Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature.

BACKGROUND: In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified? METHODS AND ANALYSIS: We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects. RESULTS: We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units. DISCUSSION: This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.

Interplay between leadership and patient safety in dentistry: a dental hospital-based cross-sectional study.

OBJECTIVES: The study aimed to study the association of leadership practices and patient safety culture in a dental hospital. DESIGN: Hospital-based, cross-sectional study SETTING: Riphah Dental Hospital (RDH), Islamabad, Pakistan. PARTICIPANTS: All dentists working at RDH were invited to participate. MAIN OUTCOME MEASURES: A questionnaire comprised of the Transformational Leadership Scale (TLS) and the Dental adapted version of the Medical Office Survey of Patient Safety Culture (DMOSOPS) was distributed among the participants. The response rates for each dimension were calculated. The positive responses were added to calculate scores for each of the patient safety and leadership dimensions and the Total Leadership Score (TLS) and total patient safety score (TPSS). Correlational analysis is performed to assess any associations. RESULTS: A total of 104 dentists participated in the study. A high positive response was observed on three of the leadership dimensions: inspirational communication (85.25%), intellectual stimulation (86%), and supportive leadership (75.17%). A low positive response was found on the following items: 'acknowledges improvement in my quality of work' (19%) and 'has a clear sense of where he/she wants our unit to be in 5 years' (35.64%). The reported positive responses in the patient safety dimensions were high on three of the patient safety dimensions: organisational learning (78.41%), teamwork (82.91%), and patient care tracking/follow-up (77.05%); and low on work pressure and pace (32.02%). A moderately positive correlation was found between TLS and TPSS (r=0.455, p<0.001). CONCLUSIONS: Leadership was found to be associated with patient safety culture in a dental hospital. Leadership training programmes should be incorporated during dental training to prepare future leaders who can inspire a positive patient safety culture.

Regional perspectives on patient safety policies and initiatives: a focus group study with patient safety leaders in the Middle East and Asian regions.

Preventing and reducing risks and harm to patients is of critical importance as unsafe care is a leading cause of death and disability globally. However, the lack of consolidated information on patient safety policies and initiatives at regional levels represents an evidence gap with implications for policy and planning. The aim of the study was to answer the question of what patient safety policies and initiatives are currently in place in the Middle East and Asian regions and what were the main strengths, weaknesses, opportunities and threats in developing these. A qualitative approach using online focus groups was adopted. Participants attended focus groups beginning in August 2022. A topic guide was developed using a strengths, weaknesses, opportunities and threats framework analysis approach. The Consolidated Criteria for Reporting Qualitative Research checklist was used to ensure the recommended standards of qualitative data reporting were met. 21 participants from 11 countries participated in the study. Current patient safety policies identified were categorised across 5 thematic areas and initiatives were categorised across a further 10 thematic areas. Strengths of patient safety initiatives included enabling healthcare worker training, leadership commitment in hospitals, and stakeholder engagement and collaboration. Weaknesses included a disconnect between health delivery and education, implementation gaps, low clinical awareness and buy-in at the facility level, and lack of leadership engagement. Just culture, safety by design and education were considered opportunities, alongside data collection and reporting for research and shared learning. Future threats were low leadership commitment, changing leadership, poor integration across the system, a public-private quality gap and political instability in some contexts. Undertaking further research regionally will enable shared learning and the development of best practice examples. Future research should explore the development of policies and initiatives for patient safety at the provider, local and national levels that can inform action across the system.

Establishment-level safety analytics: a scoping review.

The use of data analytics has seen widespread application in fields such as medicine and supply chain management, but their application in occupational safety has only recently become more common. The purpose of this scoping review was to summarize studies that employed analytics within establishments to reveal insights about work-related injuries or fatalities. Over 300 articles were reviewed to survey the objectives, scope and methods used in this emerging field. We conclude that the promise of analytics for providing actionable insights to address occupational safety concerns is still in its infancy. Our review shows that most articles were focused on method development and validation, including studies that tested novel methods or compared the utility of multiple methods. Many of the studies cited various challenges in overcoming barriers caused by inadequate or inefficient technical infrastructures and unsupportive data cultures that threaten the accuracy and quality of insights revealed by the analytics.

Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

TeamSTEPPS improves patient safety.

BACKGROUND: Examine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients. METHODS: In order to improve key medical training in areas like surgical safety management, blood transfusion closed-loop management, drug safety management and identity recognition, we apply the TeamSTEPPS teaching methodology. We then examine the effects of this implementation on changes in pertinent indicators. RESULTS: Our hospital's perioperative death rate dropped to 0.019%, unscheduled reoperations dropped to 0.11%, and defined daily doses fell to 24.85. Antibiotic usage among hospitalised patients declined to 40.59%, while the percentage of antibacterial medicine prescriptions for outpatient patients decreased to 13.26%. Identity recognition requirements were implemented at a rate of 94.5%, and the low-risk group's death rate dropped to 0.01%. Critical transfusion episodes were less common, with an incidence of 0.01%. The physician's TeamSTEPPS Teamwork Perceptions Questionnaire and Teamwork Attitudes Questionnaire scores dramatically improved following the TeamSTEPPS team instruction course. CONCLUSION: An evidence-based team collaboration training programme called TeamSTEPPS combines clinical practice with team collaboration skills to enhance team performance in the healthcare industry and raise standards for medical quality, safety, and effectiveness.

Exposure control measures proposed by different organizations: the curious case of nanomaterial-involved activities.

Objectives. The unique properties of nanomaterials have turned them into an emerging threat for humans and the environment. This study therefore aimed to review exposure control measures proposed for nanomaterial-involved activities. Methods. This study is based on the published guidelines of different organizations on safe handling of nanomaterials. The search for documents was provided using the keywords 'Exposure controls', 'Good practices', 'Working safely', 'Safe practices', 'Handling safely', 'Safety guide' and 'Safety and health', combined with 'Nanomaterials', 'Nanotechnology' and 'Nanoparticles' on different databases and websites. Results. Thirty-one guidelines from 27 organizations were included. Most of the guidelines recommended engineering controls, administrative controls and personal protective equipment (PPE). Changing the physical form of nanomaterials or the process, using prevention through design (PtD) and using green chemistry principals were other suggestions to reduce exposure to nanomaterials. Conclusions. Considering the difficulty of implementation and case specificity of the solutions of the first two priorities of the hierarchy of controls (elimination and substitution), the emphasis of the guidelines on the next three priorities for controlling exposure to nanomaterials is understood. The type and method of using PPE and engineering controls should be resolved by referring to cutting-edge articles.

A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis.

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.

Evaluating Independent Double Checks in the Pediatric Intensive Care Unit: A Human Factors Engineering Approach.

OBJECTIVES: The goal of this human factors engineering-led improvement initiative was to examine whether the independent double check (IDC) during administration of high alert medications afforded improved patient safety when compared with a single check process. METHODS: The initiative was completed at a 24-bed pediatric intensive care unit and included all patients who were on the unit and received a medication historically requiring an IDC. The total review examined 37,968 high-risk medications administrations to 4417 pediatric intensive care unit patients over a 40-month period. The following 5 measures were reviewed: (1) rates of reported medication administration events involving IDC medications; (2) hospital length of stay; (3) patient mortality; (4) nurses' favorability toward single checking; and (5) nursing time spent on administration of IDC medications. RESULTS: The rate of reported medication administration events involving IDC medications was not significantly different across the groups (95% confidence interval, 0.02%-0.08%; P = 0.4939). The intervention also did not significantly alter mortality ( P = 0.8784) or length of stay ( P = 0.4763) even after controlling for the patient demographic variables. Nursing favorability for single checking increased from 59% of nurses in favor during the double check phase, to 94% by the end of the single check phase. Each double check took an average of 9.7 minutes, and a single check took an average of 1.94 minutes. CONCLUSIONS: Our results suggest that performing independent double checks on high-risk medications administered in a pediatric ICU setting afforded no impact on reported medication events compared with single checking.

