Identifying common problems in the acquisition and deployment of large-scale,safety–critical,software projects in the US and UK healthcare systems

Public and private organisations are investing increasing amounts into the development of healthcare software. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardized procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the safety concerns that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail of electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of healthcare information systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems.     

Estimated trends and patterns of road traffic fatalities in China, 2002–2012

Objective: This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002–2012. Methods: Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years. Results: RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20–24, 40–49, and 55–64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011–2012. Conclusions: RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.     

The role of drug and alcohol use and the risk of motor vehicle crashes in Shiraz,Iran, 2014: A case–crossover study

Background: Traffic accidents and traffic-related injuries and mortality have become a major public health concern in Iran. This study aimed to examine the role of drug and alcohol use in motor vehicle accidents in Iran.

Methods: This case–crossover study was conducted on 441 drivers who survived a road traffic crash and were taken to the emergency department of Shahid Rajaee trauma hospital in Shiraz, southern Iran. Data were collected using checklists that included demographic characteristics and drug and alcohol use prior to driving. Alcohol and drug use was identified through self-report, and cannabis, morphine, and methamphetamine urine tests were used to confirm drug abuse among drivers.

Results: In total 17.9% of drivers reported using drugs (cannabis, opium, or metamphetamine) and 8.84% of drivers reported consuming alcohol prior to the collision. The crude odds ratios (ORs) for having a crash for opium, cannabis, and metamphetamine were 1.94 (95% interval confidence [CI], 1.11–3.38), 2.37 (95% CI, 1.03–5.42), 5.5 (95% CI, 1.21–24.81), respectively, and for all drugs was 3.83 (95% CI, 2.28–6.43). The OR for alcohol was 3.5 (95% CI, 1.73–7.06) based on self-report.

Conclusion: Drug and alcohol use are increasing the risk of traffic crashes in Iran. Risk-reducing programs must be designed and implemented.     

Characteristics of vehicles driven by teens and adults killed in crashes, 2013–2017

Introduction: Teen drivers experience higher crash risk than their experienced adult counterparts. Legislative and community outreach methods have attempted to reduce this risk; results have been mixed. The increasing presence of vehicle safety features across the fleet has driven fatality numbers down in the past decades, but the disparity between young drivers and others remains. Method: We merged Fatality Analysis Reporting System (FARS) data on fatal crashes with vehicle characteristic data from the Highway Loss Data Institute (HLDI). The analysis compared the vehicle type, size, age, and the presence of select safety features in vehicles driven by teens (ages 15–17 years) and adult drivers (ages 35–50 years) who were killed in crashes from 2013 to 2017. Results were compared with a similar analysis conducted on data from 2007 to 2012. Results: Teen drivers were more likely than their adult counterparts to be killed while driving older, smaller vehicles that were less likely to have the option to be equipped with side airbags. Discussion: Teenage drivers remain more likely to be killed while driving older, smaller vehicles than adult drivers. Parents and guardians are mainly responsible for teen vehicle choice, and should keep vehicle size, weight, and safety features in mind when placing their teen in a vehicle. Practical Application: These findings can help guide safer vehicle choice for new teen drivers.     

Conflict,justice, and inequality: Why perceptions of leader–member exchange differentiation hurt performance in teams

To better understand why leader–member exchange (LMX) differentiation in teams may be detrimental to individual and team performance, we propose that team members' perception of LMX differentiation (PLMXD) is more important than statistical measures of LMX differentiation. Specifically, we hypothesize a multilevel model in which relationship conflict and procedural justice (climate) mediate the relationships of individual and collective PLMXDs with individual and team performance, respectively. Using a sample of 235 individuals in 53 teams, we found that individual PLMXD was negatively related to individual performance through relationship conflict perceptions, controlling for LMX. At the team level, collective PLMXD was negatively related to team performance through procedural justice climate and relationship conflict, controlling for a statistical measure of LMXD. Theoretical implications and directions for future research are explored.     

Prevalence and characteristics of road traffic injuries among young drivers in Oman, 2009–2011

Objectives: Studies from different parts of the world have indicated that the impact of road traffic incidents disproportionally affects young adults. Few known studies have been forthcoming from Arabian Gulf countries. Within Oman, a high proportion of the population is under the age of 20. Coupled with the drastic increase in motorization in recent years, there is a need to understand the state of road safety among young people in Oman. The current research aimed to explore the prevalence and characteristics of road traffic injuries among young drivers aged 17–25 years.

