Yes / Patient safety culture/climate in maternity units has been linked to better safety outcomes. Nurses have a crucial role in patient safety and represent the majority of staff in maternity units. In many countries, nurses are recruited from abroad, bringing their own perceptions of patient safety culture. Nonetheless, little is known about the relationship between perceptions of patient safety culture and nurses’ nationality. Understanding this relationship will assist stakeholders in designing a responsive programme to improve patient safety culture. Aims: To investigate the association between nurses’ nationality and their perceptions about patient safety culture in maternity units in Ministry of Health hospitals in Oman. Methods: In 2017, the Safety Attitude Questionnaire (SAQ) was distributed to all staff (892 distributed, 735 returned) in 10 maternity units. Results: About three-quarters (74%, 541/735) of the returned SAQs were completed by nurses, of whom 34% were non-Omani, 21.8% were Omani and 44.7% did not report their nationality (missing). Overall, the mean safety score for non-Omani nurses was significantly higher than for the Omani nurses: 3.9 (SD 1.3) vs 3.6 (SD 1.2) (P < 0.001). The mean safety score for stress recognition was significantly lower for non-Omani nurses: 2.8 (SD 1.5) vs 3.2 (SD 1.3) (P < 0.001). Conclusion: Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses except in respect of stress recognition. Decision-makers, directors, and clinicians should consider these differences when designing interventions to improve patient safety culture. / This study is part of a PhD study that was funded by the Ministry of Health in Oman

A operação segura e confiável de usinas nucleares não depende só da excelência técnica do projeto e construção, mas também das pessoas e da organização. Por essa razão, a importância dos fatores organizacionais nos mecanismos causais de acidentes tem sido reconhecida por uma série de organizações de pesquisas na Europa, EUA e Japão. Deficiências nesses fatores revelam fragilidades na cultura de segurança da organização. Uma preocupação básica na avaliação de uma cultura de segurança é garantir que os instrumentos de pesquisa sejam válidos e confiáveis. Nas áreas de saúde e de segurança do trabalho há uma série de instrumentos para avaliar a cultura de segurança, para os quais são apresentados estudos de suas proporiedades psicométricas (confiabilidade e validade), mas muito pouco com essas qualidades na área nuclear. No caso específico do Brasil, nenhum. Portanto, o principal objetivo deste trabalho foi desenvolver um modelo capaz de avaliar com medidas válidas e confiáveis a cultura de segurança de instalações nucleares. O instrumento de pesquisa foi desenvolvido com base em princípios psicométricos estabelecidos para pesquisas quantitativas e, portanto, foram realizadas a análise da confiabilidade e as validações de conteúdo, de face e de construto. O instrumento foi aplicado nos institutos de pesquisa da Comissão Nacional de Energia Nuclear (CNEN), obtendo-se um total de 226 questionários respondidos. Os resultados da pesquisa possibilitaram caracterizar demograficamente os respondentes e identificar muitos aspectos fortalecidos, mas também algumas fragilidades na cultura de segurança dos institutos avaliados. O instrumento apresentou boas evidências de confiabilidade com o coeficiente alpha de Cronbach de 0,95 para o instrumento como um todo. A validação de construto foi realizada por meio de uma análise fatorial utilizando-se a Análise de Componentes Principais (ACP) e rotação fatorial ortogonal Varimax. Os resultados da análise fatorial permitiram concluir que o instrumento possui boas evidências de validade de construto, mas também sugeriram alguns ajustes no caso de uma nova aplicação do instrumento. / The safe and reliable operation of nuclear power plants does not depend only on technical excellence, but also it depends on people and on the organization. For this reason, the importance of organizational factors in causal mechanisms of accidents has been recognized by a number of research organizations in Europe, USA and Japan. Deficiencies in these factors reveal weaknesses in the organization\'s safety culture. A primary concern in evaluating a safety culture is to ensure that research instruments are valid and reliable. In the areas of occupational health and safety there are series of tools to evaluate the safety culture that present studies of its psychometric properties (reliability and validity), but very few of these qualities in the nuclear area. In the specific case of Brazil, none of these tools exist. Therefore, the main objective of this study is to develop a model to assess the safety culture in nuclear facilities with valid and reliable measures. The survey instrument was developed in accordance with the psychometric principles established for quantitative research and thus were held to analyze the reliability and validation of content, face and construct. The instrument was applied in the research institutes of the Brazilian Nuclear Energy National Commission (CNEN), yielding a total of 226 completed questionnaires answered. The survey results made it possible to characterize demographically the respondents and identify many strengthened aspects, but also some weaknesses in the safety culture of the evaluated institutions. The instrument showed good evidence of reliability with Cronbach\'s alpha coefficient 0,95 for the total instrument. The construct validation was performed by means of a factor analysis with Principal Component Analysis (PCA) extraction method and Varimax orthogonal factor rotation. Although factor analysis results have shown that the instrument has good evidence of construct validity, some adjustments in case of a new application of the instrument have also been suggested.

