Level Of Safety Climate Research Articles

Association between safety leading indicators and safety climate levels

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

Evaluating the Safety Climate of Ethnic Minority Construction Workers in Hong Kong

The Hong Kong construction industry is facing a severe labour shortage due to an ageing workforce and a lack of new entrants, even at a time of construction boom. To improve this situation, ethnic minorities (EMs) have been attracted to join the construction industry. In many developed countries, however, some unofficial statistics show that EMs suffer higher fatality rates than their local counterparts. It is clear that the safety of ethnic minority (EM) construction workers requires more attention. The objectives of this study, therefore, were to evaluate the safety climate among EM construction workers in Hong Kong, to predict the impact of safety climate factors as they affect the likelihood of injury occurrences and to determine the relationships between safety climate and the safety performance of EM workers. A questionnaire survey was administrated to Pakistani and Nepalese construction workers in Hong Kong. The results revealed that the overall average safety climate score for both EM groups was not very high and that the Pakistani worker scores were higher than the Nepalese worker scores. EM frontline-workers scored less than EM supervisors and managers. Among seven safety climate factors, Workers personal involvement in safety and health (F5) was ranked highest and Perception of safety rules and regulations (F4), was ranked lowest. Risk taking behaviour and perception of work risk (F3) and Workers personal involvement in safety and health (F5) were identified as significant predictors of injury occurrence. Furthermore, the safety climate was significantly associated with the degree of safety participation and safety compliance. It was expected that the findings of the study would provide an insight into the level of safety climate among EM workers, enabling organizations and practitioners around the world to improve safe working among EM workers.

Nurse perceptions of safety climate in Australian acute hospitals: a cross-sectional survey.

Objectives The aim of the present study was to explore nurse perceptions of safety climate in acute Australian hospitals. Methods Participants included 420 nurses who have worked on 24 acute wards from six Australian hospitals. The Safety Attitudes Questionnaire (SAQ) Short Form was used to quantify nurse perceptions of safety climate and benchmarked against international data. Generalised linear mixed models were used to explore factors that may influence safety climate. Results On average, 53.5% of nurses held positive attitudes towards job satisfaction followed by teamwork climate (50.5%). There was variability in SAQ domain scores across hospitals. The safety climate and perceptions of hospital management domains also varied across wards within a hospital. Nurses who had worked longer at a hospital were more likely to have poorer perceptions of hospital management (β=-5.2; P=0.014). Overall, nurse perceptions of safety climate appeared higher than international data. Conclusions The perceptions of nurses working in acute Victorian and New South Wales hospitals varied between hospitals as well as across wards within each hospital. This highlights the importance of surveying all hospital wards and examining the results at the ward level when implementing strategies to improve patient safety and the culture of safety in organisations. What is known about the topic? Prior studies in American nursing samples have shown that hospitals with higher levels of safety climate have a lower relative incidence of preventable patient complications and adverse events. Developing a culture of safety in hospitals may be useful in targeting efforts to improve patient safety. What does this paper add? This paper has shown that the perceptions of safety climate among nurses working in acute Australian hospitals varied between hospitals and across wards within a hospital. Only half the nurses also reported positive attitudes towards job satisfaction and teamwork climate. What are the implications for practitioners? Programs or strategies that aim to enhance teamwork performance and skills may be beneficial to improving the culture of safety in hospitals. Wards may also have their own safety 'subculture' that is distinct from the overall hospital safety culture. This highlights the importance of tailoring and targeting quality improvement initiatives at the ward level.

Measuring safety climate in acute hospitals: Rasch analysis of the safety attitudes questionnaire.

BackgroundThe Safety Attitudes Questionnaire (SAQ) is commonly used to assess staff perception of safety climate within their clinical environment. The psychometric properties of the SAQ have previously been explored with confirmatory factor analysis and found to have some issues with construct validity. This study aimed to extend the psychometric evaluations of the SAQ by using Rasch analysis.MethodsAssessment of internal construct validity included overall fit to the Rasch model (unidimensionality), response formats, targeting, differential item functioning (DIF) and person-separation index (PSI).ResultsA total of 420 nurses completed the SAQ (response rate 60 %). Data showed overall fit to a Rasch model of expected item functioning for interval scale measurement. The questionnaire demonstrated unidimensionality confirming the appropriateness of summing the items in each domain. Score reliabilities were appropriate (internal consistency PSI 0.6–0.8). However, participants were not using the response options on the SAQ in a consistent manner. All domains demonstrated suboptimal targeting and showed compromised score precision towards higher levels of safety climate (substantial ceiling effects).ConclusionThere was general support for the reliability of the SAQ as a measure of safety climate although it may not be able to detect small but clinically important changes in safety climate within an organisation. Further refinement of the SAQ is warranted. This may involve changing the response options and including new items to improve the overall targeting of the scale.Trial registrationThis study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921 (21 March 2011).Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1744-4) contains supplementary material, which is available to authorized users.

