The Relationship between Food Safety Culture Maturity and Cost of Quality: An Empirical Pilot Study in the Food Industry.

In the food industry, a mature food safety culture (FSC) is linked to better food safety performance. However, the relationship between FSC maturity and key economical performance indicators, such as cost allocation, remains unexplored. This research is the first pilot study to empirically explore the association between FSC maturity and cost of quality (CoQ). A CoQ survey was developed and pretested. CoQ data were collected through collaboration with company management. FSC maturity was assessed through a validated mixed-method assessment (diagnostic instrument, questionnaires, and interviews). A convenience sample of five food processing companies was assembled and subjected to FSC and CoQ assessment. Results revealed that monitoring CoQ is not yet standard practice in the food industry: three out of five companies were unable to specify all failure costs. For prevention and appraisal costs, results showed descriptively and statistically that when these costs are higher, FSC is more mature. Considering the theoretical context of the research (CoQ models and available literature), these results present the first empirical evidence to substantiate that FSC could replace product/service quality in CoQ models. Findings justify the push for a shift in perception, from considering FSC as a task on the list of resource demanding activities toward a narrative in which FSC contributes to financial health.

Development, Feasibility, and Knowledge Impact of a Massive Open Online Course on Radiation Safety: A Multicentre Prospective Cohort Study.

OBJECTIVE: This study reports the development of an innovative, interactive Massive Open Online Course (MOOC) teaching radiation safety principles in the vascular workplace, using stepwise e-learning with multiple choice question tests (MCQs), educational videos, and a serious game. The aim was to study the MOOC impact on radiation safety knowledge and assess its feasibility and acceptability. METHODS: An international multicentre prospective study included team members active in the hybrid operating room. The MOOC was offered voluntarily via a secure online learning platform. A standardised MCQ test (15 questions) assessed radiation safety knowledge pre- and post-course (range 0 - 100%). Acceptability and feasibility were tested via the previously validated, Evaluating e-learning system success (EESS) model, using five point Likert scales. RESULTS: In eight centres across four countries, 150 of 203 invited endovascular team members consented. Over a seven week study period, surgeons (28%, including vascular surgery trainees and consultants), nurses (27%, including scrub, circulating and anaesthetic nurses), anaesthetists (43%, including trainees and consultants), and radiographers (3%) participated. Of those, 67% completed the course. The average radiation knowledge improved by 22.8% (95% CI 19.5 - 26.0%; p < .001) after MOOC completion, from 48% to 71% (standard deviation [SD] 14 and 15% respectively), requiring a mean time investment of 169 minutes (SD 89 minutes). In centres with a radiographer, mean knowledge gain after MOOC completion was significantly smaller (14%, SD 19% vs. 24%, SD 16%, p = .036). The course was deemed feasible and acceptable according to the EESS model with a total mean score of 3.68/5. CONCLUSION: This newly developed, multimodal MOOC was deemed feasible and effective across multiple international centres. The MOOC significantly contributes to radiation safety education of the entire endovascular team, improving radiation safety knowledge. The course may optimise workplace radiation safety behaviour and therefore enhance team and patient safety.

Food safety culture maturity and its relation to company and employee characteristics.

Three facets of food safety culture (FSC) (i.e., food safety management system (FSMS), human-organizational and human-individual building block), were diagnosed through a validated mixed-method assessment in twenty food processing companies. Many underdeveloped dimensions were detected in the FSMS and the human-organizational building block, while the human-individual building block was more mature. It was explored whether company (e.g., company size) and employee characteristics (e.g. leaders vs. non-leaders) are associated with FSC maturity (based on 1410 employee responses) through a cluster analysis and statistical (Mann-Whitney U and Kruskal-Wallis) tests. Results revealed significant differences (p-value <0.05) based on company characteristics (significant differences based on: size, belonging to a larger group, product type, place in the supply chain, training frequency, certificates, maturity of control and assurance activities) and employee characteristics (significant differences based on: leaders vs. non-leaders, daily direct contact with food or not, seniority, time since training and psychosocial well-being). These findings are useful to develop tailored food safety culture improvement interventions to enhance the maturity of food safety culture in food companies, as these might focus on lower perceiving (sub)groups of employees or lower perceiving (sub)groups of companies.

