Enhancing intersection safety in autonomous traffic: A grid-based approach with risk quantification

Existing studies on autonomous intersection management (AIM) primarily focus on traffic efficiency, often overlooking the overall intersection safety, where conflict separation is simplified and traffic conflicts are inadequately assessed. In this paper, we introduce a calculation method for the grid-based Post Encroachment Time (PET) and the total kinetic energy change before and after collisions. The improved grid-based PET metric provides a more accurate estimation of collision probability, and the total kinetic energy change serves as a precise measure of collision severity. Consequently, we establish the Grid-Based Conflict Index (GBCI) to systematically quantify collision risks between vehicles at an autonomous intersection. Then, we propose a traffic-safety-based AIM model aimed at minimizing the weighted sum of total delay and conflict risk at the intersection. This entails the optimization of entry time and trajectory for each vehicle within the intersection, achieving traffic control that prioritizes overall intersection safety. Our results demonstrate that GBCI effectively assesses conflict risks within the intersection, and the proposed AIM model significantly reduces conflict risks between vehicles and enhances traffic safety while ensuring intersection efficiency.

The application of systematic accident analysis tools to investigate food safety incidents

Effective food safety (FS) management relies on the understanding of the factors that contribute to FS incidents (FSIs) and the means for their mitigation and control. This review aims to explore the application of systematic accident analysis tools to both design FS management systems (FSMSs) as well as to investigate FSI to identify contributive and causative factors associated with FSI and the means for their elimination or control. The study has compared and contrasted the diverse characteristics of linear, epidemiological, and systematic accident analysis tools and hazard analysis critical control point (HACCP) and the types and depth of qualitative and quantitative analysis they promote. Systematic accident analysis tools, such as the Accident Map Model, the Functional Resonance Accident Model, or the Systems Theoretical Accident Model and Processes, are flexible systematic approaches to analyzing FSI within a socio-technical food system which is complex and continually evolving. They can be applied at organizational, supply chain, or wider food system levels. As with the application of HACCP principles, the process is time-consuming and requires skilled users to achieve the level of systematic analysis required to ensure effective validation and verification of FSMS and revalidation and reverification following an FSI. Effective revalidation and reverification are essential to prevent recurrent FSI and to inform new practices and processes for emergent FS concerns and the means for their control.

When tomorrow comes: A prospective risk assessment of a future artificial general intelligence-based uncrewed combat aerial vehicle system

There are concerns that Artificial General Intelligence (AGI) could pose an existential threat to humanity; however, as AGI does not yet exist it is difficult to prospectively identify risks and develop requisite controls. We applied the Work Domain Analysis Broken Nodes (WDA-BN) and Event Analysis of Systemic Teamwork-Broken Links (EAST-BL) methods to identify potential risks in a future 'envisioned world' AGI-based uncrewed combat aerial vehicle system. The findings suggest five main categories of risk in this context: sub-optimal performance risks, goal alignment risks, super-intelligence risks, over-control risks, and enfeeblement risks. Two of these categories, goal alignment risks and super-intelligence risks, have not previously been encountered or dealt with in conventional safety management systems. Whereas most of the identified sub-optimal performance risks can be managed through existing defence design lifecycle processes, we propose that work is required to develop controls to manage the other risks identified. These include controls on AGI developers, controls within the AGI itself, and broader sociotechnical system controls.

Safety culture in maternity hospital: Perception of nurse-midwives

AIM

To explore nurse-midwives' perceptions of safety culture in maternity hospitals.

DESIGN

A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research.

METHODS

Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis.

FINDINGS

Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication.

CONCLUSION

The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential.

IMPACT

Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

A palpable sense of frustration with NHS patient safety culture development

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses two recent reports on NHS patient safety.

Understanding the regulator-regulatee relationship for developing safety culture

Regulatory authorities in safety-critical industries typically seek to influence the safety culture of the organizations they oversee. However, we know little about how regulatory authorities achieve this influence (e.g., what roles are adopted, relationship characteristics) and, more generally, about how external actors shape an organization's safety culture. Using a qualitative design in the nuclear industry, we developed our conceptual and empirical understanding of the roles through which a regulator influences the safety culture of their regulated organizations and what characteristics within the regulator-regulatee relationship facilitate positive safety culture developments. Data were collected through interviews with inspectors from a nuclear regulator and employees of regulated nuclear organizations, and from an inspection of regulatory documents. The findings identified that the regulator was perceived to hold three complementary roles for safety culture development: being an enforcer, working as a partner (providing opportunities for licenseholders to improve beyond compliance), and acting as an advisor to regulated organizations. Analysis also showed that effective relationships in these roles, and which were central to influencing safety culture, were perceived to be characterized by professionalism, transparency, and balance between formal enforcement and informal exchange. Theoretical implications to advance conceptualizations of safety culture as well as practical implications for risk regulators are discussed.

Intern nursing students' perceptions of patient safety culture and their experiences with factors affecting the safety of care in hospital settings: A mixed method study

BACKGROUND

Patient safety culture is a globally studied subject as it plays a significant role in preventing and reducing errors. There is limited mixed-method research into the in-depth investigation of intern nurses' views on patient safety in hospital settings and the factors affecting it.

OBJECTIVE

This study was conducted to determine intern nursing students' perceptions of patient safety culture and their experiences with exploring factors affecting the safety of care in hospital settings.

