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 safety counterculture challenge to a “safety climate”

This case study is about a small group of workmen caught in a common dilemma regarding work safety. They must work safely and maintain production within a pathological organization that does not meaningfully reward participation or communication. They do so as a group and socially construct danger, injury and safety for themselves. They constitute a functioning counterculture and challenge the safety climate contrived by managers. Although limited in scope, the study suggests that we can learn from the details of their interactions with their work environment, with one another, and with their managers.     

Safety climate: Leading or lagging indicator of safety outcomes?

This paper theorizes how and why safety climate can be conceived as both a leading and a lagging indicator of safety events (i.e., accidents, injuries). When safety climate is conceived as a leading indicator, a prospective design is utilized and safety climate data are correlated with accidents/injuries that occur in the future. When safety climate is conceived as a lagging indicator, retrospective designs are used in which safety climate data are correlated with prior accidents/injuries. We examine the research literature to reveal that safety climate has been investigated as both a leading and a lagging indicator, but it is usually only examined as one or the other within a given study and has been examined as a lagging indicator most frequently. Consistent with our theorizing, prospective designs yield stronger relationships than retrospective designs, suggesting that safety climate is a better leading indicator than lagging indicator; however, it is clearly both. Implications for safety climate research and study design 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.     

An investigation of the relationship between organizational climate and professional drivers’ driver behaviours

The aim of this study was to investigate the relationship between organizational climate and driver behaviours of professional drivers. The sample consisted of 230 male professional drivers. The participants completed a questionnaire including the Driver Behaviour Questionnaire (DBQ), Hofstede’s Organizational Culture Scale, and a background information form. Results of the factor analysis of Hofstede’s Organizational Culture Scale yielded two dimensions, which were named as “work orientation” and “employee consideration”. Analyses of Covariance (ANCOVA) revealed significant main and interaction effects of organizational climate on errors, and violations after controlling for the statistical effects of age, annual mileage and the organization types. Drivers with low scores of work orientation reported significantly higher frequencies of errors and violations than drivers with high scores of work orientation. It was also found that drivers with low scores of employee consideration reported higher frequencies of errors and violations than drivers with high scores of employee consideration. The effect of interaction between work orientation and employee consideration dimensions was only found on the frequencies of violations.     

Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries?

PROBLEM: Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. METHOD: A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. RESULTS: Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.     

Can level of safety climate predict level of orientation toward safety in a decision making task?

Establishing the relationship between level of safety climate and safety performance is a current challenge. This work examines the relationship between level of safety climate and orientation toward safety in the decision making process and choice. Alternatively, this work seeks to answer the question of whether level of safety climate can predict safety-oriented decision making. A generalized safety climate questionnaire and a decision making simulation are utilized to examine this relationship. The results indicate that level of safety climate is not a significant predictor of the decision process; however, it was found to be a significant predictor of the selection of safer choices.     

A ventilation cooling shirt worn during office work in a hot climate: cool or not?

The aim of the study was to identify whether a ventilation cooling shirt was effective in reducing heat strain in a hot climate. Eight female volunteers were exposed to heat (38?°C, 45% relative humidity) for 2?h with simulated office work. In the first hour they were in normal summer clothes (total thermal insulation 0.8?clo); in the second hour a ventilation cooling shirt was worn on top. After the shirt was introduced for 1?h, the skin temperatures at the scapula and the chest were significantly reduced (p?<?0.05). The mean skin and core temperatures were not reduced. The subjects felt cooler and more comfortable by wearing the shirt, but the cooling effect was most conspicuous only during the initial 10?min. The cooling efficiency of the ventilation shirt was not very effective under the low physical activity in this hot climate.     

Educational status and organizational safety climate: Does educational attainment influence workers’ perceptions of workplace safety?

From a practical perspective, understanding the impact of education on perceptions of workplace safety would benefit management’s decisions regarding workers’ adaptability, general work effectiveness, accident frequency, implementation of safety management policies, and handling of education-related accident characteristics. The current study thus examined the relationship between educational attainment and (i) safety perception, (ii) job satisfaction, (iii) compliance with safety management policies, and (iv) accident frequency. Participants were Ghanaian industrial workers (N = 320) categorized into four educational groups based on their responses: basic education 50% (n = 159); secondary education, n = 98 (30%); vocational/professional education, 17% (n = 56); and university education, 3% (n = 7). Workplace safety perception was assessed with Hayes et al.’s 50-item Work Safety Scale (WSS): a scale that effectively captures the dimensions identified by safety experts to influence perceptions of workplace safety. Multivariate analysis (MANOVA) was used to test for differences of statistical significance. Posterior comparison with t-test consistently revealed significant differences between the two higher-educated cohorts and their lower-educated counterparts. The results indicated a positive association between education and safety perception. Higher-educated workers recorded the best perceptions on safety, indicated the highest level of job satisfaction, were the most compliant with safety procedures and recorded the lowest accident involvement rate.     

