In public health, prevention is a fundamentally political process as both the selection of problems to be addressed and solutions recommended reflect decisions that are informed by economic, social and cultural forces. Yet prevention is often presented as a monolithic enterprise, an objective and scientific discourse that does not take sides. Behind this facade of political neutrality, diversely positioned individuals and groups often fail to find and/or sustain a common ground for shared prevention initiatives. Increasingly, many prevention awareness campaigns focus upon true accounts or injury narratives that serve both as a catalyst to build multipartite consensus through developing shared collaborative prevention discourses and practices and to mobilize public support for health and safety issues. While the use of the true account form is a recommended strategy in the public health literature directed toward practitioners, the engagement of true accounts in prevention campaigns has not been adequately problematised and examined from a critical social theoretical perspective. A qualitative, sociologically oriented case study of the use of the true account form, the commemorative, in young worker safety campaigns is proposed to deepen our understanding of this particular type of prevention intervention in particular and prevention as an enterprise more generally. The study investigates the socio-historical context in which the Young Worker Memorial LifeQuilt, a Canadian young worker educational initiative, emerged and unraveled as a multipartite prevention campaign centered upon the true account form of consensus commemoratives. A key finding is that true accounts of young workers killed on the job are socially mediated to diffuse blame and build consensus between diversely positioned occupational health and safety practitioners and the family survivors of workplace tragedies. What is included and excluded from these true accounts of workplace injuries, as socially constructed narratives in multipartite prevention awareness campaigns, may be, in part, a product of the terms and conditions negotiated between lead players. The true accounts included in collaborative, cross-institutional prevention campaigns, while referencing real events, may be told in ways that accommodate and harmonize the political perspectives of diversely positioned stakeholders. Conversely, the true account form is a potentially problematic strategy for collaborative prevention discourses and practices, as consensus commemoratives can be retold as critical remembrances of workplace death, with the result that the unifying narrative of a shared, collective memory project is undermined. This dissertation finds that the activity of collaboration shapes prevention as a socio-political activity/practice.

I vår tid växer nya generationer upp i ett samhälle med hög förändringstakt. Ur ett personsäkerhetsperspektiv innebär förändringsintensiteten en osäkerhet gällande vilka potentiella risker vi utsätts för. Risker kan identifieras och hanteras genom ett systematiskt säkerhetsarbete. Det kräver en god säkerhetskultur som bland annat innebär att samtliga individer inom en organisation vet hur det ska påtala risker för sin arbetsgivare och känner sig trygga att göra det (Reason, 1997; Power, 2007). Arbetsmiljölagen (1977:1166) föreskriver att risker ska identifieras och hanteras i ett systematiskt arbetsmiljöarbete. Samtidigt rapporteras att ca trettio procent av tusen grundskollärare upplever någon form av risk i samband med att föra fram kritik till eller om sin arbetsgivare (Helte, 2011). Hur påverkar den situationen förekomsten av internrapportering, förmåga att hantera risker och att dra lärdom av händelser? Är skolan en lärande organisation? Syftet med studien är att få en inblick i hur riskbilden kan se ut på en skola och, belysa hur fyra pedagoger upplever kulturen på sin arbetsplats, generellt och i förhållande till det systematiska arbetsmiljöarbetet enligt arbetsmiljölagens (1977:1166) intentioner. Studien genomfördes som en kvalitativ fallstudie. Studiens resultat visar att i samtliga fall var avsaknaden av en god säkerhetskultur med systematisk och strukturell approach anmärkningsvärd, även på de skolor som hade en trygg och öppen kultur. Den riskbild som framkom i intervjuerna omfattade risker i den psykiska och fysiska arbetsmiljön. Riskerna var tätt sammanlänkade med den pedagogiska verksamheten. Informanterna förmedlade behov av ökat systematiskt säkerhetsarbete och nämnde flera önskvärda effekter inom hela verksamheten som detta skulle kunna medföra. / In our time, new generations grow up into a society of rapid change. From a personal security point of view, the high rate of change implies an uncertainty regarding which potential dangers we will face. Risks can be identified, addressed and managed through Systematic Safety Work. It requires a good safety culture which among other things means that everyone knows how they are supposed to report risks to their employers and that they are comfortable doing so. (Reason; 1997; Power, 2007). The Work Environment Act (1977:1166) stipulates that risks are to be identified and managed in a Systematic Safety Work. At the same time it is reported that about thirty percent of one thousand teachers experience some kind of risk expressing criticism to or about their employers. (Helte, 2011). How does this affect internal reporting, ability to manage risks and to learn from incidents? Is school a Learning Organization? The purpose of this study is to gain insight into what kind of risks there are in school and to illustrate how four teachers experience the culture in their workplaces, generally and in relation to Systematic Safety Work according to the intentions of the Work Environment Act (1977:1166). The study was conducted as a qualitative case study. Our results demonstrate that in all cases there was a notable lack of good safety culture including systematic and structural approach. This also applied even to the schools with a confident and open culture. The risks which were expressed in the interviews concerned both mental and physical work environment. The risks were closely interconnected with the educational activities. Informants conveyed the need for increased Systematic Safety Work and mentioned several desirable effects in the whole school organization as a result.

