Safety Culture Research Articles

Learning in radiation oncology: 12-month experience with a new incident learning system.

Safety and quality improvement are essential to clinical practice in radiation therapy as planning and treatment increase in complexity and sophistication. An incident learning system (ILS) is a safety and quality improvement tool that can aid risk mitigation to improve patient safety and quality of care. The aim of this study was to quantify the impact of implementing a new e-ILS, Learning In Radiation ONcology (LIRON), on reporting and safety culture within a local health district (LHD). The ILS (LIRON) was implemented in 2020 with the intent of tracking actual incidents, near misses and procedural non-compliances for analysis of root causes and contributing factors. A survey was conducted after 12 months of LIRON use, and distributed to radiation oncologists, radiation therapists and radiation oncology medical physicists within the LHD. Results were compared with the responses to a pre-ILS implementation survey, to review changes in staff perceptions of safety culture, barriers to reporting and ILS understanding. Survey response rates were similar at baseline and at the 12-month follow-up, 64% and 63%, respectively. Findings showed increased ILS participation (49-71%), increased perception of no barriers to reporting (34-43%) and increased encouragement to report (37-43%). Greater confidence in the department's ability to learn from the ILS was evident (24-46%). Initial findings of LIRON implementation show positive impact but warrant further long-term review for greater understanding of its impact on staff perceptions, safety culture and improving departmental processes.

Resilience as Safety Culture in German Emergency Medical Services: Examining Irritation and Burnout.

The stress levels in emergency services are enormous. The resulting stress can range from psychological irritation to burnout. This study examines the importance of resilience in the German EMS and its significance for the risk of irritation and burnout among EMS personnel. A quantitative cross-sectional online survey was conducted among 285 EMS personnel in Germany. Resilience was measured by the RS-13 Scale, irritation by the Irritation Scale (IS), and burnout by the Maslach Burnout Inventory (MBI). Sociodemographic and job-related data were also collected. A classification into resilient groups was used to compare stress levels. More than one-third (39%) of the participants had a low level of resilience. EMS personnel with high levels of resilience had significantly lower scores on the cognitive and emotional irritation dimensions, as well as on the burnout dimensions of emotional exhaustion and cynicism. Resilience plays an important role in the safety culture of emergency services. The results support the hypothesis that high levels of resilience lead to less stress and help people cope better with stress. Almost two-fifths of the participants had lower resilience, underscoring the need for safe communication and targeted measures to strengthen resilience. Regular training, a supportive work environment, and promoting team cohesion and social support can improve emergency responders' mental health and job performance. Future research should develop specific intervention strategies and evaluate their effectiveness to ensure the long-term health of emergency responders and improve the quality of emergency care.

Preoperative Multidisciplinary Team Huddle Improves Communication and Safety for Unscheduled Cesarean Deliveries: A System Redesign Using Improvement Science.

Optimal communication between care teams is a critical component in providing safe, timely, and appropriate patient care. Labor and delivery (L&D) units experience rapidly changing clinical scenarios often requiring escalation in care and unplanned cesarean deliveries (CDs). The University of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care. Using the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases. Our primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure. Huddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion. In an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care.

A critical examination of safety culture in the superyacht industry

A critical examination of safety culture in the superyacht industry

The Influence of Safety Compliance on Safety Climate with Safety Culture as a Mediator among Grab Drivers in South Jakarta

This study aims to analyze the influence of safety compliance, safety culture and safety climate among Grab drivers in South Jakarta. By gaining an in-depth understanding of these factors, it is expected that more effective safety strategies and programs can be developed to ensure the safety of both drivers and passengers, as well as to enhance security in future online transportation operations. The research employs a quantitative methodology with descriptive and inferential approaches. Data collection was conducted through questionnaires distributed to 98 Grab drivers in the South Jakarta area. The data were analyzed using SmartPLS 3.0 software with the Partial Least Square (PLS) method. The results of the study indicate a significant influence of safety compliance on safety culture, as well as on safety climate. These findings confirm that good safety compliance contributes to the formation of a strong safety culture and overall enhancement of the safety climate. Additionally, it was found that safety culture has a strong positive impact on safety climate.