A operação segura e confiável de usinas nucleares não depende só da excelência técnica do projeto e construção, mas também das pessoas e da organização. Por essa razão, a importância dos fatores organizacionais nos mecanismos causais de acidentes tem sido reconhecida por uma série de organizações de pesquisas na Europa, EUA e Japão. Deficiências nesses fatores revelam fragilidades na cultura de segurança da organização. Uma preocupação básica na avaliação de uma cultura de segurança é garantir que os instrumentos de pesquisa sejam válidos e confiáveis. Nas áreas de saúde e de segurança do trabalho há uma série de instrumentos para avaliar a cultura de segurança, para os quais são apresentados estudos de suas proporiedades psicométricas (confiabilidade e validade), mas muito pouco com essas qualidades na área nuclear. No caso específico do Brasil, nenhum. Portanto, o principal objetivo deste trabalho foi desenvolver um modelo capaz de avaliar com medidas válidas e confiáveis a cultura de segurança de instalações nucleares. O instrumento de pesquisa foi desenvolvido com base em princípios psicométricos estabelecidos para pesquisas quantitativas e, portanto, foram realizadas a análise da confiabilidade e as validações de conteúdo, de face e de construto. O instrumento foi aplicado nos institutos de pesquisa da Comissão Nacional de Energia Nuclear (CNEN), obtendo-se um total de 226 questionários respondidos. Os resultados da pesquisa possibilitaram caracterizar demograficamente os respondentes e identificar muitos aspectos fortalecidos, mas também algumas fragilidades na cultura de segurança dos institutos avaliados. O instrumento apresentou boas evidências de confiabilidade com o coeficiente alpha de Cronbach de 0,95 para o instrumento como um todo. A validação de construto foi realizada por meio de uma análise fatorial utilizando-se a Análise de Componentes Principais (ACP) e rotação fatorial ortogonal Varimax. Os resultados da análise fatorial permitiram concluir que o instrumento possui boas evidências de validade de construto, mas também sugeriram alguns ajustes no caso de uma nova aplicação do instrumento. / The safe and reliable operation of nuclear power plants does not depend only on technical excellence, but also it depends on people and on the organization. For this reason, the importance of organizational factors in causal mechanisms of accidents has been recognized by a number of research organizations in Europe, USA and Japan. Deficiencies in these factors reveal weaknesses in the organization\'s safety culture. A primary concern in evaluating a safety culture is to ensure that research instruments are valid and reliable. In the areas of occupational health and safety there are series of tools to evaluate the safety culture that present studies of its psychometric properties (reliability and validity), but very few of these qualities in the nuclear area. In the specific case of Brazil, none of these tools exist. Therefore, the main objective of this study is to develop a model to assess the safety culture in nuclear facilities with valid and reliable measures. The survey instrument was developed in accordance with the psychometric principles established for quantitative research and thus were held to analyze the reliability and validation of content, face and construct. The instrument was applied in the research institutes of the Brazilian Nuclear Energy National Commission (CNEN), yielding a total of 226 completed questionnaires answered. The survey results made it possible to characterize demographically the respondents and identify many strengthened aspects, but also some weaknesses in the safety culture of the evaluated institutions. The instrument showed good evidence of reliability with Cronbach\'s alpha coefficient 0,95 for the total instrument. The construct validation was performed by means of a factor analysis with Principal Component Analysis (PCA) extraction method and Varimax orthogonal factor rotation. Although factor analysis results have shown that the instrument has good evidence of construct validity, some adjustments in case of a new application of the instrument have also been suggested.

