Safety-related Behaviors Research Articles

Piloting and evaluating feasibility of a training program to improve patient safety for inter-professional inpatient care teams \u2013 study protocol of a cluster randomized controlled trial

BackgroundImproving patient safety is a major goal in healthcare systems worldwide. There are several international training programs to improve patient safety, but they are often focused on single topics and professions. Therefore, one inter-professional training program for inpatient care teams, which combines key areas of patient safety (Teamwork, Error management and Patient involvement), was developed by our research group. In the present study we aim to (1) pilot this training program by comparing two different training formats (e-learning only versus blended learning) with a waiting control group and (2) evaluate the feasibility of the intervention.Methods and analysis(1) To pilot the intervention a cluster randomized controlled trial will be performed at three study sites. Therefore, an e-learning group and a blended learning group will be compared to a waiting control group at three points of assessment; (2) The feasibility of the intervention will be evaluated using qualitative methods. We will conduct problem-focused individual interviews as part of the post-intervention measurement in order to collect information on acceptance, implementation, promoting factors and barriers from the staffs’ perspective.DiscussionThe study puts forth a training program which has the potential to improve patient safety in inpatient care. Members of inter-professional inpatient care teams can receive systematic training in three competencies which are central to patient safety management. Thus, we expect the greatest improvement in staff Safety-related behavior regarding Teamwork, Error management and Patient involvement as well as Subjectively perceived patient safety in the blended learning group. In addition, the development of an optimal implementation strategy can foster implementation of the intervention in healthcare practice. Consequently, the intervention could be used continuously and comprehensively for advanced training of hospital staff.Trial registrationThe study has been registered in the German Register of Clinical Trials (DRKS-ID: DRKS00012818). Registered on August 8, 2017.

Using the capability approach and organizational climate to study occupational health and safety

The Capability Approach, first developed by Amartya Sen, cab be used as a mean to analyse occupational health and safety related behaviours. Accidents at work more frequently occur among atypical workers and migrants, making this an interesting context in which to apply Sen's theoretical framework; namely showing how freedoms, rights, organisational climate and capabilities are important factors in risk prevention. It is logical to expect that workers' participation and rights should provide a safer environment, but the application of the Capability Approach offers a tool to measure organisational inequalities and their consequences. Furthermore, its application could help to improve occupational health and safety chiefly among atypical workers. In this paper, I consider Safety Capability to encompass the workers attitude to their own protection, their understanding of safety procedures and the risks they face, and their freedom to ask their organisation to comply with the law and implement safe work processes.

Attitudes towards patient safety culture among postgraduate nursing students in China: A cross-sectional study

Patient safety is crucial to healthcare quality. It is important to assess the nursing students' safety attitudes to identify the weaknesses for developing education program and fostering students' engagement in patient safety practices. This study aimed to assess attitudes towards patient safety culture among postgraduate nursing students in China, and explore the factors that affect their safety attitudes and the relationships of safety attitudes and safety-related behaviors. This study used a cross-sectional survey design. A convenience sample of 231 postgraduate nursing students from ten medical universities in China completed the Chinese version of Safety Attitude Questionnaire, including six domains: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions and stress recognition. The mean scores of the six domains ranged from 65.22 to 70.75 on a 100-point scale. Percentages of positive responses for the six domains were below 55%, with the two lowest percentages for working conditions (35.9%) and safety climate (30.7%). Significantly lower domain scores were found in students with younger age, no work experience, higher workload and received safety education. There were positive correlations between the six domains and safety-related behaviors except for stress recognition. Nursing educators should focus more on the improvement of patient safety education and establishment of supportive work environment to enhance postgraduate nursing students’ attitudes towards safety culture.

Young people use their smartphone all the time – even when crossing the street?

