Patient safety has progressed in 15 years from being a relatively insignificant issue to a position high on the agenda for health care providers, managers and policymakers as well as the general public. Sweden has seen increased national, regional and local patient safety efforts since 2011 when a new patient safety law was introduced and a four-year financial incentive plan was launched to encourage county councils to carry out specified measures and meet certain patient safety related criteria. However, little is known about what structures and processes contribute to improved patient safety outcomes and how the context influences the results. The overall aim of this thesis was to generate knowledge for improved understanding and explanation of influences on patient safety in the county councils in Sweden. To address this issue, five studies were con-ducted: interviews with nurses and infection control practitioners, surveys to patient safety officers and a document analysis of patient safety reports. Patient safety officers are healthcare professionals who hold key positions in their county council’s patient safety work. The findings from the studies were structured through a framework based on Donabedian’s triad (with a contextual element added) and applying a learning perspective, highlight areas that are potentially important to improve the patient safety in Swe-dish county councils. Study I showed that the conditions for the county councils’ patient safety work could be improved. Conducting root-cause analysis and attaining an organizational culture that encourages reporting and avoids blame were perceived to be of importance for improving patient safety. Study II showed that nurses perceived facilitators and barriers for improved pa-tient safety at several system levels. Study III revealed many different types of obstacles to effective surveillance of health care-associated infec-tions (HAIs), the majority belonging to the early stages of the surveillance process. Many of the obstacles described by the infection control practi-tioners restricted the use of results in efforts to reduce HAIs. Study IV of the Patient Safety Reports identified 14 different structure elements of patient safety work, 31 process elements and 23 outcome elements. These reports were perceived by patient safety officers to be useful for providing a structure for patient safety work in the county councils, for enhancing the focus on patient safety issues and for learning from the patient safety work that is undertaken. In Study V the patient safety officers rated efforts to reduce the use of antibiotics and improved communication be-tween health care practitioners and patients as most important for attaining current and future levels of patient safety in their county council. The patient safety officers also perceived that the most successful county councils regarding patient safety have good leadership support, a long-term commitment and a functional work organisation for patient safety work. Taken together, the five studies of this thesis demonstrate that patient safety is a multifaceted problem that requires multifaceted solutions. The findings point to an insufficient transition of assembled data and information into action and learning for improved patient safety.

The current study assessed an error reflection intervention on Algebra I students’ conceptual and procedural knowledge and sense of belonging to mathematics. Also of interest was whether perceptions of the functionality of errors mediated the effect of condition on learning and sense of belonging to mathematics. Middle school students (N = 207) were randomly assigned within classroom to one of four conditions: 1) a Problem-Solving Control group, 2) a Correct Examples Control group, 3) a Correct Examples Error Reflection condition that promoted reflection on hypothetical errors through self-explanation prompts, or 4) an Incorrect Examples Error Reflection condition that promoted reflection on displayed errors within the example through self-explanation prompts. Conceptual and procedural knowledge, sense of belonging to mathematics and perceived functionality of errors were measured pre- and post-intervention. After controlling for unanticipated clustering effects, results suggest that reflecting on and explaining errors within a worked examples intervention is just as effective at promoting learning as traditional problem solving alone or working with traditional correct worked examples and written self-explanation prompts. Students’ sense of belonging to mathematics or perceived functionality of errors for learning were high at the start of the study and remained so throughout the intervention. Perceptions of the functionality of errors were unrelated to learning and sense of belonging to mathematics. The limited size of the minority population in the sample did not allow for exploration of differential effects of condition for underrepresented minority (URM) students. However, these students reported lower feelings of belonging to mathematics than non-URM students. Implications for theory and practice are discussed. / Educational Psychology

