A human factors and reliability approach to clinical risk management: Evidence from Italian cases

Similarly to the industrial sector in the late 1980s, nowadays leading organizations in the healthcare sector acknowledge the fact that human errors, adverse events and system failures must be managed and controlled. Whilst Human Reliability Analysis (HRA) has been well-accepted and integrated into safety management processes in other industries, the application of such error techniques to the problem of managing the associated risks in healthcare is rare. The main purpose of this research is to analyse clinical risk management (CRM) and patient safety improvement in Italian healthcare organizations, through human factors and human reliability theories. In particular, the specific objectives are to explore the Italian state-of-the-art in CRM, with regard to organizational and managerial issues; to identify and verify the factors influencing the growth and sharing of the safety culture and to understand and describe the possibility of transferring human reliability methodologies and theories to the domain of healthcare.Six case studies belonging to the Italian scenario have been performed, in order to describe the Italian healthcare system and to identify the key influencing factors of CRM policies.Results obtained from within and cross-case analysis give an empirical contribution to the recent introduction of CRM in the Italian context and a theoretical contribution referring to the framework used to analyse CRM in healthcare organizations, and to the indications which emerged on the key factors influencing CRM.     

Accounting for the quality of work life

This study describes the development and issuance of an independent report on the quality of work life in a Corporation. The theory underlying the report, criteria, definitions, measurement procedures, the properties of the measures, and report itself are presented. A survey indicating a favourable reception to the data by stockholders, financial analysts, and employees is analysed. Recommendations for increased collaboration between accountants and behavioural scientists in the measurement and assessment of the quality of work life are presented in an effort to stimulate further research in the development of standardized measures and in the preparation of independent reports on the quality of work life in organizations.     

The impact of a large‐scale traumatic event on individual and organizational outcomes: exploring employee and company reactions to September 11, 2001

Much of the literature on stress and organizational outcomes has focused on organizational factors and has ignored extraorganizational stressors that lead to perceived stress. However, research in other fields and recent studies in management suggests that acute‐extraorganizational stressors, such as traumatic events, may have potentially negative and costly implications for organizations. This study tests a theoretical model of traumatic stress and considers the relationship between strain from an acute‐extraorganizational stressor, the terrorist attack on September 11, 2001, and absenteeism. Using a sample of 108 MBA and MPA students, this study suggests that strain caused by an acute‐extraorganizational stressor can have important consequences for organizations. Namely, employees who report more strain from a traumatic life event are more likely to be absent from work in the weeks following the event. Copyright © 2002 John Wiley & Sons, Ltd.     

Macroergonomics and Total Quality Management: How to Improve Quality of Working Life?

Abstract

In this paper, we present a macroergonomic model of work design that is applied and tested to examine Total Quality Management (TQM) in the public sector. According to the model, TQM can influence different aspects of work design and quality of working life (QWL), Questionnaire data collected in 2 public sector organizations in the USA show that TQM can have both positive and negative impact on work design and QWL. The main positive impact of TQM was found on job content, job control and participation, and social relationships. The main negative impact of TQM was on workload, uncertainty, and clarity of job duties. The impact of TQM on QWL was mixed. Our results show that the impact of TQM on work design and QWL varied very much across the 6 participating departments, as well as within the departments. Further research is warranted to assess the human impact of TQM, in particular research on the linkage between various aspects of TQM, on one hand, and work design and QWL, on the other hand.     

Negotiating a flexible work arrangement: How women navigate the influence of power and organizational context

Prior work‐life research has highlighted that while organizations may be introducing more work‐life policies, organizational members are not necessarily using these policies. Empirical research is needed that focuses on the individual and provides insight into who is taking advantage of these policies and how they go about negotiating access. In this study, we explore this issue as we investigate the behavioral dynamics that underlie women's experiences negotiating a flexible work arrangement. Focusing on the individual, we examine the influence that perceptions of power and organizational work‐life support have on flexible work arrangement negotiations. The results of our research indicate that both macro level factors such as perceived work life support and micro level factors such as perceptions of power affect both the process and outcomes of these negotiations. We explore the implications these findings have for work‐life and negotiation research. Copyright © 2011 John Wiley & Sons, Ltd.     

