Fatal occupational injury is a construction and management problem in the United States. Fatality rates among specialty trade contractors made up the largest percent of fatalities in construction at 62% per year. The purpose of this nonexperimental study was to examine the relationship between the quality of information in construction safety plans and construction safety among specialty trade contractors. The theoretical foundations for the study were Petersen'€™s accident/incident theory and work systems theory. The key research question was to examine the relationship between information quality and construction safety among specialty trade contractors. A survey with closed-ended questions was used to collect primary data from a self-selection sample of 134 specialty trade contractors in the United States. Spearman rank correlation coefficient (rs) was used to measure the strength of the relationship between information quality and construction safety. Results indicated that the quality of information in construction safety plans (measured by the relevance, accuracy, timeliness, and completeness of information) did not have any statistically significant relationships with construction safety among U.S. specialty trade contractors. Further research is needed to understand if the variables used in this study are relevant predictors for construction safety. This study connects with positive social change by bringing into focus quality information systems research required to improve safety among U.S. specialty trade contractors and provide safety professionals a direction for continuous safety improvement in the U.S. construction industry, thus benefitting construction stake holders.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13004号 / 論社医博第8号 / 新制||社医||9(附属図書館) / 32932 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 木原 正博, 教授 黒田 知宏 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Safety is an important concern within the construction industry.  Many different management strategies exist in the literature, but despite ambitious efforts to improve the safety and prevent accidents, the accident incidence is still unacceptably high. This paper examines the employment of a safety manager in the Swedish construction industry as a strategy to foster a better safety culture, and discusses how the safety manager should approach the project based organisation (PBO). The study uses an abductive approach with an iteration of interviews, observations and a literature study to gain deeper knowledge of the subject. The research comprises a cross sectional interview study of semi-structured interviews to narrate the role of the safety manager accompanied with a short survey. The study is limited to three projects of one Swedish construction company, and a new role not yet established in the company. Furthermore, the study uses a human resource management approach with focus on communities of practice and boundary spanning. The findings report that the safety managers take on a role as a boundary spanning link between well-established but unsynchronized communities of practice. The identified communities are the HR department and the PBOs. Furthermore, the safety manager functions as a “double-sided” boundary spanner, to broke knowledge and support employees to achieve a satisfactory safety culture.  However, the narratives express a present ambiguity and a need to clarify the role and its responsibilities regarding safety in the PBO. The thesis contributes with insights of the safety manager’s practice and discusses how safety knowledge should be transferred between communities of practice in the fragmented PBO and its high level of tacit knowledge. / Arbetsmiljö och säkerhet är ett viktigt ämne inom byggbranschen. Många olika strategier och metoder för att förbättra arbetsmiljön finns också tillgängliga. Trots detta inträffar alltför många olycksfall. Denna studie undersöker strategin att anställa en safety manager i den svenska byggbranschen för att främja en bättre säkerhetskultur samt diskuterar hur en safety manager bör utöva sin profession.  Ett kvalitativt abduktivt arbetssätt har tillämpats där intervjuer och observationer har växlats med litteraturstudier för att erhålla förståelse av ämnet. Studien är en multipel tvärsnittsfallstudie med semistrukturerade intervjuer samt en mindre enkätundersökning. Studien omfattar tre projekt i ett svenskt företag. Det teoretiska perspektivet utgår från, samt begränsas av koncepten human resource management (HRM), communities of practice och boundary spanning.  Resultatet visar att safety managern kan fungera som en boundary role som länkar ihop olika osynkroniserade communities. Det identifieras att effektiv boundary spanning kan ske mellan HR-avdelningen och projektorganisationerna samt mellan produktionsledningen och yrkesarbetarna inom projektorganisationerna. Safety managern blir en double-sided boundary spanner som knowledge broker samt en support för anställda för att främja en god säkerhetskultur. Resultatet visar samtidigt att det råder oklarheter kring rollen och att bland annat ansvarsområden behöver förtydligas för att nå full potential. Studien bidrar med insikter i hur safety manager-rollen uppfattas och hur den fungerar, samt hur den kan förbättras. Vidare bidrar studien med förståelse för hur rollen kan främja kunskapsöverföring avseende arbetsmiljö mellan communities där hög grad av tyst kunskap råder.

