What is safety leadership? A systematic review of definitions.

INTRODUCTION: To the authors' knowledge, no systematic review has examined the definition of safety leadership in the academic literature to date. A review was therefore carried out to determine how safety leadership was defined in the peer reviewed empirical literature and thematic analysis was employed to identify patterned meanings across the data. METHOD: Thirty-seven primary definitions, or definitions that were not borrowed from other studies, were identified. Of these 37, seven conceptual definitions were found to be evidence-based, six of which were endorsed by their operational counterpart definitions and one which was derived using exploratory research. RESULTS: These seven definitions showed strong alignment with the three themes that emerged from the thematic analysis that capture the why, how, and who of safety leadership. Transformational leadership theory formed the foundation for many of the definitions in the academic literature, despite recent evidence suggesting that adopting multiple forms of leadership styles would be more effective for improving workplace safety. PRACTICAL APPLICATIONS: Gaps in the current evidence base are explored and suggestions for future research are discussed.

Beyond boundaries: The mechanisms by which host organizations' safety climates impact on-site contractors' safety and retention.

INTRODUCTION: Despite growing concerns over safety risks associated with on-site contractors in high-risk industries, little research has examined how host organizations affect their safety. Drawing from the open systems perspective, this study investigated the influence of host organizations' safety climates on on-site contractor employees' safety and job attitudes. METHOD: The study used multi-level structural equation modeling (MSEM) to test hypothesized relationships among variables with survey data collected from 1,720 employees of 68 on-site contractor organizations and 3,205 employees of six host organizations. RESULTS: At the organization-level, host organizations' safety climates were associated with their on-site contractor employees' safety behaviors, job attitudes, and injuries, and these effects were mediated by the safety climate of the on-site contractor organizations. CONCLUSIONS: This study demonstrates that the safety climates of host organizations can extend to their on-site contractor organizations. Therefore, fostering a positive safety climate not only benefits the host organizations themselves but also creates a crucial environmental cue that shapes the safety climate and outcomes of on-site contractors. PRACTICAL APPLICATIONS: Leading by example and fostering a positive safety climate within the organization are effective ways for a host organization to ensure the safety of its on-site contractors.

Perceptions of organization, job attitudes, challenges, and solutions among medical school administrative staff.

PURPOSE: Staff is essential to the university's efficient administrative operations, which are critical for education, research, and service. Medical schools, often independent, need specialized administrative elements. This study explores how medical school staff perceives the organization using the Six-Box model and evaluates their perceived organizational support, job satisfaction, and organizational commitment based on the concept of job attitudes. METHODS: This study employs a mixed-methods approach, integrating quantitative and qualitative data via a convergent parallel design. It simultaneously collects and analyzes data from a survey and consensus workshop for medical school staff. The survey data were statistically analyzed (IBM SPSS ver. 25.0; IBM Corp., USA), and the workshop discussions were subjected to content analysis. The findings combined provide a comprehensive understanding of the medical school administrative system. RESULTS: Quantitative analysis revealed purpose (3.80) as the highest-rated organizational perception and rewards (2.72) as the lowest. Similarly, job satisfaction was highest (3.63) in job attitudes, while perceived organizational support (2.96) was the lowest. Group differences were observed by gender, enrollment capacity, and contract type (p<0.05). In qualitative research, keywords appeared in relation to their experiences within the medical school organization, encompassing doctor training, emotional responses, administrative features, personal attributes, and cultural influences. Overload, faculty issues, and communication gaps are obstacles. Strategies for overcoming these challenges focus on improving staff treatment, resource allocation, training, and communication channels. CONCLUSION: This study was conducted to explore a broad understanding of the administration of medical schools. Findings suggest challenges with workload, communication, and organizational support. We propose a dedicated medical school administrative system, improved work conditions, and enhanced communication.

Associations Between Organizational Support, Burnout, and Professional Fulfillment Among US Physicians During the First Year of the COVID-19 Pandemic.

