A new model was developed to enhance the understanding of the full context of work associated hazards, to explore the connection between OHS performance and a systematic approach to safety, and to simplify approaches to OHS management. This Safe Place, Safe Person, Safe Systems model was derived from the literature and used as the basis for the development of a framework, consisting of 60 elements which was transformed into an assessment tool. This assessment tool was trialled with a pilot study on a medium sized manufacturing plant in the plastics industry, and the tool and Preliminary Report peer reviewed by an expert panel using the Nominal Group Technique. After refinements were made to the assessment tool it was applied to eight case studies that were drawn from advertisements. This qualitative study consisted of two parts: firstly the assessment using the Safe Place, Safe Person, Safe Systems framework; and secondly a controlled self assessment exercise to target improvements to three of the elements over a period of four months. The study illustrated that the Safe Place, Safe Person, Safe Systems framework could be successfully applied in a range of industries to promote OHS improvements and to provide a systematic, planned approach to fulfilling OHS responsibilities. The application of this framework highlighted that: there is a need for further education on the correct application of the risk assessment process and the responsibilities owed to contractors; techniques such as dynamic risk assessments are more suitable where the place of work is variable and hazards are unpredictable; more focus is needed on the appropriate management of hazardous substances with long term health consequences; and that the level of formality invoked for treating hazards does not necessarily equate to improved risk reduction outcomes. The Safe Place, Safe Person, Safe Systems framework was found to be applicable to small, medium and large organisations provided the assessment was scoped to a small division of relatively homogeneous activity to ensure a more representative hazard profile. This approach has provided a way forward to simplify OHS management and also offers practical direction for implementing a targeted OHS improvement program.

Les systèmes de gestion intégrée en environnement et en santé et sécurité du travail (SGI) sont un nouveau paradigme de gestion dans les organisations modernes. Ces systèmes sont construits à partir des normes ISO 14001 et d’OHSAS 18001, basées sur la prévention des risques et le principe de précaution. La littérature sur les SGI témoigne d’un marasme conceptuel prédominant depuis plus de 10 ans; elle insiste sur l’urgence d’un consensus taxinomique et conceptuel afin de définir les systèmes de gestion intégrée et de différencier le mécanisme d’intégration de celui de l’implantation. Cette lacune conceptuelle enlise les connaissances dans un fossé épistémologique, retardant ainsi le débat dans ce nouveau champ d’études. Les rares connaissances dont nous disposons dans ce domaine proviennent de quelques études théoriques et de six études empiriques, toutes préoccupées par la compatibilité des multiples systèmes et des avantages économiques de leur intégration. Les évidences engendrées par ces études sont insuffisantes pour appréhender la dynamique du nouveau paradigme dont les effets demeurent peu connus. Cette situation révèle l’urgence d’agir dans un contexte où l’utilisation des SGI se multiplie, et où leur tendance à minimiser l’importance des risques devient de plus en plus préoccupante. Aucune étude ne s’est encore penchée sur l’implantation d’un SGI en environnement et en santé et sécurité du travail construit uniquement à partir des normes ISO 14001 et d’OHSAS 18001. Cette connaissance est importante pour expliquer les effets de tels systèmes. C’est dans cette perspective que nous avons réalisé cette première étude empirique d’un SGI selon les normes ISO 14001 et d’OHSAS 18001. Nos questions de recherche portent sur le mode, le degré d’implantation, les effets du SGI, ainsi que sur les facteurs contextuels qui interviennent pour expliquer les variations dans le degré d’implantation et les effets du SGI. Il s’agit d’une recherche à prélèvement qualitatif qui repose sur un devis d’étude de cas, avec des niveaux d’analyse imbriqués, et comportant une double visée descriptive et explicative. Notre échantillon, de type raisonné, regroupait trente-cinq intervenants provenant de différentes instances hiérarchiques ; il incluait également des représentants syndicaux. Notre échantillon était composé de 7 usines, accréditées aux normes ISO 14001, OHSAS 18001, et dispersées dans différentes villes du Québec. Ces usines différaient tant par leur technologie, leur âge, leur taille, et leurs types de production. Nos données ont été recueillies en 2004; elles sont basées sur des entrevues semi dirigées, sur des observations directes lors de la visite des lieux; elles s’appuient aussi sur des consultations de documents internes et sur des outils électroniques implantés. La transcription des entrevues effectuée, le contenu des discours a été catégorisé selon les cinq dimensions du SGI: engagement, planification, mise en opération, contrôle et revue de la direction. Une condensation horizontale avait précédé l’analyse de chaque cas et l’analyse transversale des cas selon une approche à la fois inductive et déductive. Les résultats de notre recherche ont révélé deux modes d’implantation : le mode d’enrichissement et le mode de fusion. Ces modes dépendaient de la nature des structures fonctionnelles en place. La visée d’amélioration continue à la base du SGI n’avait pas réussi à concilier les approches traditionnelles bottom up et top down qui ont dominé cette implantation; son mécanisme était guidé par 4 types de stratégies : l’économie des ressources, le contrôle des forces d’influences, la stratégie des fruits faciles à cueillir et la stratégie à petits