First studies from the USA indicate that distraction may also become a major health problem for pedestrians. To examine the scope of this problem for young people, an observational study was conducted in Braunschweig, Germany, looking at street crossing behaviours of students in the vicinity of four major high schools (n = 1386, 609 male, 737 children 10–14 years of age, and 649 adolescents 15–19 years). The observer recorded basic characteristics of the pedestrians (age and gender) as well as their activities before and while crossing the street (including mobile phone use). Crossing behaviour was rated with regard to safety while crossing (e.g. checking the road for cars before crossing). About 10.5% of the students used their mobile phones (looking at it and/or typing) while crossing the street. Being alone increased this to 15.3%. Talking to others lead to a reduction to 7.2%. Neither age nor gender nor the type of crossing infrastructure influenced this frequency significantly. Using the mobile phone substantially reduced safety-related behaviours before crossing the street. Although no risky situation was directly observed, the results indicate a potential safety decrement due to mobile phone use for young pedestrians while crossing the road.

The Relationship Between Patients' Safety-Related Behaviors and Safety Events and Patient Experiences in Korean Hospitals.

There is increasing interest in patient participation in healthcare aimed at enhancing safety. The purposes of this study were to examine levels of patients' safety-related behaviors and to determine their relationships with safety events and care experiences. A cross-sectional survey was conducted with 360 patients in two tertiary general hospitals in Korea. The final dataset consisted of 341 patient responses. A questionnaire was developed to collect information concerning patients' safety-related behaviors, care experiences, and the occurrence of safety events. Univariate and multivariate analyses were performed. On average, patients participated in 10.0 (SD 5.4) safety-related behaviors. Sixty-five (19.1%) patients reported experiencing at least one adverse event related to medical management. The mean problem score for care experience was 39.4 (SD 27.8) out of 100.0. Multiple logistic analysis showed that patients with adequate health literacy and higher activation levels were more likely to have high safety-related behavior participation levels. High participation in safety-related behaviors was negatively associated with the occurrence of safety events. However, no significant relationship was found between patient participation and the total problem scores for care experience. These findings suggest that efforts to support patients with limited health literacy and low activation levels are needed to facilitate patient participation. Active participation in safety-related behaviors can contribute to improving patient safety.

Why are patients not more involved in their own safety? A questionnaire-based survey in a multi-ethnic North London hospital population

PurposeActive patient participation in safety pathways has demonstrated benefits in reducing preventable errors, especially in relation to hand hygiene and surgical site marking. The authors sought to examine patient participation...

An evaluation of the effects of an innovative school-based cycling education program on safety and participation

Cycling education programs for children could play a role in promoting both cycling participation and cycling safety, and they exist in many countries – often in school settings. Evaluations have generally shown improvements in skills and knowledge, but effects on less-researched outcomes such as safety-related behaviour, crashes or injuries, cycling participation, and cycling confidence, are unclear. The present research evaluated Safe Cycle, an innovative Australian school-based program that addresses hazard awareness and overconfidence in addition to more typical content (e.g. handling skills), in terms of a comprehensive range of outcomes. Students from Years 4 to 8 (n = 108) completed online surveys in class before, immediately after, and approximately 14 weeks after, the 8-week program was delivered. Significant increases in knowledge and confidence were observed, while results also suggested increases in cycling participation. The program appeared to address illusory invulnerability effectively, but there was no evidence that the program improved safety-relevant cycling behaviours or experience of crashes. The benefits of Safe Cycle might be enhanced by including elements to increase motivation to perform safety-relevant behaviours and durability of program effects.

Assessing Locus of Control in Pilots

Abstract. The present study systematically assessed the factor structure, internal consistency, and construct validity of the Aviation Safety Locus of Control scale (ASLOC) on 476 European pilots (4.6% female). Independent confirmatory factor analyses showed a strong correlation between the latent factors of Internal and External LOC, justifying proceeding with a one-factor solution (assessing internal LOC after reverse-scoring items). This model achieved adequate fit with excellent internal consistency, after refining with structural equation modeling. Furthermore, flight hours significantly predicted Internal LOC after controlling for age, suggesting that pilots’ work experience can enhance internal attributions of control. This has implications for safety-related behaviors and protection against accidents.