Safety climate and attitude toward medication error reporting after hospital accreditation in South Korea.

This study compared registered nurses' perceptions of safety climate and attitude toward medication error reporting before and after completing a hospital accreditation program. Medication errors are the most prevalent adverse events threatening patient safety; reducing underreporting of medication errors significantly improves patient safety. Safety climate in hospitals may affect medication error reporting. This study employed a longitudinal, descriptive design. Data were collected using questionnaires. A tertiary acute hospital in South Korea undergoing a hospital accreditation program. Nurses, pre- and post-accreditation (217 and 373); response rate: 58% and 87%, respectively. Hospital accreditation program. Perceived safety climate and attitude toward medication error reporting. The level of safety climate and attitude toward medication error reporting increased significantly following accreditation; however, measures of institutional leadership and management did not improve significantly. Participants' perception of safety climate was positively correlated with their attitude toward medication error reporting; this correlation strengthened following completion of the program. Improving hospitals' safety climate increased nurses' medication error reporting; interventions that help hospital administration and managers to provide more supportive leadership may facilitate safety climate improvement. Hospitals and their units should develop more friendly and intimate working environments that remove nurses' fear of penalties. Administration and managers should support nurses who report their own errors.

An Engineering or Behavioural Approach? A Study into Employees’ Perceptions Regarding the Effectiveness of Occupational Road Safety Initiatives

Background and Aims: Considerable variation has been documented with fleet safety interventions’ abilities to create lasting behavioural change, and research has neglected to consider employees’ perceptions regarding the effectiveness of fleet interventions. This is a critical oversight as employees’ beliefs and acceptance levels (as well as the perceived organisational commitment to safety) can ultimately influence levels of effectiveness, and this study aimed to examine such perceptions in Australian fleet settings. Method: 679 employees sourced from four Australian organisations completed a safety climate questionnaire as well as provided perspectives about the effectiveness of 35 different safety initiatives. Results: Countermeasures that were perceived as most effective were a mix of human and engineering-based approaches: (a) purchasing safer vehicles; (b) investigating serious vehicle incidents; and (c) practical driver skills training. In contrast, least effective countermeasures were considered to be: (a) signing a promise card; (b) advertising a company’s phone number on the back of cars for complaints and compliments; and (c) communicating cost benefits of road safety to employees. No significant differences in employee perceptions were identified based on age, gender, employees’ self-reported crash involvement or employees’ self-reported traffic infringement history. Perceptions of safety climate were identified to be “moderate” but were not linked to self-reported crash or traffic infringement history. However, higher levels of safety climate were positively correlated with perceived effectiveness of some interventions. Conclusion: Taken together, employees believed occupational road safety risks could best be managed by the employer by implementing a combination of engineering and human resource initiatives to enhance road safety. This paper will further outline the key findings in regards to practice as well as provide direction for future research.

Measurement equivalence of a safety climate scale across multiple trucking companies

