Safety Research Research Articles

The role of interpersonal conflict as a cause of work-related stress in construction managers in Ireland

Purpose The purpose of this study is to provide evidence to support an emerging theory that interpersonal conflict is the primary cause of workplace stress among a self-selected sample of Irish construction managers. Design/methodology/approach Eighteen construction managers working in Ireland were recruited for this study. Using semi-structured interviews and interpretative phenomenological analysis as the research methodology, the causes of their workplace stress were investigated. Findings Participants reported that the principal cause of their workplace stress was high levels of interpersonal conflict between colleagues. The effects of this interpersonal conflict included avoidance behaviour, ill health, absences from the workplace and loss of productivity issues. Deadlines, penalty clauses, lack of appreciation, cliques, costs, communication, temporary contracts and delays were also reported stressors. Research limitations/implications A limitation of the study is the small sample of 18 construction managers and the limited geographical area. Social implications The social implications of this study could be to clearly identify that interpersonal conflict may be under reported in the construction industry, and there is a possibility that it is being misclassified as other workplace behaviours such as bullying, harassment and workplace violence. If this is so, this could aid future researchers in addressing this challenging workplace behaviour. Originality/value The current consensus in the literature is that the three main causes of workplace stress are bullying, harassment and violence. However, the role and importance of interpersonal conflict as reported in this study, with the exception of North America and China, is not reflected in the wider health and safety research literature. In addition, interpersonal conflict and its reluctance to be reported is largely absent from construction safety research. The findings of this study may be explained if the workplace stress research community is currently misclassifying interpersonal conflict as a manifestation of bullying, harassment or violence. If this is the case, interpersonal conflict needs further research. This is to establish if this cause of construction-related workplace stress needs to be reconsidered as a standalone phenomenon in the wider family of challenging workplace behaviours.

Preservatives for postmortem brain tissue in biomechanical testing: A pilot study.

Postmortem human subject (PMHS) studies are essential to brain injury research in motor vehicle safety. However, postmortem deterioration reduces the similarity between postmortem test results and invivo response in material testing of brain tissue and in biomechanical testing of the whole head. This pilot study explores the effect of potential preservatives on brain tissue breakdown to identify promising preservatives that warrant further investigation. To identify preservatives with potential to slow postmortem degradation, samples from an initial PMHS were refrigerated at 10°C to qualitatively compare tissue breakdown from 58 to 152 h postmortem after storage in candidate solutions. On brain tissue samples from a second PMHS, compressive stiffness was measured on six samples immediately after harvest for comparison to the stiffness of 23 samples that were stored at 10°C in candidate solutions for 24 h after harvest. The candidate solutions were artificial cerebrospinal fluid (ACSF) without preservatives; ACSF with a combination of antibiotics and antifungal agents; ACSF with added sodium bicarbonate; and ACSF with both the antibiotic/antifungal combination and sodium bicarbonate. Results were analyzed using multiple linear regression of specimen stiffness on harvest lobe and storage solution to investigate potential differences in tissue stiffness. Qualitative evaluation suggested that samples stored in a solution that contained both the antibiotic/antifungal combination and sodium bicarbonate exhibited less evidence of tissue breakdown than the samples stored without preservatives or with only one of those preservatives. In compression testing, samples tested immediately after harvest were significantly stiffer than samples tested after 24 h of storage at 10°C in ACSF (difference: -0.27 N/mm, 95% confidence interval (CI): -0.50, -0.05) or ACSF with antibiotics/antifungal agents (difference: -0.32 N/mm, 95% CI: -0.59, -0.04), controlling for harvest lobe. In contrast, the stiffness of samples tested after storage in either solution containing sodium bicarbonate was not significantly different from the stiffness of samples tested at harvest. There was no significant overall difference in the mean tissue stiffness between samples from the frontal and parietal lobes, controlling for storage solution. Given the importance of PMHS studies to brain injury research, any strategy that shows promise for helping to maintain invivo brain material properties has the potential to improve understanding of brain injury mechanisms and tolerance to head injury and warrants further investigation. These pilot study results suggest that sodium bicarbonate has the potential to reduce the deterioration of brain tissue in biomechanical testing. The results motivate further evaluation of sodium bicarbonate as a preservative for biomechanical testing using additional test subjects, more comprehensive material testing, and evaluation under a broader set of test conditions including in whole-head testing. The effect of antibiotics and antifungal agents on brain tissue stiffness was minimal but may have been limited by the cold storage conditions in this study. Further exploration of the potential for microbial agents to preserve tissue postmortem would benefit from evaluation of the effects of storage temperature.

