Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

BARRIERS TO THE ADOPTION OF NEW SAFETY TECHNOLOGIES IN CONSTRUCTION: A DEVELOPING COUNTRY CONTEXT

The adoption rate of new technologies is still relatively low in the construction industry, particularly for mitigating occupational safety and health (OSH) risks, which is traditionally a largely labor-intensive activity in developing countries, occupying ill-afforded non-productive management resources. However, understanding why this is the case is a relatively unresearched area in developing countries such as Malaysia. In aiming to help redress this situation, this study explored the major barriers involved, firstly by a detailed literature review to identify the main barriers hampering the adoption of new technologies for safety science and management in construction. Then, a questionnaire survey of Malaysian construction practitioners was used to prioritize these barriers. A factor analysis further identified six major dimensions underlying the barriers, relating to the lack of OSH regulations and legislation, technological limitations, lack of genuine organizational commitment, prohibitive costs, poor safety culture within the construction industry, and privacy and data security concerns. Taken together, the findings provide a valuable reference to assist industry practitioners and researchers regarding the critical barriers to the adoption of new technologies for construction safety management in Malaysia and other similar developing countries, and bridge the identified knowledge gap concerning the dimensionality of the barriers.

The effect of organizational communication, transformational leadership and organizational learning to OSH performance A Case Study in PT WASKITA KARYA

Cases of work accidents are still happening today, including the construction service company. It indicates that the safety performance of construction service companies is not optimal, so it is important and needs to be investigated, especially safety culture, organizational communication, learning organization, and transformational leadership. Hence, this study explores the role of organizational communication in mediating the influence of transformational leadership and learning organization on safety culture and safety performance. The study used a quantitative approach through a survey with a questionnaire instrument designed on a Likert scale. The participant is 218 workers of PT. Waskita Karya (Persero) Tbk. Data analysis using structural equation modeling. The results showed that transformational leadership, learning organization, and safety culture had a positive and significant direct effect on work safety performance and safety culture, in addition the result also confirm that the key success factor for safety performance is organizational communication. Based on these findings, practically it is recommended that organizational communication among the workforce needs to be improved continuously to make a greater contribution to safety culture and performance.

Conceptualizing the Contextual Dynamics of Safety Climate and Safety Culture Research: A Comparative Scientometric Analysis

Safety climate and safety culture are important research domains in risk and safety science, and various industry and service sectors show significant interest in, and commitment to, applying its concepts, theories, and methods to enhance organizational safety performance. Despite the large body of literature on these topics, there are disagreements about the scope and focus of these concepts, and there is a lack of systematic understanding of their development patterns and the knowledge domains on which these are built. This article presents a comparative analysis of the literature focusing on safety climate and safety culture, using various scientometric analysis approaches and tools. General development patterns are identified, including the publication trends, in terms of temporal and geographical activity, the science domains in which safety culture and safety climate research occurs, and the scientific domains and articles that have primarily influenced their respective development. It is found that the safety culture and safety climate domains show strong similarities, e.g., in dominant application domains and frequently occurring terms. However, safety culture research attracts comparatively more attention from other scientific domains, and the research domains rely on partially different knowledge bases. In particular, while measurement plays a role in both domains, the results suggest that safety climate research focuses comparatively more on the development and validation of questionnaires and surveys in particular organizational contexts, whereas safety culture research appears to relate these measurements to wider organizational features and management mechanisms. Finally, various directions for future research are identified based on the obtained results.

The Influence of Human-Organizational Factors on Falling Accidents From Historical Text Data

This paper firstly proposes a modified human factor classification analysis system (HFACS) framework based on literature analysis and the characteristics of falling accidents in construction. Second, a Bayesian network (BN) topology is constructed based on the dependence between human factors and organizational factors, and the probability distribution of the human-organizational factors in a BN risk assessment model is calculated based on falling accident reports and fuzzy set theory. Finally, the sensitivity of the causal factors is determined. The results show that 1) the most important reason for falling accidents is unsafe on-site supervision. 2) There are significant factors that influence falling accidents at different levels in the proposed model, including operation violations in the unsafe acts layer, factors related to an adverse technological environment for the unsafe acts layer, loopholes in site management in the unsafe on-site supervision layer, lack of safety culture in the adverse organizational influence layer, and lax government regulation in the adverse external environment layer. 3) According to the results of the BN risk assessment model, the most likely causes are loopholes in site management work, lack of safety culture, insufficient safety inspections and acceptance, vulnerable process management and operation violations.

Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

Systemic Approach to Failure Analysis: A Study of Sociotechnical Organization

The paper is an attempt to explore systemic approach to accidents analysis within sociotechnical organization. Unsafe behaviors can result in systemic failures and accidents. The research data came from within an industrial radiography organization where radiation source is used to detect cracks or hidden flaws within machinery and welding joints. The radioactive source can cause severe detrimental effects, even death, if not used safely. This paper is on two isolated events happen in the same company, Industrial Services Private Limited (not real name). The company top management was dealing with the financial crisis and to maintain quality of its services and the safety of staff. The leadership of the company made several business and operational decisions to manage the financial crisis. During that time, several near miss incidents took place, but the first major incident took place when the radiography gamma projector, along with the radioactive source, fallen out of the vehicle because of improper back door closure of the vehicle. In the second incident, the radioactive source remained unshielded after a radiography job, this caused overexposure to radiography workers. The paper provides an opportunity to understand how an organization’s leadership can create conditions for errors and mistakes that result in poor safety culture and ultimately the accident which resulted the system failure and operation shutdown. The paper also tries to propose a conceptual framework to improve safety culture within the sociotechnical systems for the future research in this area.

Avaliação do trabalho em equipe na Unidade de Terapia Intensiva Materna com relação a Cultura de Segurança do Paciente

O objetivo deste estudo foi avaliar o trabalho em equipe de uma unidade de terapia intensiva materna, na perspectiva da equipe multiprofissional de saúde com relação a cultura de segurança do paciente. Estudo transversal, realizado entre fevereiro e março de 2021, que utilizou para a coleta de dados o questionário Hospital Survey on Patient Safety Culture, que avalia 12 dimensões da Cultura de Segurança do Paciente sendo para fins deste estudo, avaliado os itens que compõem as dimensões “Trabalho em equipe dentro da unidade” e “Trabalho em equipe entre as unidades”, constituindo assim, 8 itens. Participaram do estudo 40 profissionais. Ao analisar os itens avaliados, observou-se que 3 foram considerados áreas de força para a CSP, 1 como área neutra e 4 classificados como frágeis. Pode-se afirmar que na perspectiva da equipe multiprofissional da UTIM, o trabalho em equipe dentro da unidade é forte para a CSP, pois eles se tratam com respeito, apoiando uns aos outros, além de trabalharem como equipe quando há muito trabalho a ser realizado. No que se refere ao trabalho em equipe entre as unidades, os profissionais acreditam que os setores das maternidades não estão bem coordenadas entre si e que não existe uma boa cooperação entre as unidades que precisam trabalhar em conjunto.