Examining Factors that Influence the Existence of Heinrich's Safety Triangle Using Site-Specific H&S Data from More than 25,000 Establishments

Relationship Between Companies' Responses to Near-Miss Reports and Turnover Intentions of Workers: A Nationwide Cross-Sectional Study

Background

Effective near-miss management is important in preventing workplace accidents. A company's inadequate response to near-miss reports can lead workers to feel insecure and dissatisfied with the company. We investigated the relationship between companies' responses to near-miss reports and turnover intentions of workers.

Methods

We conducted a cross-sectional study using online self-administered questionnaire survey to workers aged ≥20 years in Japan in March 2022. The analysis included 5,071 participants who had near-miss experiences and reported them to their companies. The independent variable was companies' responses to near-miss reports, classified into three categories: adequate response group, inadequate response group, and no response group. The dependent variable was turnover intentions. We calculated the odds ratio and 95% confidential interval (CI) using multilevel logistic regression analyses nested for industries and adjusted for covariates.

Results

Of the 5,071 participants, 3,058 (60.3%) were adequate response group, 1,484 (29.3%) were inadequate response group, and 529 (10.4%) were no response group. In multivariable adjusted model, compared with adequate response group, the odds ratio of inadequate response group and no response group were 1.80 (95% CI: 1.56-2.08) and 2.63 (95% CI: 2.15-3.22), respectively.

Conclusion

Our results suggested that there was a relationship between companies' responses to the near-miss reports and turnover intentions of workers. It is important not only to collect near-misses but also to respond appropriately to the reports and provide feedback to workers.

A prospective cohort study of perceived organizational support and occupational accidents and near-miss events among Japanese workers

INTRODUCTION

Preventing occupational accidents is a major global challenge, and employee safety practices play a crucial role in accident prevention. Although perceived organizational support (POS) is related to safety practices, there is currently insufficient evidence supporting a relationship between POS and occupational accidents. We investigated the relationships between POS and both occupational accidents and near-miss events that can lead to accidents in the following year among workers in various industries in Japan.

METHOD

This prospective cohort study was conducted from March 2022 to March 2023 using a questionnaire survey. In total, 9916 participants who completed the follow-up survey and met our inclusion criteria were analyzed. The follow-up survey asked participants about both occupational accidents and near-miss events experienced in the year following the baseline assessment. POS was evaluated at baseline using the eight-item version of the Survey of Perceived Organizational Support. Odds ratios (ORs) for the relationships between POS and occupational accidents and near-miss events were estimated using multilevel logistic regression analyses nested by industries.

RESULTS

The ORs for self-reported occupational accidents were significantly higher for the moderate (OR = 1.41, 95% confidence interval [CI]: 1.10-1.82), low (OR = 1.49, 95%CI: 1.18-1.89), and very low (OR = 2.03, 95%CI: 1.61-2.56) POS groups compared with the very high group. The ORs for self-reported near-miss events were also significantly higher for the moderate (OR = 1.21, 95%CI: 1.03-1.43), low (OR = 1.20, 95%CI: 1.03-1.40), and very low (OR = 1.56, 95%CI: 1.34-1.82) groups than the very high group.

CONCLUSIONS

Our findings suggest lower POS is related to a higher occurrence of occupational accidents and near-miss events in the following year. Organizations should consider enhancing employees' POS to reduce occupational accidents and near-miss events.

PRACTICAL APPLICATIONS

To enhance employees' POS, organizations should address identified antecedents of POS (e.g., fairness, supervisor support, rewards, favorable job conditions, and human resource practices).