Research on safety supervision and management system of China railway based on association rule and DEMATEL.

Safety management is a key issue in the railroad industry that needs to be continuously focused on. And it is essential to study causes of accidents for preventing accidents. However, there is a limited academic discussion on the systematic study of organizations and accidents, as well as their safety-related interactions and accidents, as opposed to human-caused disasters. Thus, the model of China's railway safety supervision and management system by sorting out the existing organizations involved in management in China is established in this paper. Firstly, social forces and auxiliary enterprises are specifically added to the model. And then, the relationship between organizations and accidents, as well as the relationship between safety interactions among organizations and accidents are explored by analyzing 224 accident reports, which led to 4 principles for accident prevention. Finally, based on these principles, measures to secure organizational nodes, as well as measures to promote safe interactions among organizations are proposed. The results showed that: (1) China Railway node is not only the most critical node in the safety supervision and management system but also the most vulnerable to the influence of other nodes. (2) The accident occurred due to the simultaneous occurrence of an accident at the China Railway node and the social force node. (3) When there are often safety risks in auxiliary enterprises and social forces simultaneously, the government's management is likely to be defective. The findings in this study can provide helpful references not only for improvement of safety management system structure and supervision and management mechanism but also for the formulation of safety supervision and management policies in China and other countries.

A Bibliometric Analysis of Neuroscience Tools Use in Construction Health and Safety Management.

Despite longstanding traditional construction health and safety management (CHSM) methods, the construction industry continues to face persistent challenges in this field. Neuroscience tools offer potential advantages in addressing these safety and health issues by providing objective data to indicate subjects' cognition and behavior. The application of neuroscience tools in the CHSM has received much attention in the construction research community, but comprehensive statistics on the application of neuroscience tools to CHSM is lacking to provide insights for the later scholars. Therefore, this study applied bibliometric analysis to examine the current state of neuroscience tools use in CHSM. The development phases; the most productive journals, regions, and institutions; influential scholars and articles; author collaboration; reference co-citation; and application domains of the tools were identified. It revealed four application domains: monitoring the safety status of construction workers, enhancing the construction hazard recognition ability, reducing work-related musculoskeletal disorders of construction workers, and integrating neuroscience tools with artificial intelligence techniques in enhancing occupational safety and health, where magnetoencephalography (EMG), electroencephalography (EEG), eye-tracking, and electrodermal activity (EDA) are four predominant neuroscience tools. It also shows a growing interest in integrating the neuroscience tools with artificial intelligence techniques to address the safety and health issues. In addition, future studies are suggested to facilitate the applications of these tools in construction workplaces by narrowing the gaps between experimental settings and real situations, enhancing the quality of data collected by neuroscience tools and performance of data processing algorithms, and overcoming user resistance in tools adoption.

Improvement of road safety management systems of local governments in Korea after evaluating related indicators.

This study analyzes what has changed in the road safety management systems (RSMS) of local governments after evaluating the related indicators continuously from 2015 to 2019. It has evaluated 24 indicators in four areas of RSMS such as institutional management, intervention, intermediate outcome, and the final outcome, according to Han and Lee (2020). It seems that continuous evaluation of indicators of RSMSs in local governments for five years has helped to improve road safety performance in local governments. The result shows that the average overall scores have increased from 77.92 to 83.89, a 7.7% increase. This improvement should have resulted from the competition between local governments, which do not want to be at the bottom in the score comparison. The most remarkable increase has been identified in the areas of institutional management and intervention. They have increased by 13.3% and 16.0%, respectively. In terms of types of local governments, it has been found that the increase in overall scores is higher in provinces which include most rural areas than in metropolitans. However, it has been found that the improvement of institutional management and interventions are not directly associated with the increase of the intermediate and final outcomes, at least during the five years. Further studies examining the relationship between the four areas of RSMS are needed.

Study on the Interaction Behaviors Identification of Construction Workers Based on ST-GCN and YOLO.

