Identifying crash-prone locations with quantile regression

Identifying locations that exhibit the greatest potential for safety improvements is becoming more and more important because of competing needs and a tightening safety improvement budget. Current crash modeling practices mainly target changes at the mean level. However, crash data often have skewed distributions and exhibit substantial heterogeneity. Changes at mean level do not adequately represent patterns present in the data. This study employs a regression technique known as the quantile regression. Quantile regression offers the flexibility of estimating trends at different quantiles. It is particularly useful for summarizing data with heterogeneity. Here, we consider its application for identifying intersections with severe safety issues. Several classic approaches for determining risk-prone intersections are also compared. Our findings suggest that relative to other methods, quantile regression yields a sensible and much more refined subset of risk-prone locations.

Patient safety in surgical environments: cross-countries comparison of psychometric properties and results of the Norwegian version of the Hospital Survey on Patient Safety

BACKGROUND

How hospital health care personnel perceive safety climate has been assessed in several countries by using the Hospital Survey on Patient Safety (HSOPS). Few studies have examined safety climate factors in surgical departments per se. This study examined the psychometric properties of a Norwegian translation of the HSOPS and also compared safety climate factors from a surgical setting to hospitals in the United States, the Netherlands and Norway.

METHODS

This survey included 575 surgical personnel in Haukeland University Hospital in Bergen, an 1100-bed tertiary hospital in western Norway: surgeons, operating theatre nurses, anaesthesiologists, nurse anaesthetists and ancillary personnel. Of these, 358 returned the HSOPS, resulting in a 62% response rate. We used factor analysis to examine the applicability of the HSOPS factor structure in operating theatre settings. We also performed psychometric analysis for internal consistency and construct validity. In addition, we compared the percent of average positive responds of the patient safety climate factors with results of the US HSOPS 2010 comparative data base report.

RESULTS

The professions differed in their perception of patient safety climate, with anaesthesia personnel having the highest mean scores. Factor analysis using the original 12-factor model of the HSOPS resulted in low reliability scores (r = 0.6) for two factors: "adequate staffing" and "organizational learning and continuous improvement". For the remaining factors, reliability was ≥ 0.7. Reliability scores improved to r = 0.8 by combining the factors "organizational learning and continuous improvement" and "feedback and communication about error" into one six-item factor, supporting an 11-factor model. The inter-item correlations were found satisfactory.

CONCLUSIONS

The psychometric properties of the questionnaire need further investigations to be regarded as reliable in surgical environments. The operating theatre personnel perceived their hospital's patient safety climate far more negatively than the health care personnel in hospitals in the United States and with perceptions more comparable to those of health care personnel in hospitals in the Netherlands. In fact, the surgical personnel in our hospital may perceive that patient safety climate is less focused in our hospital, at least compared with the results from hospitals in the United States.

Safety climate: new developments in conceptualization, theory, and research

Although the important role of safety climate in safety outcomes has been established and many studies have been done by scholars in different disciplines and across different cultures, there are still gaps in the literature. The articles in this Special Issue explore the topics of new developments in the conceptualization of safety climate and occupational/industry-focused studies of safety climate, with the goal of identifying different challenges and findings that arise within or across various occupations or industries. We are pleased to have a closing article by Dr. Dov Zohar on "Thirty Years of Safety Climate Research: Reflections and Future Directions."

Thirty years of safety climate research: reflections and future directions

Looking back over 30 years of my own and other safety-climate scholars' research, my primary reflection is that we have achieved an enormous task of validating safety climate as a robust leading indicator or predictor of safety outcomes across industries and countries. The time has therefore come for moving to the next phase of scientific inquiry in which constructs are being augmented by testing its relationships with antecedents, moderators and mediators, as well as relationships with other established constructs. Whereas there has been some significant progress in this direction over the last 30 years (e.g. leadership as a climate antecedent), much more work is required for augmenting safety climate theory. I hope this article will stimulate further work along these lines.

The REACH perspective: toward a new concept of toxicity testing

A sustainable society and a healthy society are major goals for European policymakers. Although most Europeans live a longer healthy life than ever, there is growing concern and anxiety about unknown health risks and threats of chemicals and a strong demand for more knowledge and more control. European legislation is responding to these demands. An example is the program on Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), which came into force in 2007. It is a gigantic task for industry and for administrators to evaluate safety files of thousands of chemicals in a period of 12 years and to collect new data for chemicals not yet evaluated. Costs, number of toxicity tests, and number of animals that are needed are already well documented. REACH uses strict guidelines and focuses on apical endpoints that have been covered in the past by animal tests. Animal tests are slow, use unrealistic high doses, and have been shown to not always predict human toxicity correctly. The REACH program has made a clear opening for reduction of in vivo animal tests. Sharing toxicity data is a major improvement. For low tonnage levels, no further in vivo testing is allowed. The combination of scientifically valid information from alternative tests with available animal and human data into a weight-of-evidence approach is part of the integrated test strategy under REACH. Interpretation of this integrated information requires a high degree of expertise, flexibility, and openness toward scientific advances. This will be crucial for the success of the REACH program. It means a shift of attitude and will put a heavy responsibility on scientific experts and regulators, but it is also an opportunity for meeting the safety expectations of our modern society.

Hazard and operability (HAZOP) analysis. A literature review

Hazard and operability (HAZOP) methodology is a Process Hazard Analysis (PHA) technique used worldwide for studying not only the hazards of a system, but also its operability problems, by exploring the effects of any deviations from design conditions. Our paper is the first HAZOP review intended to gather HAZOP-related literature from books, guidelines, standards, major journals, and conference proceedings, with the purpose of classifying the research conducted over the years and define the HAZOP state-of-the-art.

Selection criteria to protect the blood donor in North America and Europe: past (dogma), present (evidence), and future (hemovigilance)

The safety of the blood supply depends on measures to protect not only the transfusion recipient but also the blood donor. Donor selection criteria have been voluntarily adopted or enforced through regulation in different countries, but review of practices in different blood centers reveals wide disparity in the current approaches. Such variability in practice suggests that the criteria for the protection of donor are often arbitrary or reflect deeply engrained precautionary practices and exposes the inherent uncertainty about the best way to minimize risk to the donor. Certain selection criteria introduced years ago have become dogma in some countries but were never subjected to systematic study and persist despite available evidence that the measures do not measurably improve donor safety. Current efforts to define a rational, evidence-based approach are crucial to eliminate practices that lead to the unnecessary deferral of large numbers of blood donors without improving the safety of the donation process. Future prospects to improve the safety of the donation process rest with hemovigilance initiatives to monitor the effectiveness of interventions to minimize the risks to blood donors.

Future directions for older driver research

The Western world is facing a growing proportion of older drivers on our roads as the population ages and, with, it a likely increase in crashes involving seniors. This paper sets out to review what we know about older drivers and what is still unclear and in need of future knowledge and intervention. Issues related to crash epidemiology, licensing, medical fitness-to-drive, the role of new safety technology, and life after the car are briefly reviewed with the aim of identifying key areas for future research and action. A list of priority topics is included to help address this burgeoning safety area.