Effects of transformational leadership and organizational climate on project performance in industrial revolution 5.0: a systematic literature review

Purpose The relationships between transformational leadership (TL), organizational climate (OC) and project performance have been investigated by previous studies, but no review of existing studies has systematically analyzed the effects of TL and OC on project performance in the industrial revolution (IR) 5.0 era. Therefore, this study aims to conduct a systematic literature review on the effects of TL and OC on project performance in IR 5.0, and to identify mainstream research topics, research gaps and future research directions. Design/methodology/approach To do this, a total of 53 included journal articles were obtained after initially retrieving 648 documents from the Scopus database by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It consists of four main steps, namely, identification of documents, screening, eligibility and included articles. In addition, science mapping analyses were conducted for keyword co-occurrence and document analyses, which aided in identifying the mainstream research topics, research gaps and future research directions. Findings The results report the annual publication trends, keywords and document analyses. Furthermore, a detailed qualitative discussion highlighted four mainstream research topics including TL in project management; the relationship between TL, OC and innovation; safety climate; and OC in project management. Moreover, this review study identified four research gaps and future research directions aligned with the mainstream research topics. They include: longitudinal investigations and multinational corporation surveys in TL; scope and longitudinal data in innovation; mono-method bias and universality of safety climate; and more comprehensive analyses of OC. Originality/value This review study would contribute to not only advancing the effects of TL and OC on project performance in IR 5.0, but also enabling project managers to understand TL or OC issues to improve project performance.

Psychosocial workplace safety in mental health services - Commentary and considerations to improve safety.

Psychosocially unsafe workplaces are related to burnout, especially amongst trainees and psychiatrists. Burgeoning research on psychosocial workplace safety indicates the importance of organisational governance to reduce adverse professional, and consequently patient, outcomes in healthcare by balancing job demands and resources. We provide a brief commentary on the relevance of the concept of the Psychosocial Safety Climate model for mental health services and healthcare workers, and considerations for action. Based on the Extended Job Demand-Resource model, the Psychosocial Safety Climate model has been developed and validated in community and healthcare environments. Psychosocial safety is also an Australian workplace safety requirement. An important direction to improve working conditions, reduce adverse outcomes, and improve recruitment and retention of healthcare workers, may be to adopt and formalise psychosocial workplace safety as a key performance indicator of equal importance to productivity for mental healthcare services.

The use of artificial intelligence in education in the light of security Culture according to the opinions of Hungarian and Turkish youth

Today, the importance of information security in education is increasingly emphasised. For members of generations X, Y and Alpha, ICT tools have become everyday objects of use, making it essential that teaching methods adapt and innovate accordingly. In particular, it is important that students learn to use data and devices safely, and the necessary guidelines should be integrated into the educational process. The six principles of security set out by the OECD apply to both students and teachers and provide guidance for users. Safety awareness is central to the development of a safety culture. In addition to knowledge and competences, safety culture also includes awareness and intentionality, which are essential for future success. There are many dimensions and aspects of awareness, but perhaps the most important in the context of education is the development of the digital dimension. However, it is also important to teach young people about the safe use of artificial intelligence and the limits of its applicability. The aim of our study is to examine how young people use the opportunities offered by digitalisation in educational institutions, with a particular focus on the use of AI and the perceptions and visions of its use. We will interpret this through an intercultural lens, comparing the intercultural characteristics and attitudinal differences of Hungarian and Turkish youth based on a questionnaire survey conducted in both countries.