Safety assessment of sand casting explosion accidents by testing cavity pressure of the sand mold to protect employee health

Excessive cavity pressure may result in a sand casting explosion, and corresponding measures should be adopted to prevent these consequences. In this study, the pressure variations in the cavity were first investigated based upon on-site testing by taking the resin contents into consideration, and then the evolution characteristics of sand casting explosion accidents were analyzed in depth by system dynamics, chaos theory, and the bow-tie model. When the resin contents are 1.3 wt%, 1.4 wt%, and 1.5 wt%, the pressures of the gas vent increase by 27.0 Pa, 32.8 Pa, and 35.6 Pa, respectively. To reduce the pressure of the cavity, the resin content should be reduced. The evolutionary process of sand casting explosion accidents has a noticeable butterfly effect and randomness, whose occurrence is comprehensively affected by human, object, environment, management and emergency subsystems. The leading causes of sand casting explosion accidents mainly include the extensive gas evolution characteristics of foundry sand, cavity exhaust blockage, and inadequate safety monitoring. The leading consequences of sand casting explosion accidents mainly include casualties, secondary disasters, and social panic. The implications of these findings concerning sand casting explosion accidents can be regarded as the foundation for accident prevention in practice.

A chemical accident cause text mining method based on improved accident triangle

BACKGROUND

With the rapid development of China's chemical industry, although researchers have developed many methods in the field of chemical safety, the situation of chemical safety in China is still not optimistic. How to prevent accidents has always been the focus of scholars' attention.

METHODS

Based on the characteristics of chemical enterprises and the Heinrich accident triangle, this paper developed the organizational-level accident triangle, which divides accidents into group-level, unit-level, and workshop-level accidents. Based on 484 accident records of a large chemical enterprise in China, the Spearman correlation coefficient was used to analyze the rationality of accident classification and the occurrence rules of accidents at different levels. In addition, this paper used TF-IDF and K-means algorithms to extract keywords and perform text clustering analysis for accidents at different levels based on accident classification. The risk factors of each accident cluster were further analyzed, and improvement measures were proposed for the sample enterprises.

RESULTS

The results show that reducing unit-level accidents can prevent group-level accidents. The accidents of the sample enterprises are mainly personal injury accidents, production accidents, environmental pollution accidents, and quality accidents. The leading causes of personal injury accidents are employees' unsafe behaviors, such as poor safety awareness, non-standard operation, illegal operation, untimely communication, etc. The leading causes of production accidents, environmental pollution accidents, and quality accidents include the unsafe state of materials, such as equipment damage, pipeline leakage, short-circuiting, excessive fluctuation of process parameters, etc. CONCLUSION: Compared with the traditional accident classification method, the accident triangle proposed in this paper based on the organizational level dramatically reduces the differences between accidents, helps enterprises quickly identify risk factors, and prevents accidents. This method can effectively prevent accidents and provide helpful guidance for the safety management of chemical enterprises.

How Metaphors of Organizational Accidents and Their Graphical Representations Can Guide (or Bias) the Understanding and Analysis of Risks

The history of safety science has seen the flourishing of several models and metaphors aimed at describing organizational accidents' dynamics. Metaphors and their graphical representations are powerful tools to frame risks and adverse events in socio-technical systems; they help in coping with systemic complexity but can also become a constraint and even bias the understanding of our environment. This paper aims to investigate how metaphors and their graphical representations influence the comprehension of organizational accidents, how they could be misinterpreted, and, as a result, generate misunderstandings of events. To address these questions, we analyze three paradigmatic accident causation models, typical of three phases in the evolution of models in the last century, describing how the related metaphors and depictions could influence the perception and understanding of risk factors. In addition, we present some possible misunderstandings that could be produced by the metaphor and graphical features of representations, with a particular focus on safety outcomes. Eventually, we provide a framework with the basic characteristics of an effective model and metaphor for the description and analysis of organizational accidents in modern complex socio-technical systems. This framework could be used as a guide for proposing new and more effective models in safety science.