GOAL: This research aimed to evaluate variations in perceived organizational support among physicians during the first year of the COVID-19 pandemic and the associations between perceived organizational support, physician burnout, and professional fulfillment. METHODS: Between November 20, 2020, and March 23, 2021, 1,162 of 3,671 physicians (31.7%) responded to the study survey by mail, and 6,348 of 90,000 (7.1%) responded to an online version. Burnout was assessed using the Maslach Burnout Inventory, and perceived organizational support was assessed by questions developed and previously tested by the Stanford Medicine WellMD Center. Professional fulfillment was measured using the Stanford Professional Fulfillment Index. PRINCIPAL FINDINGS: Responses to organizational support questions were received from 5,933 physicians. The mean organizational support score (OSS) for male physicians was higher than the mean OSS for female physicians (5.99 vs. 5.41, respectively, on a 0-10 scale, higher score favorable; p < .001). On multivariable analysis controlling for demographic and professional factors, female physicians (odds ratio [OR] 0.66; 95% CI: 0.55-0.78) and physicians with children under 18 years of age (OR 0.72; 95% CI: 0.56-0.91) had lower odds of an OSS in the top quartile (i.e., a high OSS score). Specialty was also associated with perceived OSS in mean-variance analysis, with some specialties (e.g., pathology and dermatology) more likely to perceive significant organizational support relative to the reference specialty (i.e., internal medicine subspecialty) and others (e.g., anesthesiology and emergency medicine) less likely to perceive support. Physicians who worked more hours per week (OR for each additional hour/week 0.99; 95% CI: 0.99-1.00) were less likely to have an OSS in the top quartile. On multivariable analysis, adjusting for personal and professional factors, each one-point increase in OSS was associated with 21% lower odds of burnout (OR 0.79; 95% CI: 0.77-0.81) and 32% higher odds of professional fulfillment (OR 1.32; 95% CI: 1.28-1.36). PRACTICAL APPLICATIONS: Perceived organizational support of physicians during the COVID-19 pandemic was associated with a lower risk of burnout and a higher likelihood of professional fulfillment. Women physicians, physicians with children under 18 years of age, physicians in certain specialties, and physicians working more hours reported lower perceived organizational support. These gaps must be addressed in conjunction with broad efforts to improve organizational support.

The Challenges of Implementing a Safety Culture.

This article provides an update on patient safety data recently reviewed by and recommendations of the President's Council of Advisors on Science and Tech - nology. This article attempts to capture the impact of the eroding ability of the nursing workforce to perform its traditional role of blocking errors before they harm patients. Some strategies, tactics, and practice examples to assist in renewing this protective capacity in today's challenging environment are presented. Finally, acknowledging the variability of substantive support for maintaining a safety culture provided by individual health care organizations, this article encourages and applauds the personal courage of nephrology nurses and other health care providers as they engage and assist their clinical and quality improvement teams in addressing the persistence of what Hughes (2008) termed the "everydayness of errors" (p. 1-7).

Decoding stakeholder priorities of safety culture preferences in the oil and gas industry.

Safety culture is a critical determinant of organisational performance, particularly in high-risk industries especially in oil and gas. Understanding stakeholder preferences is essential for developing effective strategies that enhance safety culture. This study utilised the Analytic Hierarchy Process (AHP) to prioritise stakeholder preferences, identifying key elements of safety culture in Malaysia's oil and gas sector. This study employed a structured methodology to evaluate safety culture within the oil and gas industry, focusing on 18 sub-elements across three key domains: psychological, behavioural, and situational factors. A diverse sample of industry experts was recruited using purposeful and snowball sampling to ensure a comprehensive representation of stakeholder views. The AHP framework was applied to analyse the data, utilizing structured questionnaires and multicriteria decision-making techniques to prioritize the identified safety culture elements. The AHP analysis identified distinct priorities among different professional groups within the oil and gas sector. Safety and Health Practitioners emphasized practical elements such as safety rules and management commitment, while academicians prioritized knowledge and training. Management personnel highlighted the importance of safety ownership and communication, whereas policymakers focused on broader, policy-oriented aspects. The findings suggest that safety culture improvement initiatives should be tailored to address the specific needs and priorities of each professional group. A nuanced understanding of stakeholder preferences is crucial for developing comprehensive strategies that integrate observable behaviours, situational conditions, and psychological factors, ultimately fostering a robust safety culture in the oil and gas industry.