Research on the configuration of factors influencing safety citizenship behavior of construction workers based on fsQCA

ABSTRACT Objectives. How to promote the safety citizenship behavior (SCB) of construction workers has been studied in academic circles. However, most current research methods focus on the ‘net effect' between the independent variable and SCB. Methods and Results. Based on the fuzzy set qualitative comparative analysis (fsQCA) method and from the perspective of ‘configuration’, this article proposes that the emergence of SCB not only depends on a single condition, but also depends on the interaction of safety leadership behavior (SLB), organizational safety climate (OSC), organizational safety support (OSS), safety attitude (SA), safety motivation (SM), safety risk perception (SRP) and psychological belonging (PB). Conclusion. The research shows that the emergence of construction workers’ SCB can be realized through different combinations of variables, and both ‘external environment-driven' and ‘interpersonal relationship-driven' paths can promote the generation of SCB. This research provides a more systematic and practical explanation for how to promote the generation of SCB of construction workers, expand the research scope of safety management and play a positive role in reducing the incidence of safety accidents in the construction industry.

The Impact of Job Insecurity on Miner Safety Behavior—A Study Based on SEM and fsQCA

The intelligent transformation of coal mines is one of the current trends in developing China’s coal mining industry. To explore the impact of miners’ insecurity on their safety behavior under this trend, miners’ psychological resilience was introduced as the mediating variable, and team safety climate was used as the moderating variable to conduct a questionnaire survey of frontline miners. The data analysis was carried out using descriptive statistics, correlation analysis, structural equation modeling (SEM), and the fsQCA method to explore the impact of job insecurity on miners’ risk behavior through psychological resilience from the dimensions of job loss insecurity, job performance insecurity, and interpersonal insecurity. The results show that the sense of insecurity of the miners has a significant negative correlation with security behavior and a significant negative correlation with psychological toughness; miners’ psychological resilience plays an intermediary role in the correlation between job loss insecurity and miners’ risk behavior. Meanwhile, team safety climate has a significant moderating effect on the relationship between job insecurity and psychological resilience, as well as the relationship between psychological resilience and safety behavior; that is, a good team safety climate can effectively reduce the negative impact of job insecurity brought about by the transformation and upgrading of coal mines.

Implementing OKR Framework in Solving Safety Culture and Safety Program Issues to Elevate Safety Performance of PT. X-Y Whilst Preserve The ESG Rating of PT.X

Implementing OKR Framework in Solving Safety Culture and Safety Program Issues to Elevate Safety Performance of PT. X-Y Whilst Preserve The ESG Rating of PT.X

A Systematic Review of Occupational Health and Safety in Mining Sector in Pakistan

The mining sector in Pakistan is regarded as a hazardous occupation due to its dangerous nature and workingenvironment, which frequently results in deadly accidents. This study is aimed to conduct a systematic review of theexisting studies on occupational safety and health in the mining sector of Pakistan. For this systematic review, Web ofScience, PubMed, Science Direct, Science Hub, and Google Scholar were consulted to search data. Followingkeywords were used related to occupational health and safety in mining: occupational health and safety (OH&S),mining safety measures, mining health issues, and mining safety culture in Pakistan's mining industry. The result of themeta-analysis shows that OH&S is a major concern in the mining sector. Natural factors, including roof falls, gases anddust, and explosions, as well as human factors such as lack of training, ignorance of safety measures, lack ofknowledge, outdated mining methods, and neglect of safety equipment (helmets, goggles, safety gloves, and masks),have led to accidents and casualties. Demographic factors such as age and personal factors like work experience andduration of job are also major causes of mining accidents that lead to fatalities and injuries. The government,stakeholders, and miners themselves have not been able to take serious initiatives to ensure safety. This studyconcluded that mining conditions are hazardous throughout the country. Workers lives are in danger. Improvements insafety measures not only protect workers lives but also decrease mining accidents, and lead to increased production

Prediction of accident-proneness among a sample of Iranian workers: usefulness of an adjusted version of the Health Belief Model with spiritual health

