intervention significantly increased safety preparedness and the internal safety locus of control among the students in the intervention condition in comparison to those in the control condition. Students in the intervention condition also showed reduced risk-taking attitudes relative to those in the control condition. Furthermore, those who benefited most from the program were high conscientiousness students. The sensation-seeking level or vocational track did not moderate any of the intervention effects.ConclusionThe results demonstrated that safety competencies can be modified by intervention techniques based on a social-cognitive framework.Practical implicationsThis study provides tools for school-based safety training and future intervention development. Further research is needed to study the relationships between cognitive factors, safety behavior, and accidents.     

Where to focus? Insights from safety personnel and external safety consultants on lessons learned about safety climate interventions – A qualitative approach

Introduction: Safety climate is important for promoting workplace safety and health. However, there is a dearth of empirical research on the effective ways of planning, designing, and implementing safety climate interventions, especially regarding what is going to be changed and improved. To address this gap, the present study sought to extract a comprehensive pool of compiled suggestions for safety climate intervention based on qualitative interviews with professionals in occupational safety and health management from potentially hazardous industries. Method: A series of systematic semi-structured interviews, guided by a comprehensive sociotechnical systems framework, were conducted with company safety personnel (n = 26) and external safety consultants (n = 15) of 21 companies from various industries. The taxonomy of five work system components of the sociotechnical systems approach served as overarching themes, representing different areas of improvement in an organization for occupational safety and health promotion, with an aim of enhancing safety climate. Results: Of the 36 codes identified, seven codes were based on the theme of external environment work system, four were based on the theme of internal environment work system, five were based on the theme of organizational and managerial structure work system, 14 codes were based on the theme of personnel subsystem, and six were based on the theme of technical subsystem. Conclusions: Safety climate intervention strategies might be most commonly based upon the principles of human resource management (i.e., codes based on the personnel subsystem theme and organizational and managerial structure work system theme). Meanwhile, numerous attributes of external/internal environment work system and technical subsystem can be jointly improved to bolster safety climate in a holistic way. Practical Applications: More systematic and organized management of safety climate would be available when various interrelated codes pertinent to a given context are carefully considered for a safety climate intervention.     

The effect of workers' visibility on effectiveness of intervention programs: supervisory-based safety interventions

INTRODUCTION: This paper discusses an organizational change intervention program targeting safety behaviors and addresses important considerations concerning the planning of organizational change. Using layout of the plant as a proxy for ease of daily leader-member interaction, the effect of workers' visibility on the effectiveness of supervisory-based safety (SBS) interventions is examined. Through a reinforcement-learning framework, it is suggested that visibility can affect supervisors' incentive to interact with subordinates regarding safety-related issues. METHOD: Data were collected during SBS intervention studies in five manufacturing companies. RESULTS: Results suggest a reinforcement cycle model whereby increased visibility generates more frequent exchanges between supervisors and employees, resulting in improved safety behavior among employees. In turn, employees' safer behavior reinforces continued supervisory safety-related interaction. CONCLUSION AND IMPACT ON INDUSTRY: Visibility is an important moderator in supervisory based safety interventions, and can serve to increase workplace safety. Implications of these findings for safety are discussed.     

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.     

A new approach to managing work-related road traffic injury: The development of a health investment framework

Objective: Statistics indicate that employees commuting or traveling as part of their work are overrepresented in workplace injury and death. Despite this, many organizations are unaware of the factors within their organizations that are likely to influence potential reductions in work-related road traffic injury.

Methods: This article presents a multilevel conceptual framework that identifies health investment as the central feature in reducing work-related road traffic injury. Within this framework, we explore factors operating at the individual driver, workgroup supervisor, and organizational senior management levels that create a mutually reinforcing system of safety.

Results: The health investment framework identifies key factors at the senior manager, supervisor, and driver levels to cultivating a safe working environment. These factors are high-performance workplace systems, leader–member exchange and autonomy, trust and empowerment, respectively. The framework demonstrates the important interactions between these factors and how they create a self-sustaining organizational safety system.