Pancreatic extracorporeal shock wave lithotripsy: a key technology truly improves treatment model for pancreatic stones

Abstract Chronic pancreatitis (CP) is characterized by irreversible destruction of pancreatic parenchyma, inflammatory cell infiltration and progressive fibrosis of pancreatic tissue. Obstruction of pancreatic duct by pancreatic stone is the common pathological change in the course of CP with the incidence of over 50 % at the diagnosis of CP. These ductal stones would cause pancreatic parenchymal hypertension and local ischemia, which was eventually followed by recurrent episodes of painful pancreatitis or other manifestations of pancreatic exocrine and endocrine insufficiency. Removing pancreatic stones has been confirmed as the core to reduce pressure, improve drainage and lessen pain. Surgical therapy achieves satisfying pain relief with more complications, higher cost and less repeatability compared with endoscopic therapy. Endoscopic retrograde cholangiopancreatography, which used to be the standard endoscopic therapy for pancreatic stones, would fail if these stones are large or complex, while pancreatic extracorporeal shock wave lithotripsy (P-ESWL), which has been applied since 1987, could overcome this problem. Up to now, a large number of guidelines have recommended the P-ESWL as the first-line treatment strategy for radiopaque obstructive main pancreatic duct stones larger than 5 mm located in the head/body of the pancreas, and P-ESWL had completely changed the traditional treatment model for CP patients with pancreatic stones. In this article, we will focus on the technical progress, efficacy, safety and potential research areas of P-ESWL, we also give us suggestions for lithotripters improvement.

Work-related Road Traffic Crashes in Malaysia: A Comparison between Fatal and Temporary Injury Cases

Introduction: Work-related road traffic crashes have significant implications for both employers and employees, leading to devastating consequences such as fatalities, injuries, and property damage. Despite the increasing focus on road safety research, little attention has been given to identifying factors associated with work-related road crashes. This paper explores and compares the characteristics of fatal cases (FOT) with the characteristics of temporary injury cases (HUS) in work-related road traffic crashes. Materials and methods: Seven years of work-related road crash claim compensation data between 2014 and 2020 was obtained from the Social Security Organization (SOCSO). A total of 546 cases were involved, including 56 FOT and 490 HUS cases. Categorical data analysis techniques were employed to examine the distinctions between FOT and HUS cases. Results: The results indicate a lower representation of transportation sectors in FOT cases, with the corresponding odds approximately 84% lower. Conversely, small and middle enterprises exhibit an odds ratio of about 5.1 times higher in FOT compared to HUS cases. Conclusion: The findings from this study can serve as proactive measures for employers in addressing work-related road traffic crashes. This includes enhancing road safety awareness programs specifically focusing on groups engaged in nighttime shifts and those involved in sending and pickup duties. Considering the distinct risk profiles of large enterprises versus small and medium enterprises, future studies are necessary to clarify the effectiveness of the road safety initiatives undertaken by both types of enterprises.

Ergonomic Risk Assessment of Warehouse Workers in the Courier Service Industry: A Case Study from Kuantan, Malaysia

The global surge in demand for courier services has introduced both benefits and challenges. Courier workers face immense pressure to handle large volumes of orders, leading to increasing cases of health and occupational injuries. The lack of ergonomic interventions in their work highlights the urgent need for ergonomic assessments in the courier industry. In Malaysia, current ergonomic risk assessments for warehouse courier workers are insufficient, making it essential to identify prevalent musculoskeletal disorders (MSDs) and determine the associated risk factors and levels posed by their daily tasks. This study aimed to address this gap by conducting ergonomic risk assessments among 35 warehouse workers using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), the Initial Ergonomic Risk Assessment (ERA) Checklist, and Rapid Entire Body Assessment (REBA). Three different work tasks were observed: scanning and sorting, tiered storage and stacking, and load unloading. The findings revealed that lower back pain was the most common ailment (14.5%), followed by hip pain (8.39%) and neck pain (7.89%). The tiered stacking storage activity posed the highest ergonomic risk, with identified risk factors including awkward postures, static and sustained activity, and repetitive tasks. The REBA analysis indicated a very high-level risk for tiered stacking storage, necessitating immediate ergonomic interventions. These findings contribute to the field of ergonomics and provide valuable insights for safety practitioners, ergonomists, researchers, and academicians in occupational safety and health and the courier service industries.