Organizational Characteristics of Hospitals Meeting STRIDE Program Adoption Benchmarks to Support Mobility for Hospitalized Persons.

There are few validated contextual measures predicting adoption of evidence-based programs. Variation in context at clinical sites can hamper dissemination. We examined organizational characteristics of Veterans Affairs hospitals implementing STRIDE, a hospital walking program, and characteristics' influences on program adoption. Using a parallel mixed-method design, we describe context and organizational characteristics by program adoption. Organizational characteristics included: organizational resilience, implementation climate, organizational readiness to implement change, highest complexity sites versus others, material support, adjusted length of stay (LOS) above versus below national median, and improvement experience. We collected intake forms at hospital launch and qualitative interviews with staff members at 4 hospitals that met the initial adoption benchmark, defined as completing supervised walks with 5+ unique hospitalized Veterans during months 5 to 6 after launch with low touch implementation support. We identified that 31% (n = 11 of 35) of hospitals met adoption benchmarks. Seven percent of highest complexity hospitals adopted compared to 48% with lower complexity. Forty-three percent that received resources adopted compared to 29% without resources. Thirty-six percent of hospitals with above-median LOS adopted compared to 23% with below-median. Thirty-five percent with at least some implementation experience adopted compared to 0% with very little to no experience. Adopters reported higher organizational resilience than non-adopters (mean = 23.5 [SD = 2.6] vs 22.7 [SD = 2.6]). Adopting hospitals reported greater organizational readiness to change than those that did not (mean = 4.2 [SD = 0.5] vs 3.8 [SD = 0.6]). Qualitatively, all sites reported that staff were committed to implementing STRIDE. Participants reported additional barriers to adoption including challenges with staffing and delays associated with hiring staff. Adopters reported that having adequate staff facilitated implementation. Implementation climate did not have an association with meeting STRIDE program adoption benchmarks in this study. Contextual factors which may be simple to assess, such as resource availability, may influence adoption of new programs without intensive implementation support.

Patient safety culture in times of the COVID-19 pandemic: a cross-sectional study in a hospital.

OBJECTIVES: to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture. METHODS: a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened. RESULTS: all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors. CONCLUSIONS: with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution's leaders.

Nurses' perceptions of patient safety culture and adverse events in Hail City, Saudi Arabia: a cross-sectional approach to improving healthcare safety.

OBJECTIVE: This study aimed to assess nurses' perceptions of patient safety culture (PSC) and its relationship with adverse events in Hail City, Saudi Arabia. DESIGN: A cross-sectional study was conducted between 1 August 2023 and the end of November 2023 at 4 governmental hospitals and 28 primary healthcare centres. SETTING: Hail City, Saudi Arabia. PARTICIPANTS: Data were collected from 336 nurses using 3 instruments: demographic and work-related questions, PSC and adverse events. RESULTS: Nurses had positive responses in the dimensions of 'teamwork within units' (76.86%) and 'frequency of events reported' (77.87%) but negative responses in the dimensions of 'handoffs and transitions' (18.75%), 'staffing' (20.90%), 'non-punitive response to errors' (31.83%), 'teamwork across units' (34.15%), 'supervisor/manager expectations' (43.22%) and 'overall perception of patient safety' (43.23%). Significant associations were found between nationality, experience, current position and total safety culture, with p values of 0.015, 0.046 and 0.027, respectively. Nurses with high-ranking perceptions of PSC in 'handoffs and transitions,' 'staffing' and 'teamwork across hospital units' reported a lower incidence of adverse events than those with low-ranking perceptions, particularly in reporting pressure ulcers (OR 0.86, 95% CI 0.78 to 0.94, OR 0.82, 95% CI 0.71 to 0.94 and OR 0.83, 95% CI 0.70 to 0.99, respectively) (p<0.05). Nurses with high-ranking perceptions of PSC in UK 'handoffs and transitions' reported a lower incidence of patient falls. Similarly, those with high-ranking perceptions in both 'handoffs and transitions' and 'overall perception of patient safety reported a lower incidence of adverse events compared with those with low-ranking perceptions, especially in reporting adverse drug events (OR 0.83, 95% CI 0.76 to 0.91 and OR 0.75, 95% CI 0.61 to 0.92, respectively) (p<0.05). CONCLUSION: From a nursing perspective, hospital PSCs have both strengths and weaknesses. Examples include low trust in leadership, staffing, error-reporting and handoffs. Therefore, to improve staffing, communication, handoffs, teamwork, and leadership, interventions should focus on weak areas of low confidence and high rates of adverse events.