Conclusions: The framework aims to provide insight into the future development of interventions that are strategically aligned with the organization and target elements that facilitate and enhance driver safety and ultimately reduce work-related road traffic injury and death.     

Evaluating an intervention to improve belt fit for adult occupants: Promoting positive beliefs

IntroductionSeat belt use provides significant public health benefit, however, most public awareness campaigns have generally focused on seat belt use rather than encouraging adults to improve seat belt fit with belt placement. This study provides an evaluation of a video-based intervention to improve adult belt fit assessing whether a video-based intervention can target beliefs and knowledge of seat belt placement and be perceived as relevant by the target audience.MethodAn intervention group of 29 adults (15 women and 14 men) and a comparison group of 99 adults (41 women and 47 men) participated.ResultsThe intervention group had significantly more favorable beliefs around belt fit than the comparison group related to Health Belief Model constructs of higher self-efficacy, greater benefits, and fewer barriers. The intervention group was also significantly better at accurately drawing belt fit than the comparison group. The video intervention was described as relevant, interesting, and the intervention group favored the provision of a diverse sample of models in the intervention.ConclusionsOverall, the study provides insight into relevant target beliefs for an intervention focused on belt fit and suggests that a brief video-based intervention in the style of a public service announcement may be effective in promoting positive beliefs and knowledge around belt fit. Future efforts should confirm these findings with a larger sample size spanning multiple geographic and demographic areas.Practical applicationsThese findings can help better inform intervention initiatives to improve occupant belt fit.     

Actual safety performance of the Malaysian offshore oil platforms: Correlations between the leading and lagging indicators

IntroductionThis study establishes the correlations between performance of a set of key safety factors and the actual lagging performance of oil platforms in Malaysia, hence the relevance of the key safety factors in evaluating and predicting the safety performance of oil and gas platforms. The key factors are crucial components of a safety performance evaluation framework and each key safety factor corresponds to a list of underlying safety indicators.MethodIn this study, participating industrial practitioners rated the compliance status of each indicator using a numbering system adapted from the traffic light system, based on the actual performance of 10 oil platforms in Malaysia. Safety scores of the platforms were calculated based on the ratings and compared with the actual lagging performance of the platforms. Safety scores of two platforms were compared with the facility status reports' findings of the respective platforms.ResultsThe platforms studied generally had good performance. Total recordable incident rates of the platforms were found to show significant negative correlations with management and work engagement on safety, compliance score for number of incident and near misses, personal safety, and management of change. Lost time injury rates, however, correlated negatively with hazard identification and risk assessment. The safety scores generally agreed with findings of the facility status reports with substandard process containment found as a contributor of hydrocarbon leaks.ConclusionsThis study proves the criterion validity of the safety performance evaluation framework and demonstrates its usability for benchmarking and continuous improvement of safety practices on the Malaysian offshore oil and gas platforms.Practical applicationsThis study reveals the applicability of the framework and the potential of extending safety reporting beyond the few conventional lagging safety performance indicators used. The study also highlights the synergy between correlating safety factors to streamline safety management on offshore platforms.     

Benefactor or burden: Exploring the professional identity of safety professionals

IntroductionThe professional identity of safety professionals is rife with unresolved contradictions and tensions. Are they advisor or instructor, native or independent, enforcer of rules or facilitator of front-line agency, and ultimately, a benefactor for safety or an organizational burden? Perhaps they believe that they are all of these. This study investigated professional identity through understanding what safety professionals believe about safety, their role within organizations, and their professional selves. Understanding the professional identity of safety professionals provides an important foundation for exploring their professional practice, and by extension, understanding organizational safety more broadly.MethodAn embedded researcher interviewed 13 senior safety professionals within a single large organization. Data were analyzed using grounded theory methodology. The findings were related to a five-element professional identity model consisting of experiences, attributes, motives, beliefs, and values, and revealed deep tensions and contradictions. This research has implications for safety professionals, safety professional associations, safety educators, and organizations.     