Does workplace telepressure get under the skin? Protocol for an ambulatory assessment study on wellbeing and health-related physiological, experiential, and behavioral concomitants of workplace telepressure.

BACKGROUND: The daily working life of many employees requires the use of modern information and communication technology (ICT) devices such as computers, tablets, and smartphones. The double-edged nature of digital work environments has been increasingly highlighted. Benefits such as increased flexibility come at a personal cost. One of the potential downsides is workplace telepressure, i.e., the experience of urge and preoccupation to quickly reply to work-related messages and demands using ICT. There is initial - mainly survey-based-evidence that workplace telepressure may have negative effects on a variety of wellbeing and health outcomes. AIMS AND HYPOTHESES: Adopting the Effort-Recovery Model and the concept of allostatic load as theoretical frameworks, the present study aims to investigate the hypothesis that workplace telepressure is significantly associated with increased "wear and tear", in the form of more psychosomatic complaints, worse sleep quality (self-reported and actigraphy-based), worse mood, and biological alterations (lower cardiac vagal tone, lower anabolic balance defined as the ratio of salivary dehydroepiandrosterone to salivary cortisol, and higher salivary alpha-amylase). Additionally, the study aims to investigate the hypothesis that connection to work defined as work-related workload and work-related perseverative cognition plays a significant role in the mediation of these relationships. METHODS: To test our hypotheses, we will conduct an ambulatory assessment study with a convenience sample of 120 healthy workers regularly using ICTs for job communication. For one week, participants will be asked to complete electronic diaries assessing their level of workplace telepressure, psychosomatic complaints, sleep quality, mood, work-related workload, and work-related perseverative cognition. They will also continuously wear the Bittium Faros 180L ECG monitor, the wrist-worn actigraph MotionWatch 8, and perform saliva sampling five times per day. DISCUSSION: This study will be the most comprehensive ambulatory investigation of workplace telepressure and its psychophysiological concomitants to date and constitutes an important step towards understanding how high levels of workplace telepressure may lead in the long term to secondary alterations (e.g., hypertension, chronic inflammation) and disease (e.g., heart disease). The findings of this study are also anticipated to contribute to guiding the development and implementation of interventions, programs, and policies relevant to employees' digital wellbeing.

The underpinning of meaningful activities by brain correlates: a systematic review.

Introduction: Engaging in meaningful activities contributes to health and wellbeing. Research identifies meaningfulness by analysing retrospective and subjective data such as personal experiences in activities. Objectively measuring meaningful activities by registering the brain (fNIRS, EEG, PET, fMRI) remains poorly investigated. Methods: A systematic review using PubMed, Web of Science, CINAHL, and Cochrane Library. Findings: Thirty-one studies investigating the correlations between daily activities in adults, their degree of meaningfulness for the participant, and the brain areas involved, were identified. The activities could be classified according to the degree of meaningfulness, using the attributes of meaningfulness described in the literature. Eleven study activities contained all attributes, which means that these can be assumed to be meaningful for the participant. Brain areas involved in these activities were generally related to emotional and affective processing, motivation, and reward. Conclusion: Although it is demonstrated that neural correlates of meaningful activities can be measured objectively by neurophysiological registration techniques, "meaning" as such has not yet been investigated explicitly. Further neurophysiological research for objective monitoring of meaningful activities is recommended.

Assessing endovascular team performances in a hybrid room using the Black Box system: a prospective cohort study.