DESIGN AND METHODS

A convergent mixed-method design was used. The study group was selected using the purposive sampling method. STROBE and COREQ checklists were followed. The quantitative phase was descriptive and correlational, and the qualitative phase was phenomenological. Quantitative data were collected using a "Personal Information Form" and "Patient Safety Culture Scale" and qualitative data using a "Semi-Structured Interview Form." Mean ± standard deviation, median (min-max), frequency, percentage values, Shapiro-Wilk, and Mann-Whitney U tests were employed to evaluate quantitative data. The inductive content analysis method was used to analyze qualitative data.

SETTING AND PARTICIPANTS

The study consisted of intern nursing students from a university in the 2020-2021 academic year. The quantitative phase of the research was conducted with 38 and the qualitative phase with nine intern nursing students. In the qualitative phase, the saturation point was taken as a basis.

RESULTS

In the study, nursing students' perceptions of patient safety culture were high (3.24 ± 0.49; min = 1.88 and max = 4). The results of the qualitative data analysis indicated that the factors affecting patient safety in hospital settings consisted of three themes, namely "health professionals, care environment, and patients and caregivers" and nine subthemes.

CONCLUSIONS

Intern nursing students had high perceptions of patient safety culture and had highly significant experiences with the factors affecting safe care in hospital settings.

Maturity of Food Safety Management Systems in the Vietnamese Seafood Processing Industry

Fifty-nine percent (59%) of the reported food safety issues in Vietnam are related to seafood products, mainly fish and fish products. The international export of seafood products continues to grow due to intensification of the production in the Vietnamese seafood processing industry. To ensure the production of safe food, a company-specific, effective food safety management system is essential. This research explores the maturity of food safety management systems in a convenience sample of the Vietnamese seafood processing industry to identify potential gaps and interventions for improvement. The food safety management system diagnostic instrument was used to assess the context riskiness, maturity of control and assurance activities and food safety performance of 11 companies. Maturity of their food safety management systems was further explored through hierarchical cluster analysis, and the differences in maturity between clusters were statistically tested through Mann-Whitney U tests (nonparametric). The influence of companies' organizational characteristics on the maturity of control and assurance activities was assessed through nonparametric K independent tests. A variability in the maturity of food safety management systems between the eleven Vietnamese companies was measured. Cluster analysis revealed two clusters, Cluster I (six companies) and Cluster II (five companies). The companies in both these clusters operate under a moderate level context riskiness and average to advanced level of food safety performance. However, control and assurance activities are at a lower maturity in Cluster I compared to Cluster II. None of the companies' organizational characteristics (i.e. certification level) have a statistically significant influence on the maturity of control and assurance activities. However, compliance with multiple food safety standards and the presence of physical intervention system(s) have a positive influence on food safety performance.

Safety Climate in the Utility Industry: Perceptual Discrepancies Across Organizational Hierarchy

OBJECTIVES

This study aims to extend safety climate research by considering perceptions across the following three hierarchical levels within a workplace: (1) senior leaders/executives, (2) field leaders/supervisors, and (3) front-line employees.

METHODS

We conducted a quantitative survey study at a US utility company where we collected data related to safety climate perceptions and employee-reported safety behaviors across the different levels of organizational hierarchy.

RESULTS

The findings revealed the highest safety climate scores among senior leaders/executives, followed by field leaders/supervisors, and then employees, suggesting potential discrepancies between espoused and enacted safety values in the workplace.

CONCLUSIONS

These results suggest that supervisors and top managers may have different mental models of workplace safety compared with employees. Consequently, assessing perceptions at different organizational levels provides a fuller picture of safety in the workplace.

An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study

BACKGROUND

Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate.

PURPOSE

The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate.

DESIGN

A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines.

METHODS

The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis.

RESULTS

Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate.

CONCLUSION

The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety.

IMPLICATIONS

Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management.

PATIENT OR PUBLIC CONTRIBUTION

The study included nurses in the intervention and the data collection processes.

IMPACT

Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.

Burdens of infection control on healthcare workers: a scoping review

INTRODUCTION

Hospital-acquired infections (HAIs) pose a significant risk to patients, and are a major focus of infection prevention and control policies (IPC). One under-recognized reason for the generally poor compliance with IPC is that it is burdensome for healthcare workers (HCWs).

AIM

To identify the burdens of IPC for HCWs.

METHODS

PubMed and CINAHL were searched for studies published in English since 2000 regarding compliance with IPC and the burdens associated with compliance. After screening 1018 initial results, 25 articles were included in the final review.

RESULTS

Evidence was found for burdens including dermatological complications, headaches, sensory symptoms and time pressure. Tools designed to measure compliance with IPC have limitations, and rarely assess the burdens of compliance. A strong safety culture predicted positive compliance, while knowledge of the underlying rationale for IPC had a non-linear relationship with compliance.

CONCLUSION

Future research should clarify IPC-related burdens and how these may be minimized to achieve better compliance.