To promote and establish a safe environment in an organization, it is critical to get an accurate measurement and understanding of employees’ safety climate perceptions. The goals of the current study were (1) to assess the measurement equivalence (ME) of the safety climate scale for mobile lone workers developed by Huang et al. (2013, Transp. Res. Part F Traffic Psychol. Behav., 17, 5) across different trucking companies with different managerial and safety practices and (2) to adopt confirmatory factor analysis (CFA)‐based and item response theory (IRT)‐based ME testing techniques that allow for more reliable measurement of important psychological safety constructs and accurate use of the measure. ME refers to the extent to which scales or items have the same measurement implications, such as factor structure of the scale, amount of explained variance with the scale constructs, and item functioning parameters from IRT framework, and are interchangeable across measurement situations. Based on the shared mental model theory, social learning theory, and social exchange theory, ME of safety climate was examined across the eight trucking companies recruited in the Huang et al.'s study. A CFA‐based linear approach and an IRT‐based nonlinear approach were used. Results supported that the safety climate scale items and measurement constructs have consistent meaning across different trucking companies, and the safety climate scores based on the scales can be used for the comparison of safety climate levels across multiple trucking companies as well as safety climate interventions.Practitioner points Generalizability of psychological measurement tools, such as safety climate scales, can be examined with ME analysis based on CFA and IRT frameworks. Measurement equivalence of the trucking industry‐specific safety climate scale (Huang et al., 2013) was supported across multiple trucking companies, indicating that there may be common features of safety climate dimensions that are particularly relevant to the trucking industry. The trucking industry‐specific safety climate scale can be used to gauge the level of safety climate within a given trucking company and to make cross‐company comparisons.

Safety Climate Level as a Tool Aiding Safety Management in a Production Facility

The article presents results of a safety climate research in a production facility. Assuming that work safety is correlated with safety climate it can be argued that by shaping the climate, which includes worker's comfort and beliefs regarding work safety management, one can efficiently manage organization's safety. So far it has been stated several times that workers’ tiredness and their mood can be a cause of their mistakes and in effect it can decrease their efficiency and the quality of their work. Safety level has been researched with author's questionnaire. The devised questionnaire allows to analyze the level of safety culture on many different layers, depending on company's needs and specificity. The results of the research has been presented both in a collective form, of a radar chart or safety climate index, with regard to researched group - i.e. depending on age, education, etc. The possibility of multi - aspect data analysis allows to adjust tools and methods increasing safety level depending on what is required. For example, adjusting safety training to workers’ age, or focusing on those safety aspects which in the questionnaire turned out to be the weakest points of the whole safety management system.

Evaluation of Safety Climate Level in a Production Facility

The article presents the problem of evaluation of safety climate in a production facility. It shows selected, most popular and available tools for measuring its level. On the basis of that there has been presented author's questionnaire for evaluation of safety climate level which includes, among other, the following issues: I. Knowledge of work safety, II. Values and beliefs regarding work conditions, III. Clear communication regarding health and safety at work, IV. Attitudes towards health and safety services - personal influence on health and safety at work, V. Superiors’ approach to health and safety problems, VI. Evaluation of training in the area of health and safety, VII. Stress resilience, VIII. Motivation to safe behavior, IX. Making use of cultural offer. To each of the issues there have been assigned five-question modules, to achieve clarity and legibility of the questionnaire. There has also been used five-point Likert scale. To confirm the validity of the above assumptions there has been carried out a piloting research which allowed to simplify and modify the questionnaire. The obtained results can be referred to age, education and job experience of workers. The final result is a collective comparison in a form of a radar chart, which shows general level of safety climate in the analyzed production facility, and allows for an indicator approach to the problem.

Study on occupational safety climate in different types of enterprises and its relationship with occupational accidental injury

To evaluate the occupational safety climate in different types of enterprises and its relationship with occupational accidental injury. A cross-sectional survey based on self-report questionnaires was performed among 3311 front-line workers from 54 medium and small-sized manufacturing enterprises of different types in Zhongshan, China to investigate the socio-demographic characteristics, safety climate experience in workplace, and incidence of occupational accidental injury in the past year. Analysis of the data revealed that employees in different types of companies perceived different levels of safety climate, according to the scores on four subscales; the European and American enterprises had significantly better safety climate than the Hong Kong and Chinese private enterprises (P < 0.01). The self-reported rates of occupational injury were 3.38%, 4.76%, and 6.72%, respectively, for European and American, Hong Kong, and Chinese private enterprises (χ(2) = 6.78, P < 0.05). After control of such factors as age, sex, income, education level, and marriage, the logistic regression analysis showed that the risk of occupational accidental injury in the European and American enterprises was significantly lower than that in the Chinese private enterprises (OR = 0.57, 95%CI = 0.35-0.91). The type of enterprise influences the occupational safety climate and incidence of occupational injury among workers.