Multi-omics analysis reveals that Cas13d contributes to PI3K-AKT signaling and facilitates cell proliferation via PFKFB4 upregulation

The CRISPR-Cas system is a powerful gene editing technology, the clinical application of which is currently constrained due to safety concerns. A substantial body of safety research concerning Cas9 exists; however, scant attention has been directed toward investigating the safety profile of the emergent Cas13 system, which confers RNA editing capabilities. In particular, uncertainties persist regarding the potential cellular impacts of Cas13d in the absence of reliance on a cleavage effect. In this study, we conducted an initial exploration of the effects of Cas13d on HeLa cells. Total RNA and protein samples were extracted after transfection with a Cas13d-expressing plasmid construct, followed by transcriptomic and proteomic sequencing. Differential gene expression analysis identified 94 upregulated and 847 downregulated genes, while differential protein expression analysis identified 185 upregulated and 231 downregulated proteins. Subsequently, enrichment analysis was conducted on the transcriptome and proteome sequencing data, revealing that the PI3K-Akt signaling pathway is a common term. After intersecting the differentially expressed genes enriched in the PI3K-Akt signaling pathway with all the differentially expressed proteins, it was found that the expression of the related regulatory gene PFKFB4 was upregulated. Moreover, western blot analysis demonstrated that Cas13d can mediate PI3K-Akt signaling upregulation through overexpression of PFKFB4. CCK-8 assay, colony formation, and EdU experiments showed that Cas13d can promote cell proliferation. Our data demonstrate, for the first time, that Cas13d significantly impacts the transcriptomic and proteomic profiles, and proliferation phenotype, of HeLa cells, thus offering novel insights into safety considerations regarding gene editing systems.

Typology of solutions addressing diagnostic disparities: gaps and opportunities.

Diagnostic disparities are preventable differences in diagnostic errors or opportunities to achieve diagnostic excellence. There is a need to summarize solutions with explicit considerations for addressing diagnostic disparities. We aimed to describe potential solutions to diagnostic disparities, organize them into an action-oriented typology with illustrative examples, and characterize these solutions to identify gaps for their further development. During four human-centered design workshops composed of diverse expertise, participants ideated and clarified potential solutions to diagnostic disparities and were supported by environmental literature scan inputs. Nineteen individual semi-structured interviews with workshop participants validated identified solution examples and solution type characterizations, refining the typology. Our typology organizes 21 various types of potential diagnostic disparities solutions into four primary expertise categories needed for implementation: healthcare systems' internal expertise, educator-, multidisciplinary patient safety researcher-, and health IT-expertise. We provide descriptions of potential solution types ideated as focused on disparities and compare those to existing examples. Six types were characterized as having diagnostic-disparity-focused examples, five as having diagnostic-focused examples, and 10 as only having general healthcare examples. Only three solution types had widespread implementation. Twelve had implementation on limited scope, and six were mostly hypothetical. We describe gaps that inform the progress needed for each of the suggested solution types to specifically address diagnostic disparities and be suitable for the implementation in routine practice. Numerous opportunities exist to tailor existing solutions and promote their implementation. Likely enablers include new perspectives, more evidence, multidisciplinary collaborations, system redesign, meaningful patient engagement, and action-oriented coalitions.

Investigating the influence of streetscape environmental characteristics on pedestrian crashes at intersections using street view images and explainable machine learning