Process Safety Management (PSM) is concerned with the safe handling of products, safe production of products and the safe operation of the process as confirmed by Thrower (2013). The Occupational Safety and Health Administration (OSHA) (2012) promulgated the PSM standard in 1992, which incorporated fourteen elements, to decrease the occurrence of process safety incidents. Walt and Frank (2007) described the cracks in the implementation of PSM programs, emanating from major process safety incidents and compliance audits. This was confirmed by the decaying process safety performance observed in recent years. It was thus proposed that an analysis into the diverse process safety incident causes and its comparison against the implemented OSHA PSM program, would suggest its associated shortcomings. The aim of the study was to determine the most effective approach to implement and sustain PSM in an organisation to prevent and manage the occurrence of major industrial catastrophes. A semi-qualitative study was conducted through the employment of a survey questionnaire and published incident investigation reports. A total of fifty random process safety incidents were interpreted from published and accredited secondary literature. Most of the secondary literature was obtained from the Health and Safety Executive (HSE) and Centre for Chemical Process Safety (CCPS) databases. From the study findings, Mechanical Integrity (MI) failures were found to significantly and consistently contribute to process safety incidents. Further analysis specifically concluded that equipment or control failure was the significant cause. Employee Participation (EP) was found to statistically correlate with the other elements. The researcher found that literature agreed with the aforementioned findings and this study verified that the EP element was instrumental in the implementation of the other elements. The researcher used literature to confirm that safety culture and leadership commitment was crucial to effective and sustainable PSM programs. The case study analysis validated this observation. Therefore the most effective approach to implement and sustain PSM was to adopt the DuPont, Centre for Chemical Process Safety (CCPS), Risk Based PSM framework or Energy Institute (EI) models. To conclude, this study was effective as all the objectives and the aim was achieved. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2014

Process Safety Management (PSM) is concerned with the safe handling of products, safe production of products and the safe operation of the process as confirmed by Thrower (2013). The Occupational Safety and Health Administration (OSHA) (2012) promulgated the PSM standard in 1992, which incorporated fourteen elements, to decrease the occurrence of process safety incidents. Walt and Frank (2007) described the cracks in the implementation of PSM programs, emanating from major process safety incidents and compliance audits. This was confirmed by the decaying process safety performance observed in recent years. It was thus proposed that an analysis into the diverse process safety incident causes and its comparison against the implemented OSHA PSM program, would suggest its associated shortcomings. The aim of the study was to determine the most effective approach to implement and sustain PSM in an organisation to prevent and manage the occurrence of major industrial catastrophes. A semi-qualitative study was conducted through the employment of a survey questionnaire and published incident investigation reports. A total of fifty random process safety incidents were interpreted from published and accredited secondary literature. Most of the secondary literature was obtained from the Health and Safety Executive (HSE) and Centre for Chemical Process Safety (CCPS) databases. From the study findings, Mechanical Integrity (MI) failures were found to significantly and consistently contribute to process safety incidents. Further analysis specifically concluded that equipment or control failure was the significant cause. Employee Participation (EP) was found to statistically correlate with the other elements. The researcher found that literature agreed with the aforementioned findings and this study verified that the EP element was instrumental in the implementation of the other elements. The researcher used literature to confirm that safety culture and leadership commitment was crucial to effective and sustainable PSM programs. The case study analysis validated this observation. Therefore the most effective approach to implement and sustain PSM was to adopt the DuPont, Centre for Chemical Process Safety (CCPS), Risk Based PSM framework or Energy Institute (EI) models. To conclude, this study was effective as all the objectives and the aim was achieved. / MIng (Development and Management Engineering), North-West University, Potchefstroom Campus, 2014