Safety climate and injury occurrence of repair, maintenance, minor alteration and addition works

Purpose – The repair, maintenance, minor alteration and addition (RMAA) sector has been expanding in many developed cities. Safety problems of the RMAA sector have attracted the attention of many governments. This study has the objectives of comparing the level of safety climate of workers, supervisors and managers in the RMAA sector; and explaining/predicting the impact of safety climate on injury occurrence of workers, supervisors and managers. Design/methodology/approach – A questionnaire survey was administered to RMAA contracting companies in Hong Kong. Findings – When comparing the safety climate perception of workers, supervisors and managers in the RMAA sector, the supervisors group had the lowest mean safety climate score. Results showed that a positive workforce safety attitude and acceptance of safety rules and regulations reduced the workers' likelihood of having injuries. A reasonable production schedule led to a lower probability of supervisors being injured. Management commitment and effective safety management reduced the probability of managers being injured. Originality/value – This study revealed variations of safety climate at the different levels in the organizational hierarchy and their varying influence on safety performance of the RMAA sector. Safety of RMAA works could be improved by promulgating specific safety measures at the different hierarchy levels.

Non-Fatal Occupational Injuries and Safety Climate: A Cross-Sectional Study of Construction Building Workers in Mit-Ghamr City, Dakahlia Governorate, Egypt

Background: Construction is a dangerous industry, with high rates of fatal and non-fatal injuries. Although, safety climate has been linked with safety performance and work-related accidents, yet it is scarcely studied and considered in injury prevention programs in developing countries. So, the objectives of this study are to find out the magnitude, pattern and risk factors of non-fatal occupational injuries among a sample of construction building workers and to explore the level of safety climate and its relationship with occupational injuries. Methods: A cross-sectional study was conducted on 91 workers, who fulfilled the inclusion criteria, in 18 large construction sites in Mit-Ghamr city, Dakahlia Governorate. Data about socio-demographic and occupational characteristics, description of occupational injuries, and work-related and behavioral risk factors were collected using a structured questionnaire. Results: Occupational injuries in the past 12 months were reported by 46.2% of workers. The most common body parts injured were upper and lower limbs (31.0% and 26.2%). The majority of injuries were cuts/lacerations (30.9%) and contusions (28.6%). Falls (47.6%) and injuries by manual tools (23.8%) were the main causes of injuries. The majority of injured workers (90.5%) reported complete recovery after the most serious injury. The average of working days was lost per year due to occupational injuries (18.6 ± 7.8 days/year). None of the injured workers reported receiving sufficient first-aid treatment at worksite or filling an accident notification form. Extended working hours, poor safety climate, short duration of work, job dissatisfaction, young age, and job stress were significant risk factors of occupational injuries. Conclusion: Non-fatal occupational injuries are common among this sample of construction workers with significant relation to extended working hours and poor safety climate and other risk factors. So, it is important to build upon this research in order to help develop successful policies to prevent work-related injuries and promote safer work practices for construction building workers.

Development and validation of safety climate scales for lone workers using truck drivers as exemplar

The purpose of this study was to develop and test the reliability and validity of a new scale designed for measuring safety climate among lone workers, using truck drivers as exemplar. The new scale employs perceived safety priority as the metric of safety climate and a multilevel framework, separating the measurement of organization- and group-level safety climate. The second purpose of this study was to compare the predictive power of generic items with trucking industry-specific ones. Three dimensions for each of the two levels of safety climate were drawn from the results. The organization-level safety climate dimensions were proactive practices, driver safety priority, and supervisory care promotion. The group-level safety climate dimensions were safety promotion, delivery limits, and cell phone disapproval. Predictive validity of both generic and industry-specific items was supported, but the industry-specific items provided a stronger predictive value. Results showed that the scale is a reliable and valid instrument to measure the essential elements of safety climate for truck drivers in the lone working situation.

Measurement equivalence and mean comparisons of a safety climate measure across construction trades

The use of safety climate measures for needs assessment and interventions has become increasingly popular. However, no research to date has examined whether the meaning and level of safety climate may differ across different groups of interest. This study used multi-group confirmatory factor analyses to investigate the measurement equivalence of a multidimensional safety climate measure across ten construction trade groups (N=4725). In addition, observed mean differences in safety climate perceptions between trades were examined. Results revealed strong measurement equivalence of the safety climate measure across the construction trade groups. Further, significant mean differences were found between the ten trade groups on all four safety climate scales.

Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals—A cross sectional study

Objectives(1) To describe the levels of implicit rationing of nursing care in Swiss acute care hospitals; (2) to explore the associations between nine selected potential rationing predictors and implicit rationing of nursing care. DesignCross sectional multi-center study. SettingsA quota sample of 35 acute care hospitals from the German, French and Italian speaking regions of Switzerland participating in RN4CAST (Registered Nurse Forecasting) study. Participants1633 registered nurses working in randomly selected medical, surgical or medical–surgical units. MethodsImplicit rationing of nursing care, i.e., the withholding of any of 32 necessary nursing measures due to a lack of nursing resources, was measured using the revised Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Nine potential rationing predictors, e.g., staffing and resource adequacy, patient-to-nurse ratio, nurse education, and confounding variables, e.g., nurse gender and age, hospital typology, were assessed with validated instruments or single items of the RN4CAST study. Descriptive statistical procedures were used as appropriate. Three level regression models were used to investigate the effect of the selected nine predictors on rationing at the nurse, unit and hospital levels. ResultsNinety-eight percent of the participating nurses reported that, in their last seven working days, they had to ration at least one of the 32 nursing tasks listed in the BERNCA. The mean rationing level of 1.69 (SD=0.571) indicates that on average the nurses reported ‘rarely’ being unable to perform the nursing tasks listed in the BERNCA. Multilevel regression analysis confirmed two of the nine tested predictors: better unit level staff resource adequacy and a more favorable hospital level safety climate were both consistently significantly associated with lower rationing levels. Counter to our assumptions, the other two nurse practice environment dimensions, the three workload measures, nurse experience and nurse education were not associated with rationing. ConclusionsRationing frequency varied among the 32 BERNCA items, indicating differing prioritizations of necessary nursing tasks. The identified rationing predictors, staff resource adequacy and safety climate, can determine starting points for interventions, i.e., proactive changes to improve staff resource adequacy when rationing exceeds predefined thresholds, increasing the risk of negative effects on patient outcomes.

An examination of the relationship amongst profiles of perceived organizational values, safety climate and safety outcomes

The aim of the current study was to understand how different patterns of perceived organizational values are related to safety. We surveyed individuals working in high risk industries, assessing perceptions of organizational values, psychological safety climate and safety incidents. Modal Profile Analysis (MPA) identified four commonly perceived profiles across the sample. Results from a one-way MANOVA indicated that individuals who perceived that their organization strongly emphasizes either: (a) employee well-being (a human relations profile); or (b) employee well-being in conjunction with goal attainment (a joint human relations–rational goal profile); reported higher levels of safety climate and fewer safety incidents. Individuals who perceived that their organization strongly emphasizes either: (a) formal processes and procedures (an internal process profile); or (b) formal processes and procedures in conjunction with goal attainment (a joint internal process–rational goal profile), reported lower levels of safety climate and more safety incidents. These findings are discussed in terms of their theoretical contribution to the safety climate literature, and in relation to the practical importance that values play in influencing employee perceptions of safety.

Safety climate and verbal abuse among public hospital-based workers in Costa Rica

Low levels of safety climate and training have been associated with higher occurrence of occupational-related health outcomes; workplace violence and verbal abuse could be considered an early indicator of escalating psychological workplace violence. We examined whether low level of safety factors were associated with a higher prevalence of verbal abuse at the workplace. We used data from a cross-sectional survey administered among a stratified random sample of 1,000 employees from 10 of the 29 public hospitals in Costa Rica. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using survey logistic regression models to estimate the association between safety factors and verbal abuse from the following sources: administrators, supervisors, patients, patients' relatives and coworkers. There was a high prevalence of verbal abuse among the healthcare workforce from both external (i.e., patients and patients' relatives) and internal workplace sources (i.e., coworkers, supervisors and administrators). A low level of safety climate was associated with verbal abuse from all sources with associations ranging from verbal abuse from administrators (OR=6.07; 95%CI: 2.05-17.92) to verbal abuse from patients (OR=2.24; 95%CI: 1.23-4.09). These results highlight the need to address organizational characteristics of the workplace that may increase the risk of verbal abuse for the future development of prevention interventions in this setting.