BackgroundWorkforce health is one of the primary and challenging issues, especially in industrialized countries. The purpose of the present study was to evaluate the ability to predict accident-proneness among Saveh Industry workers in Iran, based on an extended Health Belief Model, that included the construct of spiritual health.MethodThis descriptive-analytical study was conducted in 2022 on 384 workers in Saveh, Iran. The study aimed to explore relationships between accident proneness behavior, spiritual health, and health beliefs. The accident-proneness questionnaire consisted of two parts: the first part included demographic questions, and the second part comprised 9 sections covering personality traits, workplace harmful factors, miscellaneous factors, musculoskeletal disorders, safety culture, safety attitudes, job stress, organization interest, and degree of risk-taking. The Health Belief Model included 31 questions, while spiritual health was measured with the 20-question Paloutzian and Ellison questionnaire. The collected data were analyzed using SPSS version 26 software.ResultsIn terms of accident proneness, 229 (59.6%), exhibited high levels, 148 (38.5%) had medium levels, and 7 (1.8%) showed low levels of accident-proneness. Hierarchical multiple regression analysis showed that in the first model, variables of perceived self-efficacy, vulnerability, and severity independently predicted workers accident proneness, explaining a total of 43% of variance in accident proneness behavior. In the second step, perceived self-efficacy (β = 34%), perceived sensitivity (β = 27%), spiritual health (β = 16%), and perceived severity (β = 12%) were included, respectively, which explained a total of 46% of the variance of accident-prone behavior of workers.ConclusionGiven the high rate of accident proneness observed in this study, there is a critical need for policymakers and health planners to design policies aimed at mitigating the risks associated with occupational accidents. Furthermore, the findings highlight the potential of integrating spiritual health into the Health Belief Model, as a conceptual framework for planning effective intervention programs to enhance workplace safety.

Experiences of Faculty in Nursing Colleges: A Descriptive Phenomenology Study

The future of patient care is being paved by nurse educators, who mentor, teach, and inspire the next generation of novice nurses. Without them, aspiring nurses wouldn't be prepared to handle the constantly shifting needs of the modern, dynamic healthcare system. Nursing faculty needs to be knowledgeable and competent in evidence-based practice, informatics, quality improvement, inter-professional teamwork, and patient-centred care that are delivered with a focus on a culture of safety. As nursing faculties perform multidimensional work with balancing their home environment can create chaos in their life. Hence this aspect lit a spark within us to conduct a qualitative study on Nursing facultiesof southern region of Tamilnadu to analyse their work experiences. Further the study was led by in-depth face to face interview by using semi structured questionnaires. The data saturation was attained with sixteen participants. Colaizzi’s method was incorporated to analyse the data from the nursing faculty. This qualitative study lead a hand for us to showcase various themes like daily routine, job satisfaction, work life balance, interpersonal relationship and difficulties and challenges. There were also various subthemes which gave us insight on work atmosphere of the staff. Hence this study gave us an in-depth knowledge and understanding of individual nursing faculty and improvement so that the work balance could be maintained.

MODERN CONCEPT OF OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT WITH A RISK-BASED APPROACH

The article justifies implementing a risk-based approach (RBA) in occupational safety and health (OSH) management. It considers the limitations of traditional methods of implementing preventive measures focused on reactive measures designed to respond to immediate security challenges. It further proposes modern proactive strategies that can monitor, predict, and prevent dangerous situations in the workplace in advance. The study develops and substantiates the RBA’s main principles and underscores elements, methodologies, and their integration into existing OSH management systems. It provides arguments to support decentralising decision-making closer to the sources of hazards to allow for a faster and more effective response. It also emphasises the fragmented nature of the current occupational safety and health legislation, making it challenging to integrate RBA. Recommendations suggest improving the legislative framework to support RBA and provide employers greater flexibility in choosing risk management tools and methods. The authors recognise a systematic risk monitoring and assessment approach as a critical need. The absence of regular audits and risk assessments hinders the identification and prevention of hazards. The study proposes the introduction of modern technologies and methodologies, such as the Fine and Kinney method, the Elmeri system, and the Ishikawa diagram, to improve the risk identification and assessment processes. The article also stresses the importance of informing employees about potential risks and preventive measures, which contributes to the overall safety culture in organisations. In addition, the authors outline an algorithm for implementing RBA, which includes auditing workplaces, creating electronic registers, developing safety instructions, systematic risk assessment, documenting results, and informing stakeholders. The proposed approach aims to proactively identify and mitigate occupational risks, which helps to reduce workplace accidents and occupational diseases. The article concludes that the transition to a risk-based approach is essential for improving workplace safety, reducing occupational risks, and supporting the sustainable development of enterprises. By applying RBA, organisations can achieve higher occupational safety, reduce the costs associated with accidents and injuries, and contribute to a safer and healthier work environment. Keywords: risks, occupational safety, occupational health, production, risk-based approach.