Methods: Crash data from 2009 to 2011 were extracted from the Directorate General of Traffic, Royal Oman Police (ROP) database in Oman. The data were analyzed to explore the impact of road crashes on young people (17–25 years), the characteristics of young driver crashes, and how these differ from older drivers and to identify key predictors of fatalities in young driver crashes.

Results: Overall, young people were overrepresented in injuries and fatalities within the sample time period. Though it is true that many young people in crashes were driving at the time, it was also evident that young people were often victims in a crash caused by someone else. Thus, to reduce the impact of road crashes on young people, there is a need to generally address road safety within Oman. When young drivers were involved in crashes they were predominantly male. The types of crashes these drivers have can be broadly attributed to risk taking and inexperience. Speeding and nighttime driving were the key risk factors for fatalities.

Conclusion: The results highlight the need to address young driver safety in Oman. From these findings, the introduction of a graduated driver licensing system with nighttime driving restrictions could significantly improve young driver safety.     

Calorimetry studies of ammonium nitrate – Effect of inhibitors,confinement, and heating rate

Ammonium nitrate (AN) has been widely used as a fertilizer for almost a century because it is an excellent nitrogen source. However, AN related explosions continue to occur time and again, despite the fact that AN has been extensively investigated. There have been more than 70 AN-related incidents during the last century, which reemphasize the dire need for further research on AN reactive hazards. This research focuses on the alternatives to make AN safer as a fertilizer by reducing its explosivity, by studying the effect of inhibitors, confinement, and heating rate on AN thermal decomposition using the Reactive Systems Screening Tool (RSST). First, the thermal decomposition of AN in the presence of different types of additives, including sodium bicarbonate, potassium carbonate, and ammonium sulfate, was studied under two concentrations, i.e., 2.8 wt.% and 12.5 wt.%. The results show that they are good inhibitors for AN. Second, the effect of confinement was tested by observing AN decomposition under five different initial pressures, varying from ambient pressure to 187 psig. It is concluded that confinement is dangerous to AN, which should be avoid in AN storage and transportation. Lastly, the effect of heating rate was studied by heating up AN under two heating rates of 0.25 °C min⁻¹ and 2 °C min⁻¹. The lower the heating rate, the lower the “onset” temperature detected.     

Ergonomics and Quality Management—Humans in Interaction With Technology,Work Environment,and Organization

Abstract

In many studies, ergonomics has been shown to influence human performance. The aim of this paper was to demonstrate imp ortan t ergonomics influences on quality in industrial production, from the perspective of interactions between humans, technology, organization, and work environment. A second aim was to elab orate on the implications of these findings for the development of quality management strategies. This paper shows that ergonomics problems in terms of adverse work environmental conditions, in appropriate design of technology, and an unsuitable org an izatio n are important causes of quality deficiencies. Problem solving aimed at improving ergonomics, quality, and productivity simultaneously is likely to obtain sup po rt from most of the interest parties of the company, and may also enhance participation. Ergonomics has the potential of becoming a driving force for the development of new quality management strategies.     

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.     

Effects of controller-pilot communication medium,flight phase and the role in the cockpit on pilots’ workload and situation awareness

This study explores the effects of communication medium, flight phase, and the role in the cockpit on pilots’ workload and situation awareness. Eight pilots with the experience of Controller-Pilot Data Link Communications (CPDLCs) participated in this simulated experiment. Two types of communication medium (voice and datalink), three types of flight phase (departure, cruise, and arrival), and two types of role (pilot flying and pilot non-flying) were investigated in the experiment. The results indicated that flight phase is a significant factor and cruise is the most suitable phase for datalink use on pilots’ acceptance, workload, and situation awareness performance. Both medium and role were not the significant factors. Since there is no significant difference on medium when no extra tasks and interferences involved in a normal flight, that the use of CPDLC can be justified during all phases of a no-event flight. In addition, the results of usability indicated that the simulated CPDLC with command selection functions proposed in this study provides good utility for the participants. In order to use the CPDLC for all phases of flight in the future, adding more command selection functions in place of typing messages by pilots and accommodating appropriate interfaces for different phases are recommended to enhance the usability of the CPDLC unit.     

