Safety Culture Research Articles

Radiation safety of dentomaxillofacial radiology in Finland: Reported abnormal irradiation-related incidents during 2012–2022

IntroductionThis study evaluates adverse events (AEs) in dentomaxillofacial radiology (DMFR) in Finland, including their quantity, nature, and outcomes. It also compares reporting activity between public and private healthcare organizations, as they share same legal obligations to report AEs. Two-thirds of dental images are taken in public, the rest in private healthcare. MethodsIn Finland, radiation-related AEs are reported to the Radiation and Nuclear Safety Authority (STUK). We categorized DMFR-related AEs by nature, outcome, and imaging modality. We also submitted a questionnaire to STUK to gather information on their observations and remarks made during inspections of establishments providing dental imaging services. ResultsDuring 2012–2022, STUK received reports of 1343 DMFR-related AEs, mostly causing patient harm (92.9%) leading almost always to excessive radiation doses (99.7%). Private healthcare reported most AEs (65.2%), with municipal institutions reporting the remainder (34.8%). Intraoral-related AEs (20.0%) slightly outnumbered panoramic-related ones (18.7%), but the majority (56.7%) didn't specify the imaging modality. CBCT-related incidents were least reported (4.5%). During STUK's inspections, remarks mostly concerned deficiencies in practical quality assurance (31.3%) or technical quality assurance (32.9%). ConclusionDMFR-related AEs may be underreported despite legal obligations, with most stemming from human error, highlighting the need to enhance patient safety culture. There's a notable reporting gap between private and public healthcare providers relative to the number of dental radiographs conducted. Organizational deficiencies in practical and technical quality assurance underscore the importance of ongoing education, as well as monitoring by STUK. Implications for practiceEnhancing patient safety culture in dentistry, including dentomaxillofacial radiology, demands customized multiprofessional development, as unaltered patient safety procedures from medicine and secondary care may not align with dentistry's requirements.

Radiation to Chemicals Unpacking Occupational Safety Hazards in Educational Hospital through the HOSHRA Lens

Objective: The current study evaluates occupational safety and health risks in educational hospitals using the Hoshra index by concentrating on the detection and control of frequent hazards.Methods: Using a structured approach, the HOSHRA index classifies risks in to physical, chemical, biological, ergonomic and psychological domains. The framework supports targeted risk scoring, improving the efficiency with which hospitals can allocate resourcesFindings: The analysis uncovers important types of healthcare worker hazards. Biological and psychological risks appear to be particularly suboptimal, emphasizing the importance of effective infection control interventions, as well as psychological care. The study underscores the need to have a culture of safety that supports hazard reporting and management.Novelty: This is one of the first to use the HOSHRA index in many educational hospital, introducing new methods for risk analysis and assessment beyond traditional classic styles.Research Implications: The results highlight the need for adapted and risk based strategies in healthcare settings. Healthcare organizations can improve the well-being of staff and, by extension, patient care outcomes, by aligning safety protocols with the unique features of wards.

Routine Postclinical Event Debriefings on Inpatient Pediatric Units.

Debriefings are an underutilized opportunity to enhance team performance and safety culture. Little is known about the impact of postclinical event debriefing programs in Pediatric Hospital Medicine (PHM). We sought to develop a standardized debriefing process with multidisciplinary involvement after all clinical events on PHM service lines. Our primary aim was to achieve 75% debriefing completion rate over 12 months with debriefing duration less than 10 minutes. A standardized postclinical event debriefing process was created at a large tertiary children's hospital. We aimed to debrief after clinical events on PHM services. The debriefing process was developed with key stakeholders and used a key driver diagram and Plan-Do-Study-Act cycles to refine the process. The project team reviewed the data monthly. During our 20-month study period, debriefing completion rate sustained a median of 66% with a median debriefing time of 7 minutes. Most debriefings (61%) had all core team members present with attending physicians (pediatric hospitalists) being absent most often. Barriers to debriefing with all core members present included service type, time of day, and shift change. Process changes were implemented based on concerns addressed in the debriefings. Multidisciplinary, postclinical event debriefings were successfully implemented on inpatient pediatric wards. Future steps include process implementation on non-PHM units in our hospital based on expressed interest and to further assess how debriefings optimize team performance and improve clinical outcomes.