The construction industry is accident-prone, and unsafe behaviors of construction workers have been identified as a leading cause of accidents. One important countermeasure to prevent accidents is monitoring and managing those unsafe behaviors. The most popular way of detecting and identifying workers' unsafe behaviors is the computer vision-based intelligent monitoring system. However, most of the existing research or products focused only on the workers' behaviors (i.e., motions) recognition, limited studies considered the interaction between man-machine, man-material or man-environments. Those interactions are very important for judging whether the workers' behaviors are safe or not, from the standpoint of safety management. This study aims to develop a new method of identifying construction workers' unsafe behaviors, i.e., unsafe interaction between man-machine/material, based on ST-GCN (Spatial Temporal Graph Convolutional Networks) and YOLO (You Only Look Once), which could provide more direct and valuable information for safety management. In this study, two trained YOLO-based models were, respectively, used to detect safety signs in the workplace, and objects that interacted with workers. Then, an ST-GCN model was trained to detect and identify workers' behaviors. Lastly, a decision algorithm was developed considering interactions between man-machine/material, based on YOLO and ST-GCN results. Results show good performance of the developed method, compared to only using ST-GCN, the accuracy was significantly improved from 51.79% to 85.71%, 61.61% to 99.11%, and 58.04% to 100.00%, respectively, in the identification of the following three kinds of behaviors, throwing (throwing hammer, throwing bottle), operating (turning on switch, putting bottle), and crossing (crossing railing and crossing obstacle). The findings of the study have some practical implications for safety management, especially workers' behavior monitoring and management.

Multifaceted Intervention to Improve Patient Safety Incident Reporting in Intensive Care Units.

OBJECTIVES: Patient safety incident reporting in our institution's intensive care units (ICUs) had fallen 30% below national benchmarks during the COVID-19 pandemic. Underreporting diminishes awareness of risks and precludes organizational learning from near misses. We aimed to increase the ICU number of patient safety incident reports by 30% from 27 to 35 reports/1000 patient-days without negatively impacting culture of safety as measured by patient-care staff surveys. METHODS: Single-institution prospective interventional study with 9 ICUs receiving a multifaceted intervention developed using quality improvement methodology during February-April 2022. Study intervention involved creation of patient safety peer-leadership role, feedback process, interactive dashboards for patient safety data, and education resources accessible via quick response codes. Primary outcome was patient safety incident reports/1000 patient-days. Intensive care unit patient-care staff culture of safety was assessed with surveys. RESULTS: Intensive care unit patient safety incident reporting increased by 48% after intervention (40 versus 27 reports/1000 patient-days [ P = 0.136]). Near misses were the most common incident report. Intensive care unit patient-care staff ratings of patient safety did not change; 80% rated patient safety as good or better after intervention versus 78% at baseline ( P = 0.465). However, significant improvement was observed for subcomponents related to learning culture and support for staff involved in patient safety incidents. Most reports (>80%) were submitted by nurses. CONCLUSIONS: This multifaceted quality improvement intervention increased patient safety incident reporting in the ICUs. Increases in ratings of learning culture and support for staff underline the importance of a well-functioning patient safety incident reporting system in an institutional culture of safety.

Evaluating the effectiveness of strategies for implementation of health and safety programs on construction sites in Nigeria: A mixed-method study.

INTRODUCTION: Empirical and anecdotal evidence show that construction projects are delivered on work sites where unsafe acts and conditions abound. Researchers have investigated the strategies that can be adopted to effectively implement health and safety (H&S) in projects so as to reduce the high rates of accidents, injuries and fatalities. However, the effectiveness of these strategies have not been marginally established. Therefore, this study established the effectiveness of H&S implementation strategies on accidents, injuries, and fatalities reduction in Nigerian construction projects. METHOD: A mixed-method research design was adopted for data collection in the study. Physical observations, interviews, and a questionnaire were the instruments used for data collection in the mixed-method research design. RESULTS: The resultant data identified six appropriate strategies for enabling the desired levels of H&S program implementation on construction sites. Setting up statutory bodies such as the Health and Safety Executive to promote awareness, good practices, and standardization was adjudged pertinent as one of the effective H&S implementation programs that can be used to reduce accidents, incidents, and fatalities in projects. It is expected that the adoption of these strategies would culminate in effective H&S program implementation and subsequently a reduction in the prevalence of accidents, injuries, and fatalities in projects.