Development of a 3D risk analysis technique for fire disaster and its application on accident simulation of a public site

In this research, we constructed a three-dimensional fire risk analysis technique (3D-FRAT) for common building fires. To demonstrate its effect, the 3D-FRAT employed a self-developed 3D risk-calculating module in combination with the Fire Dynamics Simulator (FDS) software to simulate the Welcome Restaurant accident that happened on February 15, 1995 in Taichung City, Taiwan. This study only focuses on thermal radiation and provide a preliminary method to quantify a fire risk. Different firefighting equipment that comply with the related building and fire-preventive regulations have been used in the simulations to test their mitigating effectiveness on the accident. The results were shown by animation, 3D pictures, and sliced pictures to facilitate the researchers’ understanding of human hazards caused by thermal radiation or smoke in a specific fire accident. The minimal personnel escaping times for different hazardous factors were estimated; various firefighting designs that can reduce loss of human life and property were also perused. According to the simulation results, the individual risk values in Welcome Restaurant were between 3.108 × 10⁻⁹ to 2.719 × 10⁻⁵ (deaths/year). It is foreseeable that the 3D-FRAT can become a useful tool for related organizations to choose better fire-resistant buildings or fire-fighting equipment in the future.     

Changes in production concepts emphasize problems in work-related well-being

Recurrent changes in work life, although necessary for competitive and financial reasons, seem to increase time pressure, stress, health complaints and safety problems of workers. The dynamics of recent workplace transformations are not sufficiently understood from the perspective of everyday work, particularly by health and safety experts. In this paper, the Activity Theoretical Approach is used to reconceptualize work-related well-being in situations of rapid change. The key concepts in this paper are production and service concepts and their asynchronies. Many asynchronies were observed in the analysis of the two cases of different types of organizations. These asynchronies are a major challenge for experts on well-being, especially since continuous change has now become an inseparable part of work life.     

Villains,victims, and heroes: Accounting for the roles human activity plays in LOPA scenarios

When a team is analyzing a LOPA scenario, the team needs to consider all three roles played by human interaction in the scenario: that of cause, as a result of human error; that of receptor, both in terms of safety impacts (inside the fence line) and community impacts (outside the fence line); and that of independent layer of protection (IPL), considering both administrative controls and human responses. Frequently, the nature of these three roles are inter-related, and setting guidance that is internally consistent is important to using LOPA to assess risk rather than as a means to game the analyses to simply achieve a wished-for result.A number of criteria have been proposed to quantify human involvement, typically as cause, as receptor, or as IPL. Establishing a framework to look at all three in a unified way is more likely to result in analyses that are consistent from scenario to scenario.This paper describes such a framework and presents it in a way that allows organizations to review their own criteria for quantifying human involvement in LOPA. It also examines some of the published LOPA criteria for human involvement and looks at them in terms of consistency of approach between evaluation of cause, receptor, and IPL. Finally the paper makes suggestions to use in calibrating LOPA methodologies to achieve consistent and believable results in terms of human interaction within and between scenarios that have worked for other organizations.     

The impact of preventive coping on business travelers' work and private life

Frequent business travel can be a burden for travelers' work and private life. We tested whether preventive coping (the proactive accumulation of resources in advance of potential stressors) makes such trips beneficial despite their potential to be stressful. In a longitudinal three‐wave study, we investigated whether frequent travel relates to an increase or decrease in work–life balance, emotional exhaustion, work engagement, and relationship satisfaction depending on preventive coping. Findings from a sample of 133 frequent business travelers revealed significant indirect effects for emotional exhaustion, work engagement, and relationship satisfaction through work–life balance. Among employees who engaged less in preventive coping, a higher number of business trips was related to a decrease in work–life balance, which, in turn, was related to more emotional exhaustion, less work engagement, and lower relationship satisfaction. Among those who reported higher preventive coping, we found opposing indirect effects: Frequent travel was related to an increase in work–life balance and, in turn, to less emotional exhaustion, more work engagement, and higher relationship satisfaction. These findings advance our knowledge in the field of business travel, future‐oriented coping, and work–life balance. They highlight that travelers and their organizations should resort to preventive coping to make frequent travel more beneficial.     