pas. Pour analyser le degré d’implantation, nous avons tenu compte de l’effort de structuration du SGI et de la force d’utilisation des processus implantés à chacune des cinq dimensions du SGI. Les résultats de notre recherche révèlent une variabilité certaine du degré d’implantation entre les usines d’une part, et entre les processus associés aux cinq dimensions du SGI d’autre part. L’analyse des discours a permis de produire cinq hypothèses qui soutiennent l’effort de structuration et la force d’utilisation du SGI: (i) l’hypothèse de la force de cohésion, (ii) l’hypothèse de la spécificité du processus, (iii) l’hypothèse de la portée du processus, (iv) l’hypothèse de la capacité organisationnelle, (v) l’hypothèse de l’acceptation du changement. L’implantation du SGI était soumise à l’influence de multiples facteurs; ils étaient de nature politique, structurelle et organisationnelle. Ces facteurs avaient agi sur le processus d’implantation en amorçant une cascade d’interactions au cours desquelles leurs forces d’influences se renforçaient, se neutralisaient ou s’additionnaient pour affecter le degré d’implantation. Les facteurs facilitant touchaient surtout l’effort de structuration ; ils incluaient : l’expérience des systèmes de gestion, l’implication de la direction, celle du syndicat ou du CSS, la structure organisationnelle, le niveau d’éducation, l’âge et la taille de l’usine. Quant aux facteurs contraignants, ils agissaient sur la force d’utilisation ; ils incluaient : la lourdeur procédurale, le manque de temps, le manque de formation, le manque de ressources, la culture organisationnelle, la structure organisationnelle, le fossé intergénérationnel, l’absence du syndicat et l’âge de l’usine. Trois effets proximaux escomptés par l’entreprise ont été observés. (i) La rigueur de la gestion était associée à l’application des exigences du SGI; elle touchait la gouvernance en environnement et en santé et sécurité du travail, les mécanismes de gestion et les procédés de production. (ii) La standardisation était reliée au mode d’implantation du SGI; elle concernait les pratiques, les outils, les méthodes de travail et l’organisation des ressources. (iii) La rupture des silos est un effet relié au mode d’implantation du SGI; elle touchait les structures départementales, les frontières professionnelles, les relations et climat de travail. Ces effets proximaux avaient provoqué plusieurs effets émergents, plus distaux: une augmentation du pouvoir de contrôle syndical, un renforcement de la légitimité des recommandations soumises par les spécialistes professionnels, la création de réseaux inter organisationnels et le transfert du savoir. L’implantation du SGI avait transformé la gouvernance et les pratiques en environnement et en santé et sécurité du travail dans les sept usines. Toutefois, elle ne semblait pas garantir l’immunité du processus de gestion des risques à l’environnement ni à la santé et sécurité du travail. Sa capacité à diluer les risques devait retenir l’attention des politiques de santé publiques et des programmes de prévention des risques à l’environnement et à la santé et sécurité du travail. L’amélioration de la gestion des risques demeurait un effet attendu non observé et soumis à des facteurs contextuels qui pourraient l’empêcher de se concrétiser. À cet égard, le transfert du savoir, renforcé par l’émergence des réseaux inter organisationnels, semblait offrir une avenue beaucoup plus prometteuse et accessible. C’est l’une des contributions de cette recherche. Elle a aussi (i) proposé une typologie des modes d’implantation et des effets du SGI (ii) préconisé une méthode détaillée d’une meilleure appréciation du degré d’implantation (iii) précisé le rôle des facteurs contextuels dans l’explication des variations du degré d’implantation et dans la production des effets, (iv) proposé des hypothèses sur la structuration et l’utilisation du SGI (v) offert une perspective plurielle et approfondie de la dynamique de l’implantation du SGI grâce à la variété de l’échantillon des répondants et des usines. Il s’agit de la première étude de terrain dans le domaine. À notre connaissance, aucune autre étude n’a eu de tels résultats. Mots Clés : ISO 14001, OHSAS 18001, gestion intégrée, environnement, santé et sécurité du travail, risques environnementaux, risques en santé et sécurité du travail, analyse d’implantation, degré d’implantation, SGI, transfert du savoir. / Integrated environmental, health and safety management systems (IMS) are a new management paradigm of modern organizations. These systems are built mainly from the ISO 14001 and OHSAS 18001 norms, which are based on risk prevention and the precautionary principles. For the past ten years, the literature on IMS has been governed by a conceptual stagnation, which is now begging for a taxonomic consensus in order to define IMS, clarify both integration and implementation processes, and to move beyond structures to address processes. As a result, the knowledge about IMS has been embroiled in an epistemological ditch, thus delaying debates in this emerging field of study. Scarce publications about IMS come from a few theoretical papers and six empirical investigations, all preoccupied by systems compatibility and the economic advantages of management systems integration. Evidence generated by these studies is not sufficient to apprehend the dynamics of the new paradigm, whose effects remain little known about until now. This situation is becoming alarming in a context where the use of integrated environmental health and safety management systems is increasing and where these IMS are raising concerns about their capacity to minimize risk in one domain or another. So far, no study has investigated the implementation of integrated environmental health and safety management systems built from ISO 14001 and OHSAS 18001 norms. Such knowledge is cardinal to help explain the effects of such IMS. It is in this