Decoding stakeholder priorities of safety culture preferences in the oil and gas industry

Safety culture is a critical determinant of organisational performance, particularly in high-risk industries especially in oil and gas. Understanding stakeholder preferences is essential for developing effective strategies that enhance safety culture. This study utilised the Analytic Hierarchy Process (AHP) to prioritise stakeholder preferences, identifying key elements of safety culture in Malaysia's oil and gas sector. This study employed a structured methodology to evaluate safety culture within the oil and gas industry, focusing on 18 sub-elements across three key domains: psychological, behavioural, and situational factors. A diverse sample of industry experts was recruited using purposeful and snowball sampling to ensure a comprehensive representation of stakeholder views. The AHP framework was applied to analyse the data, utilizing structured questionnaires and multicriteria decision-making techniques to prioritize the identified safety culture elements. The AHP analysis identified distinct priorities among different professional groups within the oil and gas sector. Safety and Health Practitioners emphasized practical elements such as safety rules and management commitment, while academicians prioritized knowledge and training. Management personnel highlighted the importance of safety ownership and communication, whereas policymakers focused on broader, policy-oriented aspects. The findings suggest that safety culture improvement initiatives should be tailored to address the specific needs and priorities of each professional group. A nuanced understanding of stakeholder preferences is crucial for developing comprehensive strategies that integrate observable behaviours, situational conditions, and psychological factors, ultimately fostering a robust safety culture in the oil and gas industry.

Safety culture: from student to professional

Traffic safety culture, recently this definition is very often heard at conference calls of heads of services. What does this concept imply, how is it interconnected with safety management and why do these areas of work relate to the main tasks of the Russian Railways holding in the field of traffic safety and operation of railway transport? The article discusses the causes of traffic safety violations, which are associated with the influence of the human factor, violation of labor discipline, and improper performance of official duties. The main objective of the study is to find approaches to raising the level of safety culture among railway workers. Most often, when solving a certain task, it is necessary to go beyond it and consider issues that at fi rst glance do not relate to the essence of the problem, but the more you delve into the study, you come to conclusions that show the connection between themselves sometimes in the most unexpected and unpredictable way. How to improve the traffic safety culture among the company’s employees? Is it possible to correct employees whose professional experience has been assessed not for one year, but for decades? Is it possible to change the thinking of an employee whose professional experience has been assessed not for one year, but for decades? In my opinion, an employee who has been violating for many years will no longer be able to perform his job duties properly. This is a “professional” defect that cannot be corrected, because most often it was taught this way during an internship in production. Most cases could have been avoided because minor violations combined with certain factors are fatal.

Rural adolescent attitudes and use of helmets while riding ATVs, motorcycles and dirt bikes

