The relationship between national culture and safety culture: Implications for international safety culture assessments

Impact of Medical Oncology-Focused Quality Programs on Cancer Care Around the World

Quality cancer care is efficient, accessible, coordinated, and evidence-based. Recognizing the necessary key components, development of pathways and guidelines to incorporate these key domains, and finally respectful adaptation to cultural differences can ensure that cancer care globally is of the highest quality. This quality care should be judged not only on how it optimizes health outcomes for patients, but also its impact on the care providers and the global community.

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.

Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ)

AIM

This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ).

METHODS

In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023.

RESULTS

Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]).

CONCLUSION

The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.

Nursing students' evaluation of patient safety culture in three central European countries: a cross-sectional study

OBJECTIVES

This cross-sectional study aimed to investigate and compare the perceptions of nursing students regarding patient safety culture (PSC) during the COVID-19 pandemic in three Central European countries.

METHODS

Data were collected from 624 nursing students between April and September 2021 using the Hospital Survey on Patient Safety Culture.

RESULTS

The evaluation of the PSC dimensions did not reach the expected level of 75 %. Significant associations were found between the perception of the dimensions of the individual PSC and age, student status, study year, and clinical placement. The overall patient safety grade, the number of events reported, and the number of events reported by nursing students were significantly predicted by several dimensions of the PSC (p<0.05).

CONCLUSIONS

The evaluation of patient safety culture by nursing students offers a unique perspective. Students come with 'fresh eyes' and provide different perspectives that can provide healthcare leaders with a practical opportunity to identify blind spots, review and improve safety protocols, and foster a more inclusive culture that prioritizes patient safety.

Children's disaster knowledge, risk perceptions, and preparedness: A cross-country comparison in Nepal and Turkey

While children are one of the groups at risk in disasters, they can also take an active part in disaster management, provided that the opportunity is given. This research examined the effect of disaster experience, disaster education, country, and city socioeconomic status on children's perceived risk and preparedness with a survey of 1335 children between 11 and 14 years old, in Nepal and Turkey. The survey used questionnaires and the pictorial representation of illness and self measure (PRISM) tool. Results showed that (1) children's risk perceptions were in line with their country-specific objective risks; (2) there were differences between the countries in relation to perception of risk for all the hazards except wildfire; (3) socioeconomic status had a statistically significant effect on children's perceptions of risk and preparedness for earthquakes, wildfires, that is, children who live in wealthier places had higher perceived risk and preparedness; (4) children in both countries showed similar trends in their knowledge of the correct protective actions to take in the event of a hazard occurrence. However, there is still room to enhance children's knowledge, in terms of safety behaviors, as the children selected many incorrect protective actions. There are important implications in terms of child-centered disaster management which hopefully will make life safer and help to create more resilience to disaster in society as a whole.

Testing the association between the enabling and enacting factors of patient safety culture and patient safety: structural equation modelling

BACKGROUND

Despite evidence linking a safety culture with patient safety, the processes by which aspect of safety culture influences patient safety are not yet well understood. Thus, this study aimed to test a theoretical model of the relationships between three enabling factors (supervisor/clinical leader support for patient safety, hospital management support for patient safety, and psychological safety), and four enacting factors of patient safety culture (handoffs and information exchange, teamwork, error reporting intention, and withholding voice) with nurse assessments of patient safety.

METHODS

A cross-sectional, descriptive correlational study design was used. Between May and June 2020, 526 nurses who provided direct care to patients in medical surgical units in three Korean hospitals completed an online survey that included four standardized scales or subscales. Structural equation modelling was used to test the hypothesized model.

RESULTS

Among the three enabling factors, psychological safety was associated with all four enacting factors, and all enacting factors were associated with overall patient safety. Hospital management support was associated with all enacting factors except teamwork, but supervisor/clinical leader support was associated with only handoffs and information exchange, and withholding voice. Thus, teamwork was influenced only by psychological safety. Findings demonstrate overall support for the theoretical model of safety culture wherein enabling factors influence enacting factors which, in turn, lead to patient safety outcomes, but emphasize the critical nature of psychological safety among nursing staff.

CONCLUSION

This study provides further insight into the importance of support from hospital management and unit supervisors/clinical leaders for patient safety to motivate and enable hospital nurses to enact behaviours necessary for patient safety. However, such support must also take the form of enhancing psychological safety for nursing staff.