Factors influencing fire accidents in urban complexes: a combined DEMATEL and ISM study

Fire outbreaks in urban complexes are a major safety concern worldwide. Therefore, this study aims to examine the critical factors that influence fire accidents and their interaction mechanisms in urban settings. A (software factors, hardware factors, environmental factors, parties and other factors, SHEL) model is developed to identify 15 risk factors in four categories affecting fire incidents in urban complexes. The Decision-making Trial and Evaluation Laboratory method (DEMATEL) and Interpretive Structural Modeling (ISM) are employed to identify the key factors and their interrelationships, using the evaluation metrics of degree of influence, affected degree, centrality, and hierarchical structure. The results show that lack of safety management rules and regulations (S13), poor security awareness (S1), and uncorrected hidden dangers (S11) are the top three critical factors. Based on the hierarchical structure and centrality values, eight critical paths with the highest impact on fires are identified; for instance, Path 39 (comprising, lack of safety management rules and regulations (S13) → lack of fire training and drills (S12) → insufficient security knowledge (S2) → poor security awareness (S1) → poor sense of security responsibility (S3) → uncorrected hidden danger (S11) → inadequate maintenance of fire-fighting facilities (S14) → Accident), which, among all disaster impact paths, has the highest centrality value of 21.8796 (out of a total of 15 factors and total centrality value of 42.9226; Path 39 involves seven factors, but its centrality value accounts for 50.97% of the total). Finally, based on the factor analysis results, suggestions for fire control measures are provided to prevent fire accidents and ensure the safety of people and property.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education

Background

In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up.

Method

At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis.

Result

320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms.

Conclusion

Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Systematic Review of Morbidity and Mortality Meeting Standardization: Does It Lead to Improved Professional Development, System Improvements, Clinician Engagement, and Enhanced Patient Safety Culture?

OBJECTIVES

This systematic review sought to better understand the effect of standardized Morbidity and Mortality meetings (M&Ms) on learning, system improvement, clinician engagement, and patient safety culture.

METHODS

Three electronic databases were searched using a range of text words, synonyms, and subject headings to identify the major concepts of M&M meetings. Articles published between October 2012 (the end date of an earlier review) and February 2021 were assessed against the inclusion criteria, and thematic synthesis was conducted on the included studies.

RESULTS

After abstract and full-text review in Covidence, from 824 studies identified, 16 met the eligibility criteria. Studies were mostly surveys (n = 13) and evaluated effectiveness primarily from the perspectives of M&M chairs and participants, rather than assessment of objective improvement in patient outcomes. The most prevalent themes relating to the standardization of M&M processes were case selection (n = 15) and administration (n = 12). The objectives of quality improvement and education were equally prevalent (12 studies each), but several studies reported that these 2 objectives as conflicting rather than complementary. Clinician engagement, patient safety culture, and organizational governance and leadership were identified as facilitators of effective M&Ms.

CONCLUSIONS

There is insufficient evidence to guide best practice in M&Ms, but standardized structures and processes implemented with organizational leadership and administrative support are associated with M&Ms that address objectives related to learning and system improvement. Standardization of the structures and processes of M&Ms is perceived differently depending on participants' role and discipline, and clinician engagement is critical to support a culture of safety and quality improvement.

The factors influencing patient safety management as perceived by emergency department nurses: A qualitative study

AIM

One of the most important, unpredictable and stressful areas in hospitals is the emergency department (ED) where seconds are crucial for providing immediate care and saving the patients' lives. Therefore, the present study aimed to identify the factors which impact the patient safety management as perceived by the ED nurses in Southern Iran.

DESIGN

This is a qualitative, descriptive study.

METHODS

The participants were 23 ED nurses selected via purposeful sampling who were asked to take part in an interview. Data were collected using semi-structured, individual, in-depth interviews and analysed via content analysis.

RESULTS

Analysis of the qualitative data yielded 4 themes and 12 subthemes. The four main themes were: negligence of safety standards and standard precautions, disregard of ethical principles, professional challenges and inefficient organizational management.

A Combined Assessment Tool of Teamwork, Communication, and Workload in Hospital Procedural Units

Teamwork, communication, and workload issues continue to contribute to patient safety events. The authors developed a diagnostic mixed methods toolkit combining a behavior observation tool, semistructured interview guide, and surveys to proactively identify relevant gaps. Applied across 14 units at three hospitals, this toolkit yielded 344 findings with 156 associated recommendations and took, on average, four days of observation. On a scale from 1 (not at all helpful) to 6 (substantially helpful), leaders indicated that the assessment and its recommendations were very helpful (median 5, interquartile range 5-6, 34 survey respondents, 47.9% individual-level response rate, 85.7% unit-level response rate). Integrating this tool into a broader safety strategy can help inform organizational improvement efforts.

Framework for the assessment of the safety culture in the oil and gas industry

Approaches to safety culture assessment may have many limits if supported exclusively by quantitative methods. Based on this, a research team developed a quantitative-qualitative approach to assess the maturity of the safety culture on an oil platform. To that end, the team sought to develop and test a method consisting of an initial ethnographic phase followed by four other distinct phases: definition of homogeneous groups; production of customized questionnaires; quantitative evaluation; and qualitative assessment. The results show the emergence of trends, from pre-defined themes in safety culture to specific levels of maturity for each of the homogeneous groups. At the same time, it was perceived that the maturity level of the groups is defined from the daily work practices developed by each one of them. This experience allowed us to propose a framework for assessing the maturity levels of safety culture for the oil and gas industry.