Assessment of Occupational Health and Safety Management System Implementation in General Hospital

Objective: This study aims to assess the application of Occupational Health and Safety Management System (OHSMS) in Kertosono Regional General Hospital by identifying the obstacles and strategies that exist, as well as successful system implementation for health sector.Methods: This study utilized a mixed-methods design to assess OHSMS effectiveness and employee perceptions before and after implementation.Findings: Results show a statistically significant decrease in incidents at work after implementation of an OHSMS, which confirms that the global safety performance of this plant is affected by the OHSMS. By contrast, though inadequate instruction, lack of continuous leadership dedication and investment were some major obstacles to successful operation of OHSMS.Novelty: The findings from this study suggest the importance of structured safety management systems designed for public healthcare workers, and provide practical suggestions to bolster the effectiveness of OHSMS in Indonesia.Research Implications: The results also emphasize the importance of ongoing education and training, strong leadership support, as well as providing sufficient resources to promote a culture of safety in healthcare settings. Future research might instead seek upper bounds benefit of an OHSMS for safety or examine how technology can be integrated to provide monitoring, training function on a continuous basis.

Leading by example: Culture, leadership, and accountability

AbstractProcess safety practices and management systems have been in place for many years and have been widely credited for reductions in major accident risk. However, many organizations today are challenged by inadequate management system performance, resource pressures, and stagnant or declining process safety performance. Systems for managing process safety have not been fully successful in some organizations due to a variety of issues; major, frequent contributors include a lack of senior management commitment and poor safety culture. Senior management commitment and safety culture are inextricably linked, as the quality of an organization's leadership and their commitment will drive or limit the culture. Changes to improve management systems are relatively easy to implement, but extremely difficult to sustain without strong leadership commitment and total line management support. It is not just a case of changing the systems, but also changing the safety culture of the organization. Safety culture tends to be the result of everything that happened or failed to happen and represents the organization's shared values, beliefs, attitudes, and behaviors with respect to safety (occupational safety and process safety). To change the safety culture and sustain the change, leadership must care and explicitly show that they care all of the time. Only then can an organization begin to improve its culture. The first step for any organization is identifying and understanding their existing culture. This paper will present the essential features of a sound safety culture and a methodology for identifying safety culture weaknesses based upon a culture, leadership, and accountability (CLA) review protocol used at different levels of the organization. Other key steps involved in changing and sustaining an improved safety culture will also be addressed.

Responsible leadership and workplace safety: do safety culture and safety motivation matter?

PurposeWe sought to examine the effect of responsible leadership on employee safety in the workplace both directly and indirectly through mediation effects of safety motivation and safety culture in the oil and gas industry in Ghana.Design/methodology/approachWe employed a quantitative approach (survey) to collect data from 226 pump attendants of the fuel stations in the Accra Metropolis. This study used PLS-SEM to test the research hypotheses in the study.FindingsOur findings show that leaders’ responsible behaviours had a positive and significant impact on both their employees’ wellbeing and safety as well as their motivation to adhere to safety standards and also imbibe a sense of safety culture in the workplace. Furthermore, the inclusion of safety motivation and safety culture as mediating variables reveal that leaders’ ability to achieve a robust workplace safety through responsible leadership was partially contingent on these organisational factors.Practical implicationsWe highlight that leaders should continuously improve their responsible leadership behaviours and also the management of oil and gas companies should encourage managers to focus on day-to-day interactions with employees on safety-related matters (e.g. effectively inspiring and motivating employees to adhere to safety standards and procedures and applying sanctions when necessary).Originality/valueThis study answers the recent calls for a contingency perspective on the relationship between leadership styles and organisational/employee level outcomes by providing empirical support for our conceptual model which identifies safety motivation and safety culture as important organisational factors by which responsible leaders can positively influence workplace safety.

Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association.

The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.

SOCIAL AND PEDAGOGICAL ACTIVITY IN UKRAINE: CURRENT TRENDS IN THE CONTEXT OF WAR

The article presents the results of a study on social and pedagogical activity in Ukraine in the context of the Russian-Ukrainian war, including current trends in the work of a social pedagogue in the educational sphere. The emphasis is placed on the importance of social and pedagogical/social work in the context of the war, which has caused significant challenges in the humanitarian sphere. The importance of support from the international community is emphasized, particularly in the social sphere (providing shelter for Ukrainian refugees, supporting the education of Ukrainian children displaced to other regions and abroad, humanitarian aid at the beginning of the fullscale war, etc.). The research methodology includes methods of theoretical and empirical analysis, including theoretical analysis of international guidelines for social and pedagogical/social work; empirical analysis of normative and instructional documents on the activities of a social pedagogue in the educational sphere, including in the context of the Russian-Ukrainian war; empirical (qualitative) analysis of essays by students of the specialty "social work" of the University "Ukraine" (Kyiv, Ukraine) on the topic "Social pedagogy: essence and importance in the context of the Russian-Ukrainian war"; generalization and systematization of research results. Due to the specifics of the research, we gave preference to the qualitative methodology. The results of the study allowed us to generalize the current trends in social and pedagogical activity in the educational sphere. These include: creation of a psychologically comfortable educational environment for all participants in the educational process (pupils, teachers, parents); providing psychosocial support to students affected by the war (children from families of combatants, children from families of internally displaced persons, etc.); implementation of measures for social adaptation and rehabilitation; formation of a culture of safety and other competencies important in the context of war, etc.

Analysis of Safety Climate in Construction of Coal Fired Steam Power Plant (CFSPP) X with Capacity 2x1000 MW

Introduction: Power plant construction process is complex with a lot of labor, machines and flammable materials, and the work carried out has high risk such as lifting, working at height, hot work such as welding, grinding, cutting and other activities that have a high risk. Objective: The objective of the research is to find out the overall picture of Work Safety Climate at CFSPP X and picture of Safety Climate at the Work and Personal level. Method: The design of this research is quantitative method, 58 questions by Zou & Sunindijo's Safety Climate framework in research of Fatma Lestari, et, al. 2020. Result: The description of the working Safety Climate of CFSPP X from 6 Dimension of Safety Climate are, Management Commitment mean is 3.92, Communication mean is 3,91, Training mean is 3,89, Personal Accountability mean is 3,87, Rule and Safety Procedure mean is 3,92, Supportive Environment mean is 3,90. The description of the Safety Climate at work and personal levels is good, with scores for all dimensions more than >3.30. There were 3 statements that received disagree answer from several respondents, which are: I report people who ignore safety procedures, 23 respondents, my responsibility is to work safely, including reporting colleagues who are not working safely, 5 respondents. There are punishments for unsafe behavior, 14 respondents. The Safety Climate dimension with the highest score is Management Commitment and Roles & Safety Procedure. Conclusion: The description of the Work Safety Climate, both at work and personal level, is good with score of more than >3.30. Disagree answer from several respondents was related to not wanting to report people who ignore safety procedures because there is punishment for unsafe behavior. The Safety Climate dimension with the highest score is Management Commitment, and for work attributes, both work and personal, Management Commitment and Rule & Safety Procedure dominate the highest average score.