Integrated Approach for Safety Culture Factor Evaluation from a Sustainability Perspective

Traditionally, sustainable development has been seen as a combination of three pillars: economic, social and environmental development. In recent years, another one has been added to these three pillars, namely culture, as being indispensable in achieving sustainable development. This study proposes an integrated approach for the identification and classification of safety culture factors in the company in a sustainability context. The research design was based on the assumption that safety culture is part of organizational culture that should support the development of corporate sustainability. Firstly, the identification of the safety culture factors (SCFs) based on the literature review was presented. Then, the ISM method was used to identify the interaction between SCFs and to develop the hierarchical structure of these factors. In the next step, ISM was integrated with the MICMAC method to cluster the factors based on driving power and dependence power into four categories. Finally, safety culture factors with high driving power were rated using the fuzzy TOPSIS method from the sustainability dimension perspective. This approach was used in an automotive industry company to improve and develop the company's practices aimed at implementing a sustainable development strategy. A sensitivity analysis was also carried out to monitor the robustness of the approach.

The effect of an embargo, sanctions and culture on safety climate: A qualitative view from aviation maintenance in the MENA region

INTRODUCTION

Safety climate assessment is a key measure of organizational safety. A strong safety climate is integral to the high safety performance in aviation. Most survey instruments that purport to measure safety climate are derived from evidence obtained in developed countries in the west. It is rare for these studies to examine the influence of macro-environmental factors on safety climate, and rarer still in countries found in the Middle East and North Africa (MENA) region.

METHOD

The researchers conducted 28 semi-structured interviews with experienced aviation maintenance engineers from a national carrier in the region. The interview questions were derived from an extensive review of existing studies of safety climate. Data from interview transcripts were coded, creating a data structure using participant quotes for 1st order codes and arriving at three aggregate dimensions: organizational commitment to safety, organizational safety practices and social relationships and their consequences.

RESULTS

Commercial considerations influenced negatively organizational commitment to safety. Organizational safety practices were weak. There was a lack of safety training, a lack of resources to support safe working, poor safety communication, and a failure to report safety issues. Strong friendships were developed through working together in teams. This adversely influenced the reporting of errors and the punishment of violations.

DISCUSSION AND CONCLUSION

The apparently weak organizational safety climate reported here was attributed to financial constraints following the imposition of economic sanctions and embargos, and to the influence of Arabic cultural values that privilege family connections and the importance of maintaining harmony in social relationships that precludes punishment.

PRACTICAL APPLICATION

Financial constraints inevitably limit resources for safety and encourage prioritization of production. Arabic cultural values inhibit the development of a 'just' culture and a 'reporting' culture and challenge the universal adoption of approaches for promoting organizational safety developed in the West.

Assessing the Mediating Role of Safety Communication Between Safety Culture and Employees Safety Performance

The main purpose of this research was to investigate the mediating role of safety communication (SCO) in the relationship between safety culture (SC) and safety performance (SP) amongst employees in the petrochemical industry. Safety communication methods not only enhance working conditions but also have a positive impact on employee's behaviors and attitudes toward safety leading toward reduced incidents in the workplace environment. A stratified sampling method was followed to collect data in the petrochemical industry in Malaysia. Structural equation modeling (SEM) was utilized to analyze the hypothesized model, using data from 320 participants. The findings reveal that safety communication partially mediates the association between safety culture and safety performance. Further, safety culture was found to have a significant and positive effect on safety performance. This -study makes a significant theoretical contribution by providing empirical evidence on the direct and indirect relationship between safety culture and safety performance in the petrochemical industry.

Human, Organisational and Societal Factors in Robotic Rail Infrastructure Maintenance

Robotics are set to play a significant role in the maintenance of rail infrastructure. However, the introduction of robotics in this environment requires new ways of working for individuals, teams and organisations and needs to reflect societal attitudes if it is to achieve sustainable goals. The following paper presents a qualitative analysis of interviews with 25 experts from rail and robotics to outline the human and organisational issues of robotics in the rail infrastructure environment. Themes were structured around user, team, organisational and societal issues. While the results point to many of the expected issues of robotics (trust, acceptance, business change), a number of issues were identified that were specific to rail. Examples include the importance of considering the whole maintenance task lifecycle, conceptualizing robotic teamworking within the structures of rail maintenance worksites, the complex upstream (robotics suppliers) and downstream (third-party maintenance contractors) supply chain implications of robotic deployment and the public acceptance of robotics in an environment that often comes into direct contact with passenger and people around the railways. Recommendations are made in the paper for successful, human-centric rail robotics deployment.