Organizational Learning in the Morbidity and Mortality Conference

INTRODUCTION

The focus of morbidity and mortality conferences (M&MCs) has shifted to emphasize quality improvement and systems-level care. However, quality improvement initiatives targeting systems-level errors are challenged by learning in M&MCs, which occurs at the individual attendee level and not at the organizational level. Here, we aimed to describe how organizational learning in M&MCs is optimized by particular organizational and team cultures.

METHODS

A prospective, multiple-case study design was used. Using purposive sampling, three cases covering different medical/surgical specialties in North America were chosen. Data collection included direct observations of the M&MC, semistructured interviews with key M&MC members, and documentary information.

RESULTS

The role of the M&MC in all cases integrated two key concepts: recognition of system-wide trends and learning from error, at an organizational and team level. All cases provided evidence of double-loop learning and used organizational memory strategies to ensure knowledge was retained within the organization. A patient safety culture was linked to the promotion of open communication, fostering learning from adverse events.

CONCLUSION

This study describes three cases of systems-oriented M&MCs that reflected elements of organizational learning theory. The M&MC can therefore provide a context for organizational learning, allowing optimal learning from adverse events.

Dynamic short-term crash analysis and prediction at toll plazas for proactive safety management

Toll plazas are commonly recognized as bottlenecks on toll roads, where vehicles are prone to crashes. However, there has been a lack of research analyzing and predicting dynamic short-term crash risk specifically at toll plazas. This study utilizes traffic, geometric, and weather data to analyze and predict dynamic short-term collision occurrence probability at mainline toll plazas. A random-effects logit regression model is employed to identify crash precursors and assess their impacts on the probability of crash occurrence at toll plazas. Meanwhile, a Long Short-Term Memory Convolutional Neural Network (LSTM-CNN) network is applied for crash prediction. The results of random-effects logit regression model indicate that the flow standard deviation of downstream, upstream occupancy, speed difference and occupancy difference between upstream and downstream positively influence the probability of crash occurrence. Conversely, an increase in the proportion of ETC lanes negatively impacts the probability of crash occurrence. Additionally, there appears a higher likelihood of crashes occurring during summer at toll plaza area. Furthermore, to address the issue of data imbalance, Synthetic Minority Oversampling Techniques (SMOTE) and class weight methods were employed. Stacked Sparse AutoEncoder-Long Short-Term Memory (SSAE-LSTM) and CatBoost were developed and their performance was compared with the proposed model. The results demonstrated that the LSTM-CNN model outperformed the other models in terms of the Area Under the Curve (AUC) values and the true positive rate. The findings of this study can assist engineers in selecting suitable traffic control strategies to improve traffic safety in toll plaza areas. Moreover, the developed collision prediction model can be incorporated into a real-time safety management system to proactively prevent traffic crash.

Safety climate scale for vineyards: an external validity study

OBJECTIVES

Agriculture entered the discussions about safety climates late, despite being one of the most hazardous industries. We recently developed a safety climate scale in Bordeaux vineyards, for which we provided good evidence of reliability and construct validity (Grimbuhler and Viel 2019). In this study, we aimed to establish the external validity of this safety climate scale with the help of an independent national sample of vineyard professionals.

POPULATION AND METHODS

We approached vineyard managers and operators during compulsory training and certification procedures for pesticide-related activities. Trainees giving informed consent for participation in the study were asked to complete a safety climate questionnaire at the start and end of a training session. In total, 406 vineyard managers or operators completed the questionnaire at the start of the study, 37 of whom declined to complete the questionnaire at the end of the training session, leaving 369 subjects available for pretraining/post-training comparisons. Statistical comparisons were based on t-tests and mixed models for repeated measures.

RESULTS

A mean safety climate score of 82.91 (SD: 9.06) was obtained in the initial survey in the Bordeaux region, whereas the safety climate score was estimated at 83.78 (SD 10.39) in this nationwide survey (P = 0.23). A significant increase was observed after the training course, for the safety climate score (7.5%, P < 10-15) and for each of its 7 dimensions (P < 10-4 or less), in both univariate and multivariate analyses. However, the magnitude of these increases varied with dimension, ranging from 2.4% for rules and best practices to 15.5% for communication and feedback.

CONCLUSIONS

External validity was demonstrated by transferability and sensitivity to intervention. This safety climate scale can now be considered to provide a good inference of the safety culture, with a meaning generalizable across vineyards.

What can Safety Cases offer for patient safety? A multisite case study

BACKGROUND

The Safety Case is a regulatory technique that requires organisations to demonstrate to regulators that they have systematically identified hazards in their systems and reduced risks to being as low as reasonably practicable. It is used in several high-risk sectors, but only in a very limited way in healthcare. We examined the first documented attempt to apply the Safety Case methodology to clinical pathways.

METHODS

Data are drawn from a mixed-methods evaluation of the Safer Clinical Systems programme. The development of a Safety Case for a defined clinical pathway was a centrepiece of the programme. We base our analysis on 143 interviews covering all aspects of the programme and on analysis of 13 Safety Cases produced by clinical teams.