BACKGROUND: The hybrid room (HR) is a complex, high-risk environment, requiring teams (surgeons, anesthesiologists, nurses, technologists) to master various skills, including the 'As Low As Reasonably Achievable' principle of radiation safety. This prospective single center cohort reports the first use of the Operating Room Black Box (ORBB) in a HR. This medical data recording system captures procedural and audio-visual data to facilitate structured team performance analysis. METHODS: Patients planned for endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR) or treatment of symptomatic iliac-femoral-popliteal atherosclerotic disease (Peripheral Vascular Interventions or PVI) were included. Validated measures and established assessment tools were used to assess (non-)technical skills, radiation safety performance and environmental distractions. RESULTS: Six EVAR and sixteen PVI procedures were captured. Technical performance for one EVAR was rated 19/35 on the procedure-specific scale, below the 'acceptable' score of 21. Technical skills were rated above acceptable in all PVI procedures. Shared decision making and leadership were rated highly in 12/22 cases, whereas surgical communication and nurses' task management were rated low in 14/22 cases. Team members rarely stepped back from the C-arm during digital subtraction angiography. Radiation safety behavior was scored below 'acceptable' in 14/22 cases. A median (interquartile range) number of 12 (6-23) auditory distractions was observed per procedure. CONCLUSIONS: The ORBB facilitates holistic workplace-based assessment of endovascular performance in a HR by combining objective assessment parameters and rating scale-based evaluations. Strengths and weaknesses were identified in team members' (non-)technical and radiation safety practices. This technology has the potential to improve vascular surgical practice, though human input remains crucial. (NCT04854278).

Surgeons' Leadership Style and Team Behavior in the Hybrid Operating Room: Prospective Cohort Study.

OBJECTIVE: This study aimed to assess the relationship between surgeons' leadership style and team behavior in the hybrid operating room through video coding. Secondly, possible fluctuations possible fluctuations in leadership styles and team behavior during operative phases were studied. BACKGROUND: Leadership is recognized as a key component to successful team functioning in high-risk industries. The 'full range of leadership' theory is commonly used to evaluate leadership, marking transformational, transactional, and passive. Few studies have examined the effects of these leadership styles on team behavior in surgery and/or their fluctuations during surgery. METHODS: A single-center study included patients planned for routine endovascular procedures. A medical data capture system was used to allow post hoc video coding through Behavior Anchored Rating Scales. Multilevel statistical analysis was performed to assess possible correlations between leadership style and 3 team behavior indicators (speaking up, knowledge sharing, and collaboration) on an operative phase level. RESULTS: Twenty-two cases were analyzed (47 hours recording). Transformational leadership is positively related to the extent to which team members work together (γ=0.20, P <0.001), share knowledge (γ=0.45, P <0.001), and speak up (γ=0.64, P <0.001). Passive leadership is significantly positively correlated with speaking up (γ=0.29, P =0.004). Leadership style and team behavior clearly fluctuate during a procedure, with similar patterns across different types of endovascular procedures. CONCLUSIONS: Consistent with other professional fields, surgeons' transformational leadership enhances team behavior, especially during the most complex operative phases. This suggests that encouraging surgeons to learn and actively implement a transformational leadership style is meaningful to enhance patient safety and team performance.

When Thoughts Have No Off Switch: The Cost of Telepressure and Message-based Communication behaviour within Boundary-crossing Contexts.

Communication technology enables employees to be constantly connected at the cost of potentially blurring the boundaries between work and private life, which can be detrimental to their well-being. The present study utilised a quantitative diary approach (N = 269 employees, N = 1256 data points) to provide further evidence on the association between telepressure and ruminative thoughts within boundary-crossing contexts (i.e., including work-related behaviour and cognitions during leisure time as well as private-related behaviour and cognitions at work). On a day-to-day level, we examined if context-incongruent telepressure had a positive effect on context-incongruent affective rumination through context-incongruent message-based communication behaviour. Multilevel analyses supported our hypothesised mediation models. Altogether, findings reveal that quickly replying towards messages or its related cognition (i.e., telepressure) may result in a resource-draining experience in terms of affective rumination within both boundary-crossing contexts. Theoretical and practical implications as well as future research avenues are discussed.

