Addressing Worker Safety and Health Through the Lens of Strategic Enforcement-Part One.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces that present a dizzying array of hazards, is daunting. Every day, workers are maimed or die from workplace injuries or occupational illnesses. Hence, government agencies must use all available means to ensure the laws intended to keep workers safe and healthy in their workplaces are maximally effective in accomplishing that purpose. This paper addresses this challenge through the lens of strategic enforcement. It examines how federal and state authority are designed to interact to ensure worker protection in this space, and focuses on what tools for deterring violations - many unrecognized or underutilized by worker safety agencies - are available to leverage the limited resources that inevitably constrain the agencies' reach. The forthcoming Part II will, among other things, showcase a number of noteworthy state and local initiatives that exceed the federal standard.

Assessment of work safety analysis performance among rural hospitals of Chirumanzu district of midlands province, Zimbabwe.

Ensuring workplace safety for healthcare workers is vital considering the important role they play in various societies which is to save life. Healthcare workers face different risks when performing tasks in various departments within hospitals, hence there is a need to assess work safety analysis procedures among healthcare workers. As a result, this study aims to assess the effectiveness of work safety analysis procedures among healthcare workers at Muvonde and Driefontein Sanatorium rural hospitals in Chirumanzu district. The research applied the descriptive cross-sectional design, combining quantitative and qualitative data collection methods. A questionnaire with both closed and open ended questionnaire was used for data collection among 109 healthcare workers at Muvonde hospital and 68 healthcare workers at Driefontein Sanatorium hospital. Secondary data sources, observations and interviews were also included as data collection methods. Quantitative data collected during the study was analysed using SPSS version 25. Braun and Clarke (2006)'s six phase framework was applied for qualitative data analysis. Ethical approval form was obtained from the District Medical Officer and Midlands State University. Findings of the study indicated that risks identified at Muvonde and Driefontein Sanatorium rural hospitals are classified as ergonomic, physical, chemical, psychosocial and biological risks. Respondents specified that these risks occur as a result of inadequate equipment, poor training, negative safety behaviour, poor management and pressure due to high workload. Safety inspection, safety workshops and monitoring of worker's safety behaviour were mentioned as measures to manage risks. However, the strengths and weaknesses of the current safety procedures need to be assessed to highlight areas for improvement to reduce occurrence of risks within the hospitals.

The relationship between hospital patient safety culture and performance on Centers for Medicare & Medicaid Services value-based purchasing metrics.

BACKGROUND: Despite the intense policy focus on reducing health-care-associated conditions, adverse events in health care settings persist. Therefore, evaluating patient safety efforts and related health policy initiatives remains critical. PURPOSE: The aim of this study was to explore the relationship between hospital patient safety culture and hospital performance on Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) metrics. METHODOLOGY/APPROACH: A pooled cross-sectional study design was used utilizing three secondary datasets from 2018 and 2021: the Hospital Survey on Patient Safety Culture, the American Hospital Association annual survey, and the Hospital Compare data from CMS. We used two multivariable linear regression models to examine the relationship between organizational patient safety culture and hospital performance. The dependent variables included the overall CMS total performance score (TPS) and the four individual TPS domain scores. Hospital patient safety culture, the independent variable, was operationalized using two measures from the Hospital Survey on Patient Safety Culture: (a) the domain score of overall perceptions of patient safety and (b) the patient safety grade. RESULTS: We observed positive and significant associations between hospital patient safety culture and a hospital's overall TPS and the "patient and community engagement" and "safety" domains. CONCLUSION: Findings suggest that building a strong patient safety culture has the potential to lead health care organizations to achieve high performance on HVBP metrics. PRACTICE IMPLICATIONS: Our findings have important policy implications for both the future of CMS HVBP as a motivator of patient safety and how health care managers integrate culture change into programs to meet external quality metrics.

Methodological issues in measuring psychosocial safety climate: a systematic review protocol.

INTRODUCTION: This systematic review aims to highlight the methodological inconsistencies in studying psychosocial safety climate (PSC). Highlighting the diverse dimensions and implications of PSC, this review seeks to enhance the replicability and comparability of studies, contributing to the development of standardised measurement techniques for the construct. METHODS AND ANALYSIS: The methodology encompasses a comprehensive search strategy in PubMed Central, Web of Science, Scopus, JSTOR, Embase, Science Direct, ProQuest, Google and Google Scholar from 28 January 2024 to 30 September 2024. A team of trained reviewers, under the guidance of the authors, will scrutinise eligible studies for inclusion based on predefined criteria. This will ensure a diverse yet focused selection of articles aligned with the research objectives. Robust data extraction and appraisal processes will be followed. Adopting a qualitative synthesis approach, the review aims to generate descriptive and analytical themes, uncovering nuanced dimensions of PSC beyond individual study findings. The protocol emphasises consultation with domain experts and a chartered librarian to refine research questions and optimise search strategies for selecting very relevant articles for the review. We will adopt qualitative data synthesis in summarising and presenting the results and findings for our review of PSC methodological issues. ETHICS AND DISSEMINATION: Ethical approval is not needed for this systematic review because the data for this review will be extracted from already published journal articles. The protocol for this review has been registered in the Open Science Framework. This review and its findings will be published in an academic journal and or presented at scientific conferences. TRIAL REGISTRATION NUMBER: OSF registration: https://doi.org/10.17605/OSF.IO/3UZC2.