Made available in DSpace on 2016-03-15T19:26:24Z (GMT). No. of bitstreams: 1 Antonio Cesar Barbariniprot.pdf: 5498245 bytes, checksum: 8ee5821aba2d4d3741856a81ee04776b (MD5) Previous issue date: 2015-03-04 / The challenges of the business environment in the 2010s are becoming increasingly complex, with fast-paced changes and different kinds of pressure from competition, customers, regulatory agencies, unions, the economy, etc. In this context, organizations need to be more responsive to change and learn quickly in the face of new demands. In the 80s and 90s, the quality of products and services was the rule to differentiate between companies on the market, which made organizations seek models and systems to ensure compliance with the highest standards of quality required in different markets. In addition, companies increased their standards of operational efficiency, productivity and reliability, but also ended up becoming more similar and only slightly differentiated among themselves. Organizations now face the challenge of adopting more flexible systems, standards and structures in order to facilitate adaptation to the current context, which is extremely dynamic. In this scenario, innovation can help organizations become more competitive, as long as they can continually learn, by taking advantage of the informal learning in the workplace, which represents more than 80% of the total number of learning opportunities. Considering the current levels of complexity, dynamism and uncertainty present in the work environment, errors or failures are by-products of organizational processes and are not necessarily bad; it is important that organizations can quickly learn from the mistakes, through people. Some factors may influence the creation of an environment where people can learn from mistakes, experiment and apply ideas, by adopting innovative work behaviors. This quantitative study seeks to examine the relationship between the factors that influence learning from errors and the innovative work behaviors in a multinational organization in the pharmaceutical segment. The research with employees from different areas received 146 valid responses which were analyzed using confirmatory factor analysis with the SmartPLS 2.0 M3 software. The hypothesis that the Factors that Influence the Learning from Mistakes have positive relationship with the Innovative Work Behaviors was confirmed. The structural coefficient obtained between the two dimensions was 0.618 (p< 0.001), which means that the construct Factors that Influence the Learning from Mistakes explains 38% of the variation in the indices of the Innovative Work Behaviors construct. The companies ability to quickly learn from mistakes and experiments, taking advantage of the human capital potential, particularly through innovative work behaviors, can be a critical aspect of differentiation in the marketplace and a way for companies to obtain competitive advantage. This study aims to contribute to the expansion of knowledge on the subject, highlighting the importance of the proper management of the factors that may influence the learning from mistakes in the work environment. In addition, this study contributes with the validation and adaptation of the original scales of constructs studied to the Brazilian context. / Os desafios do ambiente de negócios nos anos 2010 se tornam cada vez mais complexos, com mudanças em ritmo acelerado e pressões de ordem econômica, regulatória, da concorrência, dos clientes etc. Nesse contexto, as organizações precisam ser mais ágeis, para mudar e aprender rapidamente, diante das novas demandas. Nas décadas de 1980 e 1990, a qualidade dos produtos e serviços servia para diferenciar as empresas no mercado, o que fez com que as organizações buscassem modelos e sistemas para assegurar conformidade com os altos padrões de qualidade exigidos nos diferentes mercados. Além disso, as empresas aumentaram seus padrões de eficácia operacional, produtividade e confiabilidade, mas também acabaram tornando-se mais parecidas e pouco diferenciadas entre si. As organizações agora se deparam com o desafio de adotar sistemas, normas e padrões mais flexíveis, que facilitem a adaptação ao atual contexto extremamente dinâmico. Nesse cenário, a inovação pode ajudar as organizações a se tornarem mais competitivas, desde que possam aprender continuamente, aproveitando especialmente as situações de aprendizagem informal no trabalho, que representam mais de 80% do total das oportunidades de aprendizagem. Considerando os níveis atuais de complexidade, dinamismo e incertezas presentes no ambiente de trabalho, os erros ou falhas acabam sendo subprodutos dos processos organizacionais e não são necessariamente ruins; é importante que as organizações possam aprender rapidamente a partir dos erros, por meio das pessoas. Alguns fatores no âmbito da organização podem influenciar a criação de um ambiente onde as pessoas possam aprender com os erros, experimentar e aplicar ideias, adotando comportamentos inovadores no trabalho. Este estudo de natureza quantitativa busca examinar as relações entre os fatores que influenciam a aprendizagem a partir dos erros e os comportamentos inovadores no trabalho em uma organização multinacional do segmento farmacêutico. A pesquisa com funcionários de diferentes áreas obteve 146 respostas válidas e os dados foram analisados utilizando-se a análise fatorial confirmatória com o software SmartPLS 2.0 M3. A hipótese de que os Fatores que Influenciam a Aprendizagem a Partir dos Erros têm relação positiva com os Comportamentos Inovadores no Trabalho foi confirmada. O coeficiente estrutural obtido entre as dimensões foi de 0,618 (p<0,001), sendo que o construto Fatores que Influenciam a Aprendizagem a Partir dos Erros explica 38% da variação dos índices do construto Comportamentos Inovadores no Trabalho. A capacidade das empresas aprenderem rapidamente a partir dos erros e experimentos, aproveitando o potencial do capital humano existente, especialmente através de comportamentos inovadores no trabalho, pode ser um aspecto crítico para diferenciação no mercado e para a obtenção de vantagem competitiva. Este estudo visa contribuir para a ampliação dos conhecimentos sobre o tema, destacando a importância da gestão adequada dos fatores que influenciam a aprendizagem a partir dos erros no ambiente de trabalho. Adicionalmente, contribui para a validação e adaptação das escalas originais dos construtos estudados para o contexto brasileiro.