An evaluation of Ontario's Group Education Session (GES) for license renewal of seniors aged 80 and above

IntroductionIn 1996, the Ministry of Transportation in Ontario (MTO) implemented the Group Education Session (GES), which is a mandatory license renewal program for drivers aged 80 and older. This study describes an evaluation of the GES to assess its impact on road safety in Ontario, as well as its effect on the safety of individual drivers who participated in the program.MethodsTime series analysis of senior driver records both before and after implementation of the GES, and logistic regression and survival analysis examining senior driver records prior to, and following, their participation in the GES.ResultsUsing time series analysis there is some evidence to suggest that the GES had a positive impact on road safety. According to the other analyses, participation in the GES is associated with a decrease in the odds of collisions and convictions, regardless of whether drivers pass their first attempt of the knowledge test or not. In addition, failing the first road test and/or having demerit points are strong indicators of future collision and conviction involvement.DiscussionResults from this evaluation suggest that the GES has had a protective effect on the safety of senior drivers.Practical ApplicationsThe findings and discussion will help MTO improve the GES program and provide insights to other jurisdictions that have, or are considering, introducing new senior driver programs.     

Leader communication approaches and patient safety: An integrated model

IntroductionLeader communication is known to influence a number of employee behaviors. When it comes to the relationship between leader communication and safety, the evidence is more scarce and ambiguous. The aim of the present study is to investigate whether and in what way leader communication relates to safety outcomes. The study examines two leader communication approaches: leader safety priority communication and feedback to subordinates. These approaches were assumed to affect safety outcomes via different employee behaviors.MethodQuestionnaire data, collected from 221 employees at two hospital wards, were analyzed using structural equation modeling.ResultsThe two examined communication approaches were both positively related to safety outcomes, although leader safety priority communication was mediated by employee compliance and feedback communication by organizational citizenship behaviors.ConclusionThe findings suggest that leader communication plays a vital role in improving organizational and patient safety and that different communication approaches seem to positively affect different but equally essential employee safety behaviors.Practical applicationsThe results highlights the necessity for leaders to engage in one-way communication of safety values as well as in more relational feedback communication with their subordinates in order to enhance patient safety.     

Determinants of safety outcomes and performance: A systematic literature review of research in four high-risk industries

IntroductionIn spite of increasing governmental and organizational efforts, organizations still struggle to improve the safety of their employees as evidenced by the yearly 2.3 million work-related deaths worldwide. Occupational safety research is scattered and inaccessible, especially for practitioners. Through systematically reviewing the safety literature, this study aims to provide a comprehensive overview of behavioral and circumstantial factors that endanger or support employee safety.MethodA broad search on occupational safety literature using four online bibliographical databases yielded 27.527 articles. Through a systematic reviewing process 176 online articles were identified that met the inclusion criteria (e.g., original peer-reviewed research; conducted in selected high-risk industries; published between 1980-2016). Variables and the nature of their interrelationships (i.e., positive, negative, or nonsignificant) were extracted, and then grouped and classified through a process of bottom-up coding.ResultsThe results indicate that safety outcomes and performance prevail as dependent research areas, dependent on variables related to management & colleagues, work(place) characteristics & circumstances, employee demographics, climate & culture, and external factors. Consensus was found for five variables related to safety outcomes and seven variables related to performance, while there is debate about 31 other relationships. Last, 21 variables related to safety outcomes and performance appear understudied.ConclusionsThe majority of safety research has focused on addressing negative safety outcomes and performance through variables related to others within the organization, the work(place) itself, employee demographics, and—to a lesser extent—climate & culture and external factors.Practical applicationsThis systematic literature review provides both scientists and safety practitioners an overview of the (under)studied behavioral and circumstantial factors related to occupational safety behavior. Scientists could use this overview to study gaps, and validate or falsify relationships. Safety practitioners could use the insights to evaluate organizational safety policies, and to further development of safety interventions.     