perspective that we have undertaken this first empirical study of an IMS built from ISO 14001 and OHSAS 18001. Our research questions address the mode of implementation, the degree of implementation and the effects of the IMS, as well as the contextual factors whose influence on the implementation help explain the variations in the degree of implementation and the effects of the IMS. This qualitative inquiry uses a single case study with multiple levels of analysis. Our purposeful sample of thirty five participants was drawn from different levels of hierarchy, including union executives and representatives. Our purposeful sample of plants consisted of seven ISO 14001 and OHSAS 18001 certified plants located in different cities in Quebec, Canada. These plants differed by their technology, their age, their size and their types of production. Our data were collected in 2004 from semi-directed interviews, direct observation during site visits, and consultation of documentation and assessment of functionalities of implemented management tools. Interviews were transcribed verbatim and their content was categorized based on the five dimensions of the IMS: commitment policy, planning, deployment, control and management review. Horizontal condensation preceded within case and transversal analysis, using both inductive and deductive approaches. Our results indicate two implementation modes: the enrichment mode and the fusion mode, both related to the functional structures in place. Despite its aim of continuous improvement, the IMS was unable to reconcile the two traditional approaches of top down and bottom up, which have dominated this implementation which was supported by four strategies: economy of resources, control of influence, low hanging fruits and the small steps strategy. In order to analyze the degree of the IMS implementation, we have taken into consideration two aspects of the process: The effort of structuring the IMS and the scope of utilization of the implemented processes. Our results showed evidence of variation in the degree of IMS implementation; this variation was observed among the plants as well as among the processes implemented at each one of the five IMS steps. The analysis of discourses has allowed the production of five hypotheses that support IMS structuring and utilization (i) Cohesion forces hypothesis (ii) Process specificity hypothesis (iii) Scope of process hypothesis (iv) Organizational readiness hypothesis (v) Acceptance of change hypothesis. IMS implementation was influenced by political, structural and organizational factors. These factors have played their influence by catalyzing non -linear interactions, during which their influence could be neutralized, added or reinforced, hence generating variations in the degree of implementation. Facilitating factors have affected the effort of IMS structuring and included: experience working with management system, upper management commitment, implication of union or of health and safety committee representatives, organizational structure, level of education, plant age and plant size. Inhibiting factors have affected mainly the utilization of implemented processes. These factors included: procedural heaviness, lack of time, lack of training, lack of resource, organizational culture, organizational structure, intergeneration gap and lack of union implication. Three proximal effects anticipated by the organization under study were observed. (i) Increase in the rigor of management is an effect which was associated with the application of IMS requirements. It implied EHS governance, integrated management mechanisms and production processes (ii) Standardization is an effect which was associated rather with the implementation mode. It implied EHS practices, tools, work methods and organization of resources. (iii) Rupture of departmental silo is an effect associated with the mode of implementation. It involved organizational structures, professional boundaries and the working relations and climate. These proximal effects have induced several emerging effects, which were more distal. These were: increased control power of the union; increased legitimacy of recommendations by EHS professionals; creation of inter-organizational network and knowledge transfer. The implementation of an integrated management system in environment, occupational health and safety has transformed EHS governance and practice in all seven plants. However, this was not sufficient to grant immunity to EHS risk management processes. The potential of IMS to dilute risks should be of concern to public health policies, as well as to risk prevention programs on environment and on occupational health and safety. Improvement of EHS risk management was an expected effect but was not observed at the moment of our study. Several contextual factors may have intervened to alter its occurrence. To this regard, knowledge transfer, reinforced by the emergence of intra-organizational networks, seem to offer a very promising and affordable alternative. This is one of the contributions of our study research, which, in addition has (i) proposed a nomenclature to classify the modes of implementation and effects of IMS (ii) proposed a detailed method to appreciate the degree of implementation (iii) stated the roles played by contextual factors in explaining variations in the degree of IMS implementation and in the production of effects (iv) proposed a hypothesis on IMS structuring and utilization (v) through the diversity of our sample, offered a plural and sound perspective on the dynamics of IMS implementation. This is the first field study of this new paradigm. To our knowledge, no other study has produced such results. Keywords : ISO 14001, OHSAS 18001, integrated management system, IMS, environment, Occupational Health and Safety, environmental risks, occupational health and safety risks, implementation analysis, implementation level, knowledge transfer.

