Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.

The aim of the thesis was to find out about the use of personal protective equipment (PPE) in a middle-sized company in the northern part of Sweden in general was like, due to the winter climate by looking at factors promoting and inhibiting the use of PPE. The study design is a case study in focus groups conducted in one company SA Englund AB. There were 3 focus groups and 12 participants in total. The questions were written by the project- team and the questions about the winter climate were written by the author. The focus group questions were conducted in Swedish and asked in February in Sweden when it is winter. The approach with asking the questions in the focus groups in February was for the workers to have a fresh memory of PPE in the winter climate. The results showed that a construction site is a complex work environment, and the use of PPE differs from person to person. There is not a single answer on how to work with the use of PPE, but to improve PPE in general and in a winter climate has been discussed. Sub-categories include: demands of the customer, the fear of looking foolish, providing complementary supplies of the suppliers and the combination of working indoors/outdoors. The conclusion is that there are many contributing factors to why PPE is not always being used when it should. PPE is also being used at some sites all the time like helmets. This is a sign of good safety culture in many eyes while it can be a problem with bent forward postures and helmets that causes neck problems. Another problem is the performance pay, which leads to shortcuts when using PPE to save time. The thesis was written within the field of work environment and ergonomics with a focus on working preventively with accidents and ill-health in the work environment.

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Bakgrund: Antalet personer med obesitas ökar världen över och definieras genom ett Body Mass Index (BMI) över 30. Det ställer ökade krav på sjukvården att möta behovet av vård hos dessa patienter. Att bli sövd är förenat med risker, där ett högt BMI ökar risken vid generell anestesi. En förändrad anatomi och fysiologi hos patienter med obesitas utgör en ökad risk vid generell anestesi, vilket är någonting anestesisjuksköterskan måste vara förberedd på och kunna hantera. Syfte: Studiens syfte var att beskriva anestesisjuksköterskans erfarenhet av generell anestesi av patienter med obesitas för att säkerställa säker vård. Metod: Deskriptiv design med kvalitativ ansats. Totalt fem anestesisjuksköterskor intervjuades individuellt på en operationsavdelning i Mellansverige under perioden december 2023 till januari 2024. Resultat: Anestesisjuksköterskans erfarenheter presenteras i tre kategorier; Skapa egna förutsättningar för säker vård, process av mental och praktisk förberedelse för att hantera olika situationer, samt organisatoriska förutsättningar för säker vård. Vidare framkom åtta subkategorier; Identifiera patientutmaningar, ta stöd i team, erfarenhet medför trygghet, preoperativa förberedelser och använda hjälpmedel, förutse och hantera peroperativa risker, planera och utföra omvårdnadsåtgärder inför väckning och postoperativ vård, planerat operationsprogram påverkar, samt tillgänglighet till resurser. Slutsats: Studien visar att stöd i team samt att vara erfaren medför trygghet och ger goda förutsättningar för att skapa säker vård. Organisatoriska förutsättningar såsom operationsprogram och tillgänglighet till resurser är förutsättningar som påverkar möjlighet att skapa säker vård. / Background: The prevalence of obesity is increasing worldwide, with a Body Mass Index (BMI) above 30 defining the condition. This places increased demands on healthcare providers to meet the care needs of these patients. Being put under anesthesia is associated with risks, with even a high BMI increasing the risk of general anesthesia. An altered anatomy and physiology in obese patients pose an increased risk during general anesthesia, which the nurse anesthetist must be prepared for and be able to handle. Aim: The aim of the study was to describe the nurse anesthetist's experience of general anesthesia in obese patients in order to ensure safe care. Method: A descriptive design with a qualitative approach was employed. A total of five nurse anesthetists were interviewed individually in a surgical ward in central Sweden during the period December 2023 to January 2024. Results: The nurse anesthetists' experiences are presented in three categories: creating one's own conditions for safe care, the process of mental and practical preparation to handle different situations, and organizational conditions for safe care. Furthermore, eight subcategories emerged: identifying patient challenges, taking support in teams, experience brings safety, preoperative preparation and use of aids, anticipating and managing peroperative risks, planning and performing nursing measures for wake-up and postoperative care, planned surgical program affects, and availability of resources. Conclusion: The study indicates that the provision of support within teams and the possession of experience affords security and facilitates the creation of safe care. Organizational conditions, such as the surgical program and the availability of resources, are conditions that affect the possibility to create safe care.