Comprehensive Evaluation of Deep Coal Miners' Unsafe Behavior Based on HFACS-CM-SEM-SD

The unsafe behavior of miners seriously affects the safety of deep mining. A comprehensive evaluation of miners' unsafe behavior in deep coal mines can prevent coal mine accidents. This study combines HFACS-CM, SEM, and SD models to evaluate miners' unsafe behaviors in deep coal mining. First, the HFACS-CM model identifies the risk factors affecting miners' unsafe behavior in deep coal mines. Second, SEM was used to analyze the interaction between risk factors and miners' unsafe behavior. Finally, the SD model was used to simulate the sensitivity of each risk factor to miners' unsafe behavior to explore the best prevention and control strategies for unsafe behavior. The results showed that (1) environmental factors, organizational influence, unsafe supervision, and unsafe state of miners are the four main risk factors affecting the unsafe behavior of miners in deep coal mines. Among them, the unsafe state of miners is the most critical risk factor. (2) Environmental factors, organizational influence, unsafe supervision, and the unsafe state of miners have both direct and indirect impacts on unsafe behaviors, and their immediate effects are far more significant than their indirect influence. (3) Environmental factors, organizational influence, and unsafe supervision positively impact miners' unsafe behavior through the mediating effect of miners' unsafe states. (4) Mental state, physiological state, business abilities, resource management, and organizational climate were the top five risk factors affecting miners' unsafe behaviors. Taking measures to improve the adverse environmental factors, strengthening the organization's supervision and management, and improving the unsafe state of miners can effectively reduce the risk of miners' unsafe behavior in deep coal mines. This study provides a new idea and method for preventing and controlling the unsafe behavior of miners in deep coal mines.

Importance-Based Key Basic Event Identification and Evolution Mechanism Investigation of Hydraulic Support Failure to Protect Employee Health

Background: Although hydraulic support can help enterprises in their production activities, it can also cause fatal accidents. Methods: This study established a composite risk-assessment method for hydraulic support failure in the mining industry. The key basic event of hydraulic support failure was identified based on fault tree analysis and gray relational analysis, and the evolution mechanism of hydraulic support failure was investigated based on chaos theory, a synthetic theory model, and cause-and-effect-layer-of-protection analysis (LOPA). Results: After the basic events of hydraulic support failure are identified based on fault tree analysis, structure importance (SI), probability importance (PI), critical importance (CI), and Fussell–Vesely importance (FVI) can be calculated. In this study, we proposed the Fussell–Vesely–Xu importance (FVXI) to reflect the comprehensive impact of basic event occurrence and nonoccurrence on the occurrence probability of the top event. Gray relational analysis was introduced to determine the integrated importance (II) of basic events and identify the key basic events. According to chaos theory, hydraulic support failure is the result of cross-coupling and infinite amplification of faults in the employee, object, environment, and management subsystems, and the evolutionary process has an obvious butterfly effect and inherent randomness. With the help of the synthetic theory model, we investigated the social and organizational factors that may lead to hydraulic support failure. The key basic event, jack leakage, was analyzed in depth based on cause-and-effect-LOPA, and corresponding independent protection layers (IPLs) were identified to prevent jack leakage. Implications: The implications of these findings with respect to hydraulic support failure can be regarded as the foundation for accident prevention in practice.

Clinical Evaluation of Intraoperative Near Misses in Laparoscopic Rectal Cancer Surgery

OBJECTIVE

To investigate the frequency, nature, and severity of intraoperative adverse near miss events within advanced laparoscopic surgery and report any associated clinical impact.

BACKGROUND

Despite implementation of surgical safety initiatives, the intraoperative period is poorly documented with evidence of underreporting. Near miss analyses are undertaken in high-risk industries but not in surgical practice.

METHODS

Case video and data from 2 laparoscopic total mesorectal excision randomized controlled trials were analyzed (ALaCaRT ACTRN12609000663257, 2D3D ISRCTN59485808). Intraoperative adverse events were identified and categorized using the observational clinical human reliability analysis technique. The EAES classification was applied by 2 blinded assessors. EAES grade 1 events (nonconsequential error, no damage, or need for correction) were considered near misses. Associated clinical impact was assessed with early morbidity and histopathology outcomes.