No / Estimates show that as many as one in 10 patients are harmed while receiving hospital care. Previous strategies to improve safety have focused on developing incident reporting systems and changing systems of care and professional behaviour, with little involvement of patients. The need to engage with patients about the quality and safety of their care has never been more evident with recent high profile reviews of poor hospital care all emphasising the need to develop and support better systems for capturing and responding to the patient perspective on their care. Over the past 3 years, our research team have developed, tested and refined the PRASE (Patient Reporting and Action for a Safe Environment) intervention, which gains patient feedback about quality and safety on hospital wards. Methods/design A multi-centre, cluster, wait list design, randomised controlled trial with an embedded qualitative process evaluation. The aim is to assess the efficacy of the PRASE intervention, in achieving patient safety improvements over a 12-month period. The trial will take place across 32 hospital wards in three NHS Hospital Trusts in the North of England. The PRASE intervention comprises two tools: (1) a 44-item questionnaire which asks patients about safety concerns and issues; and (2) a proforma for patients to report (a) any specific patient safety incidents they have been involved in or witnessed and (b) any positive experiences. These two tools then provide data which are fed back to wards in a structured feedback report. Using this report, ward staff are asked to hold action planning meetings (APMs) in order to action plan, then implement their plans in line with the issues raised by patients in order to improve patient safety and the patient experience. The trial will be subjected to a rigorous qualitative process evaluation which will enable interpretation of the trial results. Methods: fieldworker diaries, ethnographic observation of APMs, structured interviews with APM lead and collection of key data about intervention wards. Intervention fidelity will be assessed primarily by adherence to the intervention via scoring based on an adapted framework. Discussion This study will be one of the largest patient safety trials ever conducted, involving 32 hospital wards. The results will further understanding about how patient feedback on the safety of care can be used to improve safety at a ward level. Incorporating the ‘patient voice’ is critical if patient feedback is to be situated as an integral part of patient safety improvements.

The maritime industry is vital to the Swedish trade and economy. Shipping has less environmental impact per ton transported goods than other transport modes. Furthermore, ships use the sea as their roads, thus not requiring additional impact on the environment in the form of building roads or tracks to be able to transport goods or people. The aim of this thesis is to identify the characteristics of the safety management approach and safety management systems (SMS) in five Swedish companies operating in the Swedish shipping industry. It furthermore explores whether a new approach to safety management such as Safety II and resilience engineering can offer a complementary view to the current safety management. The study design of this thesis has been a multiple case study. A literature review has been performed to gain insights into the domain and safety management in the domain in specific. Data has been gathered through semi-structured interviews with 10 respondents working within shipping or crew management companies. Five of the respondents work ashore with safety management and five of the respondents work onboard as Chief Officers or Chief Engineer. Chief Officers as well as Chief Engineers have responsibilities regarding safety for their respective department and thus have management positions within the operations. The results show that the participating companies’ safety management and SMSs are of the reactive kind. There is furthermore a gap between work as imagined, WAI, and work as done, WAD, that affects the suitability of the routines, procedures and equipment used in operations. Complexity of a system is also a contributing factor when it comes to safety management, and in the participating companies, aspects regarding complexity were identified at a regulatory, organisational and operational level. This affects the possibility to create routines and procedures that correspond to the demands, variations and situations encountered in operations. It is suggested in this thesis that a Safety II approach to safety management, along with the use of resilience engineering to develop and enhance the domain’s adaptability, can serve as a complement to the current safety management approach. Being able to adapt, respond and manage various unforeseen situations is a way of ensuring safety in operations even in complex socio-technical systems. The resilience assessment grid, RAG, is suggested as a tool to be developed to be usable in the participating companies. The RAG could serve as a tool to taper the gap between WAI and WAD, as well as to provide input to the development of indicators other than accidents for improving safety. Furthermore, it could also facilitate learning from everyday operations and what is going well – the everyday successes in everyday execution of tasks involved in operations.

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.

Organisational and individual Health and Safety (H&S) competence is an essential element to the successful completion of a construction project in a safe way and without hazards to the health of all workforce. Under the Construction (Design and Management) (CDM) Regulations 2007, the client should take reasonable steps to ensure that the appointed duty-holders and engaged people are H&S competent to design, build or co-ordinate the project. Although the CDM Regulations 2007 and its Approved Code of Practice (ACoP) have established ‘Core Criteria’ to guide the client to assess duty-holders’ H&S competence in the outset of a project, it is still difficult for most inexperienced clients to discharge the duty of making the key decisions in H&S competence assessment. In order to help the client implement H&S competence assessment, it is important to develop a tool that can effectively and efficiently support the client to make reasonable decisions in the selection of H&S competent duty-holders. According to the findings of the case study of existing formal H&S competence assessment schemes undertaken as part of this work, H&S competence assessment was characterised as a subjective, qualitative and non-linear regulation-compliance checking process. In addition, the case study helped identify the latent shortcomings in the ‘Core Critiera’ and the operational drawbacks in current practice of implementing H&S competence assessment. Based on a review of Information Technology (I.T.) and Artificial Intelligence (A.I.) applications in construction, Knowledge-Based System (KBS) is identified as being a suitable tool to support decision-making in H&S competence assessment, mainly due to its appropriateness to solve regulation-compliance checking problems and support subjective and qualitative decision-making process. Following a decision-making framework for H&S competence assessment, a KBS decision-support model was developed, applying three mechanisms to support the reasonable decision-making for H&S competence assessment. In order to develop an appropriate and practical KBS for H&S competence assessment, a textual knowledge base was developed, specifying the minimum satisfaction standards and a rating indicator system for ‘Core Criteria’. As a result, an online KBS was developed using Java Server Pages (JSP) technology and MySQL. The online KBS applied the textual knowledge base to support the screen, rating, ranking and reporting decision-supporting mechanisms. Simultaneously, the case inquiry and expert inquiry facilities were also included in the KBS for effective decision-making. Finally, construction experts and practitioners in H&S management evaluated the validity and usability of the KBS through a questionnaire survey. The prototype KBS was borne out to be an effective and efficient decision-support tool for H&S competence assessment and have the potential to be applied in practice.

