Safety sans Frontières: An International Safety Culture Model

Factors associated with approaching Pilot Peer Support: a cross-sectional study

BACKGROUND

Pilot Peer Support Programs (PPSP) have been introduced in Europe as a measure to facilitate commercial pilots' mental health help-seeking in a confidential and non-punitive manner. However, research is scarce regarding what promotes and prevents pilots from approaching PPSP.

AIMS

To investigate if, and in which way, different organizational and individual factors are associated with pilots' attitudes towards approaching PPSP, and to examine the prevalence of possible cases of depression and anxiety disorders among commercial pilots in Europe.

METHODS

Data were collected using an anonymous web-based survey (n = 4494), covering pilots' work conditions, health and flight safety. Logistic regression was used to determine the impact of objective and psychosocial work environment factors, mental health factors, and demographic factors.

RESULTS

Key findings were that just culture (odds ratio [OR] = 2.65, 95% confidence interval [CI] 1.97, 3.56), type of employment (OR = 0.60, 95% CI 0.46, 0.78), minimum guaranteed pay (OR = 1.98, 95% CI 1.48, 2.65), and symptoms of depression (OR = 0.62, 95% CI 0.50, 0.76) and anxiety (OR = 0.66, 95% CI 0.54, 0.80) significantly predicted pilots' attitude towards approaching PPSP. The prevalence of pilots scoring above threshold for possible depression (18%) and anxiety disorders (23%) were determined.

CONCLUSIONS

Pilot Peer Support in its current form appears to be an insufficient means to facilitate pilots' mental health help-seeking, but could have an important preventive purpose. The findings could assist authorities and operators in developing measures to facilitate pilots' help-seeking, and improve mental health and flight safety.

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.

Influence of Sociodemographic, Organizational, and Social Factors on Turnover Consideration Among Eldercare Workers: A Quantitative Survey

Staff turnover in long-term care (LTC) is considered one of the main causes of staff shortages and a key problem for LTC systems in the developed world. Factors affecting staff turnover in LTC facilities are poorly understood due to a fragmented approach. The aim of this study was to use multivariate analysis to identify the factors at the macro-, meso-, and micro-level that influence LTC workers' turnover in Slovenia, a typical Central and Eastern European country. A correlational cross-sectional survey design with a self-reported online questionnaire was used among Slovenian LTC workers (N = 452). The results show that more than half of LTC workers intend to quit their jobs and leave the LTC sector. LTC workers who intend to leave are generally younger, have worked in the LTC sector for a shorter period, are mainly employed in the public sector, especially in nursing homes, and earn less. The connection between the intention to leave and the factors at the macro-, meso-, and micro-level is very high. Over 75% of the variance of intention to leave was explained by the linear influence of sociodemographic characteristics, social recognition, and work environment. Urgent measures for improving the work environment are needed.

Issues and complexities in safety culture assessment in healthcare

The concept of safety culture in healthcare-a culture that enables staff and patients to be free from harm-is characterized by complexity, multifacetedness, and indefinability. Over the years, disparate and unclear definitions have resulted in a proliferation of measurement tools, with lack of consensus on how safety culture can be best measured and improved. A growing challenge is also achieving sufficient response rates, due to "survey fatigue," with the need for survey optimisation never being more acute. In this paper, we discuss key challenges and complexities in safety culture assessment relating to definition, tools, dimensionality and response rates. The aim is to prompt critical reflection on these issues and point to possible solutions and areas for future research.

Safety training in context: technical, cultural and political factors affecting its design, delivery and transfer

INTRODUCTION

Safety training is integral to modern safety management systems. However, what is trained in the classroom is not always adopted and applied in the workplace, creating the training transfer problem. Taking an alternative ontological stance, the aims of this study were to conceptualize this problem as one of 'fit' between what is trained and the contextual factors in the work environment of the adopting organization.

