Healthcare leaders must establish a just culture to mitigate preventable medical deaths that occur at 250,000 per year, making medical errors the 3rd leading cause of death in the United States. However, there is a gap in knowledge regarding the attributes of nurse manager leadership styles that contribute to promoting a just culture at the unit level. Guided by the full range leadership theory and the just culture model, the purpose of this descriptive correlational study was to determine the relationship between nurse manager transformational, transactional, and laissez-faire leadership styles and unit level just culture perceptions and the differences between staff nurses’ and nurse managers’ perceptions of leadership styles and just culture. The Multifactorial Leadership Questionnaire and the Just Culture Assessment tool were administered to 165 U.S. hospital-based staff nurses and nurse managers. ANOVA revealed a statistically significant difference in the mean just culture scores between transformational, transactional, and/or laissez-faire leadership styles (p < .01). MANOVA outcomes were significant for the difference between the nursing staff’s and nurse managers’ perceptions of nurse managers’ leadership styles (p < .01). This study promotes positive social change identifying transformational and transactional nurse manager leadership skills as a predictor for maintaining a unit level just culture and clarifying the impact of nurse managers’ leadership styles on perceptions of patient safety among frontline nurses and hospital safety. Future research should focus on exploring the relationship between nurse-sensitive patient outcomes such as pressure injuries and hospital-acquired infections along with the unit level just culture and nurse manager leadership styles.

This project examines the safety management of civil aircraft accident investigation authorities in International Civil Aviation Organization (ICAO) Member States, with particular emphasis on the independence of the investigations. The research aims to establish the current level of resources and methodology adopted by Member States’ accident investigation authorities. The output of this work not only identifies the current situation but informs initiatives for some of the States in the process of establishing their investigation capability. ICAO Annex 13 was analysed and found to be based on the principle of independent accident investigations. Also, a four dimensional measuring index (4DMI) has been developed to measure the independence of accident investigations in ICAO Member States. Data were collected from 45 States and are presented in the thesis. As a result of applying the 4DMI to the collected data, the States were ranked according to their scores, and divided into four categories of independence. Analysis of the four categories and the scores from the four dimensions revealed that States approach the concept of investigation independence in different ways; however, there are several practices that are common within the highest independence category and several other practices that are common within the lowest independence category. The research recommends that States should work towards improving their overall investigation independence by implementing the seven identified practices in the High-Independence category and distance themselves from the five practices identified as common in the Low-Independence category.

An organizational culture of safety affects employees' attitudes, beliefs, perceptions, and values related to safe practice as well as their behaviors and level of engagement. The purpose of this project was to determine the influence of introducing the just culture model through staff engagement in an interactive workshop. A convenience sample of acute care staff were recruited for this 1-sample pretest and posttest project design. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument was used to measure safety culture perceptions on 7 dimensions pre and post intervention. For the theoretical framework, Ajzen's theory of planned behavior and Kantar's empowerment theory were used. Welch's t test results showed significant improvement in perception scores overall (t = 2.7, p < 0.01), with posttest mean scores ('= 3.7) higher than pretest mean scores ('= 3.5). The dimension-specific mean posttest scores were significantly higher on 3 of the 7 dimensions including teamwork (t = 2.99, p < 0.05), feedback and communication (t = 2.14, p < 0.05), and frequency of event reporting (t = 2.31, p < 0.05). Major implications for social change include reduction of preventable errors and iatrogenic events; creating a healthcare environment that is safe, fair, transparent, and reliable; creating organizational learning through evidence-based patient safety training; and promoting the use of perception surveys to measure and improve the culture in one's organization. The project may provide a road map for just culture implementation. Future qualitative and quantitative research should explore effects of a just culture on safety reporting patterns and specific events such reducing medication errors or risk-taking behaviors.

This project examines the safety management of civil aircraft accident investigation authorities in International Civil Aviation Organization (ICAO) Member States, with particular emphasis on the independence of the investigations. The research aims to establish the current level of resources and methodology adopted by Member States’ accident investigation authorities. The output of this work not only identifies the current situation but informs initiatives for some of the States in the process of establishing their investigation capability. ICAO Annex 13 was analysed and found to be based on the principle of independent accident investigations. Also, a four dimensional measuring index (4DMI) has been developed to measure the independence of accident investigations in ICAO Member States. Data were collected from 45 States and are presented in the thesis. As a result of applying the 4DMI to the collected data, the States were ranked according to their scores, and divided into four categories of independence. Analysis of the four categories and the scores from the four dimensions revealed that States approach the concept of investigation independence in different ways; however, there are several practices that are common within the highest independence category and several other practices that are common within the lowest independence category. The research recommends that States should work towards improving their overall investigation independence by implementing the seven identified practices in the High-Independence category and distance themselves from the five practices identified as common in the Low-Independence category.

