Safety intelligence: an exploration of senior managers' characteristics.

Senior managers can have a strong influence on organisational safety. But little is known about which of their personal attributes support their impact on safety. In this paper, we introduce the concept of 'safety intelligence' as related to senior managers' ability to develop and enact safety policies and explore possible characteristics related to it in two studies. Study 1 (N = 76) involved direct reports to chief executive officers (CEOs) of European air traffic management (ATM) organisations, who completed a short questionnaire asking about characteristics and behaviours that are ideal for a CEO's influence on safety. Study 2 involved senior ATM managers (N = 9) in various positions in interviews concerning their day-to-day work on safety. Both studies indicated six attributes of senior managers as relevant for their safety intelligence, particularly, social competence and safety knowledge, followed by motivation, problem-solving, personality and interpersonal leadership skills. These results have recently been applied in guidance for safety management practices in a White Paper published by EUROCONTROL.

Interdisciplinary communication in the intensive care unit.

BACKGROUND: Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. METHODS: Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. RESULTS: A sample of 48 doctors and 136 nurses (47% response rate) from four ICUs responded to the survey. Nurses and doctors were found to have differing perceptions of interdisciplinary communication, with nurses reporting lower levels of communication openness between nurses and doctors. Compared with senior doctors, trainee doctors also reported lower levels of communication openness between doctors. A regression path analysis revealed that communication openness among ICU team members predicted the degree to which individuals reported understanding their patient care goals ((adj)R(2) = 0.17). It also showed that perceptions of the quality of unit leadership predicted open communication. CONCLUSIONS: Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment.

Using human error theory to explore the supply of non-prescription medicines from community pharmacies.

BACKGROUND: The importance of theory in underpinning interventions to promote effective professional practice is gaining recognition. The Medical Research Council framework for complex interventions has assisted in promoting awareness and adoption of theory into study design. Human error theory has previously been used by high risk industries but its relevance to healthcare settings and patient safety requires further investigation. This study used this theory as a framework to explore non-prescription medicine supply from community pharmacies. The relevance to other healthcare settings and behaviours is discussed. METHOD: A 25% random sample was made of 364 observed consultations for non-prescription medicines. Each of the 91 consultations was assessed by two groups: a consensus group (stage 1) to identify common problems with the consultation process, and an expert group (stages 2 and 3) to apply human error theory to these consultations. Paired assessors (most of whom were pharmacists) categorised the perceived problems occurring in each consultation (stage 1). During stage 2 paired assessors from an expert group (comprising patient safety experts, community pharmacists and psychologists) considered whether each consultation was compliant with professional guidelines for the supply of pharmacy medicines. Each non-compliant consultation identified during stage 2 was then categorised as a slip/lapse, mistake, or violation using human error theory (stage 3). RESULTS: During stage 1 most consultations (n = 75, 83%) were deemed deficient in information exchange. At stage 2, paired assessors varied in attributing non-compliance to specific error types. Where agreement was achieved, the error type most often selected was "violation" (n = 27, 51.9%, stage 3). Consultations involving product requests were less likely to be guideline compliant than symptom presentations (OR 0.30, 95% CI 0.10 to 0.95, p = 0.05). CONCLUSIONS: The large proportion of consultations classified as violations suggests that either pharmacy staff are unaware of professional guidelines and thus do not follow them (therefore these acts would not be violations), or that they knowingly violate the guidelines due to reasons that need further research. The methods presented here could be used in other healthcare settings to explore healthcare professional behaviour and to develop strategies to promote patient safety and effective professional practice.

Measuring safety climate in health care.

AIM: To review quantitative studies of safety climate in health care to examine the psychometric properties of the questionnaires designed to measure this construct. METHOD: A systematic literature review was undertaken to study sample and questionnaire design characteristics (source, no of items, scale type), construct validity (content validity, factor structure and internal reliability, concurrent validity), within group agreement, and level of analysis. RESULTS: Twelve studies were examined. There was a lack of explicit theoretical underpinning for most questionnaires and some instruments did not report standard psychometric criteria. Where this information was available, several questionnaires appeared to have limitations. CONCLUSIONS: More consideration should be given to psychometric factors in the design of healthcare safety climate instruments, especially as these are beginning to be used in large scale surveys across healthcare organisations.

Benchmarking safety climate in hazardous environments: a longitudinal, interorganizational approach.

Safety climate is an important element of organizational reliability. This study applied benchmarking strategies for monitoring safety climate across nine North Sea oil and gas installations that were surveyed in consecutive years. Examination of absolute changes in safety climate complemented the benchmarking approach. Discriminant function analyses (DFA) identified the elements of safety climate predictive of self-reported accidents; correlational analyses were applied to the scale scores and accident proportions across the year period. Absolute improvements were substantial, with safety climate profiles converging in the second year. Large relative improvements were also observed. DFA highlighted perceived management commitment to safety and willingness to report accidents as significant predictors of personal accident involvement. Changes in perceived management commitment to safety were closely associated with changes in safety behavior.

Risk perceptions of offshore workers on UK oil and gas platforms.

Knowledge of the workforce's risk perceptions and attitudes to safety is necessary for the development of a safety culture, where each person accepts responsibility for working safely. The ACSNI Human Factors report stresses the importance of assessing workforce perceptions of risk to achieve a proper safety culture. Risk perception research has been criticized for insufficient analysis of the causal relationships between risk factors and perceived risk. The present study reports some of the factors which predicted risk perception in a sample of 622 employees from six UKCS offshore oil installations who completed a 15-section questionnaire. This paper focuses on the accuracy of workers' risk perceptions and what underlying factors predict the perception of personal risk from both major and minor hazards.