Darbo tikslas – įvertinti pacientų nuomonę ir požiūrį apie atliekamų paslaugų saugą PSP grandyje. Uždaviniai: Išanalizuoti pacientų nuomonę apie atliekamų medicininių paslaugų saugą PSP įstaigoje. Įvertinti paciento požiūrį apie gydymo vaistais saugumą. Išanalizuoti, paciento ir gydytojo tarpusavio pasitikėjimo aspektus, siekiant efektyvaus ir saugaus gydymo. Ištirti pacientų požiūrį į nepageidaujamų įvykių priežastis ir jų registravimo sistemą. Tyrimo metodika. Kiekybinis momentinis tyrimas. Tyrimo laikas: 2013 m. sausio - balandžio mėn. Tyrimo vieta - UAB „Šilainių šeimos sveikatos centras“. Tiriamoji imtis 378 respondentai. Atsako dažnis - 94,5 proc. Rezultatai. Respondentams svarbus sveikatos priežiūros paslaugų prieinamumas ir jų savalaikiškumas (22,49 proc. ir 20,37 proc., atitinkamai). 63,49 proc. pacientų žino, kas yra pacientų sauga, todėl vertina komunikavimą su gydytoju, teiraujasi apie paskirtus vaistus, jų pašalines reakcijas, domisi paskirtu gydymu. 38,89 proc. respondentų nuomonė apie antibiotikų skyrimo pagrįstumą yra teigiama, o juos vartoja pagal gydytojo rekomendacijas. Bendravimo tarp personalo ir paciento analizė, parodė, kad visais analizuotais atvejais tarpusavio bendravimas tarp personalo ir paciento yra vertinamas pakankamai gerai. Jaunesni respondentai žymiai dažniau nei vyresni linkę reikšti savo nuomonę, dažniau teiraujasi apie savo sveikatą, dalyvauja jiems svarbių sprendimų priėmime. Respondentai mano, kad dažniausia... [toliau žr. visą tekstą] / Objective of the work – to assess the patients’ opinion and attitude to the safety in the primary health care. Tasks: To analyze the patients’ opinion about the safety of medical services provided in the primary health care facilities. To evaluate the patient’s attitude to the safety of conservative treatment. To analyze the aspects of mutual trust of doctor and patient in order to achieve effective and safe treatment. To examine the patients’ attitude to the reasons of undesirable events and their registration system. Research methodology. Quantitative survey. Study time: January-April 2013. Place of research – Silainiai Family Health Center Ltd. Analyzed sample – 378 respondents. Response frequency – 94,5 percent. Results. The respondents find the accessability and timeliness of the health care services important (22,49 percent and 20,37 percent accordingly). 63,49 percent of the patients are familiar with the safety of patients, thus they appreciate communication with the doctor, inquire about the prescribed medicine, their side effects, and show interest in the prescribed treatment. 38,89 –percent of respondents think that prescription of antibiotics is reasonable and they use antibiotics according to the recommendations of the doctor. The analysis of the communication of the patient and the doctor revealed that in all the analyzed cases the interrelations between the staff and the patient are evaluated quite well. The younger respondents tend to... [to full text]

Darbo tikslas: ištirti pacientų saugos kultūros pokyčius ligoninėse per trejus metus. Darbo uždaviniai: ištirti sveikatos priežiūros specialistų nuomonę apie komandinio darbo svarbą pacientų saugos kultūrai; nustatyti komandinio darbo ypatumus, susijusius su pacientų saugos kultūra, padidintos rizikos pacientų saugai skyriuose; palyginti sveikatos priežiūros specialistų nuomonę apie komandinio darbo ir vadovybės požiūrio į saugą pokyčius tiriamose ligoninėse per trejus metus. Tyrimo metodika. 2012 metų lapkričio – gruodžio mėn. 10 stacionariose asmens sveikatos priežiūros įstaigose (ASPĮ) atlikta anoniminė sveikatos priežiūros (SP) specialistų apklausa EUNetPaS projekte naudotu JAV Teksaso universiteto Pacientų saugos instituto parengtu klausimynu SAQ. Ligoninės atrinktos pagal VASPVT 2009 metais vykdytą pilotinį tyrimą, įtraukiant viešasias stacionarines respublikos, regiono ir rajono lygio ligonines. Tyrime dalyvavo 880 dirbančių ASPĮ gydytojų, slaugytojų ir administratorių (atsako dažnis – 96,82 proc.). Rezultatai. Didžioji dalis SP specialistų pripažįsta komandinio darbo svarbą pacientų saugos kultūrai: trys ketvirtadaliai tirtųjų mano, kad jie dirba kaip gerai koordinuota komanda, vertina slaugytojos įnašą ir kartu dirbdami komandoje aiškinasi iškylančius