A new model was developed to enhance the understanding of the full context of work associated hazards, to explore the connection between OHS performance and a systematic approach to safety, and to simplify approaches to OHS management. This Safe Place, Safe Person, Safe Systems model was derived from the literature and used as the basis for the development of a framework, consisting of 60 elements which was transformed into an assessment tool. This assessment tool was trialled with a pilot study on a medium sized manufacturing plant in the plastics industry, and the tool and Preliminary Report peer reviewed by an expert panel using the Nominal Group Technique. After refinements were made to the assessment tool it was applied to eight case studies that were drawn from advertisements. This qualitative study consisted of two parts: firstly the assessment using the Safe Place, Safe Person, Safe Systems framework; and secondly a controlled self assessment exercise to target improvements to three of the elements over a period of four months. The study illustrated that the Safe Place, Safe Person, Safe Systems framework could be successfully applied in a range of industries to promote OHS improvements and to provide a systematic, planned approach to fulfilling OHS responsibilities. The application of this framework highlighted that: there is a need for further education on the correct application of the risk assessment process and the responsibilities owed to contractors; techniques such as dynamic risk assessments are more suitable where the place of work is variable and hazards are unpredictable; more focus is needed on the appropriate management of hazardous substances with long term health consequences; and that the level of formality invoked for treating hazards does not necessarily equate to improved risk reduction outcomes. The Safe Place, Safe Person, Safe Systems framework was found to be applicable to small, medium and large organisations provided the assessment was scoped to a small division of relatively homogeneous activity to ensure a more representative hazard profile. This approach has provided a way forward to simplify OHS management and also offers practical direction for implementing a targeted OHS improvement program.

Orientador: Otávio José de Oliveira / Banca: Márcio Minto Fabricio / Banca: Adilson Renofio / Resumo: Para que as organizações sejam competitivas e aumentem as chances de sobrevivência no mercado competitivo, é necessária a gestão do processo produtivo cada vez mais eficiente. Nesta gestão são utilizados sistemas focados em qualidade, meio ambiente, segurança e saúde no trabalho, entre outros. A integração desses sistemas otimizam recursos, processos e melhoram a imagem da organização, influenciando, assim, a lucratividade. Esta dissertação tem como objetivo formular diretrizes para o planejamento e implementação de sistema de gestão integrada em empresas da construção civil. Para a elaboração deste trabalho, foi adotada a pesquisa qualitativa, exploratória, bibliográfica com a realização de dois estudos de caso sobre os elementos do sistema de gestão integrada de duas construtoras certificadas em ISO 9001, ISO 4001 e OHSAS 18001 fazendo com que o pesquisador, se ambiente ao universo de estudo. Um referencial teórico foi apresentado sobre as características do processo produtivo, sistema de gestão da qualidade, meio ambiente, saúde e segurança no trabalho e integração desses. Conclui-se que, o objetivo traçado, foi devidamente alcançado, pois foram apresentados os elementos do sistema de gestão integrada nas duas construtoras, sendo identificadas as boas práticas e pode-se propor, diretrizes para o planejamento e implamentação do sistema de gestão integrada em empresas da construção civil / Abstract: To ensure that organizations are competitive and increase the changes of survival in competitive market, it is necessary to management of the productive process ever more efficiently. This management systems are used raised in quality, environment, health and safety at work, among others. The integration of these systems optimize resources, process, and improve the image of the organization, influencing, thus, the profitability. This dissertation has like objetctive, formulate guidelines for the planning and implementation of integrated management system in civil construction companies. For this work was adopted the qualitative research, exploratory, bibliographic with the achievement of two case studies about the elements of the integrated management system of two construction companies certifieds in ISO 9001, ISO 14001, and OHSAS 18001 making the researcher, environment the universe of study. A theoretical reference was presented about the characteristics of the production process, a system of quality management, environment, health and safety at work and integration of these. It concludes that, the outlined objective was duly achieved, because the elements of integrated management system were submitted in the two construction companies, being identified the good practices and could propose, guidelines for the planning and implementation of integrated management system in civil construction companies / Mestre

Graduation theses is directed on the Management System and the characteristics of the company and its development since 2003. Theses is introduced on the Integrated Management System, which consists of the Quality Management System, the Environmental Management System and the Occupational Health and Safety Assessment Series. The theses is especially directed on the Occupational Health and Safety Assessment Series. Management System is analyzed and steps are recommended to improve these processes.