RESULTS

The principles behind a proactive, systematic approach to identifying and controlling risk that could be curated in a single document were broadly welcomed by participants, but was not straightforward to deliver. Compiling Safety Cases helped teams to identify safety hazards in clinical pathways, some of which had been previously occluded. However, the work of compiling Safety Cases was demanding of scarce skill and resource. Not all problems identified through proactive methods were tractable to the efforts of front-line staff. Some persistent hazards, originating from institutional and organisational vulnerabilities, appeared also to be out of the scope of control of even the board level of organisations. A particular dilemma for organisational senior leadership was whether to prioritise fixing the risks proactively identified in Safety Cases over other pressing issues, including those that had already resulted in harm.

CONCLUSIONS

The Safety Case approach was recognised by those involved in the Safer Clinical Systems programme as having potential value. However, it is also fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors.

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.

Investigating the dynamic nature of landslide susceptibility in the Indian Himalayan region

Landslide susceptibility zonation (LSZ) mapping is used to delineate areas prone to landslides and is critical for effective landslide hazard management. The existing methodologies for generating such maps tend to neglect the influence of dynamic environmental variables on landslide occurrences, which may lead to obsolete and erroneous estimates of landslide susceptibility (LS) for a concerned area. Although recent studies have started to report the effects of Land Use/ Land Cover (LULC) variation on LSZ mapping, variations in other dynamic variables like rainfall, soil moisture, and evapotranspiration apart from LULC may also influence slope stability in mountainous regions. The present study investigates the impact of variations in these four variables on the LS distribution, of a selected Indian Himalayan region between 2017 and 2021. Random Forest (RF) susceptibility models are utilized for evaluating the LS for the selected years and geospatial technologies are employed for LS change detection. The results indicate up to 19% variations in the spatial extent for some of the zones of the generated LSZ maps. The research findings of this study are crucial since they reveal the impact of dynamic behavior on LS, which has not been previously documented in the literature.

Patient safety culture assessment before and after safety huddle implementation

OBJECTIVE

To identify whether safety huddle implementation enabled a change in patient safety culture.

METHOD

Quasi-experimental research that assessed patient safety culture before and after safety huddle implementation.

RESULTS.

The study revealed that 53.98% completed the two safety culture assessments, with 60.1% adherence from the nursing team, with a statistically significant difference in the second assessment regarding perception of patient safety and adverse events notified (p < 0.00). Regarding good practice indicators, a statistically significant difference (p < 0.00) was observed in item 43 and improvement in almost all dimensions in the second safety culture assessment. The huddles totaled 105 days, with 100% adherence from the nursing team. Regarding checklist items, all presented satisfactory responses (above 50%).

CONCLUSION

Safety huddles proved to be an effective tool for communication between healthcare professionals and managers, demonstrating positive impacts on good practice indicators and most safety culture dimensions.

Safe Surgery Checklist Implementation: Associations of Management Practice and Safety Culture Change

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

Research on the decision-making of work safety investment in industrial park enterprises: evidence from behavioral experiments

Due to the clustering of risk factors, industrial park safety accidents can easily trigger a domino effect. Work safety investment is the foundation of enterprise work safety in industrial parks. Therefore, increasing the work safety investment of enterprises in industrial parks is the key condition to prevent accidents. However, due to the typical negative externalities of industrial park work safety accidents, the decision-making process of work safety in park enterprises is influenced by other enterprises within the park, including imitation behaviors. This makes the decision-making of work safety in park enterprises very specific. In order to clarify the influencing factors and effects of work safety investment in industrial park enterprises, this study uses a behavioral experiment method and conducts decision-making experiments using the experimental platform O-Tree. The study recruits 76 participants who play the role of decision-makers in park enterprises. This study uses a lottery price experiment and a dictator experiment to measure the risk preference and altruism preference of the participants, respectively. The study introduces the real background of work safety investment in industrial park enterprises and collects data on work safety investment by the participants in different experimental scenarios. The research results show that the safety attitudes of decision-makers, altruism preference, accident experience, government work safety supervision, park management measures, and safety benefits positively influence work safety investment in park enterprises. The risk preference of decision-makers and the resource capability of work safety negatively influence work safety investment in park enterprises. Work safety investment in park enterprises is influenced by the work safety investment of other enterprises within the park.

Safety risk assessment of subway shield construction under-crossing a river using CFA and FER

Numerous subway projects are planned by China's city governments, and more subways can hardly avoid under-crossing rivers. While often being located in complex natural and social environments, subway shield construction under-crossing a river (SSCUR) is more susceptible to safety accidents, causing substantial casualties, and monetary losses. Therefore, there is an urgent need to investigate safety risks during SSCUR. The paper identified the safety risks during SSCUR by using a literature review and experts' evaluation, proposed a new safety risk assessment model by integrating confirmatory factor analysis (CFA) and fuzzy evidence reasoning (FER), and then selected a project to validate the feasibility of the proposed model. Research results show that (a) a safety risk list of SSCUR was identified, including 5 first-level safety risks and 38 second-level safety risks; (b) the proposed safety risk assessment model can be used to assess the safety risk of SSCUR; (c) safety inspection, safety organization and duty, quicksand layer, and high-pressure phreatic water were the high-level risks, and the onsite total safety risk was at the medium level; (d) management-type safety risks, environment-type safety risks, and personnel-type safety risks have higher expected utility values, and manager-type safety risks were expected have higher risk-utility values when compared to worker-type safety risks. The research can enrich the theoretical knowledge of SSCUR safety risk assessment and provide references to safety managers for conducting scientific and effective safety management on the construction site when a subway crosses under a river.