nesklandumus. Statistiškai reikšmingai mažiau administratorių sulaukia iš kolegų pagalbos prižiūrint pacientus lyginant su slaugytojais ir gydytojais. Daugiau negu tris ketvirtadalius SP specialistų tenkina... [toliau žr. visą tekstą] / The aim: to assess the changes of patient safety culture in hospitals during three years. The objectives: to investigate the opinion of health care professionals about the importance of teamwork for patient safety culture; to identify teamwork characteristics associated with patient safety culture in units of high-risk for patient safety; to compare the opinion of health care professionals about the changes of teamwork and management perceptions of safety during three years in the investigated hospitals. Methods. The cross-sectional survey was carried out during November – December 2012. An anonymous questionnaire method was used for this survey. SAQ questionnaires were distributed to medical staff working in 10 hospitals (N=880). Response rate was 96.82 percent. Hospitals were selected according to the methodology of Health Care Accreditation Agency under the Ministry of Health survey carried out as a pilot study in 2009. Results. Most of the health care professionals recognize the importance of teamwork for patient safety culture: three-quarters of respondents consider their actions as a well-coordinated team, acknowledge the input of nurses and together solve rising issues. There is a statistically significant difference in receiving support: less administrators receive the support while taking their duties compared with nurses and physicians. More than three-quarters of health care professionals are satisfied the cooperation with physicians, they share information about... [to full text]

Like many industries, the nuclear power industry in Sweden is currently facing the challenges of a major generational change. To meet these challenges, alongside the demands for a high level of security, the industry has attempted to standardise its mode of operations as far as possible. Apart from various technological fixes and safety devices, manuals and instructions have been modelled for every conceivable situation, or course of events; documentations and formal systems of co-ordination that become larger and larger, and more and more detailed. In high-risk industries there is a tendency to equate learning with changes in external patterns of behaviour, as against fixed standards, typically among operating staff. The acquisition  of professional skill, on the other hand, is the result of participation in practice. From this point of view, rather, learning is the outcome of reflection, upon actual events and experiences. Recurrent training can be used to promote formalisation, but also to explore and reinforce the experience based knowledge of skilled operators; between these approaches, the former prevails. Accidents and incidents incessantly put in question what is commonly referred to as the safety culture of various power plants, and subsequent to the misfortunes at Forsmark 1 in 2006, the accident was described as the culmination of a longterm decline in safety culture. The strong requirement for security and control is a cause of formalisation, whereas the need to support reflection as formation of professional skill tends to be omitted. Even so, experience based skill and knowledge remains a substantial consituent of what could be regarded as a dependable safety culture. Codified knowledge must be interpreted and applied in practice. Furthermore, experienced professionals, from encountering a great variety of situations, seem to develop what can be described as the skill of anticipation, and, as shown in connection with the incident at Forsmark 1, an ability to handle the unexpected. The urge for formalisation raises certain concerns: that of the primacy of defining the containments of professional skill, the impact and resilience of local knowledge and diversity, and the hollowing out of ability and skill within work-life organisations. The “human factor”, that is the operating staff, is commonly made responsible for established accidents and incidents. Even so, experienced personnel are able to manage a variety of unforeseen events and disturbances, that