The role of safety climate in occupational health and safety information seeking: extending risk perception attitude framework

The role of safety climate in occupational health and safety information seeking: extending risk perception attitude framework

Enhancing Biosafety and Biosecurity: Quality Management in High-Containment Laboratories

Quality Management in high-containment laboratories plays a pivotal role in ensuring the safe handling of biological agents and toxins, thereby mitigating potential biorisks. This paper provides a comprehensive exploration of the key aspects of Quality Management Systems (QMS) tailored to the unique challenges of high-containment laboratories. It delves into the significance of QMS in enhancing biosafety and biosecurity measures, safeguarding laboratory personnel, the community, and the environment. The paper also discusses the integration of international standards, risk management strategies, and the role of top management in fostering a culture of safety. Through this examination, it becomes evident that a robust QMS not only ensures compliance but also promotes continual improvement and innovation in high-containment laboratory operations, ultimately advancing the field of biosafety and biosecurity.

Interprofessional Team Training for Nursing Trainees and Medical Students in Pediatrics: Comparing Analog and Digital Formats

Pediatrics places highest demands on interprofessional teams. Although training and studies are evolving, interprofessional teaching units are regularly lacking in German-speaking countries. Analog and digitally convertible formats are rare. Since 2018, a voluntary one-day team training named "SICKO Junior" for nursing trainees and medical students has been conducted regularly in analog and in the meantime digitally. Evaluation results on the analog and digital format are compared. The content of the one-day workshop is based on a concept for medical employees. Exemplary communication in the ward round is reflected in simulations, training on the simulator for lumbar punctures serves the change of perspective. A total of 104 participants took part, 21 of them digital. The recommendation rate is 100%. All of the participants are convinced that the workshop has a positive impact on collaborative interprofessional work. There were no significant differences in the evaluation of the different workshop elements between the digital and analog trainings. The present work sheds light on the positive influence independent of the digital/analogue form. The presentation forms a blueprint for dissemination. A curricular integration seems worthwhile.Conclusion Voluntary interprofessional team training for nursing trainees and medical students with a focus on communication and error culture is as popular in digital as in analog form. Future studies should prove the influence on competence development and safety culture.

Who do you ask? predicting injury rates from survey responses.

Few studies have addressed whether using manager or worker perceptions of safety policies and practices alone predict reported injury rates less accurately than using both. This study provides an example and describes a method that can be used to address this issue with survey instruments designed to measure safety climate, policies, or practices. Using multilevel logistic regression, we estimated the relationship between worker and manager perceptions of a given exposure and the odds of worker injury during the post-survey year for three safety scales. We tested whether surveying both workers and managers provides additional predictive value compared with surveying just one group. Injury in the year following the survey was significantly associated with worker scores on two of the three scales. Manager responses were not significantly associated with injury and did not significantly improve injury rate prediction when added to a model with only worker survey responses. The capacity of manager-only or worker-only perceptions of safety policies and practices to predict worker injuries should be established before choosing to survey just one or the other. The approach and findings in this paper can be applied to other survey instruments and in other settings to help make this choice.

Heart Zone as a measure to influence traffic safety culture: which factors influence culture change?

Measures to influence traffic safety culture in designated areas (e.g. schools) exist in several different countries across the world. The Norwegian traffic safety scheme Heart Zone is a measure that aims to influence the traffic culture within a specific geographical area. The study examines whether four Norwegian schools have managed to establish a Heart Zone traffic safety culture, factors facilitating and impeding the implementation of Heart Zone traffic safety culture and subsequent changes in parents' traffic safety behavior. The study is based on survey data from four Norwegian schools (n = 220) and qualitative interviews (n = 19). Although the level of implementation varies, results from the interviews and the survey suggest that the schools have established Heart Zone cultures, where large proportions of the parents drop the children off at the recommended drop-off zone, when driving, are attentive to students who come walking/cycling within the Heart Zone and walk or cycle when transporting children within the Heart Zone. The Heart Zone culture is related to changes in parents' traffic safety behaviors and reductions in dangerous traffic situations. The study identifies specific factors facilitating and impeding traffic culture change, related to enclosed geographical areas like the Heart Zone, developing an analytical model that researchers and future traffic culture measures like this can learn from.