METHOD

Twelve semi-structured interviews were conducted with experienced health andsafety trainers having diverse backgrounds and experience. Data were thematically coded 'bottom-up' to capture reasons for safety training and where consideration of context occurs in the design and delivery of training. Then, the codes were thematically grouped against a pre-existing framework to categorize contextual factors that affect 'fit' into technical, cultural, and political factors each operating at different levels of analysis.

RESULTS

Safety training occurs to satisfy external stakeholder expectations and meet internal perceptions of need. Consideration of contextual factors can occur both in the design and delivery of training. A range of technical, cultural, and political factors were identified, which can operate at individual, organizational, or supra-organizational levels to influence safety training transfer.

CONCLUSIONS

The study draws particular attention to the influence of political factors and the impact of supra-organizational factors on the successful transfer of training, areas not consistently considered in safety training design and delivery.

PRACTICAL APPLICATION

The application of the framework adopted in this study provides a useful tool for discriminating between different contextual factors and the level at which they operate. This could enable more effective management of these factors to improve the potential for transfer of safety training from the classroom to the workplace.

Managers safety attitudes as organizational factors and pressure equipment risk predictor

BACKGROUND: Change in current approach to develop methodologies for process risk assessment, where it is commenced from the process industry and exclusively hazardous materials are dealt with, into the approach where it will be commenced from pressure equipment within any context and both technical and organizational aspects are considered, can lead to the orientation of a more comprehensive approach to risk assessment, and thereby to better results in this area. OBJECTIVE: The goal of this study implies the creation of a universal measurement instrument that will measure and quantify organizational factors impact on the risk of pressure equipment exploitation. METHODS: The research instrument was drawn from previous research and tested by the multivariate statistical methods using the sample size of 253. RESULTS: The confirmatory factor analysis conducted shows that the most influencing organizational factor is ‘subcontractors for works from other enterprises’ with maximum value of 104, whereas the factors ‘maintenance/inspection’, ‘safety and health at work’ and ‘human error’ are by 10% to 20% less influencing. There then follow ‘training and competence of employees for crisis situations’, communication’, ‘potentially hazardous materials and equipment’ and ‘organizational change management’ and the factor ‘conducting investigation after accidents’ with the lowest value of 29. Pareto analysis indicates that the factors ‘communication’, ‘subcontractors for works from other enterprises’, ’organizational changes management’, ’potentially hazardous materials and equipment’, and ‘training and competence of employees for crisis situations’ participate with 80%, and they should be given special attention in practice. CONCLUSION: The instrument offered can ensure proactive information on the influence of organizational factors as risk predictors of pressure equipment operation, before given influences lead to accidents with severe consequences.

A macroergonomics perspective for exploring safety culture factors: a qualitative content analysis approach

Objective. Although assessing safety culture is a useful approach in reducing occupational accidents, there are no qualitative examinations of it based on a systems approach. This study was conducted with the aim of explaining the experiences of gas refinement personnel on safety issues and extending safety culture constructs using a macroergonomics approach. Methods. A directed qualitative content analysis was used. Data were collected by 18 semi-structured interviews based on a work subsystems model as a guiding framework. Results. From the interviews, 420 codes were extracted. By placing codes into subsystems, five categories in the organization subsystem, two categories in the job subsystem, one category in the human subsystem, two categories in the technology subsystem and two categories in the environment subsystem emerged. In addition to the common factors in assessment scales, factors such as work schedule, safety standards in new technologies and external factors of the organization like financial conditions were considered effective for workers' attitudes and safety behaviors. Conclusion. Investigating personnel perspectives about safety in the workplace based on a macroergonomics approach developed distinct factors in safety culture. It seems that industry features, environment and technology along with organizational factors are important in assessing safety culture.

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.

Investigation of the effect of vessel type on seafarers' safety culture

Maritime transportation is indispensable for world trade. Marine casualties have serious consequences. The majority of the accidents in the maritime industry are caused by human error. If necessary precautions are taken, human error can be prevented to a great extent. Safety culture is of tremendous importance in taking precautions and preventing accidents. The concept of safety culture emerged after the Chernobyl accident. Today, the importance of safety culture in preventing accidents is accepted by all international organizations. There are many elements affecting safety culture. In this study, the situation of the safety culture of 221 deck officers against many variables was examined. According to the analysis of variance test, it has been observed that the vessel type has a significant effect on safety culture even among the officers who graduated from the same college.