sometimes occur in high-risk technology industries. At times, on the contrary, the human factor saves technology, instead of the other way around. This study explores the concept of safety culture within the nuclear power industry from an epistemological perspective. It discusses the use of recurrent training, and the role of experience based skill and knowledge in the operating of Swedish power plants. What methods can be employed to support experience based knowledge as an essential complement to standardised work processes, codified knowledge, or benchmark strategies? Principles of formalisation need to be supplemented with a more thorough exploration of professional skill, in which a distinction between behaviour and responsibility can be made. / QC 20110906

Made available in DSpace on 2010-04-20T20:15:05Z (GMT). No. of bitstreams: 1 106674.pdf: 904594 bytes, checksum: b288b443fcee4a4b63a1ee332274a957 (MD5) Previous issue date: 2007-08-15T00:00:00Z / A segurança do paciente é um dos pilares de uma organização hospitalar. O objetivo deste estudo foi conhecer as opiniões dos profissionais de saúde, que trabalham em organizações hospitalares, quanto às dimensões de segurança do paciente. Foram abordados conceitos de acreditação, qualidade, cultura de segurança e segurança do paciente. A metodologia utilizada foi a aplicação de um questionário da Agency for Healthcare Research and Quality, traduzido para o português, às lideranças administrativas e assistenciais de hospitais acreditados (tanto pela metodologia da Organização Nacional de Acreditação quanto pela metodologia da Joint Commission International), no Estado de São Paulo. Também identificou-se a freqüência com que os erros são reportados e se as respostas aos erros cometidos são punitivas ou não. / Patient safety is one of the pillars of a healthcare organization. The aim of this study was to know the opinions of the hospital staff about the safety culture dimensions. Concepts of accreditation, quality, safety culture and patient safety are approached. The methodology consisted of a questionnaire application prepared for Agency for Healthcare Research and Quality, translated to portuguese, to the medical and nonmedical leaderships of accredited hospitals (by the methodology of the Organização Nacional de Acreditação and by the methodology of the Joint Commission International), in São Paulo state. The frequency of error reporty was also identified, as well as whether the response to error is punitive or not.

Acidentes do trabalho podem comprometer a competitividade das empresas e até a sua sobrevivência, pois elevam os custos, reduzem a produtividade devido à baixa disponibilidade de pessoal e clima organizacional, além de poderem afetar a imagem da organização perante a sociedade. Geram grandes problemas para as pessoas (acidentados) e seus familiares, assim como para o país. No Brasil, as estatísticas oficiais de acidentes de trabalho apontam números elevados, mesmo considerando que ocorre subnotificação. O objetivo deste estudo foi elaborar, implantar e avaliar um processo de gestão de comportamento seguro, ferramenta voltada para prevenção de acidentes, em uma indústria de cosmético. Para tal elaboração, realizou-se uma revisão bibliográfica (sobre legislação brasileira, acidente do trabalho, prevenção, gestão do comportamento seguro, cultura de segurança e sistema de gestão de segurança e saúde ocupacional), entrevistas com lideranças e trabalhadores, treinamentos e reuniões de acompanhamento (coaching), inspeções nos postos de trabalho, auditoria de observações comportamentais e consulta a registros da empresa para avaliação do envolvimento dos gestores e trabalhadores. Verificou-se uma redução de 40% do número de acidentes no primeiro ano e redução de 79% dos acidentes até o segundo ano, além da melhoria da postura prevencionista de gestores e trabalhadores. Espera-se que esta dissertação possa ajudar e incentivar organizações a implantarem a metodologia de gestão do comportamento seguro, assim como estudantes e pesquisadores a fazerem testes, ajustes e adaptações para melhorar a performance de segurança dessas organizações, reduzindo os acidentes de trabalho e as agruras e sofrimentos que eles impõem para a classe trabalhadora.