The provision of reliable, safe, affordable and accessible power supply is one of the most important cornerstones for economic development, particularly for third world countries. Notwithstanding all known benefits of power supply, there are environmental risks associated with electricity generation, transmission and usage that need to be identified, assessed and managed. These risks range from minor to major risks such as serious bodily harm and fatalities as well as environmental degradation. In order to minimise and control the operational risks, it is key for the sector to ensure that the risks are identified and assessed using appropriate tools and systems to ensure sustainability and safe work environments. This study explored, improved and designed a tool for environmental risk assessment within Swaziland Electricity Company, (SEC) based on clause 4.3.1 of ISO 14001 (2004), Environmental Management System and Occupational Health and Safety Assessment Series, OHSAS 18001 (2007), Occupational Health and Safety System. The previous risk assessment and evaluation tool used in the company ignored existing risk control practices employed and thus did not truly quantify identified risks. The methodology presented in this study focused on the identification of hazards/aspects and risks associated with processes in electricity generation, transmission and distribution. Risks were evaluated and all possible measures to control the identified risks were suggested. The top three significant hazards identified include; exposure to live wires, road hazards and the use of uncertified/ defective/wrong equipment and/or machinery whilst the significant impacts were: soil pollution, natural resource degradation/ depletion, loss of flora and fauna and social impacts. The distribution department was observed to have the most environmental risks when compared to the other departments. The developed tool and data could be used as baseline information by other sectors wishing to implement environment and safety systems. It will also continually improve the safety and environmental performance of SEC. / Environmental Science / D. Phil. (Environmental Science)

Introdução: segundo a literatura, sais de lítio podem produzir redução da função renal. A magnitude dessa informação é debatível, uma vez que não há estudo clínico randomizado e controlado entre usuários de lítio, em sua maioria pacientes com depressão ou transtorno bipolar. A possibilidade do uso do lítio para o tratamento da demência de Alzheimer prodrômica reforça a necessidade de maior investigação de efeitos adversos atribuídos ao lítio, especialmente com relação à função renal. Objetivos: avaliar a segurança da utilização do lítio em baixa dosagem com relação à função renal de pacientes idosos. Como objetivos secundários serão avaliadas: a segurança clínica através de exame e questionário específico, as funções tireoidiana, imunológica e o metabolismo glicêmico. Métodos: estudo randomizado e placebo controlado de 2 anos, seguido de fase aberta por mais 2 anos. Foram avaliados 59 idosos com comprometimento cognitivo leve com seguimento mínimo de dois anos (fase controlada). A função renal foi estimada através das fórmulas aMDRD e CKD- EPI, a partir de exames laboratoriais e dados clínicos coletados durante o estudo. As funções tireoidiana, imunológica e glicêmica foram avaliadas respectivamente através de TSH, T4 livre, leucócitos total, neutrófilos, linfócitos, glicemia e insulinemia de jejum, e HOMA-IR. A segurança clínica foi avaliada através de entrevista sistemática realizada a cada 3 meses, utilizando exame físico e a escala UKU para efeitos adversos. Resultados: não houve piora da função renal com o uso do lítio (litemia entre 0,25-0,5 mmol/l) tanto pela aMDRD (p=0,453) como pela CKD-EPI (p=0,181). Houve aumento significativo de neutrófilos (p=0,038) e do TSH (p=0,034). O grupo lítio apresentou incidência significativamente maior de diabetes mellitus (p=0,037) e arritmias (p=0,028), maior ganho de peso (p=0,015), mais sintomas na escala UKU (p=0,045), e maior interferência dos efeitos adversos do lítio em atividades diárias (p<0,001). Houve correlação entre a opinião de médico e do paciente nas interferências das atividades diárias atribuídas aos sintomas adversos (p<0,001). Conclusões: o uso de lítio em baixa dose não alterou a função renal, produziu alterações no sistema imunológico e tireoidiano sem impacto clínico, e foi seguro clinicamente. As razões do aumento de incidência de diabetes e arritmias merecem investigação posterior / Introduction: according to the literature, lithium salts may produce a reduction in kidney function. The magnitude of this information is debatable because there is no randomized and controlled clinical trial among lithium