Patient safety culture in home healthcare centres: protocol for a scoping review.

INTRODUCTION: Patient safety culture is a critical factor in improving the quality of home healthcare and preventing adverse events in patients receiving care in home health centres. However, the concept of patient safety culture in home healthcare centres is not clearly defined, and its dimensions and characteristics are still largely unknown. The aim of this scoping review is to provide a comprehensive overview of research on patient safety culture in home healthcare centres, identify related definitions and characteristics, and focus on key factors to fill the existing knowledge gaps. METHODS AND ANALYSIS: This review will follow Arksey and O'Malley's methodological framework, updated by the Joanna Briggs Institute (JBI), which comprises five stages: identifying the research question, identifying relevant studies, selecting the studies, charting the data, and collating, summarising and reporting the results. The inclusion criteria will be based on the Population, Concept and Context framework. A comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources, with no date restrictions, was conducted with the assistance of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic. The search will be continuously updated until the study is completed. In addition, we will review the reference lists of the final included studies and their citations to find further relevant studies. Studies that are duplicates and those not written in Persian or English will be excluded. The selection of studies based on the eligibility criteria will carried out by two independent reviewers who will perform a title/abstract screening followed by a full-text screening. Data extraction will be conducted using a standardised form from the JBI. Descriptive and content analyses will be conducted to identify key concepts in the literature reviewed. ETHICS AND DISSEMINATION: No ethical review is required for this study. Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

[The Influence of Diversity Management of Nursing Organization on Organizational Commitment: Double Mediating Effect of Diversity Sensitivity Orientation and Positive Nursing Organizational Culture].

PURPOSE: The aim of this study was to identify the double mediating effect of effect of diversity sensitivity orientation and positive nursing organizational culture between diversity management and organizational commitment. METHODS: Participants were 245 nurses working in six tertiary hospitals located in 3 different regions. Data collection was conducted from February 13, 2023 to March 6, 2023 through online self-reported questionnaire. The data were analyzed by IBM SPSS Statistics 27 and SPSS PROCESS Macro 4.2 program. RESULTS: The direct effect of diversity management on organizational commitment was significant (ß = .21, p < .001). The indirect effect of diversity management on organization commitment was .34 (95% confidence interval [CI] = .23~.47). The double mediating effect of diversity sensitivity orientation and positive nursing organizational culture in the relationship between diversity management and organizational commitment was .02 (95% CI = .00~.05). CONCLUSION: Diversity sensitivity orientation and positive nursing organizational culture show double mediating effect on the relationship between diversity management and organizational commitment. Education program and human resource management strategy for enhancing diversity management, diversity sensitivity orientation and positive nursing organizational culture should be provided to improve organizational commitment, and which are needed active support of the association and nursing organization.

Assessment of safety culture in radiotherapy facilities using safety performance indicators.