Cultural Ergonomics in Ghana,West Africa: A Descriptive Survey of Industry and Trade Workers’ Interpretations of Safety Symbols

Globalization and technology transfer have led to the diffusion of risk communications to users from cultures that were not initially viewed as the target users. This study examined industry and trade workers’ overall impressions of symbols used to convey varying degrees of hazardousness. Six symbols, including symbols from the American National Standards Institute (ANSI) Z535 Standard (ANSI, 1998) and the International Organization for Standardization (ISO) 3864:1984 Standard (ISO, 1984) were selected. With the exception of the SKULL symbol, results showed wide discrepancies between users’ perceptions of the symbols and their intended meanings. Implications for cross-cultural research on warning components and risk communications are discussed.     

The injury epidemiology of adult riders in vehicle-two-wheeler crashes in China,Ningbo, 2011–2015

Introduction: We used road crashes between vehicles and two-wheelers from Yinzhou District Ningbo in 2011–2015 from the China In-depth Accident Study (CIDAS) as sample cases. The risk factors of different injury severity grades were analyzed. Method: The classification tree model was used to screen the possible interaction items, and the corresponding regression model was constructed according to the results of the tree model to explore the influencing factors of cyclist injury. Results: The road types, weather types, gender, age of the riders, and vehicle speed were significantly correlated with the dependent variables. The interaction effect of gender*road type, weather*age, weather*speed and speed*age were obtained through a tree model. Conclusions: The risk of male casualties at the crossroads was 3.31 times higher than that of female casualties at the straight roads. On sunny days, the risk of crash casualties in Ningbo was low, and the fatality risk when the speed reached 38 km/h was 10%. Under the interaction effect of weather and age, the fatality risk in cloudy/foggy and rainy days was almost coincident, and the serious risk in cloudy/foggy conditions was the highest. Practical applications: Through factor analysis, it is confirmed that there is interaction effect among the factors, and it can provide reference for relevant departments to formulate more targeted and effective governance strategies.     

Tired of innovations? Learned helplessness and fatigue in the context of continuous streams of innovation implementation

The business environment faced by contemporary organizations is highly uncertain and constantly changing. Thus, organizations have adopted and implemented a continuous stream of innovations to achieve sustainable growth and survival. Considering the demand for additional resources to implement innovations, the present study explores organizational conditions that may lead to innovation‐targeted burnout and fatigue among employees, which impede their active participation in a subsequent innovation. To this end, we propose a theoretical framework that elucidates the effects of previous innovations on the subsequent implementation behavior of employees. We identify two dimensions of the cognitive appraisal of previous innovations (i.e., intensity and failure) that shape employees' beliefs regarding innovations, such as innovation‐targeted helplessness, which ultimately results in innovation fatigue. Data collected from 84 managers and 397 employees of Chinese and Korean organizations prove the significant role of employee perceptions of previous innovations in shaping the innovation‐targeted helplessness and fatigue of employees, which ultimately affect employee behavior toward a subsequent innovation. The present conceptual and empirical analyses suggest that given continuous streams of innovation implementation, managers should carefully consider employee's perceptions of previous innovations (i.e., intensity and failure) for successful implementation of a subsequent innovation. Copyright © 2017 John Wiley & Sons, Ltd.     

Gender differences in public office workers’ satisfaction,subjective symptoms and musculoskeletal complaints in workplace and office environments

This study investigates differences between male and female public office workers’ satisfaction levels, sick building syndrome (SBS) symptoms and musculoskeletal disorder (MSD) complaints in workplace and office environments. Questionnaire surveys were performed in 30 offices from 15 public institutions. Male and female workers of the same age were coupled and selected from each office, gathering a total of 120 male and 120 female subjects. The results show that differences exist between genders in noise and lighting satisfaction levels, SBS-related symptoms (eye, nose, skin) and MSD complaints of hand/wrist/finger, while there is no difference in overall satisfaction level of office environments. The study also suggests that office design for public office workers should take into account gender differences in preventing MSDs and also SBS. The findings of this study are expected to serve as basic data for designing effective public office environments.