Psychometric Evaluation of the Korean Version of Hospital Survey on Patient Safety Culture

OBJECTIVES

This study evaluated the psychometric properties of the Korean-language version of the Hospital Survey on Patient Safety Culture (HSOPSC) among Korean nurses.

METHODS

We analyzed secondary data from 801 direct care nurses working at a tertiary, private, nonprofit, teaching hospital in South Korea. Descriptive statistics, internal consistency coefficients, and intercorrelations were calculated. The latent factor structure of the HSOPSC was examined using exploratory structural equation modeling techniques, which account for the noncontinuous nature of ordinal data.

RESULTS

Although a majority of subscales showed acceptable to good internal consistency, 4 dimensions (staffing, overall perceptions of patient safety, organizational learning-continuous improvement, and nonpunitive response to errors) had reliability levels less than 0.6. The HSOPSC items loaded somewhat diffusely on 3 subscales: staffing, teamwork across units, and organizational learning-continuous improvement. Correlations between the 12 HSOPSC factors indicated discriminant validity. Convergent validity was supported by correlations between the 12 subscales and a single-item outcome variable, namely, patient safety grade. Several items did not load well on their respective subscales, but most items fit the underlying theoretical model implied by the HSOPSC, resulting in an acceptable model fit (confirmatory fit index = 0.985, root mean square error of approximation = 0.034, weighted root mean square residual = 0.54).

CONCLUSIONS

Despite the acceptable model fit of the Korean version of HSOPSC, the psychometric properties of this instrument require further investigation to ensure it is an effective tool to measure patient safety culture and identify areas for improvement in the Korean health care system.

Exploring safety culture in the Finnish ambulance service with Emergency Medical Services Safety Attitudes Questionnaire

Background

Emergency Medical Services (EMS) is, by its nature, a challenging context that may create risks for both patients and employees. It is also known that an organisation’s safety culture has an influence on both patient and employee safety. Finnish EMS organisations lack knowledge of how their safety culture is perceived by their employees.

Aim

This study aims to test the psychometric properties of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) in a Finnish EMS setting. We also explore the connections between individual- and organisation-based characteristics and safety attitudes in the Finnish EMS.

Methods

A cross-sectional survey study design was used. The EMS-SAQ was used to collect data via social media. The instrument measures six domains of workplace safety culture: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions and stress recognition. The 5-point Likert scale was converted to a 100-point scale and mean ≥ 75 was dichotomized as a positive. Confirmatory factor analysis (CFA) was carried out to validate the EMS-SAQ in a Finnish setting. Other results were analysed by using non-parametric tests.

Results

327 responses were included in the analysis. CFA showed that the total EMS-SAQ model had acceptable goodness-of-fit values in the Finnish EMS setting. Total mean scores for each safety culture domain were identified non-positively (mean score < 75); safety climate 60.12, teamwork climate 60.92, perceptions of management 56.31, stress recognition 64.55, working conditions 53.43 and job satisfaction 70.36. Higher education was connected to lower job satisfaction and the teamwork climate within the individual characteristics. All organisation-based characteristics caused at least one significant variation in the safety culture domain scores. Working area significantly affected (p < 0.05) five out of the six safety culture domain scores.

Conclusions

The EMS-SAQ is a valid tool to evaluate safety culture among the Finnish EMS organisations; it offers a novel method to evaluate safety and patient safety within the Finnish EMS organisations. According to the findings, the organisation-based characteristics more likely had an impact on safety attitudes than did the individual-based characteristics. Therefore, it is suggested that the Finnish EMS organisations undertake safety culture development at the organisational level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-021-00960-9.