Union loyalty among white-collar workers in Japan

Previous research on Japanese union members has documented occupational differences in employees' attitudes toward union organizations (Japan Productivity Center, 1990; Morishima, 1993). Yet, little has been done to examine why these differences occur. This study examines, using a data set obtained in 1987 from about 4000 employees, the correlates of union loyalty across white-collar and blue-collar occupations, and among white-collar occupations. A model is developed from previous research on employees' attitudes toward union organizations and on Japanese industrial relations. The results obtained by OLS analyses of union loyalty correlates—members' judgements of union contributions to improvements in employment outcomes and of employers' human resource policies—indicate that Japanese unions have benefited mainly blue-collar workers and traditional white-collar workers, such as those in administrative positions, relative to those in technical positions.     

伤亡事故中生命经济价值估算研究

伤亡赔偿标准由于人的年龄、经历、工作等的不同而不同。本文参考国内外相关资料后,在人人平等的基础上区分了不同人的生命价值,设计的估算方法基本包含了各个年龄段的人的生命价值。估算结果仅适用于事故和不可抗力造成的伤亡情况,不适用于故意伤害谋杀等犯罪活动造成的伤亡。生命价值没有上限只有下限,使生命经济价值的估算值有较大提高,这对提高伤亡赔偿标准,对提高人们对生命价值的认识都有一定的价值。     

Leading indicators of safety in virtual organizations

A primary purpose in measuring safety is to develop intervention strategies to avoid future accidents. Recognizing signals before an accident occurs offers the potential for improving safety, and many organizations have sought to develop programs to identify and benefit from alerts, signals and prior indicators. In this paper, we address the challenge of identifying and evaluating leading indicators of safety in virtual organizations–organizations comprised of multiple, distributed members, temporarily linked together for competitive advantage, that share common value chains and business processes supported by distributed information technology. We begin by discussing risk propensity in virtual organizations and leading indicators of safety. We then describe a pilot study to identify leading indicators for one safety-critical system, and use the results of that study and the literature just described to propose an approach to developing leading indicators in virtual organizations.     

The context and habits of accident investigation practices: A study of 108 Swedish investigators

The context and habits of accident investigation practices were explored by means of questionnaire data obtained from accident investigators in the healthcare, transportation, nuclear and rescue sectors in Sweden. Issues explored included; resources, training, time spent in different phases of an investigation, methods and procedures, beliefs about causes to accidents, communication issues, etc. Examples of findings were: differences in the extent to which the ‘human factor’ was perceived as a dominant cause to accidents; manning resources to support investigations were perceived as rather scarce; underutilization of data from safety related processes such as risk analysis and auditing data; the phase of suggesting remedial actions (recommendations) were comparatively brief and generally not well supported. A majority of the investigators thought that the investigations were free from pressures to follow a specific direction; the investigators also thought that performing an investigation in itself (regardless of the specific results) had positive influences on safety. A majority of the investigators thought that upper management had a relatively strong influence on safety in the organizations. The results are discussed in terms of suggestions for strategies to strengthen investigation practices – particularly those conducted as part-time work in organizations.     

核电站事故前人因可靠性分析方法

人因可靠性分析 (HRA)已成为概率安全分析 (PSA)必不可少的内容 ,事故前人因事件可靠性分析对有效预防维修、调校工作中的人因失误有着重要作用 ,是人因可靠性分析的重要组成部分 ,对PSA最终计算结果有重要影响。笔者结合核电站人因可靠性分析的实际需求 ,运用了以THERP为主的人因失误概率评价方法 ,创建了事故前人因事件分析的基本程序、方法及分析文档模式 ,表述了程序化的事故前人因事件分析模式 ,为我国核电站事故前人因可靠性分析提供了完整和有效的分析方法 ,并有效用于秦山核电站的PSA。     

Rail ruminations for process safety improvement

Process safety practices have undergone multiple refinements over the past few decades, but major accidents continue to occur. Most organizations strive to improve performance by strengthening existing methods or by adopting new and/or different approaches. Central to these continual improvement efforts is the practice of applying lessons learned as a means to drive out potential risk exposures. Often, lessons learned may be transferred from other industries; indeed, high-performing organizations regularly benchmark practices outside of their immediate industry.In pursuit of continual process safety improvement, this paper examines risk management practices in the Rail Industry, and explores how methods intended for managing passenger and public rail safety may be transferred to drive continual improvement of process safety. Rail safety has its roots in engineered safety solutions; modern practices have additionally embraced the human aspects of safety performance. A selection of approaches for rail safety assessment and risk management are described in three areas considered fundamental to safety management: management of systems, management of technology, and management of human elements. In light of these examples, the authors provide views regarding how the field of process safety management may leverage the rail experience.     