Case Reports on Anatomical Variations of the Hepatic Arteries: Implications for Laparoscopic Cholecystectomy and Surgical Safety

A laparoscopic surgeon’s understanding of embryology, anatomy, and potential anatomical variations of the bile duct is crucial for safely performing gallbladder removal using this minimally invasive technique. In conducting two medical-legal autopsies, we identified a previously undocumented anatomical variant where the liver’s blood supply originates from the common hepatic artery, branching into a trident formation to form the right, left, and cystic hepatic arteries. Notably, the right hepatic artery is situated within Calot’s triangle, whereas the cystic artery is located anomalously outside the triangle. This anatomical anomaly poses significant surgical risks, including the potential for morbidity and mortality due to ischemic necrosis of the liver from vascular injury. The success of laparoscopic surgery under these circumstances relies heavily on the surgeon’s expertise in managing an atypical surgical field, adherence to a culture of safety, and a critical approach to safety in laparoscopic cholecystectomy.

Safety culture and worker fatigue management in the offshore oil and gas industry: An interview study

Multiple incidents in the offshore oil and gas industry have been associated with poor safety culture. Regular assessments of safety culture among operators and contractors is recommended as part of a safety management system. Poor safety culture has also shown to impact how operators manage offshore hazards, such as worker fatigue. Assessing workers' fatigue states is also critical to ensure safety in the offshore oil industry. This paper describes findings from an interview study that aimed to identify current safety culture assessment and worker fatigue management practices in the offshore oil and gas industry. One-hour virtual semi-structured interviews were conducted with eighteen offshore oil rig supervisors. Various state-of-the-art methods for assessing safety culture (e.g., experience sampling method) and worker fatigue (e.g., physiological sensors and psychomotor vigilance test) were introduced to the participants. Participants commented on the feasibility and potential barriers to implementation/administration of the various methods, as well as how the information might be useful in their supervisory decisions. User expectations for a safety dashboard displaying data from such tools and user requirements for such a dashboard were elicited. In addition, participants completed a modified technology readiness and acceptance model questionnaire to assess participants' readiness levels and perceived usefulness of a safety dashboard. The interview results revealed a mixed understanding of what safety culture is and opinions about safety culture measurements. Participants indicated that efforts to manage fatigue currently relied solely on supervisors' observation and workers' self-reports. Participants’ opinions about the new assessment methods varied. Some were supportive and commented that the new methods will be helpful to improve supervisory-level decisions, whereas others pointed out potential compliance issues.

Повышение надежности человеческого фактора как перспектива развития культуры безопасности в производственной деятельности энергетического комплекса ОАО «РЖД»

The criticality of improving the reliability of the human factor in the production safety culture of the JSC RZhD energy complex remains relevant. In order to resolve the issue, the analysis of various acceptable and applied psychological, managerial, and economic measures has been conducted. Measures to reduce the occupational injury rate and develop the occupational safety culture in JSC RZhD have been considered. Specific attention has been paid to the comprehensive approach that covers psychological, managerial, and economic measures. The rapid development of technologies and changing requirements in the sphere of occupational safety prioritize such aspects as professionalism, discipline, motivation for work, and compliance with instruction requirements. Specific methods, including visual information, organizational measures, improving working conditions, and training formats via improving training programs have been provided. Practical examples of the successful use of such measures in the production environment have been considered by using the example of the Power Supply Directorate of the Southeastern Railway where high-risk jobs remain specific. Various measures of encouragement and motivation for employees facilitate the significant improvement of working conditions and the reduction of injury rate. Additionally, the analysis of methods to raise employees’ awareness regarding the importance of compliance with safety rules through regular training and seminars as well as the implementation of a feedback system to ensure prompt identification and elimination of potential threats has been conducted. These measures demonstrate high efficiency and ensure further successful development of the company not only by facilitating the increase of occupational safety level and the reduction of injury rate indices but also by establishing a safety culture among employees, which ultimately affects the total production performance and reputation of JSC RZhD.