Patient safety reporting and learning system of Catalonia (SNiSP Cat): a health policy initiative to enhance culture, leadership and professional engagement.

Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021-2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027 (QPSS Plan Cat). METHODS: Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023-2027. RESULTS: The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013-2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients' falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients' falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data. CONCLUSIONS: The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027.

Relationship between patient safety culture and patient experience in hospital settings: a scoping review.

BACKGROUND: Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings. METHODS: This study was performed using the five stages of Arksey and O'Malley's Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria. RESULTS: 4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients' and families' perspectives. CONCLUSION: The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience.

Patient safety culture in a tertiary care hospital in Makkah, Saudi Arabia, a cross-sectional study.

BACKGROUND: Patient safety remains an area of global concern, and patient safety culture among healthcare staff is one of its most important determinants. Saudi Arabia is investing much effort in enhancing patient safety. Assessment of patient safety culture is enlightening about the impact of such efforts and invaluable in informing policy makers about future directions. This study aimed to assess patient safety culture in King Abdullah Medical City (KAMC), a tertiary referral center in Makkah, Saudi Arabia. METHODS: In this cross-sectional study the Hospital Survey on Patient Safety Culture (HSOPSC) version 2.0 was distributed electronically to all staff of KAMC. The HSOPSC version 2.0 Data Entry and Analysis Tool was used to compare results obtained from KAMC to those obtained from global data. Additional analyses were performed on SPSS to explore the presence of associations between responses and participant characteristics. RESULTS: A total of 350 participants completed the questionnaire, 58.6% of whom were nurses. A comparison of the composite measure of all 10 domains of the HSOPSC showed 62% positive responses at KAMC versus 70% in the global database. This difference was statistically significant, with a chi-square of 10.64 and a p value of 0.001. The percentages of positive responses from the KAMC data exceeded those from the global data in the "Organizational learning and continuous improvement" and the "Communication about error" domains (p = 0.002 and 0.003, respectively). CONCLUSION: Although safety culture seems to score lower at KAMC than globally, accelerated improvement in the future is expected based on improvement trends in the literature and the national efforts focused on patient safety.

Safety climate in the operating room in the pre-pandemic and pandemic period of COVID-19: A mixed method study.

INTRODUCTION: To verify whether the COVID-19 pandemic has had an impact on the safety climate based on the perception of the multiprofessional team in the operating room and to analyze the domains of the safety climate during the pre-pandemic and pandemic period of COVID-19, demonstrating the intersections of quantitative and qualitative approaches. METHODS: Mixed-method research using a convergent approach strategy, carried out in the operating room of a university hospital, located in Rio de Janeiro, Brazil. The nature of the quantitative phase was cross-sectional, and the nature of the qualitative phase was descriptive. We used the Pillar Integration Process to integrate the data. This research considered the pre-pandemic period was defined as before March 2020 and for the pandemic period, the 2nd and 3rd global waves. Research was approved by the institution's board management and ethics committee. RESULTS: 145 health professionals participated in the quantitative approach, and 20 in the qualitative approach. The impact of the COVID-19 pandemic was highlighted in the domains 'Perceived stress' (p-value = 0.017); 'Working conditions' (p-value = 0.040). Six categories emerged from the qualitative analysis, namely: Stress and professional performance due to COVID-19; Patient safety protocols in the operating room; Responsibility for patient safety, lack of effective communication and performance feedback; Biosafety of the professional staff in the operating room; Security culture maturity; Fair culture, organizational learning, and reporting mistakes. As a result of the data integration, 6 pillars were identified: Perception of communication in the operating room; Evolution of safety culture; Overview of protocol management and implementation; Fair organizational culture; Perception of stress due to COVID-19; Perception of professional performance due to COVID-19. CONCLUSIONS: The impact that COVID-19 had on the safety climate in the operating room is evident. It underlines the need to implement strategies that support the solidification of attitudes aimed at patient safety, even in emergencies.

High Reliability in a Safety Net Hospital Leading to Operational Excellence.