Drivers’ assessments of the risks of distraction, poor visibility at night, and safety-related behaviors of themselves and other drivers

A nationwide survey of 492 drivers, ages 18–76 yrs., assessed their understanding of risks associated with (a) driver distraction and (b) poor visibility at night, as well as performance of common safety-related behaviors by themselves and other drivers. Drivers of all ages rated use of smart phones to be significantly more distracting than tasks such as listening to music, interacting with a passenger, or talking on a phone. They reported performing safety-positive behaviors (e.g., check blind spots, use turn signals) at a high frequency, and performing safety-negative behaviors (e.g., talk on phone or send text messages) at very low frequency, although younger drivers admitted use of smart phones more frequently than older drivers. Respondents estimated that other drivers are more likely than themselves to engage in safety-negative behaviors and less likely to perform safety-positive behaviors. Differences between self and others were smaller if others were rated first. Respondents also reported that most driving tasks are easier in daylight than at night, and that they drive more slowly at night. However, they greatly overestimated how far they can see a pedestrian at night, and their lack of awareness of poor visibility at night was confirmed by insufficient use of high-beam headlights and trivial reductions in the maximum “comfortable” speeds at night. These findings indicate that most drivers are fully aware of the risks associated with distraction through use of smart phones, although younger drivers admit using those devices. Moreover, although they are dimly aware of increased difficulty when driving at night, respondents greatly overestimated the visibility of pedestrians at night, and they generally fail to compensate for limited night vision through use of high-beam headlights and reduction of speed.

When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance.

To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships. The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices. This study used a cross-sectional design to collect data from 146 nurses. Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data. A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance. The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment.

An agent-based modeling approach for understanding the effect of worker-management interactions on construction workers' safety-related behaviors

Abstract Pervasive unsafe behaviors of construction workers are the primary cause of accidents on construction job sites. The workers' safety-related behaviors are subject to a variety of factors, such as interactions with coworkers and interventions by management teams. The impacts of these factors have attracted considerable attention in academia but are yet to be fully examined. To provide a quantitative assessment of these impacts and their managerial implications in practice, an agent-based modeling approach of construction safety-related behaviors, which adopts a bottom-up architecture, is proposed in this research. This approach regards safety performance as an emergent property of the behaviors and interactions of construction workers and management teams. The development of the agent-based model is based on a range of theoretical and empirical evidence, including a cognitive analysis model for modeling worker behaviors, and site observations and surveys for the design of simulated working environment and tasks, as well as the modeling of individual behaviors and interactions. Four managerial scenarios are simulated using the proposed approach. Based on the simulation results, the effects of a number of managerial factors on the safety performance of construction workers are examined. These factors include duties of supervisors, the competency and inspection strategy of safety officers, the frequency of safety training, senior managers' involvement in safety activities and emphasis on safety goals. The effects of these factors are examined in a quantitative manner, and relevant implications for construction safety management practice are discussed. The findings prove that agent-based modeling is an effective approach for analyzing the characteristics and patterns of construction safety-related behaviors and assessing possible safety management strategies.

Home is where the mind is: Family interference with work and safety performance in two high risk industries

This study examines the process through which family interference with work (FIW) negatively relates to safety performance in two unique samples from high-risk industries. Using a sample from the construction industry, Study 1 finds that FIW is related to employees' workplace cognitive failures, which in turn, were a significant predictor of safety-related behaviors. Using a sample from a utility company, Study 2 replicates these results and demonstrates that psychological strain further explains the complex relationship between FIW and safety. Furthermore, in Study 2, the mediation pathways linking FIW with safety behaviors were moderated by employees' commitment to safety. The idea that family life can predict safety in the workplace through interference and distraction is important to the collective effort to protect worker health and critical to effective intervention design.

Training leaders to apply behavioral concepts to improve safety

Behavior-based safety (BBS) interventions have yielded positive results for safety, but recurring challenges, including lack of leadership support and perceptions of the approach blaming the worker, have been observed. A failure to properly educate leaders about the basic principles of behavior may be responsible for these challenges. A consultant workshop model has been shown to be a successful method for teaching leaders behavioral influence skills to positively impact performance in the workplace, but it has yet to be evaluated in a safety context. In this case study, a consultant workshop model was used to teach leaders at a chemical manufacturing plant basic concepts in behavioral science and project management as it relates to safety. Leaders each completed at least one project aimed at improving safety related behaviors or results while being coached. Prior to the onset of the intervention, the average number of injuries per year was 5.0 and the average total recordable rate per year was 2.0 per 100 full-time workers. After the intervention was implemented (fourth quarter of 2012–2017) the average number of injuries per year was 1.2 with an average yearly recordable rate of 0.53 per 100 full-time workers. Information about the workshop program, leader-led projects, and subsequent safety related results are discussed.