BackgroundHead injuries are the most common cause of death in some motorized vehicles for which helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ attitudes regarding helmets and their use while riding ATVs, motorcycles and dirt bikes.MethodsA convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees were surveyed. After compilation, data were imported into the statistical program, R (https://www.R-project.org/). Descriptive statistics, contingency table, logistic regression and non-parametric alternatives to ANOVA analyses were performed.Results1331 adolescents (13–18 years) participated. One half lived on a farm, 21% lived in the country/not on a farm and 28% were from towns. Nearly two-thirds (65%) owned an ATV with 77% of all having ridden one in the past year. Farm residents had the highest ATV ownership (78%) and having ridden (80%) proportions, both p < 0.001. Overall, ownership and ridership for motorcycles (22% and 30%, respectively) and dirt bikes (29% and 39%, respectively) was significantly less than ATVs, all p < 0.001. Of ATV riders, those living on farms or in the country/not on a farm rode them more frequently than those from towns, p < 0.001. Higher percentages always/mostly wore helmets when riding dirt bikes (51%) and motorcycles (57%) relative to ATVs (21%), p < 0.001. Those from farms had lower proportions wearing helmets versus those living elsewhere for all vehicles. Helmet use importance ratings (1–10, 10 high) were not different for motorcycles (mean 8.6, median 10) and dirt bikes (mean 8.3, median 10), but much lower for ATVs (mean 6.1, median 6). Females, non-owners, and helmet law supporters all had higher helmet use importance ratings. Males, those from farms, and owners and riders of the vehicles all had lower proportions that supported helmet laws. Support for helmet laws was significantly lower for ATVs (30.7%) than dirt bikes (56.3%) or motorcycles (72.3%), both p < 0.001. Those whose families had strict ATV “No Helmet, No Riding” rules had much higher helmet use and helmet importance ratings.ConclusionsOur study indicates that the safety culture surrounding helmet use is relatively poor among rural adolescents, especially on farms, and deserves targeted interventions.

Occupant complacency in workplace fire evacuations

This study explored occupant complacency during workplace fire evacuations. It is targeted at those responsible for fire safety management and fire safety practitioners with a contribution to prevent or mitigate the risk of injury or death arising out of a delayed evacuation at work. It seeks to define occupant complacency during workplace fire evacuations, identify its antecedents and explore effective measures to mitigate or control the antecedents of occupant complacency during workplace fire evacuations. Research was conducted using a survey instrument by contacting safety, health and fire safety professionals globally through convenience sampling and several international safety, health and fire safety-related institutions. This included demographics of the respondents, the confirmation of a definition of complacency, and means of dealing with complacency as defined by the questionnaire including priority strategies. The research team then sought to identify the antecedents of occupant complacency during workplace fire evacuations using raw data from a previous study. This study addresses the hypothesis that if there is a clear definition of occupant complacency during workplace fire evacuations and control measures are developed, tested and implemented, the risks of injury and death related to occupant complacency during workplace fire evacuations could be prevented or mitigated. Analysis of survey findings clarified a number of key strategies to avoid evacuation complacency including but not limited to underscoring the importance of leadership involvement within a safety culture; training and education, awareness raising and communications to avoid occupant complacency during workplace fire evacuations; evacuation drills; procedures, and the role of fire wardens. Based on information from a published report that explored individual attitudes, perceptions and experiences as well as perceived vulnerability that shape antecedents of occupant complacency during workplace fire evacuations and individual behaviours when an evacuation alarm is initiated, the authors identified and filled a gap in the report, by suggesting a working definition of occupant complacency during workplace fire evacuations and control measures to prevent or mitigate this behaviour.

A Process-Based Standardization of an Intraoperative Escalation Protocol in Anesthesiology.

Prompt recognition and management of critical events is pivotal for the provision of safe anesthetic care. This requires a well-functioning team that focuses on effective communication, timely decision-making, and escalation of potential complications. We believe that variation in bedside care leads to "near-misses," adverse outcomes, and serious safety events (SSEs). The principles of an escalation culture have been used successfully in other highly reliable industries such as aviation, military, and manufacturing. We discuss here the introduction of a unique and compelling thought-process for developing an intraoperative escalation protocol that is specifically tailored for our institution. Inspired by a critical intraoperative event, this departmental protocol was developed based on an analysis of multispecialty literature and expert opinion to decrease the incidence of SSEs. It includes a stepwise approach and incorporates patient-specific information to guide team members who encounter dynamic clinical situations. The implementation of the protocol has facilitated continuous quality improvement through iterative education, improving communication, and enhancing decision-making. Concurrently, we have plans to incorporate technology and electronic decision support tools to enhance real-time communication, monitor performance, and foster a culture of safety.