Trata-se de um estudo exploratório, descritivo de abordagem quantitativa, que teve por objetivo avaliar o processo de identificação do neonato admitido na unidade de terapia intensiva neonatal e semi-intensiva de um hospital privado no Município de São Paulo. A casuística compôs-se de 540 oportunidades de análise, selecionadas pela amostragem probabilística aleatória simples. A coleta de dados ocorreu no período de maio a agosto de 2010, por meio de um formulário, contendo as três etapas do processo de identificação: componentes de identificação, condições da pulseira e quantitativo de pulseiras. Os dados foram analisados em função da estatística descritiva, e sendo aplicado o teste estatístico com significância de 5%. No que diz respeito ao desempenho geral do processo, o percentual de conformidade foi de 82,2%. No que tange as três etapas integrantes do processo, o maior índice de conformidade (93%) foi atribuído a segunda etapa e o menor (89,3%) a terceira etapa, com diferença estatística significante (p=0,046). Em relação a primeira etapa, a presença do código de internação obteve (98,5%) de conformidade; na segunda,o melhor percentual (99,8%), foi atribuído à confecção correta da pulseira e na terceira, houve (88,5%) de conformidade para o grupo de neonatos em condições especiais, não apresentando diferença estatística significante p=0,895. Acredita-se que os achados deste estudo subsidiem as reestruturações necessárias no processo de identificação dos recém-nascidos e o estabelecimento de metas assistenciais e gerenciais, para a melhoria contínua da qualidade e da segurança dos pacientes. / This is an exploratory, descriptive study of quantitative approach, aiming to evaluate the identification procedure for newborns admitted to a neonatal intensive and semi-intensive care unit of a private hospital in the city of São Paulo. The sample consisted of 540 opportunities for analysis, selected by the simple random probability sampling. Data collection occurred between May and August 2010, using a form containing the three phases of the identification procedure: identification components, conditions of ID bracelet and quantitative of ID bracelets. Data were analyzed according to descriptive statistics and the statistical test was applied with a significance of 5%. Regarding performance of the general process, the percentage of compliance was 82.2%. Regarding the three phases of the process, the highest compliance rate (93%) was related to the second phase and the lowest (89.3%) to the third phase, with a statistically significant difference (p = 0.046). Regarding the first phase, the presence of a hospitalization code obtained (98.5%) of compliance, in the second, the best percentage (99.8%) was attributed to correct manufacturing of the ID bracelet and third, with (88, 5%) of compliance for the group of newborns under special conditions, showing no statistically significant difference p = 0.895. It is believed that the findings of this study will subsidize the necessary reorganization of newborn identification procedure and establishment of assistance and management of goals for the constant improvement of quality and patient safety.