Orientador: Professor Dr. João Manoel Losada Moreira / Esta pesquisa tem como objetivo fundamental contribuir para a supressão dos acidentes de trabalho fatais na cadeia produtiva de energia elétrica discutindo o problema em três frentes: a) estender o escopo dos bancos de dados de acidentes de trabalho fatais para toda a cadeia produtiva de energia elétrica incluindo etapas de empresas terceiras; b) incluir nos bancos de dados sobre acidentes de trabalho fatais informações que permitam avaliar as condições em que ocorreram os acidentes e formular soluções para evitá-los no futuro; c) monitorar e quantificar por meio de redes Bayesianas o nível da cultura de segurança das empresas da cadeia de energia elétrica admitindo-se uma correlação inversa entre o nível de cultura de segurança e o número de acidentes fatais nessas empresas. O setor de energia elétrica é normalmente representado pelas etapas geração, transmissão e distribuição de eletricidade. Contudo o setor elétrico, considerando toda sua cadeia produtiva é muito maior e foram identificadas 15 etapas desde a prospecção de energia primária até o descomissionamento das instalações após sua vida útil. Em relação aos bancos de dados de acidentes de trabalho, no Brasil há três bancos de dados que cobrem apenas as etapas de geração, transmissão e distribuição de energia elétrica. Foi encontrado que eles não apresentam dados completos que permitam a rastreabilidade das causas raízes dos acidentes e identifiquem as possíveis soluções para evitá-los no futuro. Por exemplo, entre 2009 e 2015 morreram 69 trabalhadores próprios e 380 terceirizados na etapa de distribuição sem maiores detalhes sobre as condições em que esses acidentes ocorreram. A inclusão das empresas terceiras na contabilidade das estatísticas de acidentes de trabalho pode ser um fator indutor de melhoria nas condições de trabalho de todo o setor de energia. O poder econômico das empresas líderes pode exigir de seus parceiros um comportamento mais adequado quanto à segurança do trabalho e supressão dos acidentes fatais. Foi proposta uma estrutura mínima de banco de dados de acidentes de trabalho no setor elétrico com informações que permitam entre outros objetivos a rastreabilidade e posterior correção dos eventos acidentais. Entre esses itens incluem-se o número de registro do acidente, nome, tipo e área de atuação da empresa e pareceres do sistema de acompanhamento da segurança do trabalho sobre acidente, por exemplo, CIPA, médico do trabalho, sindicato e supervisor técnico. A manutenção de um nível de cultura de segurança em uma empresa é importante para a supressão de acidentes de trabalho. Um modelo de monitoração da cultura de segurança baseado em redes bayesianas com 15 diferentes variáveis foi desenvolvido. Estas variáveis consideram desde o engajamento da alta administração com a segurança até treinamento de trabalhadores na utilização de equipamentos de proteção individual. Este modelo quantitativo conseguiu capturar diferenças de nível de cultura de segurança de 15 diferentes empresas de distribuição de eletricidade e mostrar uma clara correlação inversa com o número de acidentes fatais. / Tese ( doutorado)- Universidade Federal do ABC. Programa de Pós-Graduação em Energia, 2017. / This research aims at contributing to the suppression of fatal work accidents in the electricity sector, discussing the problem on three fronts: a) extend the scope of the fatal work accident data banks to the entire electrical energy production chain including services of third-party companies; b) include in the fatal accidents databases information to assess the conditions under which accidents occurred and formulate solutions to avoid them in the future; c) to monitor and quantify, through Bayesian networks, the level of safety culture of the companies in the electricity sector, assuming an inverse correlation between the level of safety culture and the number of fatal accidents in these companies. The electricity sector is usually represented by the stages of generation, transmission and distribution of electricity. However, the electrical sector, considering its entire production chain, is much larger and 15 stages have been identified from primary energy prospecting to the decommissioning of facilities after their useful life. Regarding work accident databases, in Brazil there are three databases covering only the generation, transmission and distribution stages of the electricity sector. It was found that they do not present complete data to trace the root causes of accidents and identify possible solutions to avoid them in the future. For example, between 2009 and 2015, 69 self-employed workers and 380 outsourced workers died in the distribution stage without further details of the conditions under which these accidents occurred. The inclusion of thirdparty companies in the accounting of work-accident statistics can be a factor in improving the working conditions of the entire energy sector. The economic power of leading companies can demand from their partners better behavior in terms of work safety and suppression of fatal accidents. It was proposed a minimum database structure of work accidents in the electric sector with information that allows, among other objectives, the traceability and subsequent correction of accidental events. These items include the accident record number, name, type and area of work of the company, and opinions of the accident work safety monitoring system, including those from the CIPA, occupational physician, union and technical supervisor. Maintaining a level of safety culture in a company is important for the suppression of occupational accidents. A safety culture monitoring model based on Bayesian networks with 15 different variables was developed. These variables range from senior management engagement with work safety to workers training in the use of personal protective equipment. This quantitative model was able to capture differences in the safety culture level of 15 different electricity distribution companies and show a clear inverse correlation with the number of fatal accidents.