users, being mostly patients with depression or bipolar disorder. The possibility of using lithium for the treatment of prodromal Alzheimer\'s disease dementia increases the need for further investigation of adverse effects attributed to lithium, especially regarding to renal function. Objectives: To evaluate the safety of using low-dose lithium with respect to renal function in elderly patients. Secondary objectives were the evaluation of the clinical safety through specific questionnaire and clinical assessment, and to assess thyroid, immunological and glycemic function. Methods: a randomized and placebo controlled study for 2 years, followed by an open label follow-up of 2 years. We evaluated 59 elderly patients with mild cognitive impairment with accomplishment of at least two years of the controlled phase. Renal function was estimated by the aMDRD and CKD-EPI equation, and by laboratory and clinical data collected during the trial. The thyroid, immunological and glycemic functions were respectively evaluated by TSH, free T4, leukocyte count, neutrophil count, lymphocyte count, fasting plasma glucose and insulin, and the HOMA-IR. The clinical safety was evaluated through systematic examination performed every 3 months, with physical examination, clinical interview and UKU scale for adverse effects. Results: There was no decline of renal function with the use of lithium (litemia between 0.25-0.5 mmol/l) both in the aMDRD (p=0.453) and CKD-EPI (p=0.181) equations. A significant increase of neutrophils (p=0.038) and TSH (p=0.034) were observed. The lithium group showed significantly higher incidence of diabetes mellitus (p=0.037), arrhythmias (p=0.028), weight gain (p=0.015), more symptoms of UKU scale (p=0.045), and greater interference from the adverse effects of lithium during daily activities (p<0.001). There was an observed correlation between the opinion of the attending physician and the patient in respect to the interference in daily activities secondary to the adverse symptoms (p<0.001). Conclusions: The use of lithium in low doses did not result in renal function impairment, produced subtle changes in the immunological system and thyroid function, and was clinically safe for adverse effects. The reasons for the increased incidence of arrhythmias and diabetes mellitus deserve further investigation

Nowadays preservation of safety is one of the most important conditions for consequential air traffic development. That was the reason why the Safety Management System was formed by the ICAO. Thesis´ objective was especially to scrutinize all the aspects relating to implementation of this system. In the first place every component of the system was described, eventually its function. Next point was to draft an implementation plan for small aviation operators. Besides that ways and means of evaluating effectiveness of the system and expected benefits were described. The process of implementation was consulted with several aviation operators and organizations related to civil aviation whether from the Czech Republic or abroad. Their knowledge helped in many ways to make an issue of practical implementation of the Safety Management System clear. Finally it is true to say that the Safety Management System going to be an essential part of every aviation operator in few years.

Many healthcare organisations face repetitive incidents because organisations tend to fail to learn from the past. Learning from incidents (LFI) in healthcare is a process through which healthcare professionals and the organisation as a whole seek to understand adverse events that have taken place. The LFI process consists of five main steps: data acquisition, investigation and analysis, planning interventions, implementing interventions, and evaluations. In order to reduce the reoccurrence of incidents, it is important that LFI processes are improved. As a prerequisite, it is necessary to gain insight into the steps of the LFI process to identify hindrances (bottlenecks) and mitigate them. This thesis is a broad comparative study of the LFI processes in Dutch and Swedish healthcare systems. Cross-border comparisons between LFI systems can support mutual learning, and consequently lead to improvements of healthcare organisations’ learning processes. The study consists of an analysis of Swedish and Dutch legislation, national healthcare inspectorates, and hospitals’ learning from incidents processes. Legislation was analysed through a (legal) documentation study. Healthcare inspectorates’ practices in LFI were analysed by a combination of documentation studies, and by conducting interviews with one Dutch inspector, one Swedish inspector, and one Swedish development strategist. For analysis of hospitals’ LFI processes, a questionnaire