Development and validation of an Integrated Organizational Safety Climate Questionnaire with multilevel confirmatory factor analysis

Meta-analytic and traditional reviews on safety climate reveal theoretical and methodological safety climate issues still open. The main aim of this study is to propose a questionnaire which combines recent and different approaches to safety climate, trying to give a contribute about these issues. The present research led to the development of a new questionnaire to measure safety climate, suitable for blue-collar workers, and to the evaluation of its psychometric properties, and usefulness to measure safety climate in the industrial sector. Multilevel confirmatory factor analysis (MCFA) was used to properly evaluate the factor structure underlying the safety climate questionnaire composed of three scales: organizational safety climate scale, supervisor’s safety climate scale and co-workers’ safety climate scale. The clear distinction, made with the use of three different scales, among safety agents (organization, supervisor, co-workers), allows the assessment of workers’ perceptions focused on each level, and allows to deeply explore, for instance, lateral relationships of supervisor’s safety climate and co-workers’ safety climate, analysing the interactions between the roles of these two safety agents. A two-level design was used, considering the individual level and the work-group level. Data collection involved 1,617 blue-collars from eight Italian manufacturing companies. The MCFA results demonstrated the importance to use proper analysis to study the factor structure of a multilevel construct as safety climate, and confirmed the theoretical structure of safety climate purposed from Griffin and colleagues, using not only psychological climate (i.e., the individual level), but also the group level safety climate.

Individual and work environment characteristics associated with error occurrences in Korean public hospitals

To determine individual and work environment characteristics associated with the occurrence of errors in Korean public hospitals. Medical errors are affected by individual and work environment characteristics. Few studies have examined the factors influencing medical errors, including perceptions of safety climate and individual and organisational characteristics. A survey. A questionnaire was distributed to 2358 nurses in 33 public hospitals to collect information on the frequency of errors, perceptions of safety climate and general characteristics of the participants. Data on hospital characteristics were obtained from the Regional Public Hospital Profile. The response rate was 89·7%. Multiple logistic regression analysis was performed to determine the factors influencing the occurrence of errors. Of the participants, 19% reported having made at least one error in the previous year. Nurses with better perceptions of workgroup- (OR = 0·73) and organisation- (OR = 0·69) level safety climate were less likely to make errors. Nurses with less than 3 years of nursing experience (OR = 2·05) were more likely to make errors than those with ten years or more. Nurses working at Red Cross hospitals (OR = 1·63) and in rural areas (OR = 2·04) were more likely to make errors than those at Regional Medical Centres and in urban areas, respectively. The factors associated with the occurrence of errors were perceived safety climate, years of nursing experience and hospitals' ownership and location. Public hospital executives and nurse managers should be actively involved in creating a strong safety climate. Furthermore, training programmes and managerial support focussed on improving patient safety and directed at less experienced nurses, especially those working at Red Cross hospitals in rural areas, need to be emphasised to prevent errors.

What causes an improved safety climate among the staff of a dialysis unit? Report of an evaluation in a large network

Clinical staff's safety perception is considered an important indicator of the implementation level of safety climate and safety culture. For this purpose, the Safety Climate Survey Questionnaire was submitted to the dialysis clinics staff of the Fresenius Medical Care (FME) network in Italy. Moreover, to explore how standard procedures implementation influences staff opinion of safety levels, the Universal Hygiene Precautions Questionnaire was also submitted. Safety Climate Survey and Universal Hygiene Precautions questionnaires were based on 19 and 14 statements, respectively. Staff members (n=346) of 33 dialysis units were involved: 21.4% physicians, 58.1% registered nurses and 20.5% health care assistants (HCAs). Safety Climate mean total score was 81.9%. Medical directors (91.5%) and quality-responsible head nurses (QHRNs) (87.4%) showed higher scores in comparison with staff physicians (82.4%), nurses responsible for hygiene (81.1%) and HCAs (78.8%). Staff nurses (78.9%) showed a significant difference (p<0.05) compared with medical directors. Universal Hygiene Precautions mean total score was 90.8%, not significantly different among medical directors (92%), staff physicians (91.4%), QHRNs (93.2%), nurses responsible for hygiene (91.7%) and staff nurses (91.4%). Only HCAs reported a significantly (p<0.05) lower score (83.6%) compared with medical directors. As the respondents were asked to complete both questionnaires anonymously, a direct correlation between the 2 questionnaires was not possible. A relatively high value for Safety Climate was evaluated within the FME network of Italian dialysis clinics. Management showed higher Safety Climate scores than frontline staff. Fostering communication and implementation of training programs are considered valid tools to improve safety.