From Reporting to Improving: How Root Cause Analysis in Teams Shape Patient Safety Culture.

Given the increasing focus on patient safety in healthcare systems worldwide, understanding the impact of Continuous Quality Improvement Programs (QIPs) is crucial. QIPs, including Morbidity and Mortality Conferences (MMCs) and Experience Feedback Committees (EFCs), have been identified as effective strategies for enhancing patient safety culture. These programs engage healthcare professionals in the identification and analysis of adverse events to foster a culture of safety (ie the product of individual and group value, attitudes, and perceptions about quality and safety). This study aimed to determine whether patient safety culture differed regarding care provider participation in MMCs and EFCs activities. A cross-sectional web-only survey was conducted in 2022 using the Hospital Survey on Patient Safety Culture (HSOPS) among 4780 employees at an 1836-bed, university-affiliated hospital in France. We quantified the mean differences in the 12 HSOPS dimension scores according to MMCs and EFCs participation, using Cohen d effect size. We performed a multivariate analysis of variance to examine differences in dimension scores after adjusting for background characteristics. Of 4780 eligible employees, 1457 (30.5%) participated in the study. Among the respondents, 571 (39.2%) participated in MMCs or EFCs activities. Participants engaged in MMCs or EFCs reported significantly higher scores in six out of twelve HSOPS dimensions, particularly in "Nonpunitive response to error", "Feedback and communication about error", and "Organizational learning" (Overall effect size = 0.14, 95% confidence interval = 0.11 to 0.17, P<0.001). Notably, involvement in both MMCs and EFCs was associated with higher improvements in patient safety culture compared to non-participation or singular involvement in either program. However, certain dimensions such as "Staffing", "Hospital management support", and "Hospital handoffs and transition" showed no significant association with MMCs or EFCs participation, highlighting broader systemic challenges. The study confirms the positive association between participation in MMCs or EFCs and an enhanced culture of patient safety, emphasizing the importance of such programs in fostering an environment conducive to learning, communication, and nonpunitive responses to errors. While MMCs or EFCs are effective in promoting certain aspects of patient safety culture, addressing broader systemic challenges remains crucial for comprehensive improvements in patient safety.

Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion. We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay. In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel. Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.

Analysis of the Role of Safety Leadership and the Establishment of a Safety Climate Affecting Safety Performance in the Agribusiness Industry PT. XXX in 2024

The agricultural and plantation industry (agribusiness) is a critical component of the global food supply chain, yet it is associated with a high incidence of workplace accidents. In Indonesia, this sector accounted for 17.4% of all workplace accidents from 2019 to 2021. This study aims to analyze the impact of safety leadership and the establishment of a safety climate on safety performance in the agribusiness industry, specifically within PT. XXX's oil palm plantation operations. Utilizing a cross-sectional study design and a semi-quantitative approach, the research involves 1,332 respondents selected through stratified random sampling. The findings indicate that while the majority of workers rate leadership and the safety climate as very good, there are areas needing improvement. Bivariate analysis reveals significant relationships between Safety Coaching, Safety Caring, Safety Controlling, Commitment to Safety, and Perceived Risk with Safety Performance, with p-values of 0.03, 0.042, 0.047, 0.04, and 0.01, respectively. However, Emergency Response did not show a significant relationship (P = 0.478). Multivariate analysis further identifies Safety Coaching and Perceived Risk as the most influential variables affecting safety performance. These results highlight the necessity of enhancing safety coaching programs and managing risk perception to improve workplace safety. The study underscores the importance of coaching activities to boost competence and foster a deeper understanding and awareness of effective risk management, ultimately leading to safer work processes and environments.