and interview study with fourteen Dutch and eleven Swedish hospitals were conducted. Analysis of these processes was done at the hand of a number of quality statements developed based on a literature study. The main differences between how the two countries’ learn from incidents are in data acquisition, and investigation and analysis. The Netherlands have various reporting systems, as well as diversity in incident investigation methods. Sweden has more uniformity in these matters. Moreover, Sweden has a national system for sharing lessons learned between hospitals, which can benefit the learning process on a national level. The Netherlands currently does not have such a system. Sweden and the Netherlands have similar strengths and weaknesses in LFI. Both countries have accessible data acquisition systems, and it does not take much time to report incidents. There are however significant disparities between incidents and sentinel events in both countries in the quality of investigations and analyses, planning of interventions and implementation of interventions. The implementation and evaluation phases are also regarded to have the lowest quality, based on analysis of the quality statements. Dutch and Swedish legislation and the supervision of the healthcare inspectorates only cover these last two phases to a limited extent. Requirements with respect to incidents are also only formulated to a limited extent (except data acquisition), which may explain the significant difference of quality when compared to sentinel events. There are resemblances between the scopes of the legal frameworks and inspectorates, and the LFI processes in hospitals. There is therefore reason to believe that hospitals typically do not excel above what is required by legislation or by the healthcare inspectorates. / I många vårdorganisationer upprepar sig incidenter eftersom organisationer tenderar att misslyckas med att lära sig från incidenter. Att lära från incidenter (LFI) inom hälso- och sjukvården är en process genom vilket vårdpersonal och organisationen som helhet försöker förstå incidenter som har ägt rum. LFI-processen består av fem huvudsteg: datainsamling, utredning och analys, planering av åtgärder, implementering av åtgärder, och utvärderingar. För att minska upprepande av incidenter är det viktigt att LFIprocesser förbättras. Det här examensarbetet är en jämförande studie av LFI-processerna i holländska och svenska sjukvårdssystem. Gränsöverskridande jämförelser mellan LFI-system kan stödja ömsesidigt lärande och därmed leda till förbättringar av vårdorganisationernas lärande. Studien består av en analys av svensk och holländsk lagstiftning, nationella inspektioner och sjukhusens lärande från incidensprocesser. Lagstiftningen analyserades genom en (juridisk) dokumentationsstudie. Sjukvårdsinspektionernas praxis i LFI analyserades med en kombination av dokumentationsstudier och genom att göra intervjuer med en holländsk inspektör, en svensk inspektör och en svensk utvecklingsstrateg. För analys av sjukhusens LFI-processer genomfördes en enkätstudie och intervjustudie med 14 holländska och 11 svenska sjukhus. Analysen genomfördes med ett kvalitetsindikatorer som är baserade på en litteraturstudie. De viktigaste skillnaderna mellan hur de två länderna lär sig av incidenter är inom datainsamling och incidentutredning. I Nederländerna används många olika rapporteringssystem och utredningsmetoder för händelser. Sverige har mer enhetlighet i dessa frågor. Dessutom har Sverige ett nationellt system för att dela lärdomar mellan sjukhusen, vilket kan gynna lärningsprocessen på nationell nivå. Nederländerna har för närvarande inget liknande system. Sverige och Nederländerna har liknande styrkor och svagheter i LFI. Båda länderna har tillgängliga datainsamlingssystem och det tar inte mycket tid att rapportera incidenter. Det finns betydliga skillnader mellan incidenter och händelser som har medfört allvarliga vårdskador i båda länderna. Detta gäller kvaliteten på utredningar, planering av åtgärder och implementering av årgärder. Implementerings- och utvärderingsfaserna anses ha lägsta kvalitet, baserat på analys av kvalitetsindikatorerna. Holländsk och svensk lagstiftning och tillsynen av inspektionerna täcker dessa två sista faser endast i begränsad utsträckning. Krav på incidenter formuleras också endast i begränsad omfattning (förutom datainsamling), vilket kan förklara skillnaden i kvalitet jämfört med händelser som har medfört en allvarlig vårdskada. Det finns likheter mellan räckvidden av lagstiftningen och inspektionen, och LFIprocesserna på sjukhus i både länder. Det finns därför anledning att tro att sjukhus vanligtvis inte utmärker sig högre än vad som krävs enligt lagstiftningen eller av hälsooch sjukvårdsinspektionerna.