Proposing a framework for evidence-based road safety policy-making: Connecting crash causation, countermeasures and policy

Effective evidence-based policy making within road safety is a several step cyclic process that involves gathering data about the causes of crashes, analysing these data, developing countermeasures and implementing and evaluating them. There are many examples of crash causation focused data collection activities available to policy makers but knowledge on how these finding may have led to countermeasure implementation and new policy is much less well established. This paper proposes a framework for best practice evidence-based policy making. To address existing gaps, the framework consists of three pillars: these are (1) Crash causation establishment; (2) Countermeasure development and implementation; and (3) road safety management. A key element in this framework is the recommendation for the establishment of an organisation responsible for road safety that has a strategic and coordination role. This framework, as a whole, aims to provide a practical high-level map by connecting evidence to policy at every point in the policy making cycle and ensuring that evidence-based road safety policy is a national priority. It is anticipated that using this framework to inform road safety policy development will enhance the success of any developed policy.

COVID-19 and Patient Safety-Lessons From 2 Efforts to Keep People Safe

This Viewpoint examines the similarities between medical errors and COVID-19 and discusses lessons applicable to ongoing and emerging health challenges.

Have our backs-medical-surgical nurses' safety culture experiences: An inductive qualitative descriptive study

AIM

This study aims to describe medical-surgical registered nurses' experiences with safety culture.

DESIGN

Qualitative, Inductive descriptive.

METHODS

Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed.

RESULTS

A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.

Surgical leadership in a culture of safety: An inter-professional study of metrics and tools for improving clinical practice

BACKGROUND

Leadership in a safety culture environment is essential in avoiding patient harm. However, leadership in surgery is not routinely taught or assessed. This study aims to identify a framework, metrics and tools to improve surgical leadership and safety outcomes.

METHODS

Qualitative interviews were performed with leadership experts from safety-critical professions. Non-probability-based sampling was undertaken in major international airlines. Data underwent thematic analysis and clinical adaptation by multiple surgeon-analysts using the framework method.

RESULTS

583 codes were synthesised into 10 themes. Leaders were identified as 'threat and error managers' who placed safety first. Their core attribute was humble confidence. This allowed them to set the tone for high standards of practice, whilst empowering individuals to speak up about safety issues. Safety-oriented leaders assumed complete responsibility and applied their authority discerningly to obtain optimal outcomes. Finally, effective leaders rallied support for their mission by instilling confidence, building collaborations and managing conflict.

CONCLUSIONS

Surgical leadership requires the ability to manage risk, opportunity and people. The study provides an assessment matrix and deliverable tools for improving surgical safety.

Risk self-perception and occupational accidents

INTRODUCTION

This study analyzes the relationship between measures of occupational accidents and workers' perception of risk in the workplace using nationally representative data on workers' characteristics and a complete record of occupational accidents.

METHODS

Regression analyzes addressing both the ordinal nature of the dependent variable and causality were conducted to control for different sociodemographic factors influencing workers' perceptions of occupational risks. Special attention was paid to the risk level of the worker's workgroup, existence of family responsibilities, organizational safety culture, and measures of accident rates.

RESULTS

Individuals showed different perceptions of risk based on their personal and work characteristics. Significant associations were observed between each variable of interest and risk perception. Overall, the results remain robust across specifications addressing both simultaneity and ordinality.

CONCLUSIONS

Employees' "reading" of hazards was not fully aligned with objective information on occupational accidents but depended on individual characteristics. Having family responsibilities or being unionized increased workers' risk perception, whereas belonging to a workgroup with higher accident rates reduced it.

PRACTICAL APPLICATIONS

Knowing how workers perceive risk and how this perception deviates from statistical information on accidents are essential for management to accurately design safety measures. In this regard, specific characteristics such as age, having dependents in the family, or the typology of the workers' workgroup should be taken into account. Greater knowledge of preventive measures will improve the way workers perceive risk, and ultimately contribute to reducing the likelihood of occupational accidents.

Precursory elements of safety culture: Exploratory analyses of engineering students' safety attitudes

INTRODUCTION

Safety culture as a concept has been well-researched in the literature. There is less work, however, on how individuals entering the workforce acquire and partake in safety culture over time and how they might be primed to partake in the positive elements of safety culture.

METHOD

We begin this exploration by surveying engineering students' attitudes toward safety and experiences with safety education at the Georgia Institute of Technology (n = 316).

RESULTS

We find disparities among engineering disciplines, where some majors have more negative views toward safety than others. This may point to the need for more [effective] safety education to prevent negative attitudes toward safety in the workplace. In addition to describing trends among engineering students' attitudes, this study also uses factor analysis to characterize the latent constructs of precursory safety culture: the safety-related attitudes that may direct how people engage with safety culture as early-career engineers.

PRACTICAL APPLICATIONS

The analysis provides a conceptual construction of precursor safety culture attitudes, which can serve as a guide to future measurement efforts.

Bibliometric analysis of safety management system research (2001-2021)

INTRODUCTION

Occupational health and safety (OHS) has become an integral part of human society, particularly considering the growing rates of injuries and deaths worldwide. Hence, numerous employers, governments, and stakeholders worldwide have established critical OHS measures to safeguard human health and occupational safety. Numerous studies have been conducted to identify and highlight risks and hazards, as well as to detect, monitor, minimize, and prevent workplace injuries and deaths.