This paper describes the development of the Safety Performance Indicators (SPIs), the methodology for assessment of the safety culture of radiotherapy institutions using SPIs and common strengths and common areas for improvement. SPIs were categorized into eight sections which all together contain 23 attributes and each attribute has scoring criteria from 0 to 2 (in steps of 0.5). The maximum absolute cumulative score of SPIs was 46. A relative cumulative SPIs score of >80% indicates an institution strong commitment towards safety while score <50% indicates need for additional guidance to enhance safety culture. The assessment using SPIs was conducted for 17 radiotherapy institutions. The methodology of assessment includes interactive discussion, direct observations and document analysis. The relative cumulative SPIs score of seven institutions was found to be >80% while it was found in the range of 67.0% to 80% for the remaining ten institutions. Institutions were communicated about the cumulative SPIs score, areas of strengths, and areas for improvement. SPIs were found to be a good tool for safety culture assessment and can be utilized by the radiotherapy institutes for self-assessment to identify the areas of improvement. Based on SPIs score, regulatory body can grade the institutions from a radiation safety compliance point of view.

Executive Leadership Development of Corporate Healthcare Leaders: Integrating Spirituality into the Framework.

A faith-based healthcare system implemented a Leadership as Wholeness formation program, including a spiritual formation curriculum described here. The spiritual formation curriculum intends to connect leaders with their purpose and identity to ensure mission stability in the organizational culture, now and in the future. More research must be done to understand how, or even if, these types of programs make a meaningful difference in organizational mission initiatives and workforce stability.

Staff Perspectives and Organizational Climate Factors Related to Implementation of Food is Medicine Programming in a Federally Qualified Health Center.

The Food is Medicine (FIM) movement posits that food access and knowledge are key parts of disease prevention and treatment, but little research has explored how FIM programs fit into the organizational context of federally qualified health centers (FQHC). The purpose of this study was to explore the organizational climate and clinic staff perspectives on a FIM program being implemented in an FQHC. We conducted a cross-sectional survey study with clinic staff during the early implementation of a clinicbased FIM program. Clinic staff (n=40) perceived that patient nutrition was a high priority for the clinic, but that support for providing nutrition resources was more limited. We found high willingness and likelihood of using the FIM program services among staff, but some expressed concern regarding staffing and cultural appropriateness of programming. Optimal adoption and use of FIM investments in FQHCs may be supported by integration with existing clinical workflows.

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.

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.

Revisiting organizational culture in healthcare: Heterogeneity as a resource.

Aligning culture to be similar across work units is a common organizational tactic, but its appropriateness for the multidisciplinary context of healthcare is far from certain. Variation in perceptions of culture across large health systems may serve a functional purpose in delivering high quality care and ameliorating job stress; however, past research in healthcare has focused on culture as the average set of values and norms (i.e., cultural content) rather than on (dis)agreement about values and norms among organizational members (i.e., cultural structure). This survey-based study examines both cultural content (averages among individuals) and structure (distances between individuals) in departments of a large U.S. healthcare organization (total sample = 26,314 workers, response rate = 84%). We used linear models to associate four commonly used culture measures with outcome measures (perceived care quality, intent to stay, and manageable job stress). We found substantial heterogeneity in perceptions for multiple culture types. We found curvilinear relationships between heterogeneity for all culture types and outcomes, suggesting that heterogeneity promotes positive outcomes up to a certain point after which the positive effect declines. For research, our findings point to the importance of studying culture in healthcare with greater focus on heterogeneity; for practice, this study highlights how culturally-focused efforts to improve care quality and worker experience in healthcare should be more precise about balancing cultural alignment and heterogeneity.

Understanding the impact of abusive leadership on third-party observers' turnover intentions: Insights from organizational identification and authority orientation.

This study proposes and tests a conceptual model including three predictors (observed abusive leadership, workplace identification, and authority orientation) of third-party observers' turnover intentions. Analyzing responses from of 367 sales employees from Chinese hotels suggests that organizational identification partially mediates the relationship between observed abusive leadership and observer turnover intention. Also, observed abusive leadership is negatively associated with observers' workplace identification. Finally, authority orientation is negatively associated with observers' turnover intentions. This study contributes theoretically to understanding the repercussions of abusive leadership and offers managerial insights for hospitality firms to mitigate high turnover rates.