OBJECTIVE: The objective of this work was to establish sustainable systems for quality improvement in an Academic Medical Center and Safety Net Hospital. METHOD: High reliability principles of leadership engagement, a culture of safety, and sustainable performance improvement were used. Target areas for improvement were clinical outcomes for patients, public reputation scores, and lower cost of care. The system was based on annual focused goals with specific targets, improvement teams, transparent scorecards, and data driven work. Program visibility was championed by leaders. Consistent education on quality, safety, efficiency, and effectiveness for all employees created buy-in. Data review and accountability tracked progress, helped resource allocation, and defined next steps. RESULTS: In the first 5 years, all patient quality and safety metrics improved between 10% and 60%. This improvement resulted in higher CMS Star Ranking and Leapfrog patient safety grade. The next phase included maximizing value by expanding into hospital operations and finance with a focus on improved clinical documentation and reduced length of stay and cost of care. Clinical documentation improvement led to a 15% increase in comorbidity capture. This positively impacted reported outcomes and hospital payment by appropriate risk adjustment. Length of stay was addressed with a new care coordination program and physician-driven utilization review. CONCLUSIONS: High reliability principles are applicable in a resource limited healthcare system. Improved clinical and operational results were achieved through goal setting, improvement teams, and data driven projects leading to creation of an office of operational excellence.

Developing a quality and safety assessment framework for Iran's military hospitals.

BACKGROUND: The first crucial step towards military hospitals performance improvement is to develop a local and scientific tool to assess quality and safety based on the context and aims of military hospitals. This study introduces a Quality and Safety Assessment Framework (Q&SAF) for Iran's military hospitals. METHODS: This is a literature review which continued with a qualitative study. The Q&SAF for Iran's military hospitals was developed initially, through a review of the WHO's framework for hospital performance, literature review (other related framework), review of military hospital-related local documents, consultations with a national and sub-national expert. Finally, the Delphi technique used to finalize the framework. RESULTS: Based on the literature review results; 13 hospital Q&SAF were identified. After reviewing literature review results and expert opinions; Iran's military hospitals Q&SAF was developed with 58 indictors in five dimensions including clinical effectiveness, safety, efficiency, patient-centeredness, and Responsive Management (Command and Control). The efficiency dimension had the highest number of indictors (19 indictors), whereas the patient-centered dimension had the lowest number of indices (4 indictors). CONCLUSION: Regarding the comprehensiveness of the developed assessment framework due to its focus on the majority of quality dimensions and important components of the hospital's performance, it can be used as a useful tool for assessing and continuously improving the quality of hospitals, particularly military hospitals.

Role of independent research at AERB for ensuring safety of nuclear facilities in India.

The mission of Atomic Energy Regulatory Board (AERB) of India is to ensure that the use of ionising radiation and nuclear energy in India does not cause unacceptable impact on the workers, members of the public and to the environment. AERB has the mandate to carry out detailed safety review for the siting, construction, commissioning, operation and decommissioning of nuclear and radiation facilities established within the country. To deliver and maintain a strong, credible and technically sound regulation, AERB has established the Safety Research Institute (SRI) at Kalpakkam with a robust technical infrastructure and wide knowledge base. This paper highlights the independent safety research activities carried out at SRI and its role to support and facilitate the decision-making process by AERB at various stages of regulatory review for ensuring safety of the nuclear facilities in India.

Scaling up a Positive Safety Culture among Construction Small and Medium-Sized Enterprises in Ghana.

The Ghanaian construction industry faces challenges in managing safety, especially for small and medium-sized enterprises (SMEs) that need more resources. This research addressed the critical need for a positive safety culture framework specifically designed for SMEs in Ghana. The study adopts the Delphi research approach, which involves a series of questionnaire 'rounds' to gather and refine information and develop a collaborative safety culture framework with SME stakeholders. The study employed a mixed-methods strategy, harnessing quantitative and qualitative data to meet the research goals. The critical components of the developed framework included safety commitment, adaptability, information, awareness, culture, and performance. The research offered evidence-based recommendations for effective positive safety practices across Ghana's SMEs by analysing the relationship between these interventions and safety outcomes. Applying the framework should reduce workplace accidents and foster a positive safety culture that aligns with international best practices.

A Review of Data Mining Strategies by Data Type, with a Focus on Construction Processes and Health and Safety Management.