<p>Ett flygsäkerhetsarbete bygger på ett förtroende mellan individen och organisationen. Det finns en brist inom Försvarsmakten rapporteringssystem, där fördelningen av rapporter med avseende på mänskliga misstag, är avvikande från vad som anses som normalt inom flygverksamhet. Varför avviker rapporteringen i FM från normalbilden? Ett perspektiv som kan förklara denna avvikelse är rättvisekulturperspektivet.</p><p>Syftet är att diskutera huruvida den ojämna fördelningen av avvikelserapporter med avseende på mänskliga misstag i FM flygsäkerhetsarbete kan förklaras ur ett just culture perspektiv med fokus på regler och styrdokument .</p><p>Resultatet är att FM inte är att anse som en rättvisekultur. Framförallt är detta på grund av den bristfälliga kulturella grunden, disciplinsystemet och skyddandet av rapporteringssystemet.</p> / <p>Flight safety relies on trust between the person and the organization. There is a deficiency in the Swedish armed forces reporting system whereas the distribution between human factor reports and other reports is deviant from the normal distribution in flying operations. Why is that? A perspective that could help explaining this is the <em>just culture</em> perspective.</p><p>The purpose of this essay is to discus whether the uneven distribution in the reporting system in regards of human error in the Swedish armed forces can be explained by a just culture perspective in regards of rules and documents.</p><p>The result is that the Swedish armed forces are not considered a just culture. Mainly because of the insufficient foundation of the flight safety culture, the existence of a disciplinary system and the failure to protect the reporting system.</p>

Ett flygsäkerhetsarbete bygger på ett förtroende mellan individen och organisationen. Det finns en brist inom Försvarsmakten rapporteringssystem, där fördelningen av rapporter med avseende på mänskliga misstag, är avvikande från vad som anses som normalt inom flygverksamhet. Varför avviker rapporteringen i FM från normalbilden? Ett perspektiv som kan förklara denna avvikelse är rättvisekulturperspektivet. Syftet är att diskutera huruvida den ojämna fördelningen av avvikelserapporter med avseende på mänskliga misstag i FM flygsäkerhetsarbete kan förklaras ur ett just culture perspektiv med fokus på regler och styrdokument . Resultatet är att FM inte är att anse som en rättvisekultur. Framförallt är detta på grund av den bristfälliga kulturella grunden, disciplinsystemet och skyddandet av rapporteringssystemet. / Flight safety relies on trust between the person and the organization. There is a deficiency in the Swedish armed forces reporting system whereas the distribution between human factor reports and other reports is deviant from the normal distribution in flying operations. Why is that? A perspective that could help explaining this is the just culture perspective. The purpose of this essay is to discus whether the uneven distribution in the reporting system in regards of human error in the Swedish armed forces can be explained by a just culture perspective in regards of rules and documents. The result is that the Swedish armed forces are not considered a just culture. Mainly because of the insufficient foundation of the flight safety culture, the existence of a disciplinary system and the failure to protect the reporting system.

Sustainability is a complex system of interaction between a hospital, individual, community, and environmental factors that is required to work in harmony to keep a patient healthy. With the complexities that exist within healthcare, the nurse leader is required to ensure that the care environment, processes and the safety behaviours required from nurses to provide safe healthcare is in place and sustained to contribute to the enhancement of patient safety, whilst in the care of the diverse nursing workforce. The aim of the study is to develop an action plan to sustain best safety culture practices for improved patient outcomes in hospitals with a culturally diverse nursing workforce. Methodology: A multiple method design was utilised to study the safety culture and positive work environment (hospital climate) that exists among culturally diverse nurses and how it is managed by the nurse managers in order to identify and describe actions that can be included in an action plan to sustain best safety culture practices for improved patient outcomes. Purposeful and convenience sampling methods were used in the study. Two hospitals, with a very diverse nursing workforce were purposefully selected to participate in the study. Pretesting of the questionnaire and e-Delphi embedded assessment validation instrument were done by participants not part of sample groups. Phase 1: The Hospitals outcomes data for nursing admission assessment within 24-hours, falls and hospital acquired pressure ulcer incidences and hand hygiene rates were collected on a checklist. Phase 2: Two questionnaires (1) nurses capturing: biographical data and culture, patient safety (nursing admission assessment within 24-hours, falls and HAPU and hand hygiene), and safety culture and positive work environment (hospital climate); (2) nurse managers capturing: biographical data and culture, patient safety (nursing admission assessment within 24- hours, falls and HAPU and hand hygiene), safety culture and Positive Work Environment (hospital climate) and just culture practices. Phase 3: the Draft e-Delphi action plan with embedded assessment validation instrument was developed. Phase 4: The panel experts selected to validate the e-Delphi draft action plan with embedded assessment validation instrument in pre-determined rounds. Data analysis: Phase 1: The outcomes data was displayed in bar graphs and illustrated that (1) the nursing admission assessment within 24 hour period not been sustained over time for the medical, surgical, paediatric and critical care areas; (2) a hundred and sixty two fall incidence; (3) ninety six HAPU incidences and (4) hand hygiene rate of between 80-94% being reported. Phase 2: A participation rate of 46.33% by nurses and 73.91% by nurse managers were achieved. The data for the 2 questionnaires indicated the need to include 54 action statement to address the culture, patient safety, hospital climate (PWE), safety culture and just culture gaps identified. Phase 3: the e-Delphi draft action plan developed based on literature review and data from phase 1 and phase 2. Phase 4: 100% participation rate was achieved. Consensus was reached within two rounds that the 54 action statements are essential and important for patient safety and identified the responsible persons required enacting on action statement and timeframe required to complete action. Recommendation: The Action Plan to enhance a sustainable Culture of Safety to improve patient outcomes were decided by panel experts. Plan to disseminate the plan among the CNO for implementation. / Health Studies / D. Litt. et Phil. (Health Studies)