Examining the relationship between streetscape features and road traffic accidents is pivotal for enhancing roadway safety. While previous studies have primarily focused on the influence of street design characteristics, sociodemographic features, and land use features on crash occurrence, the impact of streetscape features on pedestrian crashes has not been thoroughly investigated. Furthermore, while machine learning models demonstrate high accuracy in prediction and are increasingly utilized in traffic safety research, understanding the prediction results poses challenges. To address these gaps, this study extracts streetscape environment characteristics from street view images (SVIs) using a combination of semantic segmentation and object detection deep learning networks. These characteristics are then incorporated into the eXtreme Gradient Boosting (XGBoost) algorithm, along with a set of control variables, to model the occurrence of pedestrian crashes at intersections. Subsequently, the SHapley Additive exPlanations (SHAP) method is integrated with XGBoost to establish an interpretable framework for exploring the association between pedestrian crash occurrence and the surrounding streetscape built environment. The results are interpreted from global, local, and regional perspectives. The findings indicate that, from a global perspective, traffic volume and commercial land use are significant contributors to pedestrian–vehicle collisions at intersections, while road, person, and vehicle elements extracted from SVIs are associated with higher risks of pedestrian crash onset. At a local level, the XGBoost-SHAP framework enables quantification of features’ local contributions for individual intersections, revealing spatial heterogeneity in factors influencing pedestrian crashes. From a regional perspective, similar intersections can be grouped to define geographical regions, facilitating the formulation of spatially responsive strategies for distinct regions to reduce traffic accidents. This approach can potentially enhance the quality and accuracy of local policy making. These findings underscore the underlying relationship between streetscape-level environmental characteristics and vehicle–pedestrian crashes. The integration of SVIs and deep learning techniques offers a visually descriptive portrayal of the streetscape environment at locations where traffic crashes occur at eye level. The proposed framework not only achieves excellent prediction performance but also enhances understanding of traffic crash occurrences, offering guidance for optimizing traffic accident prevention and treatment programs.

Philosophical Investigations into AI Alignment: A Wittgensteinian Framework

We argue that the later Wittgenstein’s philosophy of language and mathematics, substantially focused on rule-following, is relevant to understand and improve on the Artificial Intelligence (AI) alignment problem: his discussions on the categories that influence alignment between humans can inform about the categories that should be controlled to improve on the alignment problem when creating large data sets to be used by supervised and unsupervised learning algorithms, as well as when introducing hard coded guardrails for AI models. We cast these considerations in a model of human–human and human–machine alignment and sketch basic alignment strategies based on these categories and further reflections on rule-following like the notion of meaning as use. To sustain the validity of these considerations, we also show that successful techniques employed by AI safety researchers to better align new AI systems with our human goals are congruent with the stipulations that we derive from the later Wittgenstein’s philosophy. However, their application may benefit from the added specificities and stipulations of our framework: it extends on the current efforts and provides further, specific AI alignment techniques. Thus, we argue that the categories of the model and the core alignment strategies presented in this work can inform further AI alignment techniques.

Applying Systems Thinking to Research into Risk Factors Influencing Earthmoving Equipment Operation Safety in Construction Sites

Earthmoving operations in the construction process are complex environments that involve interactions between equipment, the workforce, and materials within an overarching construction plan. Over the past two decades, researchers in construction have focused on improving the safety of construction earthmoving equipment due to their omnipresence in the construction environment. Although previous studies have explored safety risks and the causes of accidents involving construction earthmoving equipment, their approaches were common and lacked a comprehensive perspective. Hence, this systematic literature review applies Rasmussen’s (1997) risk management framework using a systems thinking approach to identify and classify the risk factors influencing earthmoving equipment operation safety in construction sites. Utilizing a multistep methodology, this research first identifies 38 risk factors pertinent to earthmoving equipment operations and then classifies them based on systems thinking. Social network analysis (SNA) is employed to analyze the data. The results show that most research on earthmoving equipment safety focuses on monitoring construction sites, but very little on government and regulatory roles. When considering the interdependencies of risk factors, safety training is the most important factor, followed by the largely overlooked earthmoving machinery characteristics and manufacturer’s performance. The results of this review inform both the research community and industry practitioners regarding the less-understood aspects of earthmoving equipment operation safety and future research directions.

Design of Active Fire Protection System for Warehouse Buildings Using NFPA and Indonesian National Standard (SNI)

In the operational conduct of a company, especially those relating to the storage of materials and goods in warehouses, the occupational health and safety OHS) aspects are critical factors that cannot be neglected. Fire was one of the consequences of a non-standard OHS application. The purpose of this research was to provide a proposal for the design of fire protection systems in the Archives and Documents Company, which are light fire extinguishers, sprinkler systems, hydrants, and reservoirs. This research method is observational-descriptive. In conceptual planning, layout, and coordination with the company, the researchers directly perform observations on the PT Archives and Documents to analyze and identify the deficiencies of fire protection equipment owned by the associated companies. ADC requires a total of 9 light fire extinguishers, 192 sprinkler points, 6 hydrants, and a reservoir size of 343,000 liters as a fire protection system according to the National Fire Protection Association standards (NFPA). All buildings that are occupied by humans and have a risk of fire must be equipped with fire protection. for future research in the field of fire safety research to design an emergency response plan for a building by simulating it with advanced technology. By implementing the proposed fire protection, the Company can prevent fire and spread of fire more widely