The effect of organizational justice as perceived by occupational drivers on traffic accidents: Mediating effects of job satisfaction

Introduction: Considerable research supports a positive association between the safety climate (which is a direct organizational factor) and safety performance (such as safe driving). However, indirect organizational variables that influence safe driving have gone largely unexplored. This study contributes to safety research by examining the relationship between organizational justice, which is a distal organizational factor, and traffic accidents and the mediating role of job satisfaction. Method: 233 occupational drivers employed by taxi and bus companies in South Korea participated in the study. Regression analysis was conducted using police records on participants' on-the-job traffic accidents. Results: The analysis shows that the mediation model is statistically significant. That is, drivers with a lower level of perceived organizational justice showed a higher frequency of traffic accidents, and the mediating effect of job satisfaction was also significant. Based on the results, implications and limitations are discussed. Practical applications: The findings demonstrate that in order to decrease traffic accidents, transportation companies would benefit by examining distal factors such as organizational justice. This approach suggests that the conventional framework for safety management should be broadened to include aspects of the entire organization.     

Impact of individual resilience and safety climate on safety performance and psychological stress of construction workers: A case study of the Ontario construction industry

IntroductionThe construction industry has hit a plateau in terms of safety performance. Safety climate is regarded as a leading indicator of safety performance; however, relatively little safety climate research has been done in the Canadian construction industry. Safety climate may be geographically sensitive, thus it is necessary to examine how the construct of safety climate is defined and used to improve safety performance in different regions. On the other hand, more and more attention has been paid to job related stress in the construction industry. Previous research proposed that individual resilience may be associated with a better safety performance and may help employees manage stress. Unfortunately, few empirical research studies have examined this hypothesis. This paper aims to examine the role of safety climate and individual resilience in safety performance and job stress in the Canadian construction industry.MethodThe research was based on 837 surveys collected in Ontario between June 2015 and June 2016. Structural equation modeling (SEM) techniques were used to explore the impact of individual resilience and safety climate on physical safety outcomes and on psychological stress among construction workers.ResultsThe results show that safety climate not only affected construction workers' safety performance but also indirectly affected their psychological stress. In addition, it was found that individual resilience had a direct negative impact on psychological stress but had no impact on physical safety outcomes.ConclusionsThese findings highlight the roles of both organizational and individual factors in individual safety performance and in psychological well-being.Practical applicationsConstruction organizations need to not only monitor employees' safety performance, but also to assess their employees' psychological well-being. Promoting a positive safety climate together with developing training programs focusing on improving employees' psychological health — especially post-trauma psychological health — can improve the safety performance of an organization.     

Mapping safety culture attributes with integrity management program to achieve assessment goals: A framework for oil and gas pipelines industry

Introduction: The safety of oil and gas pipelines is an increasing concern for the public, government regulators, and the industry. A safety management system cannot be efficient without having an effective integrity management program (IMP) and a strong safety culture. IMP is a formal document (policies, planning, scheduling, and technical processes) while safety culture is a measure of views, beliefs, and traditions about safety. For regulatory authorities and O&G companies, assessing the effectiveness of both the IMP and safety culture through regulatory audits is a daunting task with indistinct findings. Method: An integrated framework based on regulatory audits is developed to assess the maturity of safety culture based on IMP efficacy through risk-based approach by using failure mode and effect analysis (FMEA). The framework focuses on three distinct aspects, the probability of failure occurrence in case of the non-compliance of regulatory and program requirements, severity of non-compliance, and effectiveness of the corrective actions. Results: Program requirements and performance indicators are translated into assessment questions which are grouped into 18 IMP components. Subsequently, these components are linked with four safety culture attributes. Sensitivity analysis revealed that four IMP components, i.e., organizational roles and responsibilities, policy and commitment, risk assessment, and training and competency, significantly affect the safety culture maturity level. Conclusions: Individual assessment of IMP and safety culture in O&G sector consumes extensive time and efforts in the auditing process. The framework facilitates the process by pursuing common criteria between IMP and safety culture. The O&G companies and regulator can prioritize the improvement plans and guidelines using the framework's findings. Practicalapplications:The integrated framework developed in this research will improve the existing assessment mechanism in O&G companies. The framework has been effectively implemented on a case of 17 upstream O&G pipeline-operating companies in the province of British Columbia, Canada.     