Investigation of Unsafe Acts Influence Law Based on System Dynamics Simulation: Thoughts on Behavior Mechanism and Safety Control.

In modern safety management, it is very important to study the influence of the whole safety system on unsafe acts in order to prevent accidents. However, theoretical research in this area is sparse. In order to obtain the influence law of various factors in the safety system on unsafe acts, this paper used system dynamics simulation to carry out theoretical research. First, based on a summary of the causes of the coal and gas outburst accidents, a dynamic simulation model for unsafe acts was established. Second, the system dynamics model is applied to investigate the influence of various safety system factors on unsafe acts. Third, the mechanism and the control measures of unsafe acts in the enterprise safety system are studied. This study's main result and conclusions are as follows: (1) In the new coalmines, the influence of the safety culture, safety management system, and safety ability on the safety acts were similar. The order of influence on the safety acts in production coalmines is as follows: safety management system > safety ability > safety culture. The difference is most evident in months ten to eighteen. The higher the safety level and safety construction standard of the company, the greater the difference. (2) In the construction of the safety culture, the order of influence was as follows: safety measure elements > safety responsibility elements = safety discipline elements > safety concept elements. It shows the difference in influence from the 6th month and attains its maximum value from the 12th month to the 14th month. (3) In the construction of the safety management system, the degree of influence in new coalmines was as follows: safety policy > safety management organization structure > safety management procedures. Among them, especially in the first 18 months, the impact of the safety policy was most apparent. However, in the production mine, the degree of influence was as follows: safety management organization structure > safety management procedures > safety policy, but the difference is very small. (4) The degree of influence on the construct of safety ability was as follows: safety knowledge > safety psychology = safety habits > safety awareness, but the difference on the impact was small.

The Relationship Between Patient Safety Culture and the Intentions of the Nursing Staff to Report a Near-Miss Event During the COVID-19 Crisis.

BACKGROUND: Reporting a near-miss event has been associated with better patient safety culture. PURPOSE: To examine the relationship between patient safety culture and nurses' intention to report a near-miss event during COVID-19, and factors predicting that intention. METHODS: This mixed-methods study was conducted in a tertiary medical center during the fourth COVID-19 waves in 2020-2021 among 199 nurses working in COVID-19-dedicated departments. RESULTS: Mean perception of patient safety culture was low overall. Although 77.4% of nurses intended to report a near-miss event, only 20.1% actually did. Five factors predicted nurses' intention to report a near-miss event; the model explains 20% of the variance. Poor departmental organization can adversely affect the intention to report a near-miss event. CONCLUSIONS: Organizational learning, teamwork between hospital departments, transfers between departments, and departmental disorganization can affect intention to report a near-miss event and adversely affect patient safety culture during a health crisis.

Analyzing Subway Operation Accidents Causations: Apriori Algorithm and Network Approaches.

Subway operation safety management has become increasingly important due to the severe consequences of accidents and interruptions. As the causative factors and accidents exhibit a complex and dynamic interrelationship, the proposed subway operation accident causation network (SOACN) could represent the actual scenario in a better way. This study used the SOACN to explore subway operation safety risks and provide suggestions for promoting safety management. The SOACN model was built under 13 accident types, 29 causations and their 84 relationships based on the literature review, grounded theory and association rule analysis, respectively. Based on the network theory, topological features were obtained to showcase different roles of an accident or causation in the SOACN, including degree distribution, betweenness centrality, clustering coefficient, network diameter, and average path length. The SOACN exhibits both small-world network and scale-free features, implying that propagation in the SOACN is fast. Vulnerability evaluation was conducted under network efficiency, and its results indicated that safety management should focus more on fire accident and passenger falling off the rail. This study is beneficial for capturing the complex accident safety-risk-causation relationship in subway operations. It offers suggestions regarding safety-related decision optimization and measures for causation reduction and accident control with high efficiency.