Reducing workplace accidents through the use of leadership interventions: A quasi-experimental field study

There is increasing evidence to suggest that leaders need to use a combination of leader behaviors to successfully improve safety, including both transformational and transactional styles, but there has been limited testing of this idea. We developed a leadership intervention, based on supervisor training in both transformational and active transactional behaviors, and implemented it with supervisors at a UK-based chemical processing company. The study found that the supervisory training intervention led to significant improvements in perceived employee safety climate, over an eight-week period, relative to the comparison group. Although we found no change in the frequency of leader behaviors, the intervention was effective in helping supervisors to apply active transactional leader behaviors in a safety-critical context. The results indicated that transformational leader behaviors were already at a high level and effectively linked to safety. Our findings suggest not only that employees may be receptive to safety-related active transactional behaviors within high-risk situations, but furthermore, leaders can be trained to adjust their behaviors to focus more on active transactional behaviors in safety-critical contexts.

Identification of Safety-Related Opinion Leaders among Construction Workers: Evidence from Scaffolders of Metro Construction in Wuhan, China.

This study aimed to reveal opinion leaders who could impact their coworkers’ safety-related performance in Chinese construction teams. Questionnaires were distributed to 586 scaffolders in Wuhan to understand their opinions about influencing their coworkers, serving as the foundation for a social network analysis to identify the potential opinion leaders among workers. A further controlled trial with the identified workers was conducted to select real opinion leaders by comparing their influence on others’ safety-related behavior, followed by an association analysis to profile these opinion leaders. Two main sources of opinion leaders were identified: foremen and seasoned workers. Implementing interventions through opinion leaders resulted in better safety-related behavior performance. Furthermore, compared with education level, the association analysis results indicated that one’s practical skills and familiarity with respondents was more important in the formulation of opinion leaders. This research introduces the concept of opinion leaders into construction safety and proposes an approach to identify and validate opinion leaders within a crew, thus providing a tool to improve behavior promotion on sites, as well as a new perspective for viewing interactions among workers.

Criterion-related validity of the cultural web when assessing safety culture

The purpose of the safety culture construct is to reduce organisational and occupational accidents. However, researchers have struggled to develop validated ‘measures’ of safety culture, that unequivocally link cultural traits with actual safety performance.Johnson’s (1992) [Johnson, G., (1992). Managing strategic change—strategy, culture and action. Long Range Planning, 25(1), pp.2] qualitative cultural web tool was adapted to simultaneously produce quantitative effectiveness ratings of an organisation’s current safety arrangements for impacting personnel’s safety-related behaviour. Data was collected at 15 safety culture workshops across North America over three-weeks. The population sample comprised 700 personnel, divided into 110 respondent groups. Data were examined from two perspectives: Within the cultural web topics (Routines, Stories, Symbols, Influences, Values, Structures & Measures); and specific safety culture topics (Profit before safety, Culture of Fear, Safety Leadership, Compliance, Competency, Communication, Lessons Learned) derived from thematic content analysis across the cultural web topics.The overall safety culture was shared and stable. Cronbach’s Alpha (0.845) indicated reliability. Criterion-related validity between the organisation’s Total Recordable Incident Rates (TRIR) for the cultural web topics (r = 0.488, p < 0.01) and specific safety culture topics (r = 0.417, p < 0.01) was found. Multiple regressions against specific incident records returned adjusted R2 criterion-related validity coefficients between 0.06 and 0.45. Both perspectives confirmed the criterion-related validity of the cultural web tool, albeit stronger relationships tended to be obtained from the safety culture topics. The study results reinforce the conclusion that the tool is a reliable and valid method that can help companies reduce organisational and occupational incidents and improve their safety culture.