Improving the quality and safety of maternity services is an international top agenda item. This thesis describes the progress towards the development of a multidimensional approach to measure the quality and safety of care in ten maternity units in Oman based on three of the five dimensional Patient Safety Measurement and Monitoring Framework (PSMMF) which include measuring "past harm" and "anticipation and preparedness”. The three monitoring approaches used in this research are: (1) measuring the patient safety culture (2) measuring patient satisfaction (3) and monitoring caesarean section rates. The specific objectives of the research are to (1) measure patient safety culture level, (2) examine the association between nurse’s nationality and patient safety culture, (3) validate an Arabic language survey to measure maternal satisfaction about the childbearing experience, (4) measure patient satisfaction about the childbearing experience, and (5) to examine caesarean section rates across maternity units using statistical process control charts. This thesis started with four systematic reviews that focused on (1) the use of patient safety culture for monitoring maternity units (2) the available interventions to improve patient safety culture (3) Arabic surveys available for measuring maternal satisfaction and (4) the use of statistical process control charts for monitoring performance indicators. The overall conclusion from these reviews that these approaches are being increasingly used in maternity, found feasible and useful, and there are areas that need attention for future work. Five field studies were conducted to address the research aim and objectives. Patient safety culture was measured by a cross-sectional survey of all staff in the ten maternity units. It was found that safety culture in Oman is below the target level and that there is wide variation in the safety scores across hospitals and across different categories of staff. Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses in all domains except in respect of stress recognition and this difference need further investigation and needs to be considered by designers of interventions to enhance patient safety culture. Using two existing validated English surveys, an Arabic survey was developed, validated, and used to measure maternal satisfaction with childbirth services. It was found that the new survey has good psychometric properties and that in all the ten hospitals, mothers were satisfied with the care provided during child delivery but satisfaction score varied across hospitals and groups of participants. Caesarean section rate in the last 17 years was examined using statistical process control charts to understand the variation across the ten hospitals. It was found that caesarean section rate is above the rate recommended by the World Health Organisation. Special cause variations were detected that warrant further investigation. In conclusion, the field studies demonstrated that it is feasible to use the three approaches to monitor quality and safety in maternity units. However, further work is required to use these data to enhance the quality and safety of care. Additionally, future work is needed to cover the other three dimensions of the PSMMF. / Ministry of Health in Oman,

No / Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes. Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (i.e. no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes. The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r(2)=0.39) and patient perceptions (adjusted r(2)=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r(2)=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also possible to identify differences between the acute Hospital Trusts. The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare. TRIAL REGISTRATION NUMBER: ISRCTN07689702.