Occupational Health and Safety is largely determined by the creation of a Safety Culture that minimises risk. In South Africa the construction sector is the second most hazardous industry after mining. This study focuses on two exemplary construction firms in the Western Cape. The main research question is "How do the companies ensure coherent safety management practices that create a safety culture?" Based on a modification of a Balanced Health and Safety Scorecard for the Construction sector five sub-questions address safety management practices from a Management Perspective, an Operational Perspective, a Learning Perspective and a Client and Compliance Perspective. Data has been gathered from company documents, semistructured interviews, together with on-site observation. In conclusion the study reveals that management commitment, active communication and employee acknowledgement contribute positively to creating an effective safety culture on-site. Further studies are recommended with a specific view on small and medium companies in the construction sector. / Magister Commercii - MCom

Thesis (MBA)--Stellenbosch University, 2012. / Safety culture is a multi-layered dynamic concept, meaning that it is not only the aspects pertaining to compliance with compulsory legislation, but also many other non-compulsory safety management and leadership initiatives, which enhance the companies’ safety performance. Most of the available literature focuses on a safety climate, which is an aggregate measure of employee attitude and opinion regarding safety. This paper presents the zero harm safety culture, a common contextual framework, taking readers beyond the traditional safety climate metrics and presenting a variety of assessment and analytical tools for each level of the framework. Techniques used to transform the safety culture toward a state of zero harm are explored in this research report. Finally, 26-components exist in a zero harm safety framework, to illustrate the development and application of a zero harm safety culture in the mining industry. It is also worth mentioning that the most important element of clearly perceived leadership has been found to be neglected in the past and resulted in persistence of incidents leading to fatalities. This important factor, which requires constant leadership interaction, is what makes or breaks the zero harm safety culture framework. Hence, it is crucial that organisations appoint leaders in positions influencing direction of the safety culture, and that these individuals are committed to the drive towards zero harm. This would assist leaders in the mining industry, especially small mines where resources are scarce, to apply the zero harm framework in such a way that the drive towards a zero harm safety culture becomes a reality. When considering implementing the zero harm safety framework in any mining company, irrespective of its size, a successful safety culture can be accomplished realistically within three to five. This paper also provides a series of recommendations to help implement this framework.

Bakgrund: Säker vård är en hörnsten i vård- och omsorgsarbetet, trots det förekommer vårdskador. Vårdskador är inte enbart individorsakade utan också systemorsakade. Säkerhetskultur har visat sig påverka patientsäkerheten. I sjuksköterskans ansvar ingår praktiserandet av god och säker vård och forskning har visat att sjuksköterskor har en påverkan på patientdödligheten. Därför är det betydelsefullt att identifiera sjuksköterskors upplevelser av faktorer som påverkar säkerhetskulturen för att förbättra patientsäkerheten. Syfte: Att identifiera sjuksköterskors upplevelser av faktorer som påverkar säkerhetskulturen med utgångspunkt i modellen för patientsäkerhetskultur av Sammer et al. (2010). Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar från sökningar i databaserna PubMed och CINAHL. Materialet analyserades deduktivt utifrån en modell av patientsäkerhetskultur. Resultat: Ett flertal upplevelser av faktorer som påverkar säkerhetskulturen identifierades. Tydlighet i ansvars- och rollfördelning samt brist på information och utbildning var problemområden. Teamarbete och kommunikation var viktigt i en fungerande säkerhetskultur. Tydliga riktlinjer bidrog positivt till patientsäkerhetsarbetet och säkerhetskulturen. Att lära sig av varandra och av tidigare misstag samt att diskutera öppet med varandra och inte skuldbelägga påverkade förbättringsarbetet positivt. Ledarskap, organisation och resursfördelning spelade en viktig roll i att forma sjuksköterskors arbetsmiljö. Slutsats: En ökad medvetenhet hos sjuksköterskor om vad som påverkar säkerhetskulturen kan främja patientsäkerheten. En öppen kommunikation, kollegialt samarbete samt medvetenhet om risker och resurser möjliggör en god och säker vård. Ledarskapet har en viktig funktion för att kunna ge personalen förutsättningar att lyckas arbeta patientsäkert. / Background: Safe practice is an important element in nursing, yet adverse events occur. Adverse events are not only caused by individuals, but also systems. Safety culture has been shown to affect patient safety. To practice safe care is a nurse’s responsibility and research has shown that nurses have an impact on patient death. Therefore, it’s important to identify nurses’ experiences of factors affecting safety culture to improve patient safety. Aim: To identify nurses’ experiences of factors affecting safety culture based on the model of patient safety culture by Sammer et al. (2010). Method: A literature review based on 15 scientific articles from searches in PubMed and CINAHL. The material was analysed deductively using a safety culture model. Results: Several experiences and factors affecting safety culture were identified. Clarity in allocation of roles and responsibilities and lack of information and training were problem areas. Teamwork and communication were important in a functional safety culture. Clarity in guidelines affected patient safety work and safety culture positively. Learning from others and past mistakes as well as speaking openly and not blaming others had a positive effect on quality improvement. Leadership, organization and resource allocation were important in forming nurses’ work environment. Conclusion: Awareness among nurses of factors affecting safety culture can improve patient safety. Open communication, cooperation and awareness of risks and resources facilitate good and safe care. Leaders play key roles in providing necessary conditions for staff to be successful in safety work.

A cultura de segurança na área nuclear é definida como o conjunto de características e atitudes da organização e dos indivíduos que fazem que, com uma prioridade insuperável, as questões relacionadas à proteção e segurança nuclear recebam a atenção assegurada pelo seu significado. Até o momento, não existem instrumentos validados que permitam avaliar a cultura de segurança na área nuclear. Em vista disso, os resultados da definição de estratégias para o seu fortalecimento e o acompanhamento do desempenho das ações de melhorias tornam-se difíceis de serem avaliados. Este trabalho teve como objetivo principal desenvolver e validar um instrumento para a avaliação da cultura de segurança de organizações nucleares, utilizando o Instituto de Pesquisas Energéticas e Nucleares como unidade de pesquisa e coleta de dados. Os indicadores e variáveis latentes do instrumento foram definidos utilizando como referência modelos de avaliação de cultura de segurança da área da saúde e área nuclear. O instrumento de coleta de dados proposto inicialmente foi submetido à avaliação por especialistas da área nuclear e, posteriormente, ao pré-teste com indivíduos que pertenciam à população pesquisada. A validação do modelo foi feita por meio da modelagem por equações estruturais utilizando o método de mínimos quadrados parciais (Partial Least Square - Structural Equation Modeling PLS-SEM), no software SmartPLS. A versão final do instrumento foi composta por quarenta indicadores distribuídos em nove variáveis latentes. O modelo de mensuração apresentou validade convergente, validade discriminante e confiabilidade e, o modelo estrutural apresentou significância estatística, demonstrando que o instrumento cumpriu adequadamente todas as etapas de validação. / The safety culture in the nuclear area is defined as that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety and protection issues receive the attention warranted by their significance. Until now, there are no validated instruments to evaluate the safety culture in the nuclear area. This fact makes it difficult to assess the results of strategies for its strengthening and of the improvement actions. The main objective of this work was to develop and validate an instrument for the evaluation of the safety culture of nuclear organizations, using the Instituto de Pesquisas Energéticas e Nucleares as a research unit and data collection. The indicators and latent variables of the instrument were defined using health and nuclear area models of safety culture evaluation as reference. The data collection instrument initially proposed was submitted to the evaluation by nuclear area experts and, subsequently, to the pretest with individuals who belonged to the researched population. The validation of the model was performed through structural equation modeling using the Partial Least Square - Structural Equation Modeling - PLS-SEM method in the SmartPLS software. The final version of the instrument was composed by forty indicators distributed in nine latent variables. The measurement model showed convergent validity, discriminant validity and composite reliability, and the structural model showed statistical significance. Therefore the overall model has successfully accomplished all the validation steps.