Safety Culture: An Integration of Existing Models and a Framework for Understanding Its Development

OBJECTIVE

This study reviews theoretical models of organizational safety culture to uncover key factors in safety culture development.

BACKGROUND

Research supports the important role of safety culture in organizations, but theoretical progress has been stunted by a disjointed literature base. It is currently unclear how different elements of an organizational system function to influence safety culture, limiting the practical utility of important research findings.

METHOD

We reviewed existing models of safety culture and categorized model dimensions by the proposed function they serve in safety culture development. We advance a framework grounded in theory on organizational culture, social identity, and social learning to facilitate convergence toward a unified approach to studying and supporting safety culture.

RESULTS

Safety culture is a relatively stable social construct, gradually shaped over time by multilevel influences. We identify seven enabling factors that create conditions allowing employees to adopt safety culture values, assumptions, and norms; and four behaviors used to enact them. The consequences of these enacting behaviors provide feedback that may reinforce or revise held values, assumptions, and norms.

CONCLUSION

This framework synthesizes information across fragmented conceptualizations to clearly depict the dynamic nature of safety culture and specific drivers of its development. We suggest that safety culture development may depend on employee learning from behavioral outcomes, conducive enabling factors, and consistency over time.

APPLICATION

This framework guides efforts to understand and develop safety culture in practice and lends researchers a foundation for advancing theory on the complex, dynamic processes involved in safety culture development.

Antecedents of safety behavior in construction: A literature review and an integrated conceptual framework

There has been no scarcity in the literature of suggested antecedents of employee safety behavior, and this paper brings together the disaggregated antecedents of safety behavior in the construction field. In total, 101 eligible empirical articles are obtained. Bibliometric and context analyses are combined to identify the influential journals, scholars, keywords, use of theory, research methods, and countries or regions of the empirical samples. The 83 factors that are identified are divided into five groups, namely (a) individual characteristics, (b) workgroup interactions, (c) work and workplace design, (d) project management and organization, and (e) family, industry, and society. This indicates that the causes of safety behavior are manifold. Various factors from different systems likely work in concert to create situations in which an individual chooses to comply with safety rules and participate voluntarily in safety activities. Given this, we propose that safety behavior is only an ostensible symptom of more complex "The Self-Work-Home-Industry/Society" systems and establish a safety behavior antecedent analysis and classification model. Based on this model, we develop a resource flow model, illustrating why, how, and when the flow of resources between the five systems-namely the self system, work system, home system, work-home interface system, and industry/society system-either promotes or inhibits safety behavior. The safety behavior antecedent analysis and classification model and resource flow model are based mainly on bioecological system theory and resources theories. Avenues for future theoretical development and method designs are suggested based on the reviewed findings and the two conceptual models. The intention with this systematic review together with the two integrated conceptual models is to advance theoretical thinking on how safety behavior can be promoted, or instead, inhibited.

Spanish validation of the mindful organizing scale: A questionnaire for the assessment of collective mindfulness

INTRODUCTION

Mindful organizing (also known as collective mindfulness) is a team level construct that is said to underpin the principles of high-reliability organizations (HROs), as it has shown to lead to almost error-free performance. While mindful organizing research has proliferated in recent years, studies on how to measure mindful organizing are scarce. Vogus and Sutcliffe (2007) originally validated a nine-item "Mindful Organizing Scale" but few subsequent validation studies of this scale exist. The present study aimed to validate a Spanish version of the Mindful Organizing Scale.