Explaining People's Worry Levels During the Covid-19 Pandemic: An Analysis of Socio-Economic and Cultural Dimensions

This paper examines the influence of socio-economic and cultural dimensions (measured at the country level) on what concerns people the most about the Covid-19 pandemic. Based on secondary data, the study considers the opinion of more than 24,000 individuals living in 30 different countries, with national samples weighted to match each country's general population older than 18years of age. A set of linear Bayesian regressions was applied to 10 different types of worries reported for economic, health, and safety domains. Results demonstrate that socio-economic variables and cultural dimensions complement each other in explaining people's concerns about the effect of the Covid-19 pandemic. An overall view of the analysis also reveals that cultural dimensions exceed socio-economic variables in explaining peoples' worries about health and safety domains. Socio-economic variables are slightly more effective in explaining the worries of the economic domain. Among the cultural dimensions, long-term orientation and uncertainty avoidance are the best in explaining people's worries. The higher the score in long-term orientation, the lower the worry levels expressed by the respondents. Likewise, low scores on uncertainty avoidance generate lower levels of worries due to the Covid-19 pandemic. Finally, health worries produce a positive outcome because they explain a significant reduction in the fatality rate.

Enabling Food Safety Entrepreneurship: Exploratory Case Studies From Nepal, Senegal, and Ethiopia

Today, formal and informal enterprises are increasingly contributing to the safety and nutritional ramifications of their food business activities. Enabling entrepreneurship in a sustainable manner means making profits, striving to prevent ingress of harmful substances, and increasing the efficiency of using local natural resources and thus mitigating food hazardous footprints. Using examples from Nepal, Senegal and Ethiopia, this review provides information on microbial and chemical contamination and food adulteration that lead to having unsafe food in the market and on factors that are limiting growing food businesses. Four examples for how to accelerate food safety entrepreneurship are presented that include safely diversifying markets with animal sourced foods, sustainably using neglected and underutilized animal sources, expanding, and integrating innovative technologies with traditional practice and using digital technology to improving monitoring and safety along the food supply chain.

Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.

Soft Factors, Smooth Transport? The role of safety climate and team processes in reducing adverse events during intrahospital transport in intensive care

BACKGROUND

Intrahospital patient transports (IHTs) in intensive care involve an appreciable risk of adverse events (AEs). Research on determinants of AE occurrence during IHT has hitherto focused on patient, transport, and intensive care unit (ICU) characteristics. By contrast, the role of "soft" factors, although arguably relevant for IHTs and a topic of interest in general health care settings, has not yet been explored.

PURPOSE

The study aims at examining the effect of safety climate and team processes on the occurrence of AE during IHT and whether team processes mediate the effect of safety climate.

METHODOLOGY/APPROACH

Data stem from a noninterventional, observational multicenter study in 33 ICUs (from 12 European countries), with 858 transports overall recorded during 28 days. AEs include medication errors, dislodgments, equipment failures, and delays. Safety climate scales were taken from the "Patient Safety Climate in Healthcare Organizations" (short version), team processes scales from the "Leiden Operating Theatre and Intensive Care Safety" questionnaire. Patient condition was assessed with NEMS (Nine Equivalents of Nursing Manpower Use Score). All other variables could be directly observed. Hypothesis testing and assessment of effects rely on bivariate correlations and binomial logistic multilevel models (with ICU as random effect).

FINDINGS

Both safety climate and team processes are comparatively important determinants of AE occurrence, also when controlling for transport-, staff-, and ICU-related variables. Team processes partially mediate the effect of safety climate. Patient condition and transport duration are consistently related with AE occurrence, too.

PRACTICE IMPLICATIONS

Unlike most patient, transport, and ICU characteristics, safety climate and team processes are basically amenable to managerial interventions. Coupled with their considerable effect on AE occurrence, this makes pertinent endeavors a potentially promising approach for improving patient safety during IHT. Although literature suggests that safety climate is slow and hard to change (also compared to team processes), efforts to improve safety climate should not be forgone.

Adaptation and validation of a Korean-language version of the revised hospital survey on patient safety culture (K-HSOPSC 2.0)

Background

To date, there has been no universal and validated tool for measuring safety culture in Korea. The Hospital Survey on Patient Safety Culture (HSOPSC), version 2.0 was released by the Agency for Healthcare Research and Quality in 2019, but it had not yet been translated and assessed for use in Korea. The aim of this study was to assess the content validity and other psychometric properties of the Korean-language version of the HSOPSC 2.0.

Methods

Instrument adaptation was performed using a committee-based translation, cognitive interviews, and expert panel reviews. Confirmatory factor analysis was conducted on data obtained through an online survey from 526 registered nurses who worked on medical-surgical units in three teaching hospitals in South Korea.

Results

One item was dropped during the translation and adaption phase of the study as being a poor fit for the Korean healthcare context, resulting in excellent content validity. Confirmatory factor analysis supported the factorial structure of the K-HSOPSC 2.0. Correlations with an overall measure of patient safety provided further evidence of construct validity. Additionally, in comparing the results of this current study to those from U.S. research using the HSOPSC 2.0, it was found that Korean nurses assigned less positive scores to all dimensions of patient safety culture.

Conclusion

Our findings provide evidence of the content validity, reliability, and construct validity of the K-HOSPSC 2.0 for measuring patient safety culture in South Korean hospitals.

Hospital administrators can use this tool to assess safety culture and identify areas for improvement to enhance patient safety and quality of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-020-00523-w.

Work safety climate. Comparison of selected occupational groups

Implementation of effective programs to improve occupational safety should be linked to an understanding of the specific nature of the given job. The aim of the research was to compare occupational groups with different job-related specificities: industrial production line workers, retail workers and mine rescuers, in terms of their assessment of the work safety climate. The survey covered 2,995 respondents with diversified demographic characteristics. The study used an abridged version of the Safety Climate Questionnaire by Znajmiecka-Sikora (2019) to assess 10 separate safety climate dimensions. The results of the MANOVA multivariate analysis, Wilks' multivariate F-tests and univariate F tests prove that there is a statistically significant difference between the respondents representing the three occupational groups collectively in terms of global assessment of all work safety climate dimensions, and also indicate significant differences between workers belonging to the three occupational groups in terms of their assessment of the individual dimensions of the work safety climate, except the organization's occupational health and safety management policy as well as technical facilities and ergonomics, which may be due to the universality of the requirements set for organizations with regard to these two aspects of safe behavior. The differences observed in the assessment of the remaining work safety climate dimensions induces one to promote more differentiated and individualized activities, taking into account the work specificity and the nature of the threats occurring in the respective working environment of the representatives of the different occupations. The difference in assessment of the work safety climate found in the research encourages one to create practical programs for safety, not only in the procedural and technical dimension, but also in the social and psychological one.

A Safety Climate Framework for Improving Health and Safety in the Indonesian Construction Industry

The Indonesian construction industry is the second largest in Asia and accounts for over 30% of all occupational injuries in the country. Despite the size of the industry, there is a lack of safety research in this context. This research, therefore, aims to assess safety climate and develop a framework to improve safety in the Indonesian construction industry. Quantitative and qualitative data were collected from 311 construction workers. The results show a moderately healthy safety climate but reflect numerous problems, particularly around perceived conflicts between production and safety logics, cost trade-offs being made against other competing project priorities, poor safety communication, poor working conditions, acceptance of poor safety as the norm, poor reporting and monitoring practices, poor training and a risky and unsupportive working environment which prevents workers from operating safely. Two new safety climate paradoxes are also revealed: contradictions between management communications and management practices; contradictions between worker concern for safety and their low sense of personal accountability and empowerment for acting to reduce these risks. A low locus of control over safety is also identified as a significant problem which is related to prevailing Indonesian cultural norms and poor safety policy implementation and potential conflicts between formal and informal safety norms, practices and procedures. Drawing on these findings, a new integrated framework of safety climate is presented to improve safety performance in the Indonesian construction industry.

Inside the black box of comparative national healthcare performance in 35 OECD countries: Issues of culture, systems performance and sustainability

Background

Is national healthcare performance associated with country-level characteristics, and if so what are the implications for international health policy?

Methods and findings

We compared Hofstede’s six cultural dimensions against relative health systems performance of 35 countries. Hierarchical cluster analysis identified best-matched groupings of countries. Performance was measured by the Organisation for Economic Co-operation and Development’s (OECD’s) Health at a Glance indicators data framework (five dimensions with 57 indicators) and the United Nations’ (UNs’) Sustainability Development Goals (SDG) data set (15 indicators). Three country clusters emerged: Collective-Pyramidal (n = 9: comprising Slovak Republic, Mexico, Poland, Greece, Spain, Turkey, Portugal, Chile, and Slovenia); Collaborative-Networked (n = 12: UK, Canada, Australia, USA, Ireland, New Zealand, Netherlands, Finland, Iceland, Norway, Denmark, and Sweden); and Orderly-Future Orientated (n = 14: Korea, Estonia, Latvia, Austria, Israel, Japan, Czech Republic, Hungary, Italy, Belgium, France, Germany, Luxembourg and Switzerland). The Collaborative-Networked cluster had significantly better performing health systems measured by both the Health at a Glance and SDG performance data, followed by the Orderly-Future Orientated cluster, followed by the Collective-Pyramidal cluster. The Collaborative-Networked Cluster was characterized by low power distance (e.g., greater levels of equity), low uncertainty avoidance (e.g., toleration of others’ opinions), individualism (e.g., self-reliance) and indulgence (e.g., drives and norms to enjoy life and have fun).

Conclusions

National cultures are associated with healthcare performance on two key international measures. In national and international efforts to improve health system performance, cultural characteristics play an important role. This information may be of value to regulators, policymakers, researchers and clinicians examining the practical impact of culture on healthcare performance.

Construction Safety Success Factors: A Taiwanese Case Study

The international construction industry has long experienced high rates of occupational incidents resulting in serious injury and death. The high rate of fatal construction accidents has clearly highlighted the importance and urgency of safety management improvement for building and construction sites. This paper analyzed 33 nominated success factors of the site safety management (SSM) of building construction projects using Principle Components Analysis (PCA) to extract the success factors (SFs) of SSM in Taiwan. The internal relationships among these SFs were further explored using Structural Equation Modeling (SEM) to examine the underlying relationships. The results of this study indicate that there are moderate correlations present between the selected SFs for SSM. Management behaviors, a safe work environment and safety resources, the safety behaviors of workers, and prevention and remedial actions were found to be the major influencers for SSM performance. Furthermore, the study shows that SSM in Taiwan is still overly focused on safe working conditions, to the detriment of workers’ safety perception and training. Further work is required to ensure that safety programs are agile enough to understand and adapt to the factors which influence SSM outcomes.

Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research

Background

The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument.

Methods

This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation.

Results

The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate).

Conclusions

The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

Values-in-action that support safe production

INTRODUCTION

Safe production is a sustainable approach to managing an organization's operations that considers the interests of both management and workers as salient stakeholders in a productive and safe workplace. A supportive culture enacts values versus only espousing them. These values-in-action are beliefs shared by both management and workers that align what should happen in performing organizational routines to be safe and be productive with what actually is done. However, the operations and safety management literature provides little guidance on which values-in-action are most important to safe production and how they work together to create a supportive culture.

METHOD

The researchers conducted exploratory case studies in 10 manufacturing plants of 9 firms. The researchers compared plant managers' top-down perspectives on safety in the performance of work and workers' bottom-up experiences of the safety climate and their rates of injury on the job. Each case study used data collected from interviewing multiple managers, the administration of a climate survey to workers and the examination of the plant's injury rates over time as reported to its third party health and safety insurer.

RESULTS

The researchers found that plants with four values-in-action -a commitment to safety, discipline, prevention and participation-were capable of safe production, while plants without those values were neither safe nor productive. Where culture and climate aligned lower rates of injury were experienced.

DISCUSSION AND CONCLUSION

The four value-in-actions must all be present and work together in a self-reinforcing manner to engage workers and managers in achieving safe production. Practical application: Managers of both operations and safety functions do impact safety outcomes such as reducing injuries by creating a participatory environment that encourage learning that improves both safety and production routines.

Integrating Safety Attitudes and Safety Stressors into Safety Climate and Safety Behavior Relations: The Case of Healthcare Professionals in Abu Dhabi

Objectives

How safety climates, safety attitudes, and safety behaviors are related remains unexplored in the literature, with no study so far investigating the moderating path of safety stressors between these variables. We sought to understand the path through which safety climates may affect safety-behavior-related outcomes, such as safety compliance and participation, through the integration of safety attitudes. Since this study is related to the safety-related perception-intention-behavior relationship, safety stressors are proposed as a moderator of this relationship.

Methods

A total of 770 healthcare professionals working in public hospitals across Abu Dhabi were randomly selected for this study. We used questionnaires covering demographic details, safety behaviors, safety climates, safety attitudes, and safety stressors to obtain the data.

Results

The results revealed the partial mediating role of safety attitudes in the relationship between safety climate and safety behavior. Additionally, safety stressors did not moderate the relationship between safety climates, safety attitudes, and safety behaviors, which has some interesting implications for healthcare professionals.

Conclusions

The study suggests that safety attitudes may also regulate the impact of perceptions of management values regarding safety, policies, and procedures. It is highly likely that healthcare professionals who experience a positive workplace safety climate will form positive safety attitudes that encourage safety behavior. In addition, the homogeneous characteristics of healthcare professionals' in the UAE may also offer the positive coping strategy that caused the insignificant moderating effect of safety stressors on the relationship between safety climates, safety attitudes, and safety behaviors.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

OBJECTIVE

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

DESIGN

Literature review and an analysis framework to review studies.

SETTING

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

DATA SOURCES

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

RESULTS

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions 'staffing', 'communication openness', 'non-punitive response to error', 'organisational learning' and 'overall perceptions of safety' resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

CONCLUSIONS

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

Exploring the Multilevel Perception of Safety Climate on Taiwanese Construction Sites

This study investigates multilevel differences in safety climate (SC) perception dimensions between management and laborers on Taiwanese construction sites. With Taiwan’s high rate of construction site safety incidents, implementing successful safety strategies requires understanding differences in SC perceptions between management and laborers. This study used a structured SC questionnaire with responses from 74 managers and 261 laborers. The analysis of collected data includes (1) descriptive statistics comparing the selected dimensions; (2) Pearson correlation analysis examining relationships between SC perception dimensions; (3) t-test and one-way ANOVA to assess relationships between the respondent’s background and SC perception dimensions; and (4) Post-Tukey comparison analysis to compare the SC perception differences between management and laborers. The results indicate that management-level staff show a higher degree of SC perception than laborer-level staff. This level of SC perception varies between individual dimensions. The strongest convergence between the two groups is observed in the dimension of ‘workmate care of each other’, and the greatest divergence is found in ‘risk decision making’. Previous studies regarding SC perception in Taiwan specifically focus on construction workers and neglect the differences in perception between management and laborers. The outcomes of this study contribute to the understanding of multilevel SC perceptions, which can be used in the development of targeted strategies to improve SC on construction sites.

Safety Culture and Patient Safety Outcomes in East Asia: A Literature Review

This review examined associations between safety culture aspects and patient safety outcomes in East Asian hospitals and identified relevant research priorities. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 16 articles were identified for review. Patient safety nursing activity was the most commonly investigated outcome in relation to safety culture aspects. Among safety culture aspects, feedback and communication, frequency of event reporting, teamwork within units, and managers’ support for patient safety were most significantly related to patient safety outcomes. Areas for further research include the use of theory or theoretical frameworks, consensus upon the scoring strategies for computation of safety culture scores, and selecting appropriate units of analysis and statistical analyses. Finally, researchers should examine relations between unit-specific and nation-specific safety culture and patient safety outcomes, given the influence of cultural attitudes and behaviors on patient safety.

Psychometric Properties of the Romanian Version of the Hospital Survey on Patient Safety Culture (HSOPS)

OBJECTIVE

To explore psychometrics of the Romanian version of the Hospital Survey on Patient Safety Culture (HSOPS) released by the US Agency for Healthcare Research and Quality in 2004.

MATERIAL AND METHODS

The original US survey with 12 composites and 42 items was translated (back translation method), pre-tested on a few staff and then minimally adjusted. A qualitative cross-sectional study was carried out in units from six hospitals in four Romanian regions, based on the census of medical and non-medical staff (n. 969). Participants completed a paper-based self-administered questionnaire. The main outcome measures were: descriptive statistics, confirmatory factor analysis (CFA), internal reliability and intercorrelations among survey composites.

RESULTS

Nurses accounted for 67% of respondents, and doctors for 23%. Most work units were surgery (24%) and medical specialties (22%). After individual-level CFA on half of the sample, Staffing and Overall perceptions of patient safety composites were dropped and Feedback & communication about error and Communication openness composite items were aggregated to a single Communication composite. Subsequent CFA on the second half of the sample indicated that the novel composite structure adequately fitted the data: comparative fit index=0.90; root mean square error of approximation=0.06; standardized root mean square residual=0.06. Internal consistency was .0.70 for most composites. Spearman intercorrelations among the patient safety composites at the individual level averaged 0.28.

CONCLUSION

Psychometrics of the Romanian version of the HSOPS tested in Romania was acceptable for nine composites with 31 items. Integration of this survey with items more pertinent for Romania is suggested.