An Exploratory Study on the Relation between Companies' Food Integrity Climate and Employees' Food Integrity Behavior in Food Businesses.

Given the need to prevent food fraud within the international food supply chain and the current lack of research on food integrity, in this paper, the relation between the organizational food integrity climate and employees' food integrity behavior is examined to understand the role of the individual or psychological dimension in food integrity. The construct of food integrity behavior was introduced and defined, and the conceptual model of the food integrity climate in relation to food integrity behavior was elaborated along with study variables and hypotheses. In the proposed model, the potential moderating role of employees' psychological well-being (i.e., burnout and job stress) was analyzed, and two mediating variables were also proposed (i.e., knowledge and motivation) which both could explain how the prevailing food integrity climate might influence employees' food integrity behavior. Data was collected through convenience sampling in four Belgian food companies with a total of 118 participating employees through a self-assessment questionnaire. Based on the statistical analysis, it was concluded that a well-developed organizational food integrity climate promotes positive employees' food integrity behavior. Specifically, results of this semi-quantitative study demonstrated that the companies' food integrity climate is positively related to the employees' food integrity behavior both directly and indirectly, and that food integrity knowledge is a partial mediator in the relation between food integrity climate and food integrity behavior, while food integrity motivation is a full mediator. Study limitations and implications are also discussed.

Food Integrity Climate in Food Businesses: Conceptualization, Development, and Validation of a Self-Assessment Tool.

Current scientific research and industry guidelines focus on food safety, aiming to reduce unintentional food contaminations through technological and managerial measures. Due to the deceptive nature of food fraud, the fight to prevent intentional food adulteration and counterfeiting threats requires an approach that goes beyond the common food safety-based strategies and falls into the sphere of food integrity. With food integrity being an emerging discipline, a definition was proposed and the concept of food integrity climate was introduced. A food integrity climate (FIC) self-assessment tool in the form of a questionnaire, with twenty indicators and a five-point Likert rating scale was developed, expert-validated, and tested in practice in a large-scale meat distribution company. The questionnaire was designed to measure the performance level of food integrity in food businesses along the supply chain through managers' and operators' perceptions. Minor but interesting differences were found in the food integrity climate perceived between managers and operators as well as among the company's affiliates. The tool helps food businesses to get a deeper insight on the human dimension behind food integrity through the assessment of five climate components in relation to four food integrity elements, identifying strengths and weaknesses regarding a company's food integrity climate.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults.

BACKGROUND: The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM: To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS: A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS: Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (ß = -.33). Loss of meaningful activities was strongly related to mental health (ß = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS: The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Food safety governance in Saudi Arabia: Challenges in control of imported food.

The operating environment for food safety interventions in nations such as Saudi Arabia, with limited local agricultural productivity, high reliance on foreign food imports and observance of Islamic laws, is remarkably challenging for the national control and regulatory institutions, since compliance to the mandatory food safety regulations and the local religious Halal standards must be ensured. This review offers a comprehensive analysis of the recently restructured food safety governance in Saudi Arabia from the perspective of its food imports control. Specifically, the nature of the food imports, the organization of the food safety governance and the current control practices of imported food, in consideration of food safety and Halal requirements, are analyzed through a triangulation of data and information from secondary sources (academic literature review and gray literature search) and primary sources (direct consultation of field experts). Statistical trade data on imported food were also performed. Results revealed that the process of centralizing all the control and regulatory activities under a single agency, which the government started to strengthen the national food safety governance, has not been completed yet. The resulting overlap of legislative and monitoring tasks by multiple entities augments the challenge of ensuring the safety, quality, and authenticity of imported food and their compliance to Halal standards. The vulnerabilities and challenges still to be addressed by the local food industry and the public sector are discussed, with implications for national and international field practitioners and policymakers of countries facing similar challenges.

Development and validation of a behavioural video coding scheme for detecting mental workload in manual assembly.