Patient and family engagement in patient safety in the Eastern Mediterranean Region: a scoping review

BackgroundPatients can play a key role in delivering safe care by becoming actively involved in their health care. This study aimed at reviewing the literature for evidence of patients’ and families’ engagement in patient safety in the Eastern Mediterranean Region (EMR).MethodsWe conducted a scoping review of the literature published in English using PubMed, Medline, CINAHL, Scopus, ISI Web of Science, and PsycINFO until June 2023.ResultsA total of 9019 studies were screened, with 22 meeting the inclusion criteria. Our review found few published studies of patient and family engagement in patient safety research in the EMR. Thirteen studies explored the attitudes, perceptions, and/or experiences / preferences of patients, families, and healthcare providers (HCPs) regarding patient engagement in patient safety. Nine publications reported patient involvement in patient safety activities at varying levels. Three categories of factors were identified that may affect patient involvement: patient-related (e.g., lack of awareness on their role in preventing harms, unwillingness to challenge HCPs’ authority, and cultural barriers); HCP-related (e.g., negative attitudes towards patient engagement, poor patient-provider communication, and high workload); and healthcare setting-related (e.g., lack of relevant policies and guidelines, lack of training for patients, and HCPs, and lack of patient-centered approach).ConclusionThis review highlighted limitations in the current literature on patient and family engagement in patient safety in the EMR, including both the depth of evidence and clarity of concepts. Further research is needed to explore how to actively involve patients and their families, as well as to determine whether such involvement translates into improved safety in practice.

Grand rounds in methodology: designing for integration in mixed methods research

Mixed methods research is a popular approach used to understand persistent and complex problems related to quality and safety, such as reasons why interventions are not implemented as intended or...

Modernization Data Analysis and Visualization for Food Safety Research Outcomes

Appropriate data collection and using reliable and accurate procedures are the first steps in conducting an experiment that will provide trustworthy outcomes. It is key to perform an assertive statistical analysis and data visualization for a correct interpretation and communication of results. A clear statistical summary and presentation of the data is critical for the reader to easily process and comprehend experimental results. Nowadays, there are a series of different tools to perform proper statistical analysis and create elaborate graphs that will help readers to understand the data, identify trends, detect outliers, evaluate statistical outputs, etc. However, researchers that are beginning to navigate experiments do not frequently encounter a guide that can provide basic principal concepts to begin their statistical analysis and data presentation. Therefore, the objective of this article is to provide a guide or manual to analyze and presents results focused on different types of common food safety experiments, including method comparisons, intervention studies, pathogen presence experiments, bio-mapping, statistical process control, and shelf life experiments. This review will provide information about data visualization options and statistical analysis approaches for different food safety experiments. In addition, basic concepts about descriptive statistics and possible solutions for issues related to microbiological measurements will be discussed.

GWSM4C: A global wave surrogate model for climate simulation based on a convolutional architecture

Accurate and rapid ocean surface wave simulations are essential for navigation safety, marine activity, and climate change research. However, traditional numerical wave models incur substantial computational costs, especially in long-term simulations for climatology research. Deep-learning methods have shown promise in enabling faster simulations with fewer computational resources. However, the cumulative error in current deep-learning wave models limits their use as surrogate component models in climate modeling. In this work, a deep-learning model, named the Global Wave Surrogate Model for Climate simulation (GWSM4C), was developed based on a convolutional architecture, which accounts for the physical processes (wind waves and swells) of waves. Because GWSM4C can automatically generate initial conditions for each simulation moment depending only on historical wind fields, the accumulation of errors from previous simulated wave states can be avoided. The experimental results demonstrated that simulated global significant wave height produced by GWSM4C exhibited a correlation coefficient of 0.94 and a root-mean-square error of 0.21 m compared with the traditional numerical wave model. Furthermore, the generalization test of the GWSM4C indicates that it is feasible to use GWSM4C for long-term wave simulation in climatology-related studies or to integrate it into a coupled climate model as a surrogate wave component model.

Examining the Facets of Burden from Agricultural Injury: Policy Implications.