METHOD

This study presents the publication trends, research landscape, and scientific developments related to safety management systems (SMS) based on published documents from the Elsevier Scopus database. Published documents on SMS and indexed in Scopus are identified, screened, and analyzed to examine the publication trends, research developments, and scientific landscape. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), bibliometric analysis (B.A.), and systematic literature review (SLR) procedures are used. The results reveal that 799 related documents were published between 2001 and 2021.

RESULTS

The most productive stakeholders, that is, top researchers, affiliations, and countries, include Liesbeth Jacxsens, Universiteit Gent (Belgium), and the United States. This study shows that the availability of research grants, incentives, or awards is critical to the productivity of top researchers, institutions, and nations actively researching SMS topics. The bibliometric analysis reveals that the topic is characterized by high productivity, co-authorships, keyword occurrence, and citations.

CONCLUSION

The analysis shows that SMS research is a broad, multidimensional, and impactful area that has become essential for identifying, reducing, monitoring, and eliminating risks in many industries. It is concluded that the topic of the SMS remains relevant because of its impact on human health, occupational safety, and environmental well-being.

PRACTICAL APPLICATIONS

This study provides in-depth insight into expanding the scope of SMS research. Moreover, research and policymakers can facilitate decision-making and collaboration based on this study's outtakes.

Patient safety culture and satisfaction in Ghana: a facility-based cross-sectional study

BACKGROUND

Globally, one of the measures of high performing healthcare facilities is the compliance of patient safety culture, which encompasses the ability of health institutions to avoid or drastically reduce patient harm or risks. These risks or harm is linked with numerous adverse patient outcomes such as medication error, infections, unsafe surgery and diagnosis error.

OBJECTIVES

The general objective of this study was to investigate into the impact of patient safety culture practices experienced on patient satisfaction among patients who attend the Kwesimintsim Government Hospital in the Takoradi municipality.

METHODS

This study was a descriptive cross-sectional study and a consecutive sampling technique was used to select 336 respondents for the study. Data was collected using a structured questionnaire and processed using Statistical Package for Social Sciences, V.21. Both descriptive and inferential statistics were carried out and result were presented using figures and tables.

RESULTS

The study found that the overall patient safety compliance level observed by the respondents was poor (29.2%). The prevalence of adverse events experienced among the respondents was high (58%). The leading adverse events mentioned were medication errors, followed by wrong prescriptions and infections. The consequences of these adverse events encountered by the respondents were mentioned as increased healthcare costs (52%), followed by hospitalisation (43%), worsening of health conditions (41%) and contraction of chronic health conditions (22%). Patient safety cultural practices such as teamwork (β=0.17, p=0.03), response to error (β=0.16, p=0.005), communication openness (β=0.17, p=0.003) and handoffs and information exchange (β=0.17, p=0.002) were found to positively influence patient satisfaction.

CONCLUSION

The poor general compliance of the patient safety culture in the facility is unfortunate, and this can affect healthcare outcomes significantly. The study therefore entreats facility managers and various stakeholders to see patient safety care as an imperative approach to delivering quality essential healthcare and to act accordingly to create an environment that supports it.

A processing-type active real-time traceable certification system

In addition to substituting low-price and low-quality materials for high-quality materials at the food processing stage, many dishonest businesses risk adulterating chemical materials in products to reduce production costs or increase product flavor with chemical synthesis spices. As a result, the risks to food safety are increased. Most safety management and certification regulations proceed with on-site examination or sampling inspection. As current certification systems lack complete tracking and real-time certification processes, they cannot comprehensively check foods' processing and production processes and contents. Hence, food safety problems sway consumers' trust and confidence in certification systems. This study intends to improve the agricultural processing end's current food traceability certification system. Adding the design of raw material total quantity control provides a complete and sound real-time certification mechanism for citizens and businesses to assure consumer rights.

Analyzing the influential factors of process safety culture by hybrid hidden content analysis and fuzzy DEMATEL

Due to the complex nature of safety culture and process industries, several factors influence process safety culture. This paper presents a novel framework that combines the hidden content analysis method with Decision Making Trial and Evaluation Laboratory (DEMATEL) and Fuzzy logic to achieve a comprehensive set of influential factors and their relationship. The proposed methodology consists of two primary stages. Firstly, combined methods of literature review and Delphi study were used to identifying influential factors of process safety culture. Secondly, the Fuzzy-DEMATEL approach is employed to quantify and determine the relationships between different influential factors. A diverse pool of experts' opinions is leveraged to assess the impact of each factor on others and process safety culture. In the first stage, 18 factors identified as influential factors on process safety. The findings of second stage revealed that eight variables were identified as causes, while ten variables were classified as effects. Also, the Organization management's commitment to safety factor had the greatest influence among all of the factors. As well as, the most significant interaction was associated with the risk assessment and management aspect. The integrated approach not only identified the influential factors, but also elucidates the cause-effect relationships among factors. By prioritizing factors and understanding their interconnections, organizations can implement targeted safety measures to improve process safety culture. Its effectiveness in quantifying qualitative data, identifying influential factors, and establishing cause-effect relationships make it a valuable tool for enhancing safety culture in process industries.