Nas organizações de saúde, as notificações voluntárias são essenciais para a construção da aprendizagem, que é um dos fundamentos da cultura da segurança do paciente. O objetivo deste estudo foi comparar um sistema manuscrito e um sistema informatizado de notificações voluntárias de incidentes e queixas técnicas relacionados à saúde, implantados em um hospital de ensino do interior de São Paulo, por meio da análise documental das notificações encaminhadas. Os sistemas foram comparados quanto à quantidade e qualidade das notificações, categoria dos profissionais notificadores, motivos e características dos incidentes relacionados aos medicamentos. O presente estudo demonstrou que as notificações encaminhadas por meio de sistemas manuscrito e informatizado podem ser utilizadas para identificação de incidentes, mas é possível que o segundo sistema seja mais vantajoso do que o primeiro, por ter apresentado aumento do número de notificações em 58,7%; aumento da taxa de notificação em 62,3%; maior qualidade dos relatos, especialmente quanto à classificação e descrição da gravidade do incidente, e descrição do paciente; eliminação da ilegibilidade e de rasuras; ampliação da participação dos diferentes profissionais de nível superior e de profissionais de nível médio e básico, especialmente técnicos e auxiliares de enfermagem; favorecimento de relatos de incidentes que causaram danos aos pacientes, especialmente os moderados e graves; favorecimento de relatos de incidentes relacionados aos medicamentos potencialmente perigosos, de relatos de reações adversas e inefetividade terapêutica, de erros de omissão, de administração de medicamento não autorizado, de dose, erro de técnica de administração e não adesão do paciente, e também de erros de medicação mais graves, incluindo os que causaram danos aos pacientes; favorecimento de relatos de suspeita de inefetividade terapêutica de medicamentos. A implantação do sistema informatizado de notificações voluntárias de incidentes na saúde como base para a cultura de segurança do paciente no sistema de saúde brasileiro parece ser uma estratégia viável e totalmente necessária para o gerenciamento de riscos e a qualificação da assistência, tendo este trabalho contribuído para nortear como deve ser o processo de notificação voluntária de incidentes e queixas técnicas em saúde. / Voluntary incident reporting is essential in health facilities to promote learning, which is one of the fundaments of patient safety culture. This study presents a comparison between voluntary handwritten reports and a computer-based reporting system of health-related incidents and technical complaints implemented in a university hospital in the interior of São Paulo, Brazil. This comparison was conducted through a document analysis of reports and the systems were compared in terms of quantity and quality of reports, profession of those reporting the incidents, reasons and characteristics of medication-related incidents. This study revealed that both handwritten and computer-based reports can be used to identify incidents but the latter seems to be a better system because it presented an increase of 58.7% in the number of reports; an increase of 62.3% in the reporting rate; better quality reports, especially in relation to the classification and description of the incidents\' severity and description of patients; the problem of illegibility was eliminated; a greater number of workers from different professions with higher education and also with technical and primary education was observed, especially nursing technicians and auxiliaries; reports of incidents causing harm to patients was favored, especially moderate and severe incidents, in addition to reports of potentially dangerous medication-related incidents, adverse reactions and ineffective therapy, omitted errors, non-authorized administration of medication, dosage errors, administration technique, non-adherence of patients, reports of more severe medication errors, including those that harmed patients, and reports concerning suspicion of ineffective drug therapy. The implementation of a computer-based voluntary reporting system of health-related incidents to fundament a patient safety culture within the Brazilian health system seems to be a viable and essential strategy to risk management and qualify care delivery. This study can guide the process of voluntary reporting of incidents and technical complaints.