Agriculture is one of the most dangerous industries in the United States. Loss of life, injury, and illness estimates in the agriculture industry only measure a fraction of the total burden to society. The purpose of this review was to conduct a comprehensive scan of the peer-reviewed literature to catalog research that explores the burden of agricultural injury to synthesize what is currently known. In total, 116 full-text papers meeting eligibility criteria were reviewed. Publications documenting agricultural injury burden were scanned and observations were categorized using a priori themes previously identified by occupational safety and health researchers. Results from this review indicate the true burden of agricultural injury is more expansive and complex than previous narratives on injury burden would imply. Future research should consider policies that encourage the collection of more expansive injury burden data, as well as methods to incorporate them into standard injury surveillance efforts.

Patient safety — Are we speaking the same language?

BackgroundSince the radical years following the To Err is Human report, patient safety research has become settled on standardisation and audit cultures. Recent work suggests a change in direction. Current efforts exploring the intricate relationship between stability and change within organisations establish a more balanced patient safety perspective. Frontline staff insights are key to this new knowledge. AimThis study aims to explore the patient safety perceptions of registered nurses working directly with patients in acute care settings. MethodFacilitated reflexive workshops were conducted with nine wards from October to November 2022. Data analysis explored creative works and reflective notes of group discussions with frontline registered nurses using a critical lens. FindingsWe offer four analytical interpretations of how frontline registered nurses understand and experience patient safety. These are as follows: buzzwords, keep ME safe, listen to US, and this is MY role. These manifest the business of patient safety where nurses are, under siege, the silenced team member and experience tension between accountability and responsibility. DiscussionCritical questioning and reappraisal of patient safety practices require the vast knowledge of frontline staff to be fully utilised. ConclusionThis research reveals much of what is avoided in patient safety literature — the tension between what registered nurses understand, experience, and can deliver in patient safety practice. It challenges organisational leaders to enable and support frontline nurses in driving local change.

Automatic text classification of drug-induced liver injury using document-term matrix and XGBoost.

Regulatory agencies generate a vast amount of textual data in the review process. For example, drug labeling serves as a valuable resource for regulatory agencies, such as U.S. Food and Drug Administration (FDA) and Europe Medical Agency (EMA), to communicate drug safety and effectiveness information to healthcare professionals and patients. Drug labeling also serves as a resource for pharmacovigilance and drug safety research. Automated text classification would significantly improve the analysis of drug labeling documents and conserve reviewer resources. We utilized artificial intelligence in this study to classify drug-induced liver injury (DILI)-related content from drug labeling documents based on FDA's DILIrank dataset. We employed text mining and XGBoost models and utilized the Preferred Terms of Medical queries for adverse event standards to simplify the elimination of common words and phrases while retaining medical standard terms for FDA and EMA drug label datasets. Then, we constructed a document term matrix using weights computed by Term Frequency-Inverse Document Frequency (TF-IDF) for each included word/term/token. The automatic text classification model exhibited robust performance in predicting DILI, achieving cross-validation AUC scores exceeding 0.90 for both drug labels from FDA and EMA and literature abstracts from the Critical Assessment of Massive Data Analysis (CAMDA). Moreover, the text mining and XGBoost functions demonstrated in this study can be applied to other text processing and classification tasks.

Complexity and Change: Antecedents of occupational injuries

Today’s environment requires operations and supply chains to be adaptable and flexible, leading to a constant state of change. This complex business environment presents multiple difficulties in managing occupational safety. To date, safety research has largely focused on the complexity of a firm’s operations, directly linking the complexity of the operational environment to workforce safety. This research explores the effect of complexity on occupational injuries from multiple dimensions (operational, supply chain and market) to answer the question: “Do the absolute level of complexity and changes in the level of complexity exert a negative effect on a company’s safety performance?” Using secondary data from global companies listed in the United States, our results indicate that an increase in occupational injuries is generally associated with higher levels of operational complexity. This study contributes to the existing literature by conceptually and empirically confirming that supply chain and market complexity have negative implications for occupational safety. The findings also extend the existing literature, showing that an increase in the level of complexity leads to a significant increase in occupational injuries, while a decrease in complexity does not necessarily reduce occupational injuries. Our findings suggest that practitioners should be aware of the implications for safety performance when making structural decisions that create greater complexity. Furthermore, the findings also inform policymakers and regulators, suggesting that companies that are exposed to more complexity − even complexity that is exogenous to the operations − require greater attention in monitoring and auditing to ensure the safety of the workforce.

Multi‐Team Shared Expectations Tool (MT‐SET): An Exercise to Improve Teamwork Across Health Care Teams

Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.