In silico environmental risk assessment improves efficiency for pesticide safety management

Pesticides are indispensable to maintain crop quality and food production worldwide, but their use also poses environmental risks. Pesticide risk assessment involves a series of complex, expensive and time-consuming toxicity tests. To improve the efficiency and accuracy for assessing the environmental impact of pesticides, numerous computational tools have been developed. However, there is a notable deficiency in critical analysis or a systematic summary of environmental risk assessment tools and their applicable contexts. Here, many of the current approaches and tools for assessing environmental risks posed by pesticides are reviewed, and the question of whether these tools are fit for use on complex multicomponent scenarios is discussed. We analyze the adaptations of these tools to aquatic and terrestrial ecosystems, followed by the provision of resources for predicting pesticide concentrations in environmental medias, including air, soil and water. The successful application of computational tools for risk assessment and interpretation of predicted results will also be discussed. This assessment serves as a valuable resource, enabling scientists to utilize suitable models to enhance the robustness of pesticides risk assessments.

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.

Safety climate and safety behaviors: Adapting and validating a positively worded safety climate scale through the time-lagged approach

BACKGROUND

Contemporary literature raises serious questions about the inclusion of negatively worded items in the safety climate scale. Despite these reservations, limited efforts have been made to address this shortcoming.

OBJECTIVE

The present study aims to adapt and empirically validate the ten-items group-level safety climate scale with the purpose of replacing negatively worded items with positively worded ones after a thorough validation process. The present study is one of the first to propose an empirically validated group-level safety climate scale that uses positive items to measure the safety climate construct.

METHODS

Study 1 was conducted using a sample of 135 participants. Study 2 used a time-lagged approach to validate the scale, with a sample of 173 production workers from six oil and gas organizations in Malaysia. The Partial Least Squares Structural Equation Modeling (PLS-SEM) method was used to test the hypothesized relationships.

RESULTS

In Study 1, the results of the exploratory factor analysis showed good reliability for the revised scale. In Study 2, the results of the PLS-SEM analysis demonstrated a positive relationship between safety climate and safety behaviors, thereby validating the revised and translated scale of safety climate.

CONCLUSION

The revised safety climate scale will not only improve data quality, but it will also increase response rates. Additionally, the revised scale will assist managers in understanding the true perceptions of safety climate in their organization, regardless of the cultural context in which the scale is used.

Interventions to Promote Safety Culture in Cancer Care: A Systematic Review

OBJECTIVES

There is limited guidance on how to effectively promote safety culture in health care settings. We performed a systematic review to identify interventions to promote safety culture, specifically in oncology settings.

METHODS

Medical Subject Headings and text words for "safety culture" and "cancer care" were combined to conduct structured searches of MEDLINE, EMBASE, CDSR, CINAHL, Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science for peer-reviewed articles published from 1999 to 2021. To be included, articles had to evaluate a safety culture intervention in an oncology setting using a randomized or nonrandomized, pre-post (controlled or uncontrolled), interrupted time series, or repeated-measures study design. The review followed PRISMA guidelines; quality of included citations was assessed using the ROBINS-I risk of bias tool.

RESULTS

Eighteen articles meeting the inclusion criteria were retained, reporting on interventions in radiation (14 of 18), medical (3 of 18), or general oncology (1 of 18) settings. Articles most commonly addressed incident learning systems (7 of 18), lean initiatives (4 of 18), or quality improvement programs (3 of 18). Although 72% of studies reported improvement in safety culture, there was substantial heterogeneity in the evaluation approach; rates of reporting of adverse events (9 of 18) or Agency for Healthcare Research and Quality Safety Culture survey results (9 of 18) were the most commonly used metrics. Most of the studies had moderate (28%) or severe (67%) risk of bias.

CONCLUSIONS

Despite a growing evidence base describing interventions to promote safety culture in cancer care, definitive recommendations were difficult to make because of heterogeneity in study designs and outcomes. Implementation of incident learning systems seems to hold most promise.

[Evolution of the perception of the safety culture of healthcare professionals in a pediatric emergency department]

BACKGROUND AND AIM

Safety culture (SC) is a fundamental tool for minimizing adverse events and improving safety and quality of care. Our objective, therefore was to analyze the evolution of the SC of healthcare professionals in a pediatric emergency department (PED) after the implementation of a risk management system for patient safety based on the UNE:EN:ISO 179003 Standard and the execution of new safe practices for Joint Commission International accreditation. At the same time describe the current strengths and weaknesses.

METHODS

Quasi-experimental, single-center study. All PED professionals participated in the study. An initial measurement of SC was performed through the Hospital Survey on Patient Safety Culture (HSOPS) questionnaire of the Agency for Healthcare Research and Quality adapted to Spanish in 2014. Pro-patient safety strategies were implemented between 2015 and 2022. A subsequent measurement was performed in 2022.

RESULTS

The response rate in 2014 was 55% and 78% in 2022. On both occasions the group with the highest participation was nurses with 35.1% and 34.8%, respectively. Five dimensions improved after the interventions: frequency of adverse events (25.2%, p<0.001), organizational learning (25%, p<0.001), feedback and communication about errors (22.3%, p<0.001), non-punitive response to errors (6.5%, p = 0.176), and management support (4%, p = 0.333).

CONCLUSIONS

The actions carried out had a positive influence on organizational learning and the frequency of adverse events reported and communication within the team. In contrast, the perception of SC did not increase.