Evolution of working conditions under the impact of ICTs

IntroductionInformation and communication technologies (ICTs) play a major role in the current evolution of work. They are both a great tool for emancipating human beings from the most tedious and most dangerous tasks and an effective vector for intensifying work.MethodsOn the basis of three foresight exercises carried out in recent years and by describing concrete examples of work organizations, the authors highlight the main possible trends for the changes to come.ConclusionsThey conclude on a few general principles that could allow the establishment of a win–win policy.     

基于人因失误分析的医院电气安全管理研究

医院是重点用电单位,用电的安全性和供电可靠性都比较高,但因不可抗力、供电系统故障、医院管理问题、人为失误等方面的原因,仍存在发生各类电气突发事件的风险。其中,由人的误操作或不安全行为因素而诱发的电气方面的突发事件已成为医院非医疗事故的主要原因。文章针对医院电气安全操作方面的人因失误,从个人和组织两个角度进行了失误原因的分析,认为人的失误既受个体因素的影响,也受环境、制度和管理水平的影响。在此基础上,提出完善相关规章制度建设、加强教育与培训等,从组织制度建设、人员技术素质提高等方面,提出预防与减少人因失误的措施与方法,提高供配电质量,为医院医疗工作提供有效的电气安全后勤保障。     

From job-based to competency-based organizations

The efficacy of designing organizations around job structures is challenged. Although this approach has dominated the fields of organizational behavior and human resource management for decades, a number of forces have converged to suggest that a competency-based approach often is more appropriate. In the global competitive environment which large, complex organizations face, the competency-based approach and the capabilities that individuals need to acquire and develop should be the major focus. Reward systems, career tracks, selection systems, and the structure of organizations need to change to focus on competencies. The challenges and opportunities for research, theory, and practice development that a change to a competency-based approach raises are many and diverse. For example, new pay systems are needed, new selection systems are needed, indeed whole new concepts about what constitutes selection validity and career development are needed.     

A systemic methodology for risk management in healthcare sector

The recent biomedical, technological, and normative changes have led healthcare organizations to the implementation of clinical governance as a way to ensure the best quality of care in an increasingly complex environment. Risk management is one of the most relevant aspects of clinical governance and approaches put forward in literature highlight the necessity to perform comprehensive analyses intended to uncover root causes of adverse events.Contributing to this field, the present paper applies Reason’s theory of failures to work out a systemic methodology to study risks impacting not only directly but also indirectly on patients. Also, the steps of such approach are organized around Human Reliability Assessment phases, in order to take into account the human component of healthcare systems. This framework is able to foster effective decision making about reducing failures and waste and to improve healthcare organizations’ maturity towards risk management.The developed methodology is applied to the pharmacy department of a large Italian hospital. An extensive validation in different healthcare settings is required to fully prove benefits and limitations.     

Organizational antecedents and outcomes of job insecurity: a longitudinal study in three organizations in Finland

The aim of the study was to examine perceived job insecurity and its organizational antecedents and outcomes within a one‐year time period. The study was carried out by means of questionnaires, which were responded to twice, in 1995 (Time 1) and 1996 (Time 2), by employees in three organizations: a factory, a bank, and a municipal social and health care department. The present article is based on the data of those employees (n=210) who participated in the study in both years. The results indicated that perceived job insecurity varied with gender and organization, but not with time. In particular, female employees in the bank reported a high level of job insecurity compared with men. The use of a restorative strategy by management at Time 1 decreased job insecurity at Time 2, whereas job insecurity at Time 1 weakened the quality of human relations and perceived efficiency within the organizations at Time 2. Copyright © 2000 John Wiley & Sons, Ltd.