METHOD

The sample included 47 teams (comprising of a total of 573 workers with an average team size of 12.19) from a Spanish nuclear power plant. A confirmatory factor analysis (CFA), reliability analysis, and an analysis of aggregation indices were carried out. A correlation analysis and CFA were used to further validate the scale in terms of its distinctiveness from, and relationship with, other team-related variables such as safety culture, team safety climate, and team learning. Finally, evidence of criterion-related validity was collected by testing the incremental validity of the mindful organizing scale in the association with various workplace safety outcomes (safety compliance and safety participation).

RESULTS

The results confirmed a unidimensional structure of the scale and indicated satisfactory internal consistency. Aggregation of the scores to the team level was justified while significant positive correlations between mindful organizing and other team-related variables (safety culture, team safety climate, team learning) were found. Moreover, mindful organizing showed distinctiveness from safety culture, team safety climate and team learning. Finally, incremental validity of the scale was supported, as it shows to be associated with safety compliance and safety participation above and beyond other related constructs.

CONCLUSIONS

The Spanish version of the Mindful Organizing Scale has shown to be a valid and reliable scale that can be used to measure mindful organizing.

CONTRIBUTIONS

The validation of the unidimensional Spanish version of Vogus and Sutcliffe's (2007) Mindful Organizing Scale provides researchers and practitioners with a reliable and valid tool to use in Spanish speaking organizations to measure mindful organizing, which has been shown to result in more reliable performance. Theoretically, this study offers four contributions. Firstly, it validates a scale that operationalizes the 'mindful organizing' construct in a traditional high-reliability organization (nuclear power plant) which has never been done before. Secondly, it offers evidence that a mindful organizing scale can be validated in a new cultural context and language (Spanish) to any of the previous studies done before it. Thirdly, it adds to our understanding of mindful organizing's nomological network by distinguishing it from other team and safety-related variables. Lastly, it builds on current research showing sound psychometric properties of a one-dimensional, quantitative measure of mindful organizing.

Organization is also a "life form": Organizational-level personality, job satisfaction, and safety performance of high-speed rail operators

Although studies have suggested that personality can forecast safety performance at the individual level, the link between organizational-level personality and safety performance is rarely considered. On the basis of the Attraction-Selection-Attrition (ASA) theory, the present study investigated the direct and indirect effects of the organizational emergence of personality (Five-Factor Model) on individual-level outcomes (safety performance) in the high-speed rail industry. The sample consisted of 1035 high-speed rail operators in China. The results indicated that the effects of organizational-level personality on safety performance are similar to or stronger than the effects of individual-level personality. Specifically, organizational-level extraversion, agreeableness, and conscientiousness have significantly positive relationships with individual-level safety compliance and safety participation, while neuroticism has a significantly negative relationship with safety compliance and safety participation; the effect of openness to experience was not significant. Moreover, in terms of indirect effects, job satisfaction mediated the links of the four personality constructs (extraversion, agreeableness, neuroticism, and conscientiousness) with safety compliance and safety participation. These findings highlight the importance of organizational personality to improving employees' safety performance in safety-critical organizations.

The measurement equivalence of a safety climate measure across five faultlines

This study examines the appropriateness of comparing safety climate survey responses across multiple faultlines-hypothetical dividing lines that split a group into subgroups based on one or more attributes. Using survey data from 8790 employees of a multinational chemical processing and manufacturing company from 76 work sites nested within 19 different countries, we examined the multilevel measurement equivalence of a safety climate measure across cultural dimensions, survey languages, organizational hierarchy, employment arrangements, and work environments. As simulation studies support the faultline at the individual-level requires measurement equivalence tests that are different from the faultline at the country-level, we used multi-group multilevel confirmatory factor analyses for the Level-3 faultline, and multilevel factor mixture models for known classes for the Level-1 faultlines. The results demonstrated that faultlines can prevent safety climate measurement equivalence, which prohibits the aggregation of individual-level scores to higher levels and making comparisons across faultlines. This first study on multilevel safety climate measurement equivalence serves as both a warning to safety climate researchers and practitioners regarding the importance of faultlines and reminds us to consider the level of the faultlines when testing measurement equivalence with multilevel data.