The construction sector is considered one of the most hazardous industries in the world. The reason for this is due to several factors. Earlier literature shows that a construction site can be dynamic as different types of objects or people are in constant motion. Difficulties arise when trying to predict safety hazards on-site. Collisions between objects or falling from a height are examples of hazardous situations that can occur onconstruction sites. In a construction environment, there are also static risks related to, for instance, dust, unsafe substances, and chemicals from paints, fuels, and solvents. Simultaneously, society is in an era of digitalization and innovation with, among other things, artificial intelligence (AI), drones, building information modeling (BIM), virtual reality (VR), augmented reality (AR), digital twins, internet of things (IoT), automation, robotics and sensor-technologies on the topic. These tools have the potential to improvecurrent safety management methods. At the same time, the attitudes towards the construction industry are associated with traditional working methods where digitalization and new technology are perceived to be moving at a slow pace.Technologies and digital methods for securing construction sites have mainly been investigated in controlled research settings and test projects. The research gap lies in the fact that there is not enough knowledge regarding the implementation of technologies and digital methods in more authentic construction site environments. The study aims to identify different technologies and digital tools within construction safetymanagement in the Swedish context. The purpose of this thesis is to provide a general understanding of the topic and to broaden the perspective on existing attitudes and behaviors toward digital tools and technologieswithin construction safety management. In this thesis, the focus is on construction sites during the production phase with their respective personnel. Other parts of the construction project process, such as the planning and design stages, are taken into account by exploring how these stages can contribute to safer constructionsites. To obtain empirical material, methods based on qualitative research have been suitable where semi-structured interviews and fieldwork have been conducted. The Technology Acceptance Model (TAM) has been used as a theoretical framework for the results and a thematic analysis has been used as a data analysis approach.The thesis has examined how construction sites can become safer with the help of digitalization and new technology. Attitudes and behaviors towards the implementation of digital tools and technology have also been investigated. The results indicate that there are different attitudes towards the implementation of digital tools and technologies concerning safety management in both the design and planning phase and the production phase. To summarize the results, many of the interview participants were positive towards using digital tools and technologies for safety purposes. However, they were also skeptical about the success of implementation due to factors such as cost, risks, traditional methods, and attitudes and behaviors. The attitudes and behaviors, in turn, affect the actual usage of construction safety management implementations.In this thesis, we hope to broaden the perspective on how digital tools and technology could contribute to safer construction sites and the attitudes and behaviors towards the matter. / Byggsektorn anses vara en av de mest riskfyllda branscherna i världen. Anledningen till detta beror på flera faktorer. Tidigare studier visar att en bygg- och anläggningsplats kan vara dynamisk då olika typer av föremål eller människor är i ständig rörelse. Svårigheter kan därmed uppstå i arbetet med att förutse säkerhetsrisker på plats. Kollisioner mellan föremål och fall från höjder är exempel på olyckor på byggarbetsplatser. I en bygg – och anläggningsmiljö finns det också statiska risker relaterade till exempelvisdamm, farliga ämnen och kemikalier från färger, bränslen och lösningsmedel. Samtidigt befinner sig samhället i en era av digitalisering och innovation med bland annat artificiell intelligens (AI), drönare, building information modeling (BIM), virtual reality (VR), augmented reality (AR), digitala tvillingar, internet of things (IoT), automation, robotik och sensorteknik, vilka uppmärksammas på bred front. Dessahjälpmedel har potential att driva utvecklingen av arbetsmiljö - och säkerhetsarbetet inom byggbranschen. Samtidigt förknippas attityderna till byggbranschen med traditionella arbetssätt där digitalisering och ny teknik upplevs gå långsamt.Idag finns det många tekniker och digitala metoder för att säkra bygg- och anläggningsplatser. Detta har dock främst undersökts i kontrollerade forskningsmiljöer och testprojekt. Forskningsgapet ligger i det faktum att det inte finns tillräckligt med kunskap om implementering av teknik och digitala metoder i mer autentiskabygg- och anläggningsplatser. Studien syftar till att identifiera olika tekniker och digitala verktyg inom byggarbetsmiljö och säkerhet i den svenska kontexten. Syftet med denna uppsats är att ge en allmän förståelse för ämnet och att bredda perspektivet på befintliga attityder och beteenden gentemot digitala verktyg och tekniker inom byggarbetsmiljö och säkerhet. I detta examensarbete ligger fokus på byggarbetsplatser under produktionsfasen. Andra delar av byggprojektprocessen, såsom planerings- ochprojekteringsfaserna, beaktas genom att undersöka hur dessa skeden kan bidra till säkrare byggarbetsplatser. För att få fram empiriskt material har metoder baserade på kvalitativa undersökningar varit lämpliga där semistrukturerade intervjuer och fältarbete har genomförts. Technology acceptance model (TAM) har använts som ett teoretiskt ramverk för resultaten och tematisk analys har använts för att redogöra för empirin.I denna studie har det undersökts hur bygg – och anläggningsplatser kan bli säkrare med hjälp av digitalisering och ny teknik. Attityder och beteenden till implementering av digitala verktyg och teknik har också undersökts. Resultaten tyder på att det finns olika attityder till implementering av digitala verktyg och tekniker gällande byggarbetsmiljö och säkerhet i såväl planering- och projekteringsfasen som produktionsfasen. Sammanfattningsvis kan sägas att många av intervjudeltagarna var positiva till att använda digitala verktyg och tekniker i arbetsmiljö – och säkerhetssyfte. Men de var också skeptiska till framgången med implementeringen på grund av faktorer som kostnader, risker, traditionella metoder, attityder och beteenden. Attityderna och beteendena påverkar i sin tur den faktiska användningen av nya implementeringarför arbetsmiljö och säkerhetshantering. I den här uppsatsen hoppas vi kunna bredda perspektivet på hur digitala verktyg och teknik kan bidra till säkrare byggarbetsplatser och attityder och beteenden i frågan.