Seeking to improve care for young patients: Development of tools to support the implementation of the CDC Pediatric mTBI Guideline

IntroductionThe Centers for Disease Control and Prevention (CDC) Pediatric Mild Traumatic Brain Injury (mTBI) Guideline was created to help standardize diagnosis, prognosis, and management and treatment of pediatric mTBI. This paper describes the process CDC used to develop educational tools, and a dissemination and implementation strategy, in support of the CDC Pediatric mTBI Guideline.MethodsTwo qualitative data collection projects with healthcare providers who care for pediatric patients were conducted. In-depth interviews were used in both projects. Project One examined healthcare providers' guideline use and dissemination preferences. Project Two assessed perceptions of the CDC Pediatric mTBI Guideline educational tools.ResultsProject One brought to light four key areas related to Guideline usage and dissemination preferences, specifically a need for: (1) partnership with professional medical societies; (2) integration into electronic health records, mobile apps, and websites; (3) development of continuing medical education (CME) opportunities; and (4) dissemination through healthcare system leadership. In Project Two, healthcare providers reported that the CDC Pediatric mTBI Guideline educational tools were well-organized, clear and easy to navigate, and informative. Healthcare providers also requested more information on the Guideline methodology.DiscussionAssessment of pediatric healthcare providers' current use of clinical guidelines and preferences for educational tools yielded important insights that helped inform CDC's dissemination and implementation strategy for the Pediatric mTBI Guideline.Practical applicationsThe findings from these data collection projects can also inform other guideline implementation and dissemination efforts among healthcare providers.     

Medical review process and license disposition of drivers referred by law enforcement in Virginia

IntroductionMedically at-risk drivers come to the attention of licensing authorities through referrals from a variety of sources, including: physicians, family members, court systems, and law enforcement. A recently sponsored project by the National Highway Traffic Safety Administration examined a training intervention for law enforcement to increase their awareness of medical conditions and medications that impair driving and the procedures for reporting these drivers in Virginia.MethodA component of this project included an evaluation of the medical review process and licensing outcomes for 100 drivers randomly selected from a pool of over 1,000 drivers referred from law enforcement officers to the Virginia Department of Motor Vehicles over a 6-month period in 2007 and 2008 prior to any training program intervention.ResultsKey findings from the evaluation of 100 drivers referred for medical review by law enforcement were as follows. Over two-thirds of the drivers came to the attention of the referring officer because they were involved in a crash. The most prevalent indications of a medical condition or functional impairment provided by law enforcement for these referrals were: loss of consciousness, blackout, or seizures (28%); disorientation, confusion, and mental disability (16%); and physical impairments (8%). Eighty-eight percent of the drivers received some type of licensing action (e.g., restriction, suspension, or periodic review). Only 12% of the referred drivers did not require any licensing action.ConclusionsLaw enforcement provides a vital role in the identification and referral of medically impaired drivers to licensing authorities for reexamination. Training programs can inform law enforcement officers of the signs of medical impairment (both on-road behavior, and physical and psychological clues once a driver has been pulled over), and procedures for reporting their observations and concern for safety to licensing authorities.Impact on IndustryReexamination of drivers with functional and medical impairments and any consequent restrictions and/or periodic reporting requirements can improve the safety and mobility of these drivers, and the motoring public as well.