Introduktion (och syfte) – Människor på arbetsplatser, oavsett bransch, kan drabbas av bådefysiska och psykiska problem på grund av exempelvis kemikalier, maskiner, buller,stress eller trakasserier. I Sverige är byggbranschen en av de mest olycksdrabbadebranscherna och räknades som den dödligaste branschen under 2018. Samtidigt görsstora satsningar i Sverige för att arbeta säkert på byggarbetsplatser och förebyggaolyckor, som till exempel Safe Construction Training och säkerhetspark. Enligt en delforskning har, under de senaste två decennierna, intresset för begreppet säkerhetskulturökat som ett sätt att minska risken för olyckor. Säkerhetskultur definieras som cheferoch anställdas värderingar, uppfattningar och attityder om förhållande till arbetsmiljöoch säkerhet. Av denna anledning blir målet med denna studie att kartlägga faktorersom påverkar säkerhetskulturen, belysa hur en god säkerhetskultur ser ut samt vilkaåtgärder som bidrar till en förbättrad säkerhetskultur. Metod – Undersökningsstrategi för denna kvalitativa studie baseras på intervjuer ochdokumentstudier. Intervjuer valdes som den ingående empiriinsamlingen eftersom dettaär en beprövad metod för insamling av data från en utvald grupp personer. Användandetav intervju som empiriinsamling bidrar till att ange både djupare förståelse av problemeti fråga och samtidigt tillåta författaren att vägleda frågeställningen och därmed geupphov till en öppnare diskussion av ämnet. Intervjuerna som använts i denna rapportär av typen semistrukturerade, där frågorna är förutbestämda men hålls öppna. Parallelltmed intervjuerna används dokumentstudie i form av sekundärdata för att kompletteraprimärdata från intervjuerna. Resultat – Det överliggande problemet idag kring säkerhetskulturen grundar sig kringatt byggindustrin är en bransch med fler olycksrisker än andra branschen till följd avarbetsuppgifternas natur. Att förebygga olycksrisker kräver aktivt säkerhetsarbete somarbetar mot risker och olyckor som vanligtvis sker och samtidigt fokusera på attförebygga och minska antalet olyckor. Till detta krävs olycksrapporteringar samt tillbudför att möjliggöra att säkerhetsarbetet fokuserar på relevanta faktorer som kan ge positiveffekt, och minska antalet rapporterade fall. Att möjliggöra en god säkerhetskulturkrävs att arbetarna vet om de risker som finns, att rapportering är något som måste ske,oavsett olyckans storlek, samt att undvika att slarva med arbetet för att spara tid. Analys – Analysen har presenterat en djupare förståelse kring hur säkerhetsarbetetfungerar, vilka faktorer som uppenbarar sig vid granskning av olyckor och tillbud,hantering av olycksrapportering, samt arbetet mot att förebygga fler olyckor. Diskussion – Med den valda metodiken för framtagning av rapportens empiri har etttrovärdigt resultat kunnat tillhandahållas. Undersökningen har genomförts med en litenurvalsgrupp men resultaten bedöms vara användbara. Målet med denna kvalitativastudie har uppnåtts och frågeställningarna har besvarats. / Introduction (and purpose) – People in the workplace, regardless of industry, can beaffected by both physical and mental factors due to, for example, chemicals, machines,noise, stress, or harassment. In Sweden, the construction industry is one of the mostaccident-prone industries and was considered the deadliest industry in 2018. At thesame time, major investments are being made in Sweden to work safely on constructionsites and prevent accidents, such as Safe Construction Training and safety parks.According to some research, over the past two decades, interest in the concept of safetyculture has increased as a way of reducing the risk of accidents. Safety culture is definedas managers 'and employees' values, perceptions, and attitudes about the relationshipbetween the work environment and safety. For this reason, this work will aim to identifyfactors that affect the safety culture, shed light on what a good safety culture looks like,and what measures contribute to an improved safety culture. Method – The research strategy for this qualitative study is based on interviews anddocument studies. Interviews were chosen as the in-depth empirical collection as thisis a proven method for collecting data from a selected group of people. The use ofinterviews as a collection of empirical data helps to provide both a deeper understandingof the problem in question and at the same time allows the author to guide the issue andthus give rise to a more open discussion of the subject. In parallel with the interviews,a document study in the form of secondary data is used to supplement primary datafrom the interviews. Results – The overriding problem today around safety culture is that the buildingindustry maintains a greater risk of accidents than other occupations due to the natureof the tasks. To prevent the risks that an accident occurs, the demand increase for activesafety work to prevent risks and accident that are commonly occurring, while at thesame time focusing on preventing further accidents from happening. To do this, thedemand for reports regarding incidents and accidents increases, to enable the safetywork to focus in on relevant factors and decrease the number of accidents fromhappening. To enable good safety culture, the workers need to be aware of the risksduring work, that they always report accidents, and to avoid cutting corners to save time. Analysis – The analysis has presented a deeper understanding of how safety work isdone in the workplace, which factors that are presented when reviewing accidents andincidents, the handling of the accident reports, as well as the work towards preventingmore accident from happening. Discussion – With the chosen methodology for producing the report's empirical data, acredible result has been provided. The survey was conducted with a small sample group,but the results are judged to be useful. The goal of this qualitative study has beenachieved and the questions have been answered.