The consumption of unsafe fresh vegetables has been linked to an increasing number of outbreaks of human infections. In Lebanon, although raw vegetables are major constituents of the national cuisine, studies on the safety of fresh produce are scant. This research employed a holistic approach to identify the different stages of the food chain that contribute to the microbiological risks on fresh produce and the spreading of hazards. A thorough analysis of the institutional and regulatory framework and the socio-political environment showed that the safety of local fresh produce in Lebanon is at risk due to largely unregulated practices and shortfalls in supporting the agricultural environment as influenced by the lack of a political commitment. Microbiological analysis showed that the faecal indicator levels ranged from < 0.7 to 7 log CFU/g (Escherichia coli), 1.69-8.16 log CFU/g (total coliforms) and followed a significantly increasing trend from fields to the post-harvest washing area. At washing areas, Salmonella was detected on lettuce (6.7% of raw vegetables from post-harvest washing areas). This suggested that post-harvest cross-contamination occurs predominantly in the washing stage. At retails, a combination of observation and self-reported data provided an effective tool in assessing knowledge, attitudes and practices. It showed that the food safety knowledge and sanitation practices of food handlers were inadequate, even among the better trained in corporate-managed SMEs. Overall, the microbiological quality of fresh-cut salad vegetables in SMEs was unsatisfactory. The link between Staphylococcus aureus and microorganism levels on fresh salads vegetables and the overall inspection scores could not be established. On the other hand, inspection ratings on individual components, e.g., cleanliness and cross-contamination preventive measures showed significant correlation with Listeria spp. levels. Together, results confirmed that inspection ratings don’t necessary reflect the microbiological safety of fresh vegetables and that the application of control points of risk factors that likely to contribute to microbial contamination in the production environment are essential. The washing methods were limited in their effectiveness to reduce the contamination of parsley with Salmonella. In general, the pre-wash chopping and storing of parsley at 30ºC reduced the decontamination effect of all solutions, including sodium dichloroisocyanurate which was reduced by 1.3 log CFU/g on both intact and chopped leaves stored at 30ºC. In such conditions, the transfer rate of Salmonella from one contaminated parsley to subsequently chopped clean batches on the same cutting board(CB) recorded 60%-64%. Furthermore, the transmission of Salmonella persisted via washed CBs stored at 30°C for 24 h. It is recommended to keep parsley leaves unchopped and stored at 5ºC until wash for an optimum decontamination effect and to apply vigilant sanitation of CBs after use with fresh produce. This research presented important data for quantitative risk assessment for Salmonella in parsley and useful descriptive information to inform decision-makers and educators on microbial hazards associated with fresh produce in Lebanon. It also highlighted the risks areas that require urgent interventions to improve food safety. Considering the complex institutional and political challenges in Lebanon, there is an obvious need to direct development programs and support towards local agriculture production, effective education strategies and growing awareness of consumers and stakeholders on food safety related risks.

Made available in DSpace on 2014-10-09T12:42:38Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:01:49Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado em Tecnologia Nuclear) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP