Föreliggande avhandlings centrala syfte är att undersöka säkerhetskultur ombord i fartyg vilka trafikerar Östersjön. Genomgående för fartyg i Östersjöfart är täta hamnanlöp, kustnära resor, trafik i tätt trafikerade områden samt små besättningar. Tidigare forskning antyder att det kan finnas ett systemfel i sjöfarten. Charles Perrow beskriver, till exempel, sjöfarten som ett felskapande system och menar att orsaken till detta är hur sjöfarten bedrivs. James Reason menar att värdering, attityd, kompetens och beteendemönster är fyra viktiga parametrar som definierar en säkerhetskultur. Sjöfartens säkerhetsstyrningssystem, International Safety Management Code (ISM) syftar till att en proaktiv och utvecklande säkerhetskultur skapas och upprätthålls inom sjöfarten. Resultaten av den här studien visar att sjöfarten saknar en framförhållning, ”failure of foresight”, där det proaktiva arbetssättet syftar till att incidenter och olyckor kan förutses. Studien har ett etnografiskt perspektiv vilket syftar till att skapa en så fullödig beskrivning över den kultur som studeras. Totalt ingår elva olika fartyg i studien, där besöken ombord varierat från någon timme till ett par dagar. Insamlad data har via en egenutvecklad analysmodell bearbetats för att försöka förklara säkerhetskulturen. I fokus i analysmodellen står hur information, feedback, ansvar, samarbete, uppföljning samt utveckling hanteras. Studien visar att det finns behov av att diskutera och förändra säkerhetskulturen i sjöfarten, både i stort som enskilt i fartygen. Det finns ett behov av vidare studier av hur säkerhetskulturen kan förbättras, samt ett behov av riktade utbildningsinsatser inom systemtänkande, organisationsteori och säkerhetskultur. / The main purpose of this thesis is to explore the safety culture onboard vessels trading in the Baltic Sea. The common denominator for vessels trading in the Baltic Sea is frequent port visits, coastal voyages, voyages in dense trafficked areas and small crews. Earlier research shows that there may be a system fault in the shipping industry. Charles Perrow describes the maritime industry as an error inducing system. He means that the cause for that is the way shipping is carried out. In a safety culture values, attitudes, competence and behavioral patterns are four important factors that define the safety culture. The maritime safety management system, International Safety Management Code (ISM) aims towards a proactive and evolutionally safety culture in the shipping industry. The results show that shipping today lacks a foresight, “failure of foresight”, where the proactive way of work leads to incidents and accidents being anticipated. This study has an ethnographic perspective, which aims to create a thick and substantial description of the culture that is being studied. Totally a number of eleven vessels participated in the study. The visits onboard reach from a couple of hours up to a few days. Collected data has been analysed through a self-developed model in an ambition to try to explain the safety culture. The model focuses on how information, feedback, responsibility, co-operation, follow-up and development are being handled. The study reveals that there is a need to discuss and change the safety culture in the shipping industry, in large as on the single vessel. As well as a need for further studies of how the safety culture can be improved and a need for education aimed towards system thinking, organizational theory and safety culture.

Une préoccupation grandissante face aux risques biologiques reliés aux maladies infectieuses est palpable tant au niveau international que national ou provincial. Des maladies émergentes telles que le SRAS ou la grippe A/H1N1 ont amené une prise en charge des risques pandémiques et à l’élaboration de mesures d’urgence pour maîtriser ces risques : développer une culture de sécurité est devenu une priorité de recherche de l’OMS. Malgré tout, peu d’écrits existent face à cette volonté de sécuriser la santé et le bien-être par toute une série de dispositifs au sein desquels les discours occupent une place importante en matière de culture de sécurité face aux risques biologiques. Une réflexion sociopolitique était nécessaire pour les infirmières qui sont aux premières loges en dispensant des soins à la population dans une perspective de prévention et de contrôle des infections (PCI) dans laquelle elles se spécialisent. Dès lors, ce projet avait pour buts d’explorer la perception du risque et de la sécurité face aux maladies infectieuses auprès des infirmières cliniciennes et gestionnaires québécoises; d’explorer plus spécifiquement l'existence ou l'absence de culture de sécurité dans un centre de santé et de services sociaux québécois (CSSS); et d’explorer les discours en présence dans le CSSS en matière de sécurité et de risques biologiques face aux maladies infectieuses et comment ces discours de sécurité face aux risques biologiques se traduisent dans le quotidien des infirmières. Les risques biologiques sont perçus comme identifiables, mesurables et évitables dans la mesure où les infirmières appliquent les mesures de préventions et contrôle des infections, ce qui s’inscrit dans une perspective positiviste du risque (Lupton, 1999). La gestion de ces risques se décline au travers de rituels de purification et de protection afin de se protéger de toute maladie infectieuse. Face à ces risques, une culture de sécurité unique est en émergence dans le CSSS dans une perspective de prévention de la maladie. Toutefois, cette culture de sécurité désirée est confrontée à une mosaïque de cultures qui couvrent différentes façons d’appliquer ou non les mesures de PCI selon les participants. La contribution de cette recherche est pertinente dans ce nouveau domaine de spécialité que constituent la prévention et le contrôle des infections pour les infirmières québécoises. Une analyse critique des relations de pouvoir tel qu’entendu par Foucault a permis de soulever les questions de surveillance infirmière, de politique de l’aveu valorisée, de punition de tout écart à l’application rigoureuse des normes de PCI, de contrôle de la part des cadres infirmiers et d’assujettissement des corps relevant des mécanismes disciplinaires. Elle a permis également de documenter la présence de dispositifs de sécurité en lien avec la tenue de statistiques sur les patients qui sont répertoriés en tant que cas infectieux, mais également en termes de circulation des personnes au sein de l’établissement. La présence d’un pouvoir pastoral est perceptible dans la traduction du rôle d’infirmière gestionnaire qui doit s’assurer que ses équipes agissent de la bonne façon et appliquent les normes de PCI privilégiées au sein du CSSS afin de réguler les taux d’infections nosocomiales présents dans l’établissement. En cas de non-respect des mesures de PCI touchant à l’hygiène des mains ou à la vaccination, l’infirmière s’expose à des mesures disciplinaires passant de l’avertissement, la relocalisation, l’exclusion ou la suspension de l’emploi. Une culture du blâme a été décrite par la recherche d’un coupable au sein de l’institution, particulièrement en temps de pandémie. Au CSSS, l’Autre est perçu comme étant à l’origine de la contamination, tandis que le Soi est perçu comme à l’abri de tout risque à partir du moment où l’infirmière respecte les normes d’hygiène de vie en termes de saines habitudes alimentaires et d’activité physique. Par ailleurs, les infirmières se doivent de respecter des normes de PCI qu’elles connaissent peu, puisque les participantes à la recherche ont souligné le manque de formation académique et continue quant aux maladies infectieuses, aux risques biologiques et à la culture de sécurité qu’elles considèrent pourtant comme des sujets priorisés par leur établissement de santé. Le pouvoir produit des effets sur les corps en les modifiant. Cette étude ethnographique critique a permis de soulever les enjeux sociopolitiques reliés aux discours en présence et de mettre en lumière ce que Foucault a appelé le gouvernement des corps et ses effets qui se capillarisent dans le quotidien des infirmières. Des recherches ultérieures sont nécessaires afin d’approfondir ce champ de spécialité de notre discipline infirmière et de mieux arrimer la formation académique et continue aux réalités infectieuses cliniques. / At an international, national or provincial level, there is a growing concern related to biological risks and infectious disease. Emerging diseases such as SARS or influenza A/H1N1 brought a pandemic risk management and the development of emergency measures to control these risks: developing a safety culture has become a research priority for the WHO. However, few writings exist about the desire to secure health and well-being through a variety of devices in which the discourses takes a predominant place as regards of security against biological risks. From the perspective of prevention and infection control (PCI), in which the nurses specialize, a socio-political reflexion was necessary since they are at the forefront in providing care to the population. Therefore, the purpose of this project was to explore the discourses surrounding the safety culture against biological risks in the context of a Quebec healthcare facility “Centre de santé et de services sociaux” (CSSS). Biological hazards are perceived as identifiable, measurable and avoidable if the nurses apply the preventive and infection control measures, which is part of a positivist perspective of risk (Lupton, 1999). Managing these risks is declined through a purification and protection rituals in order to protect themselves from any infectious disease. Faced with these risks, a unique safety culture is emerging in the CSSS following a disease prevention perspective. However, the desired safety culture is faced with a mosaic of cultures that cover different ways to apply or not the prevention and infection control (PIC) measures according to participants. The contribution of this research is important within the prevention and control of infection field for Quebecois nurses. Critical analysis of power relations has raised questions about nursing surveillance, valorized confession policy, punishment for any deviation from the normative application of the PCI standards, monitoring by the nursing managers and subjugation of bodies within disciplinary mechanisms. It made it possible to document the presence of safety devices in conjunction with maintaining statistics on patients who are listed as infectious cases, but also in terms of flux of person’s movements within the institution. The presence of a pastoral power is perceptible in the translation of the administrative role of nurse who must ensure that its teams act in the right way and apply the preferred CSSS PIC standards to regulate the rate of nosocomial infections present within the establishment. In case of non-compliance with PIC related measures to hand hygiene or vaccination, the nurse may be subject to disciplinary action from the warning, the relocation, the exclusion or suspension of the employment. A culture of blame has been described by the search for a culprit in the institution. Within the CSSS, the Other is perceived as being the source of contamination, while the Self is seen as free from any risk from the moment the nurse respects the standards of hygiene of life in terms of healthy dietary habits and physical activity. In addition, nurses must respect the PIC standards they know little, since the research participants noted the lack of academic and continuous training concerning infectious diseases, biological hazards and safety culture that they consider prioritized by their health institution. Power produces effects on the bodies by modifying them. This ethnographic study criticizes, made it possible to raise the sociopolitic stakes connected to the involved speeches and to clarify what Foucault called the government of the bodies and his effects which are capillaries in the nurse’s daily normalities. Further researches are necessary to explore this nursing speciality and to link academic and continuous training to clinical infectious realities.

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-11-11T13:30:20Z No. of bitstreams: 0 / Made available in DSpace on 2016-11-11T13:30:20Z (GMT). No. of bitstreams: 0 / Desde que foi reconhecida a importância de se planejar um turismo sustentável, tem-se buscado ferramentas adequadas para monitorá-lo nas destinações turísticas, tornando esse um dos principais desafios da academia científica de estudos do turismo na atualidade. Diante desse contexto, o desafio apresenta-se ainda maior, quando tratamos de turismo em unidades de conservação, tendo em vista que envolve um ambiente altamente sensível e comunidades em seu entorno que podem ter, no desenvolvimento dessa atividade, sua principal renda econômica. Assim, o que se propõe neste estudo é analisar a aplicabilidade e a eficiência metodológica do monitoramento que visa ao auxílio na construção da sustentabilidade do turismo, em unidades de conservação, através de um estudo de caso no Parque Estadual do Jalapão, localizado no Estado do Tocantins, Brasil. Prioriza-se a investigação de indicadores locais abordados a partir da definição estipulada pela Organização Mundial do Turismo. Os resultados alcançados demonstraram que os indicadores estudados são instrumentos a serem considerados no processo de avaliação e quantificação do turismo em um destino com semelhantes configurações ambientais, o que viabiliza a compreensão e o fortalecimento da noção de sustentabilidade. Este estudo caracteriza-se pela sua vertente interdisciplinar e teve como norteador o método dedutivo. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Human - Technology - Organization (HTO) is a well-established, general unifying concept in the Swedish Accident Investigation Authority (SHK) that represents an approach, knowledge and use of various tools regarding interactions between people, technology and organizational factors. The HTO-perspective is well described in literature but there are few studies on how SHKs staff experiences working according to this method in their investigations. The aim of this study was therefore to describe their HTO-perspective, examine how it is used in the investigations at SHK and describe the investigators experience of working with the HTO-perspective as well as the method's usefulness compared to old methods in accident investigations. A literature study has been conducted in the areas of HTO, Theory of planned behavior (TPB) and safety culture. TPB and safety culture are described in this paper since they highlight the different aspects of a HTO-perspective. The hypothesis was answered by using semi-structured interviews. The interviews were analyzed by a content analysis and themes were identified. Furthermore the material from the interviews was subsequently structured through a Strength – Weakness – Opportunities – Threats analysis (SWOT), i.e. the informants' view on the HTO-perspective was structured based on the strengths, weaknesses, opportunities and threats SHKs staff experience that the method has in the investigative work. The informants consisted of two investigators at SHK who 3have worked with accident investigations for a long time in various roles. The results yielded that the investigators had a positive attitude towards conducting investigations according to the HTO-perspective because they feel that this perspective provides them with cross-competence. A flaw is though that the perspective lacks a structured approach. As a result of this, the investigators own experiences and expertise play a major role in the quality of the investigation. As the study's aim is met and the informants are considered to be experts the validity requirements are also fulfilled.

Background: Low morale is classified as a latent condition for performance variability in safety-critical environments. Morale management may assist in the control of performance variability as part of a systems approach to safety. A context-specific model for measuring and managing morale with reference to followership in a safety-critical air traffic control (ATC) environment could not be found. Purpose/Aim: The purpose of this study was to develop a model that enables the measurement and management of air traffic controller (ATCO) team morale. Research Design: An exploratory sequential mixed method design was adopted. A census approach to sampling was used to conduct 21 focus group sessions as the qualitative phase, providing the definition and drivers of morale. The Measure of Morale and its Drivers (MoMaD) survey instrument was created from qualitative data, then administered to 256 ATCOs in the quantitative phase. Statistical methods included exploratory factor analysis, correlation and regression analysis to construct the final MoMaD model. Results: A context-specific definition of morale is provided and communication management, team cohesion, leadership interaction, staff incentive, staffing level, workplace health and safety and mutual trust were found to be the drivers of morale in a safety-critical ATC environment. A single-item measure of perceived morale reflected the state of context-specific ATCO team morale more accurately than an existing generalisable multi-item measure. Conclusion: This study contributes to the body of knowledge by integrating applicable aspects of morale, followership, performance variability and organisational culture and climate in safety-critical ATC environments into a new theoretical framework. The MoMaD instrument is presented as a context-specific model for measuring and managing ATCO team morale in an ATC environment. Recommendations: Future research opportunities include the possible influence of morale as a predictor of morale in safety-critical environments and the development of a context-specific multi-item measure of morale for integration into the MoMaD model. / Business Management / D. B. L.

Le Comité de Retour d’Expérience (CREX) est un dispositif de gestion de la sécurité des patients en équipe, engageant les professionnels de santé dans la pratique collective de l’analyse des causes racines des événements indésirables associés aux soins. Ce dispositif, développé en France en 2005, est désormais implanté dans la majorité des établissements de santé français. Curieusement, après 10 ans de développement dans des milliers d’équipes médicales, aucun travail scientifique publié ne s’était penché sur leur fonctionnement et leurs effets sur la sécurité des patients. Mon travail de thèse a permis d’évaluer le fonctionnement des CREX, ainsi que leur association aux dimensions de la culture de sécurité des professionnels de santé. Nous avons montré que les CREX sont appropriés pour fonctionner dans les diverses spécialités d’un établissement de santé. De plus, ce dispositif permet aux soignants de réaliser des analyses des causes racines, et de décider collectivement d’actions visant à corriger les défaillances profondes des organisations. Afin d’étudier les relations entre la participation à un CREX et les dimensions de la culture de sécurité des soignants, nous avons effectué une enquête auprès de 3888 professionnels de santé, en utilisant le questionnaire Hospital Survey On Patient Safety Culture (HSOPS), dont nous avons précisé les propriétés métrologiques (psychométrie, variabilité des méthodes d’agrégation des scores, méthodes d’imputation des données manquantes). Nous avons mis en évidence des relations favorables entre la participation à un CREX et la culture de sécurité des soignants. Les CREX permettent de favoriser le travail en équipe, la multidisciplinarité, ainsi que de modifier la culture de l’erreur. Malgré ses limites, notre travail contribue à mieux connaitre les CREX et leur place dans les dispositifs de gestion de la sécurité des patients. Cette thèse plaide pour le développement d’une recherche centrée sur l’implication des professionnels de santé dans la gestion de la sécurité des patients. / The Experience Feedback Committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis of adverse events within the team. This program was created in 2005, and was implemented in the vast majority of French hospitals. Despite its wide implementation in thousands of French medical teams, the EFC still lacks scientific evaluation. To our knowledge, the EFC framework and the association between EFC and patient safety culture have never been assessed. In this context, our work aimed to determine whether patient safety culture, as measured by the Hospital Survey On Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities. Using the original data from a cross-sectional survey of 3,888 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities. We also specified the metrological properties of the transcultural adaptation of the HSOPS into French (psychometrics properties, variability of scoring strategies and missing data imputation methods). Our findings suggest that EFC participation may improve patient safety culture, teamwork and non-blame oriented processes. Despite several limitations, our study contributes to a better understanding of EFC and its position amongst patient safety systems. This thesis advocates research developments centered on health care givers involvement in patient safety management.

Ett fungerande arbetsmiljö och säkerhetsarbete är viktigt för att förebygga olyckor i arbetet. Därför är det intressant att undersöka hur säkerhetsarbetet i en processindustri upplevs, en organisation där medarbetare dagligen utsätts för risker i arbetet. Genom kvalitativa intervjuer har problemområdet undersökts i syfte att identifiera aspekter som påverkar säkerhetsarbetets förutsättningar. Studiens resultat visar att säkerhetsarbete är ett komplext område där organisatoriska, tekniska och kulturella aspekter kontinuerligt samspelar. Att säkerhet ständigt tävlar om prioritet mot produktionen är dessutom en ständig utmaning.

In hospitals of Addis Ababa, there is a high turnover of leaders while patient and health workers’ satisfaction is low, and safety and quality are in dire situations. The purpose of this study was to explore and propose strategies to improve effectiveness of hospital leadership in order to enhance the quality of health care provided in hospitals through improving health workers’ empowerment, job satisfaction and patient safety culture. Thus, a sequential explanatory mixed method research design was used. The research had three phases, in which the first phase used five structured questionnaires explored leadership styles, the health workers’ satisfaction and empowerment, patient safety culture, and the patient experience of quality of health care; while the second involved a qualitative study (content analysis); and third phase focused on the preparation of a strategy document. Data in the form of interview responses was gathered from 75 leaders, 542 health workers, 532 patients and 11 key informants. The analysis shows that, overall, hospital leaders considered themselves more transformational (M=2.98, SD=0.41) than transactional (M=2.85, SD=0.46). Job satisfaction of private and public hospital health workers were 70.8 % and 57.1 % respectively (P-value<0.001). In addition, private hospital workers had a higher score in structural and psychological empowerment than their pubic hospital counterparts; the difference was statistically significant in all dimensions (P-value <=0.03). The analysis reveals that public and private hospitals’ mean total patient safety scores were 3.58 and 3.77 respectively (P-value=0.02). Finally, the “overall rating of hospital” was better for private hospitals: 84.8% and 88.4 % respectively (P-value=0.03). The study makes a number of observations. It notes that, firstly, transformational leadership has direct and strong correlation with structural and psychological empowerment (r=0.70, P-value=0.04 and r=0.83, P-value=0.01 respectively). Secondly, structural empowerment has a direct and significant effect on psychological empowerment (β=0.28, P-value=<0.01); and minimal indirect effect on patient safety culture through psychological empowerment (β=0.05, P-value=<0.05). Thirdly, health worker job satisfaction also has had a direct effect on patient safety culture (β=0.44, Pvalue=< 0.01. The fourth and final observation is that psychological empowerment has had a direct and statistically significant effect on patient safety culture (β=0.19, Pvalue=< 0.01). These observations indicate that, although private hospitals are better in every dimension of this study, the current hospitals situation in Addis Ababa needs urgent attention. Hence, the identification and recommendation for the preparation of eight strategic priority areas along with key interventions seeking to improve the hospital leaders’ effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

No description available.

Hot och våld på arbetsplatser har länge diskuterats och studerats. Det finns vissa yrkesgrupper som är mer drabbade än andra och läraryrket beskrivs utgöra en av dessa riskgrupper. Under de senaste åren har det rapporterats om en förändring i svenska skolmiljöer där allt fler lärare utsätts för hot och våld. Forskningen om skolvåld har traditionellt fokuserats på elevernas utsatthet vilket utgjort en kunskapslucka kring lärares exponering för hot och våld. Tillgänglig forskning indikerar att utsattheten skiljer sig åt bland lärare, därmed finns ett erkänt behov av att bredda kunskapsbasen inom forskningsområdet.  Syftet med studien var att undersöka hur förekomsten av hot och våld bland lärare ser ut i Värmland. Vidare syftade studien till att belysa vilka faktorer som bidrar till lärares utsatthet samt hur skolorna hanterar hot och våld. För att besvara studiens syfte har ett kvalitativt tillvägagångssätt tillämpats. Datainsamlingen bestod av intervjuer med fem skyddsombud från olika skolor från tre kommuner i Värmland.  I studien framkom en samstämmig uppfattning om att lärare är en utsatt grupp när det kommer till hot och våld. Utsattheten skiljer sig åt mellan olika skolor och årskurser och faktorer som erfarenhet och kön har en viss påverkan på lärares utsatthet. Hur risken att drabbas av hot och våld värderas kan påverkas av attityder och acceptansnivå. Vidare belyser studien en medvetenhet om hot och våld bland lärare. / Threats and violence in workplaces have long been discussed and studied. There are certain professional groups that are more affected than others, and the teaching profession is described as one of these risk groups. In recent years, there have been reports of a change in Swedish school environments where more and more teachers are exposed to threats and violence. Research on school violence has traditionally focused on students' vulnerability, which has created a knowledge gap regarding teachers' exposure to threats and violence. Available research indicates that vulnerability differs among teachers. Thus, there is a recognized need for further research.  The objective of the study was to investigate how threats and violence occurring in school settings among teachers are perceived in Värmland. Furthermore, the study aimed to highlight which factors contribute to teachers' vulnerability and how schools deal with threats and violence. In order to answer the objective of the study, a qualitative approach was applied. The data collection was carried out using interviews with five protection officers from different schools in three municipalities in Värmland.  The study revealed a consensus that teachers are a vulnerable group when it comes to threats and violence. Vulnerability differs between different schools and grades, and factors such as experience and gender have a certain influence on teachers' vulnerability. How the risk of being affected by threats and violence is valued can be influenced by attitudes and level of acceptance. Furthermore, the study highlights an awareness of threats and violence among teachers.