Manual assembly in the future Industry 4.0 workplace will put high demands on operators' cognitive processing. The development of mental workload (MWL) measures therefore looms large. Physiological gauges such as electroencephalography (EEG) show promising possibilities, but still lack sufficient reliability when applied in the field. This study presents an alternative measure with a substantial ecological validity. First, we developed a behavioural video coding scheme identifying 11 assembly behaviours potentially revealing MWL being too high. Subsequently, we explored its validity by analysing videos of 24 participants performing a high and a low complexity assembly. Results showed that five of the behaviours identified, such as freezing and the amount of part rotations, significantly differed in occurrence and/or duration between the two conditions. The study hereby proposes a novel and naturalistic method that could help practitioners to map and redesign critical assembly phases, and researchers to enrich validation of MWL-measures through measurement triangulation. Practitioner summary: Current physiological mental workload (MWL) measures still lack sufficient reliability when applied in the field. Therefore, we identified several observable assembly behaviours that could reveal MWL being too high. The results propose a method to map MWL by observing specific assembly behaviours such as freezing and rotating parts. Abbreviations: MWL: mental workload; EEG: electroencephalography; fNIRS: functional near infrared spectroscopy; AOI: area of interest; SMI: SensoMotoric Instruments, ETG: Eye-Tracking Glasses; FPS: frames per second; BORIS: Behavioral Observation Research Interactive Software; IRR: inter-rater reliability; SWAT: Subjective Workload Assessment Technique; NASA-TLX: National Aeronautics and Space Administration Task Load Index; EL: emotional load; DSSQ: Dundee Stress State Questionnaire; PHL: physical load; SBO: Strategisch Basis Onderzoek.

Private life telepressure and workplace cognitive failure among hospital nurses: The moderating role of mobile phone presence.

AIM: To examine whether the presence of a mobile phone has a moderating role in the relationship between nurses' private life telepressure and workplace cognitive failure. DESIGN: Cross-sectional quantitative study using self-report questionnaires. METHODS: Data were collected between December 2019 - January 2020. In total, 849 Registered Nurses from three Belgian hospitals completed the online survey. Data were analysed with hierarchical regression analyses and simple slope tests. RESULTS: Overall, the positive relationship between private life telepressure and workplace cognitive failure was moderated by mobile phone presence. Specifically, the experience of private life telepressure did only relate to higher workplace cognitive failure when nurses kept their mobile phone nearby (i.e. in their pockets). Additional exploratory analyses revealed that this moderation effect only held among nurses in young adulthood and regardless of the notification settings of their mobile phone. CONCLUSIONS: The present findings indicate the unintended risk of mobile phone presence at work as it relates to higher workplace cognitive failure in nurses who experience private life telepressure. Ensuring there are clear organizational policies and practises in place to store away personal belongings of healthcare personnel during work hours would therefore seem beneficial for hospitals. IMPACT: Considering the increased presence of mobile phones nowadays, a more detailed understanding is necessary on how these devices might distract personnel in a healthcare setting. The present study gives further insight into this topic and shows that in particular nurses in young adulthood who experience telepressure towards personal messages report more cognitive failure when their personal mobile phones are present, even when they do not actually use these devices. This furnishes additional evidence in support of hospitals' formal policy to forbid personal mobile phones of healthcare personnel when at work.

Radiation Safety Performance is More than Simply Measuring Doses! Development of a Radiation Safety Rating Scale.