Modeling the Relationship between Safety Climate and Safety Performance in a Developing Construction Industry: A Cross-Cultural Validation Study

This study attempts to validate a safety performance (SP) measurement model in the cross-cultural setting of a developing country. In addition, it highlights the variations in investigating the relationship between safety climate (SC) factors and SP indicators. The data were collected from forty under-construction multi-storey building projects in Pakistan. Based on the results of exploratory factor analysis, a SP measurement model was hypothesized. It was tested and validated by conducting confirmatory factor analysis on calibration and validation sub-samples respectively. The study confirmed the significant positive impact of SC on safety compliance and safety participation, and negative impact on number of self-reported accidents/injuries. However, number of near-misses could not be retained in the final SP model because it attained a lower standardized path coefficient value. Moreover, instead of safety participation, safety compliance established a stronger impact on SP. The study uncovered safety enforcement and promotion as a novel SC factor, whereas safety rules and work practices was identified as the most neglected factor. The study contributed to the body of knowledge by unveiling the deviations in existing dimensions of SC and SP. The refined model is expected to concisely measure the SP in the Pakistani construction industry, however, caution must be exercised while generalizing the study results to other developing countries.

Risk management for drinking water safety in low and middle income countries - cultural influences on water safety plan (WSP) implementation in urban water utilities

We investigated cultural influences on the implementation of water safety plans (WSPs) using case studies from WSP pilots in India, Uganda and Jamaica. A comprehensive thematic analysis of semi-structured interviews (n=150 utility customers, n=32 WSP 'implementers' and n=9 WSP 'promoters'), field observations and related documents revealed 12 cultural themes, offered as 'enabling', 'limiting', or 'neutral', that influence WSP implementation in urban water utilities to varying extents. Aspects such as a 'deliver first, safety later' mind set; supply system knowledge management and storage practices; and non-compliance are deemed influential. Emergent themes of cultural influence (ET1 to ET12) are discussed by reference to the risk management, development studies and institutional culture literatures; by reference to their positive, negative or neutral influence on WSP implementation. The results have implications for the utility endorsement of WSPs, for the impact of organisational cultures on WSP implementation; for the scale-up of pilot studies; and they support repeated calls from practitioner communities for cultural attentiveness during WSP design. Findings on organisational cultures mirror those from utilities in higher income nations implementing WSPs - leadership, advocacy among promoters and customers (not just implementers) and purposeful knowledge management are critical to WSP success.

Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study

OBJECTIVES

Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention.

METHODS

A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders.

RESULTS

In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05).

CONCLUSIONS

The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes.

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

In this article, we examine the relationship between safety culture and national culture, and the implications of this relationship for international safety culture assessments. Focussing on Hofstede's uncertainty avoidance (UA) index, a survey study of 13,616 Air Traffic Management employees in 21 European countries found a negative association between safety culture and national norm data for UA. This is theorized to reflect the influence of national tendencies for UA upon attitudes and practices for managing safety (e.g., anxiety on risk; reliance on protocols; concerns over reporting incidents; openness to different perspectives). The relationship between UA and safety culture is likely to have implications for international safety culture assessments. Specifically, benchmarking exercises will consistently indicate safety management within organizations in high UA countries to be poorer than low UA countries due to the influence of national culture upon safety practices, which may limit opportunities for identifying and sharing best practice. We propose the use of safety culture against international group norms (SIGN) scores to statistically adjust for the influence of UA upon safety culture data, and to support the identification of safety practices effective and particular to low or high UA cultures.

Practitioner points

National cultural tendencies for uncertainty avoidance (UA) are negatively associated with safety culture.

This indicates that employee safety‐related attitudes and practices may be influenced by national culture, and thus factors outside the direct control of organizational management.

International safety culture assessments should attempt to determine the influence of national culture upon safety culture in order that benchmarking exercises compare aspects of safety management and not national culture.

Safety culture against international group norms (SIGN) scores provide a potential way to do this, and can facilitate the identification of best practice within countries operating in a low or high UA cultural cluster.