Validity testing of a tool for assessing nurse safety behaviour against blood borne infections

Objective: This study was conducted to develop and verify a tool for assessing nurse safety behaviour against blood borne infections. Design: A cross-sectional correlation study design was used. Setting and Subjects: Items were developed based on reviews of related literature, published guidelines regarding the prevention of blood borne infections, and existing tools designed to assess compliance with blood borne infection control precautions.Face and content validities of the tool was assessed by expert panels. Construct validity and reliability were examined on 320 staff and charge nurses whose duties involved direct contact with patients. Results: A 12-item, 5-point Likert-type assessment tool of nurse safety behaviour against blood borne infections was devised. Construct validity, which was investigated by exploratory and confirmatory factor analysis, and reliability of the devised tool were well supported. The devised tool has a three-factor structure, ‘use of personal protective equipment’, ‘hygiene’, and ‘compliance with precautions’. These factors were found to be interrelated, were not independent of each other, and their correlations and loading coefficients indicated good discriminant and convergent validities. Conclusion: The devised 12-item assessment tool offers a clinically useful means of properly assessing safety related behaviours, and provides specific guidelines for preventive practices that should be followed by healthcare workers.

When Death is a Good Thing: A Model Examining Mortality Cues, Death Awareness, and Safety Behavior

Drawing from terror management theory (TMT) and posttraumatic growth (PTG) theory, we develop a framework outlining how mortality cues influence safety-related behavior (i.e., safety compliance and safety participation) through death awareness. Using data collected from 163 employees over a 12-month time period, we found support for our model. Specifically, mortality cues were positively related to both death anxiety and death reflection. In turn, death reflection was positively related to safety participation, but not safety compliance. This relationship was strengthened when psychological safety climate was low. Death anxiety was a predictor of safety performance only under certain psychological safety climate conditions. These findings highlight the conceptual differences between death anxiety and death reflection for researchers to consider in the future. In addition, for work settings where mortality cues inevitably occur, these findings provide an optimistic perspective for an otherwise unfortunate event.

Working safely at some times and unsafely at others: A typology and within-person process model of safety-related work behaviors.

Why do individuals choose to work safely in some instances and unsafely in others? Though this inherently within-person question is straightforward, the preponderance of between-person theory and research in the workplace safety literature is not equipped to answer it. Additionally, the limited way in which safety-related behaviors tend to be conceptualized further restricts understanding of why individuals vary in their safety-related actions. We use a goal-focused approach to conceptually address this question of behavioral variability and contribute to workplace safety research in 2 key ways. First, we establish an updated typology of safety-related behaviors that differentiates behaviors based on goal choice (i.e., safe vs. unsafe behaviors), goal-directedness (i.e., intentional vs. unintentional behaviors), and the means of goal pursuit (i.e., commission vs. omission and promotion vs. prevention-focused behaviors). Second, using an expectancy-value theoretical framework to explain variance in goal choice, we establish within-person propositions stating that safety-related goal choice and subsequent behaviors are a function of the target of safety-related behaviors, the instrumentality and resource requirement of behaviors, and the perceived severity, likelihood, and immediacy of the threats associated with behaviors. Taken together, we define what safety-related behaviors are, explain how they differ, and offer propositions concerning when and why they may vary within-persons. We explore potential between-person moderators of our theoretical propositions and discuss the practical implications of our typology and process model of safety-related behavior. (PsycINFO Database Record

Tackling Ambulatory Safety Risks Through Patient Engagement: What 10,000 Patients and Families Say About Safety-Related Knowledge, Behaviors, and Attitudes After Reading Visit Notes.

Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes ("OpenNotes") may help close the safety gap between visits. We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes. A total of 6913 (28%) of 24,722 patients at an adult hospital and 3672 (17%) of 21,579 participants at the children's hospital submitted surveys. Approximately 75% of patients and parents each reported that reading notes helped them understand the reason for both tests and referrals, and approximately 50% felt that it helped them complete tests and referrals. Roughly 75% of participants were more likely to check and understand test results. Overall, 97% of participants reported that trust in the provider, activation, patient-provider goal alignment, and teamwork were each better or the same after reading 1 note or more. Nonwhite participants and those with high school education or less were 30% to 50% more likely to report that reading notes helped them complete tests compared with white and more educated respondents, respectively. Overall, the majority of more than 10,000 patients and parents reported reading notes helped them understand and follow through on tests and referrals. As information transparency spreads, OpenNotes can help activate patients and families, facilitate safety behaviors, and forge stronger partnerships with clinicians.