Increasingly, information technology facilitates the storage and management of data useful for risk analysis and event prediction. Studies on data extraction related to occupational health and safety are increasingly available; however, due to its variability, the construction sector warrants special attention. This review is conducted under the research programs of the National Institute for Occupational Accident Insurance (Inail). OBJECTIVES: The research question focuses on identifying which data mining (DM) methods, among supervised, unsupervised, and others, are most appropriate for certain investigation objectives, types, and sources of data, as defined by the authors. METHODS: Scopus and ProQuest were the main sources from which we extracted studies in the field of construction, published between 2014 and 2023. The eligibility criteria applied in the selection of studies were based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). For exploratory purposes, we applied hierarchical clustering, while for in-depth analysis, we used principal component analysis (PCA) and meta-analysis. RESULTS: The search strategy based on the PRISMA eligibility criteria provided us with 63 out of 2234 potential articles, 206 observations, 89 methodologies, 4 survey purposes, 3 data sources, 7 data types, and 3 resource types. Cluster analysis and PCA organized the information included in the paper dataset into two dimensions and labels: "supervised methods, institutional dataset, and predictive and classificatory purposes" (correlation 0.97-8.18 × 10-1; p-value 7.67 × 10-55-1.28 × 10-22) and the second, Dim2 "not-supervised methods; project, simulation, literature, text data; monitoring, decision-making processes; machinery and environment" (corr. 0.84-0.47; p-value 5.79 × 10-25--3.59 × 10-6). We answered the research question regarding which method, among supervised, unsupervised, or other, is most suitable for application to data in the construction industry. CONCLUSIONS: The meta-analysis provided an overall estimate of the better effectiveness of supervised methods (Odds Ratio = 0.71, Confidence Interval 0.53-0.96) compared to not-supervised methods.

Identification of key factors influencing unsafe behavior of decoration workers.

This study explores the factors influencing unsafe behaviors among decorators. The study begins with a literature review on unsafe behaviors among construction workers, compiling a checklist of factors specific to decorators. Utilizing exploratory factor analysis (EFA), a measurement scale for these factors is developed. Subsequently, stepwise regression analysis (SRA) is conducted to validate relationships and identify crucial factors. Results categorize influencing factors into three dimensions: personal, organizational and environmental. Non-compliance with safety procedures and protocols is found to correlate directly with increased unsafe behavior at an individual level. Additionally, internal safety regulations within companies are identified as having a direct negative impact on unsafe behaviors at the organizational level. This study enhances our understanding of unsafe behaviors among decorators and offers recommendations for mitigation.

The role of trust in occupational safety: research results.

This article presents the concept and results of a study on the effects of organizational trust on the safety level in an enterprise. The research results presented provide valid and reliable statistical evidence that employees' trust in management is an important factor that significantly affects safety in a company. In particular, the research findings prove that employees' trust in management affects safety outcomes indirectly (full mediation), due to the improvement in their engagement in safety citizenship behaviour (SCB); but also that better engagement in SCB should directly or indirectly contribute to the reduction of accident event occurrence through improvement in employees' health and safety (H&S) regulation compliance (partial mediation). Moreover, the research findings prove that improvement in perceived management commitment in H&S will additionally strengthen positive relationships between trust in management and SCB engagement (interaction effect).

Patient safety culture and associated factors of regional public hospitals in Addis Ababa.

BACKGROUND: Patient safety culture is the result of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment, style, and proficiency of health providers' safety management. Globally, millions of adverse events occur annually, with a significant burden on low- and middle-income countries. The burden of injuries and other harm to patients from adverse events is likely one of the top 10 causes of death and disability worldwide. This study aimed to assess patient safety culture and its associated factors in regional public hospitals in Addis Ababa. METHODS: An institution-based cross-sectional study was conducted among 494 healthcare professionals working at regional public hospitals in Addis Ababa. The data were collected using a pretested structured self-administered questionnaire from June 3 to July 30, 2023. The data were entered into Epi info version 7.2 and exported to SPSS version 26.0 for analysis. Binary logistic regression analysis was used to determine the associations between the patient safety culture (dependent variables) and socio-demographic factors, health care providers and system's. Multicollinearity was checked using VIF, and the adequacy of the final model was assessed using the Hosmer and Lemeshow goodness-of-fit test. RESULT: Overall, 48.8% (95% CI: 44.3-53.1) of participants had a good patient safety culture, for a response rate of 93.3%. Factors significantly associated with patient safety culture, as identified through factor analysis, included having 6-10 years of experience (AOR = 1.81, 95% CI = 1.13-2.88), having more than 11 years of experience (AOR = 3.49, 95% CI = 1.27-9.56), reporting adverse events (AOR = 2.47, 95% CI = 1.37-4.45), participating in patient safety programs (AOR = 3.64, 95% CI = 1.91-6.92), and working in obstetrics and pediatric wards (AOR = 0.47, 95% CI = 0.23-0.94) and (AOR = 0.21, 95% CI = 0.097-0.44), respectively. CONCLUSION: The overall level of patient safety culture in regional public hospitals was low (< 75%). Factors such as having 6 or more years of experience, reporting adverse events, participating in patient safety programs, and working in obstetrics and pediatric wards were significantly associated with patient safety culture.