Safety is the main concern of the aviation industry. All Air Navigation Service Providers must have a Safety Management System (SMS) which states how safety is handled, promoted and prioritized. By developing Key Performance indicators (KPIs), it is possible to quantify the effectiveness of a SMS, discover potential flaws and improvement measures. This thesis identifies principles behind the SMS, the development of KPIs and suggest potential KPIs for the Swedish air navigation service provider LFVs’ SMS. A literature study was performed and organisation specific documents were analysed to develop potential KPIs within the areas timely compliance with international obligations, competency and adoption and sharing of best practices based on an EASA questionnaire. This work presents a set of 27 performance indicators and recommends 6 as potential KPIs for the three areas together. The KPIs are developed specifically for LFV but could be applicable for other organisations with similar SMS structure and processes. They should be analysed within the organisation and, potentially, have thresholds set before implementation.

Heuristic estimates of probabilities may be an obstacle to decision making within High Reliability Organizations. Accident reports have found that two from each other separate phenomenon, Blame Culture and Type 1 processing constitutes a particularily serious threat to decision making. The present study (N = 70) investigated if a perceived risk of negative feedback and cognitive load would lead to more heuristic estimates on the Conjunction Fallacy. Three experiment conditions were included in the study: Negative feedback, cognitive load and control. The results were non-significant for both negative feedback and cognitive load. Furthermore, the estimated negative affect was higher when violations to the Conjunction Rule was made. Previous studies showing that high scores on the Cognitive Reflection Test (CRT) indicate less sensitivity to conjunction fallacies, were replicated. The present study concluded that the CRT may be a strong predictor of the Conjunction Fallacy.

En god säkerhetskultur är avgörande för att flygunderhållsfunktionerna i Försvarsmakten ska kunna leverera luftvärdiga flygfarkoster. Personalbrist råder i flygunderhållsfunktionerna och därför undersöks om och hur personalbristen inverkar på säkerhetskulturen. I arbetet undersöks flygunderhållsfunktionen på en skvadron inom Helikopterflottiljen. På grund av att Försvarsmakten ålägger ansvaret för säkerhetskulturen på chefer i organisationen samt att forskning på ämnet pekar på att ledarskapet är den största inverkande faktorn på säkerhetskultur så undersöktes ämnet utifrån ett ledarskapsperspektiv. Fyra chefer från flygunderhållet på Helikopterflottiljen intervjuades om faktorer som påverkar säkerhetskulturen och om personalbristen i deras organisation. Slutsatserna i arbetet är att personalbristen bland chefer leder till att chefer inte har tillräckligt med tid för att planera arbetsuppgifter och svårigheter med att visa närvaro i hangarerna. En medvetenhet om personalbristen i organisationen leder till att chefer engagerar sig mycket i personalens välmående. Personalbristen bland tekniker leder till, i kombination med två andra faktorer, att rapporteringskulturen försämrats. / Safety culture is a critical factor within aircraft maintenance organizations for delivering air-worthy aircrafts for the Swedish Armed Forces. There is a problem with insufficient manpower within the aircraft maintenance organizations, and therefore this paper aims to examine the implications this might have on safety culture. An aircraft maintenance function within the Armed Forces Helicopter wing was studied. The Swedish Armed Forces regulations inflict the responsibility for safety culture upon commanding officers. And this together with the research on the subject safety culture that says that it is leadership that inflicts on safety culture the most, dictates this paper to examine the subject from a leadership point of view. Four officers from the aircraft maintenance function was interviewed about leadership factor that inflicts with safety culture and the insufficient manpower problems. This paper concludes that commanding officers have problem finding time for planning for the workforce and making frequent tours in the hangars. Due to awareness of the problems with insufficient manpower commanding officers pay extra attention to the workforce’s wellbeing. Due to lack of manpower within the workforce, together with two other factors, the reporting culture has declined.