What signals does procedural justice climate convey? The roles of group status,and organizational benevolence and integrity

We propose and test a theoretical framework to explore why and how procedural justice climate influences individual behaviors after controlling for the influence of individual justice perception. Two types of symbolic information conveyed by procedural justice climate are considered. We argue that procedural justice climate reflects the status of or respect for a justice recipient, a work unit within an organization in our context, which then influences the identification of its members with the work unit. Procedural justice climate also reflects the moral attributes of a justice actor, herein an organization, which then influences organizational identification and perceived job security. Consistent with these arguments, results showed that perceived respect for the work unit mediated the relationship between procedural justice climate and identification with the work unit, and both perceived organizational benevolence and integrity mediated the relationship of procedural justice climate with organizational identification and job security. The two types of social identification and perceived job security were related to several outcome variables differently. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

How do organizational practices relate to perceived system safety effectiveness? Perceptions of safety climate and co-worker commitment to safety as workplace safety signals

Introduction: Integrating safety climate research with signaling theory, we propose that individual perceptions of safety climate signal the importance of safety in the organization. Specifically, we expect that three work-related organizational practices (training effectiveness, procedure effectiveness, and work pressure) relate to the broader risk control system in the workplace via individual perceptions of safety climate as a broad management signal. Further, we expect this broad management signal interacts with a local environmental signal (co-worker commitment to safety) to amplify or diminish perceived system safety effectiveness. Method: In a field study of oil and gas workers (N = 219; Study 1), we used mediation modeling to determine the relationships between work-related organizational practices, perceived safety climate, and perceived safety system effectiveness. In a field study of railway construction workers (N = 131; Study 2), we used moderated mediation modeling to explore the conditional role of co-worker commitment to safety. Results: We found that training effectiveness, procedure effectiveness, and work pressure predicted perceived system safety effectiveness indirectly via perceived safety climate (Studies 1 and 2) and that these indirect paths are influenced by co-worker commitment to safety (Study 2). Conclusions: Findings suggest that perceived safety climate is driven in part by work practices, and that perceived safety climate (from managers) and co-worker commitment to safety (from the local environment) interact to shape workplace safety system effectiveness. Practical applications: The insight that training, procedures, and work pressure are meaningful predictors of perceived safety climate as a signal suggests that organizations should be cognizant of the quality of work-related practices for safety. The insight we offer on the competing versus complimentary nature of managerial safety signals (perceived safety climate) and co-worker safety signals (co-worker commitment to safety) could also be used by safety personnel to develop safety interventions directed in both areas.     

Safety climate dimensions,leader–member exchange,and organizational support as predictors of upward safety communication in a sample of rail industry workers

The freedom employees feel to communicate safety concerns with their supervisors, termed upward safety communication, has been shown to be related to adverse safety events (Hofmann and Morgeson, 1999). Research to date has demonstrated that good supervisor–employee relationships (leader–member exchange), a sense that the organization values an employee (perceived organizational support) and safety climate (including perceived management attitudes toward safety, job demands interfering with safety, and pressure from coworkers to behave safely) all contribute to employees’ comfort in bringing up safety issues with their supervisors. However, little is known about which specific dimensions of safety climate are most predictive of upward safety communication. Using a sample of 548 railway workers, we found that when all factors were considered simultaneously using dominance analysis, the dominant factor predicting upward safety communication was perceived management attitudes toward safety, followed by job demands interfering with safety and then leader–member exchange. Implications for research and practice are discussed.     

What is most important for safety climate: The company belonging or the local working environment? – A study from the Norwegian offshore industry

Obtaining knowledge about factors affecting health, safety and environment (HSE) is of major interest to the petroleum industry, but there is currently a severe shortage of relevant studies. The aim of this study was to examine the relative influence of offshore installation (local working environment) and company belonging on employees’ opinions concerning occupational health and safety. We analyzed data from a safety climate survey answered by 4479 Norwegian offshore petroleum employees in 2005 on the dimensions “Safety prioritisation”, “Safety management and involvement”, “Safety versus production”, “Individual motivation”, “System comprehension” and “Competence” using one way analysis of variance (ANOVA), effect size and mixed model. The companies differed significantly for “Safety prioritisation”, “Safety versus production”, “Individual motivation”, “System comprehension” and “Competence”. The local offshore installation explained more of the safety climate than the company they were employed in or worked for did.