Employee injury rates in U.S. land-based operations in the energy industry are 2 to 3 times higher relative to other regions in the world. Although a rich literature exists on drivers of safety performance, no previous studies investigated factors influencing this elevated rate. Leadership has been identified as a key contributor to safety outcomes and this grounded theory study drew upon the full range leadership model, situational leadership, and leader-member exchange theories for the conceptual framework. Leadership aspects influencing safety performance were investigated through guided interviews of 27 study participants; data analyses included open and axial coding, and constant comparisons identified higher-level categories. Selective coding integrated categories into the theoretical framework that developed the idealized, transformational leader traits motivating safe behaviors of leading by example, expressing care and concern for employees' well-being, celebrating successes, and communicating the importance of safety (other elements included visibility and commitment). Employee and supervisor participants reported similar views on the idealized leader traits, but low levels of these qualities may be driving elevated injury rates. Identifying these key elements provides the foundation to creating strategies and action plans enabling energy sector companies to prevent employee injuries and fatalities in an industry where tens of thousands of employees are subjected to significant hazards and elevated risks. Creating safer workplaces for U.S. employees by enhancing leaders' skills, building knowledge, and improving behaviors will improve the employees' and their families' lives by reducing the pain and suffering resulting from injuries and fatalities.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-07-20T15:48:26Z No. of bitstreams: 1 mateusclovisdesouzacosta.pdf: 2901250 bytes, checksum: 8af7b5baf07040748804059716275b90 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-03T16:18:14Z (GMT) No. of bitstreams: 1 mateusclovisdesouzacosta.pdf: 2901250 bytes, checksum: 8af7b5baf07040748804059716275b90 (MD5) / Made available in DSpace on 2018-09-03T16:18:14Z (GMT). No. of bitstreams: 1 mateusclovisdesouzacosta.pdf: 2901250 bytes, checksum: 8af7b5baf07040748804059716275b90 (MD5) Previous issue date: 2018-06-29 / A tese tem por objetivo estimular a discussão, por meio de três estudos independentes, sobre os impactos econômico-financeiros das cesarianas desnecessárias no Brasil, estimando os custos, propondo estratégias para redução do procedimento quando desnecessário e investigando a hipótese de que obstetras induzem a demanda por cesariana. A epidemia de cesariana é um problema de saúde pública que onera financeiramente os sistemas público e privado de saúde e que desperdiça recursos que poderiam ser utilizados de maneira mais eficiente. O primeiro estudo estima o custo da cesariana desnecessária no Brasil. Tendo como base dados da pesquisa Nascer no Brasil, DATASUS, SIGTAP, UNIDAS e estimando por regressão logística, foi possível concluir que o custo da cesariana desnecessária é no mínimo R$ 10,5 milhões no setor público e R$ 17,6 milhões no setor privado, o que representa 1,6% a 6% dos gastos públicos com cesariana. O segundo estudo propõe mudança no modelo de assistência obstétrica que envolve alteração na jornada de trabalho, na forma de remuneração e no aumento da punição aos obstetras, como forma de inibir a prática de indução de demanda. A partir de referências na literatura, dados da AMB, DATASUS e da pesquisa Nascer no Brasil, atribuíram-se métricas para a utilidade do obstetra e utilizou-se uma simulação para sensibilizar as métricas de remuneração e ética profissional, permitindo observar o efeito na decisão do obstetra. Concluise que remunerar obstetras com salário fixo, introduzi-los na jornada de trabalho sob regime plantão e em equipe colaborativa e aumentar da punição pela prática antiética de indução de demanda são ações que podem somar a outros esforços para o combate à epidemia da cirurgia no Brasil. O terceiro estudo investigou a hipótese de indução de demanda por cesariana no Brasil. Com dados do DATASUS, CFM e da pesquisa Nascer no Brasil, foi possível descrever comportamentos da assistência obstétrica brasileira no que diz respeito ao volume de nascimentos por hora, processos éticos contra obstetras e a probabilidade de haver cesariana sem indicação clínica. As conclusões são de que o volume de nascimentos por cesariana no Brasil supera aos do parto vaginal em horários comerciais, que ginecologia-obstetrícia é a especialidade com maior volume processos ético-disciplinares no CFM, que a maioria das decisões dos CRM’s/CFM tem caráter reservado e que quando o trabalho de parto de mulheres de risco habitual, que se iniciou espontaneamente, é acompanhando só por médico obstetra, ocorre em dia de semana e o obstetra decidiu a via de nascimento no final da gestação, houve maior chance de cesariana, levando à suspeita da prática de medicina defensiva. / This thesis aims to stimulate the discussion, by means of three independent studies, of the economic-financial impacts of unnecessary cesarean sections in Brazil, estimating the costs, suggesting strategies to decrease this procedure when unnecessary and investigating the hypothesis that obstetricians induces the demand for this surgery. The cesarean sections epidemic is a public health issue that financially burdens both public and private health systems, wasting resources that could be used in a more efficient way. The first study estimates the cost of unnecessary cesarean section in Brazil. Basing on Birth in Brazil research, DATASUS, SIGTAP and UNIDAS data and estimating by logistic regression, it was possible to conclude that the cost of unnecessary cesarean sections is at least R$ 10,5 million in the public sector and R$ 17,6 million in the private sector, representing 1.6% to 6 % of public expenses with this procedure. The second study proposes a change in the obstetric assistance model that involves alteration in the working hours, in the remuneration forms and the increase of penalties to obstetricians, as way to inhibit the practice of demand induction. Starting from literature references, AMB, DATASUS and Birth in Brazil research data, a metric for the obstetrician utility has been attributed and a simulation to sensetize the metrics for remuneration and professional ethics has been used, allowing to observe the effects in the obstetrician decisions. It was concluded that remunerating obstetricians with a fixed wage, puting them in a on call working journey with a collaborative team and increasing penalties for the unethical practice of demand induction are means that can be added to other efforts to fight the epidemic of this surgery in Brazil. The third study has investigated the hypothesis of demand induction for cesarean sections in Brazil. With DATASUS, CFM and Birth in Brazil research data, it was possible to describe behaviors of Brazilian obstetric assistance regarding the amount of births per hour, ethical law suits against obstetricians and the probability of a cesarean section without clinical indication. The conclusions are that the amount of births by cesarean section in Brazil exceeds those of vaginal delivery during business hours, that gynecology-obstetrics is the specialty with the greatest amount of ethical-disciplinary law suits in the CFM, that most CRMs/CFM decisions have a reserved character and that when the labor of women on habitual risk, which started spontaneously, occurs on weekdays and is followed only by an obstetrician, and the obstetrician decided the birth path at the end of gestation, there was a higher chance of a cesarean section, leading to the suspicion of the defensive medicine practice.