PURPOSE: Radiation safety performance is often evaluated using dose parameters measured by personal dosimeters and/or the C-arm, which provide limited information about teams' actual radiation safety behaviors. This study aimed to develop a rating scale to evaluate team radiation safety behaviors more accurately and investigate its reliability. MATERIALS AND METHODS: A modified Delphi consensus was organized involving European vascular surgeons (VS), interventional radiologists, and interventional cardiologists. Initial items and anchors were drafted a priori and rated using five-point Likert scales. Participants could suggest additional items or adjustments. Consensus was defined as ≥ 80% agreement (rating ≥ 4) with Cronbach's alpha ≥ .80. Two VS with expertise in radiation safety evaluated 15 video-recorded endovascular repairs of infrarenal aortic aneurysms (EVAR) to assess usability, inter and intrarater reliability. RESULTS: Thirty-one of 46 invited specialists completed three rating rounds to generate the final rating scale. Five items underwent major adjustments. In the final round, consensus was achieved for all items (alpha = .804; agreement > 87%): 'Pre-procedural planning', 'Preparation in angiosuite/operating room', 'Shielding equipment', 'Personal protective equipment', 'Position of operator/team', 'Radiation usage awareness', 'C-arm handling', 'Adjusting image quality', 'Additional dose reducing functions', 'Communication/leadership', and 'Overall radiation performance and ALARA principle'. All EVARs were rated, yielding excellent Cronbach's alpha (.877) with acceptable interrater and excellent intrarater reliability (ICC = .782; ICC = .963, respectively). CONCLUSION: A reliable framework was developed to assess radiation safety behaviors in endovascular practice and provide teams with formative feedback. The final scale is provided in this publication.

Introduction of a surgical Black Box system in a hybrid angiosuite: Challenges and opportunities.

PURPOSE: In laparoscopy, the Operating Room Black Box® (ORBB) provides insights into operative performance to improve patient safety. This technology may also enhance endovascular surgical practice; however, the use of a C-arm and X-rays pose important challenges, hindering transferability to an endovascular context. We describe the first implementation of ORBB technology in a hybrid angiosuite and illustrate its value in evaluating surgeons' radiation safety, technical and non-technical performance. METHODS: Team members (surgeons, nurses, anaesthesiologists) and stakeholders were informed during several information sessions. Together with teams from Surgical Safety Technologies (Toronto, Canada), an implementation plan was developed, and video-evaluation frameworks were chosen. Radiation safety was assessed using dose measurements and video-evaluation of safety-related behaviours. Technical performance was assessed using 'global' (GRS) and 'procedure-specific' (PRS) rating scales and the 'EndoVascular Aortic Repair Assessment of Technical Expertise' (EVARATE) framework. Surgeons' non-technical skills were assessed with the NOTSS framework. RESULTS: The system captures Audio-visual data from four ceiling-mounted cameras, three ceiling-array microphones, the fluoroscopy screen and anaesthesia monitor. After patient and team consent, an elective endovascular aneurysm repair was successfully analysed. Dose-Area-Product and Air Kerma were 71094 mGy.cm2 and 270 mGy, respectively. Behavioural analysis revealed deficiencies in stepping back and radiation safety communication. Technical skill assessment was feasible: GRS: 29/40; 'PRS': 27/35; EVARATE: 29/35. Non-technical analysis highlighted surgeons' leadership qualities. CONCLUSION: An innovative data capture platform has been successfully installed to evaluate overall performance during endovascular procedures. This technology may facilitate identification of (radiation) safety-related errors and instigate educational interventions based on real-world issues.

Exploring the influence of core-self evaluations, situational factors, and coping on nurse burnout: A cross-sectional survey study.

Stress has become an inherent aspect of the nursing profession. Chronically experienced work stress can lead to burnout. Although situational stressors show a significant influence on burnout, their power to predict the complete syndrome is rather limited. After all, stressors only exist "in the eye of the beholder". This study aimed to explore how individual vulnerability factors such as core-self evaluations and coping, contribute to burnout in relation to situational stressors within a population of hospital nurses. Cross-sectional data was collected in 2014, using five validated self-report instruments: Dutch Core Self Evaluations Scale, Nursing Work Index Revised, Utrecht Coping List, Ruminative Response Scale, and Utrecht Burnout Scale. 219 of the 250 questionnaires were returned. Core-self evaluations, situational factors and coping each contributed significantly to the predictive capacity of the models of the separate burnout dimensions. Core-self evaluations was significantly related to emotional exhaustion. It was suggested that Core-self evaluations might be placed at the initiation of the loss cycle. However, further research is warranted.