RESULTS

One hundred seventy-five cases contained 1113 error events. Six hundred ninety-eight (62.7%) were near misses (median 3, IQR 2-5, range 0-15) with excellent inter-rater and test-retest reliability (κ=0.86, 95% CI 0.83-0.89, P < 0.001 and κ=0.88, 95% CI 0.85-0.9, P < 0.001 respectively). Significantly more near misses were seen in patients who developed early complications (4 (3-6) vs. 3 (2-4), P < 0.001). Higher numbers of near misses were seen in patients with more numerous (P = 0.002) and more serious early complications (P = 0.003). Cases containing major intraoperative adverse events contained significantly more near misses (5 (3-7) vs. 3 (2-5), P < 0.001) with a major event observed for every 19.4 near misses.

CONCLUSION

Intraoperative adverse events and near misses can be reliably and objectively captured in advanced laparoscopic surgery. Near misses are commonplace and closely associated with morbidity outcomes.

Classification strategies for non-routine events occurring in high-risk patient care settings: A scoping review

INTRODUCTION

Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will facilitate the comparison of results between studies.

METHODS

We conducted a literature search in PubMed, CINAHL, and EMBASE to identify studies related to NREs in high-risk domains and evaluated the methods used for event observation and description. We applied The Joint Commission on Accreditation of Healthcare Organization (JCAHO) taxonomy (cause, impact, domain, type, prevention, and mitigation) to the descriptions of NREs from the literature.

RESULTS

We selected 25 articles that met inclusion criteria for review. Real-time documentation of NREs was more common than a retrospective video review. Thirteen studies used domain experts as observers and seven studies validated observations with interrater reliability. Using the JCAHO taxonomy, "cause" was the most frequently applied classification method, followed by "impact," "type," "domain," and "prevention and mitigation."

CONCLUSIONS

NREs are frequent in high-risk medical settings. Strengths identified in several studies included the use of multiple observers with domain expertise and validation of the event ascertainment approach using interrater reliability. By applying the JCAHO taxonomy to the current literature, we provide an example of a structured approach that can be used for future analyses of NREs.

Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study

BACKGROUND

Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery.

METHODS

This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients.

RESULTS

Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics.

CONCLUSION

Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.

Lagging or leading? Exploring the temporal relationship among lagging indicators in mining establishments 2006-2017

PROBLEM

Safety management literature generally categorizes key performance indicators (KPIs) as either leading or lagging. Traditional lagging indicators are measures related to negative safety incidents, such as injuries, while leading indicators are used to predict (and therefore can be used to prevent) the likelihood of future negative safety incidents. Recent theory suggests that traditional lagging indicators also possess characteristics of leading indicators, and vice versa, however empirical evidence is limited.

METHOD

The current research investigated the temporal relationships among establishment-level injuries, near misses, and fatal events using injury and employment data from a sample of 24,910 mining establishments over a 12-year period.

RESULTS

While controlling for employee hours worked, establishment-level reported injuries and near misses were associated with of future fatal events across the sample of mines and over the time period studied. Fatal events were also associated with increases in future reported near misses, providing evidence of a cyclic relationship between them.

DISCUSSION

These findings challenge the strict categorization of injuries, near misses, and fatal events as lagging indicators. Practical applications: Understanding the KPIs that should be used to manage organizational safety, and how they can be used, is of critical practical importance. The results of the current study suggest that, depending on several considerations, metrics tied to negative safety incidents may be used to anticipate, and possibly prevent, future negative safety events.

Investigating the status of accident precursor management in East Azarbaijan Province Gas Company

Purpose. The accident precursor reporting system is a key point in preventing accidents and proper functioning of this system is critical. In the present study, the accident precursor reporting system in the Iranian East Azarbaijan Province Gas Company was investigated. Methods. This quantitative-qualitative study used field survey and document review methods to determine how the company was reporting. Qualitative content analysis approaches were used to analyze the reporting system over a 3-year period. From 1209 accident precursor reports, 2271 codes were extracted. Finally, these codes were reduced to three clusters: 996 (43.86%), 447 (19.68%) and 828 (36.46%) codes related to near misses, unsafe conditions and unsafe acts, respectively. A χ² test was used to investigate the reporting process. Results. Reporting rates varied by time (e.g., people reported more accident precursors in the first 6 solar months), by area (some areas had higher reporting rates than others) and by type of job (operational jobs had the highest reporting rate [73.16%] compared to non-operational jobs [26.84%]). Conclusion. It was suggested that policy-makers should improve the accident precursor reporting system. Changes to the current reporting system are essential to help in the prevention of future unpleasant accidents.

Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures: A Randomized Controlled Trial

WHAT WE ALREADY KNOW ABOUT THIS TOPIC

Dental procedures under sedation can cause hypoxic events and even death. However, the mechanism of such hypoxic events is not well understood.

WHAT THIS ARTICLE TELLS US THAT IS NEW

Apnea and hypopnea occur frequently during dental procedures under sedation. The majority of the events are not detectable with pulse oximetry. Insertion of a nasal tube with small diameter does not reduce the incidence of apnea/hypopnea.

BACKGROUND

Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis).

METHODS

In this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n = 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n = 20).

RESULTS

In the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h, difference: 25.1 [95% CI, 13.8 to 36.4], P < 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P < 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h vs. 50.5 [36.4, 63.9] h, difference: -2.0 [95% CI, -15.2 to 11.2], P = 0.846), not supporting the secondary hypothesis.

CONCLUSIONS

Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.

Learning from Workers' Near-miss Reports to Improve Organizational Management

Near misses recorded and reported by workers can provide awareness to the potential causes of injury and prompt safety management initiatives. Although most companies require near-miss reporting, it is unclear what the value of these reports are, if any, and how they influence subsequent actions or controls to reduce on-the-job risks. Researchers at the National Institute for Occupational Safety and Health (NIOSH) conducted a case study with an aggregates company in which near-miss reports were analyzed at each of their locations over an entire quarter during the summer of 2018. Within that quarter, workers recorded 249 near misses. Of those, 167 were valid near misses that occurred at work. Researchers coded the reports using a qualitative 5 × 5 risk matrix. Of the 167 near misses, 19% were deemed low risk, 25% moderate risk, 30% high risk, and 26% critical risk. Several patterns in the near-miss incidents were documented, including classification of incidents and common corrective actions referenced (i.e., elimination/substitution, engineering control or redesign, work process/procedures, and personal protective equipment). The analysis provides insight into ways that risk communication and management programs can be improved to reengage workers and their situational awareness on the job.

The role of risk avoidance and locus of control in workers' near miss experiences: Implications for improving safety management systems

The process industry has made major advancements and is a leader in near-miss safety management, with several validated models and databases to track close call reports. However, organizational efforts to develop safe work procedures and rules do not guarantee that employees will behaviorally comply with them. Assuming that at some point, every safety management system will need to be examined and realigned to help prevent incidents on the job, it is important to understand how personality traits can impact workers' risk-based decisions. Such work has been done in the mining industry due to its characteristically high risks and the results can be gleaned to help the process industry realign goals and values with their workforce. In the current study, researchers cross-sectionally surveyed 1,334 miners from 20 mine sites across the United States, varying in size and commodity. The survey sought to understand how mineworkers' risk avoidance could impact their near miss incidents on the job - a common precursor to lost-time incidents. Multiple regressions showed that as a miner's level of risk avoidance increased by 1 unit in the 6-point response scale, the probability of experiencing a near miss significantly decreased by 30% when adjusting for relevant control variables. Additionally, a significant interaction between risk avoidance and locus of control suggested that the effect of risk avoidance on near misses is enhanced as a miner's locus of control increases. A one-unit increase in locus of control appends the base effect of risk avoidance on near misses with an additional 8% decrease in the probability. Findings are discussed from a near-miss safety management system perspective in terms of methods to foster both risk avoidance and locus of control in an effort to reduce the probability of near misses and lost time at the organizational level within the process industry and other high-hazard industries.