Anualmente, dezenas de milhões de pacientes sofrem lesões incapacitantes ou morte devido a eventos adversos no mundo. Inúmeros são os fatores que contribuem para tal, dentre eles, as falhas de comunicação. Objetivos: identificar as não conformidades referentes aos eventos adversos: erro de medicação, flebite, queda e úlcera por pressão (UPP) que causaram dano permanente ou temporário, no triênio 2011-2013; analisar as causas raízes dos eventos adversos; estratificar os eventos relacionados às falhas de comunicação e avaliar se eram evitáveis. Método: Estudo quantitativo e exploratório-descritivo com coleta retrospectiva dos dados, desenvolvido em um hospital universitário, cuja amostra foi de 263 Relatórios de Não Conformidade. A análise dos dados ocorreu pela estatística descritiva e testes específicos. Resultados: Os eventos foram distribuídos em 39,9% de flebites, 32,7% de erros de medicação, 16% de UPP e 11,4% de quedas. A média de idade dos pacientes foi de 52,04 anos. 39,5% dos eventos ocorreram no plantão da manhã, sendo 33,1% nas UTI. Na maioria dos eventos, houve o envolvimento de mais de um profissional e, na análise de causa raiz, a maioria dos eventos apresentou mais de uma causa. 98,9% dos eventos resultaram em dano temporário e 69,2% foram considerados evitáveis. Na análise do fator comunicação, 71% dos eventos evidenciaram falha de comunicação. No erro de medicação, a prevalência foi de 53,5% com falhas na comunicação verbal e escrita; nas quedas, 36,7% apresentaram falha na comunicação verbal; nas UPP, 52,4% com falhas na comunicação verbal e escrita; nas flebites, falha na comunicação escrita em 37,1% dos eventos. Os auxiliares/técnicos de enfermagem participaram de 98,1% dos eventos com falhas na comunicação escrita. 96,8% dos eventos relacionados aos profissionais apresentaram falhas de comunicação verbal e escrita. Dos eventos que apresentaram falha de comunicação verbal, 97,5% resultaram em danos temporários. Dentre os eventos que apresentaram falha de comunicação, 82,3% foram considerados evitáveis. Conclusões: Os achados deste estudo contribuem para o aperfeiçoamento dos processos de trabalho em saúde e enfermagem, ensino e pesquisa, direcionando as ações dos gestores para a implantação de melhores práticas e a capacitação contínua dos profissionais. / Every year, tens of millions of patients suffer incapable hurting or they die from adverse events all over the world. Several factors are the causes of the events and the miscommunication is one of them. Objectives: to identify the no-conformities related to the adverse events: medication error, phlebitis, fall and pressure ulcer which caused permanent or temporary damage from 2011 to 2013; to analyze the root causes of the adverse events; to stratify the events related to miscommunication and to evaluate if they could be avoided. Methodology: Exploratory-descriptive-quantitative-study with retrospective data collection developed in a university hospital whose sample was provided by 263 Non Compliance Reports. The analysis was based on descriptive statistics and specific tests. Results: The events were divided up into 39.9 % of phlebitis, 32.7% of medication errors, 16% of pressure ulcer and 11.4% of falls. The average age of the patients was 52.04 years old. 39.5% of the events took place in the morning, 33.1% of them in intensive care units. In the most part of the events, there were at least two professionals involved. About the root cause, the most part of the events had more than one cause. 98.9% of the events resulted in temporary damages and 69.2% were considered avoidable. Analyzing the communication factor, 71% of the events revealed miscommunication existence. For errors in medication, 53.5% represent verbal and written communication failure; 36.7 % of the cases of falls presented verbal communication failure; 52.4% of the pressure ulcer had verbal and written communication failures; 37.1% of the phlebitis cases had written communication failures. The nursing assistants/technicians participated in 98.1% of the events with written communication failures. 96.8% of the events related to workers had verbal and written communication failures. There were temporary damages in 97.5% of the events in which there was the verbal communication failure. 82.3% of the events with verbal communication failure could be avoided. Conclusions: The findings resulted from this study can improve working, teaching and researches in health and nursing and also guide the managers for better practices and training of their staffs.

As instituições de saúde buscam melhorar a qualidade assistencial e segurança do paciente reduzindo agravos como a ocorrência da Úlcera por Pressão (UPP) pela análise dos processos que interferem neste resultado, um indicador de qualidade da enfermagem e serviços de saúde. Estudo objetivou analisar a ocorrência de Úlcera por Pressão em Unidades de Terapia Intensiva e a conformidade do uso de medidas preventivas pelos enfermeiros. Utilizando desenho descritivo exploratório com análise quantitativa, foram analisados dados sociodemográficos e clínicos de pacientes internados em quatro UTIs, incidência e prevalência de UPP, ações para prevenção registradas em prontuário, concordância entre enfermeiros e pesquisadora quanto subescores e escore total da escala de Braden e classificação de risco para UPP. Foram avaliados 346 pacientes, sendo 68 na UTI 1, 84 na UTI 2, 97 na UTI 3 e 97 na UTI 4. Desses, 61,8% eram do sexo masculino, média de idade 56 anos, tempo médio de internação nas UTIs 8,51 dias. A maioria apresentou escores médios na escala entre 13 e 16 na avaliação inicial. Cinqüenta e quatro pacientes (15,6%) foram admitidos na UTI com UPP e 40 (13,69%) pacientes desenvolveram UPP enquanto internados na UTI. Os pacientes que tiveram maior freqüência de UPP eram de alto risco com escores de 10 a 12. Houve predomínio de UPP na região sacral e de estágio II. A maioria desenvolveu-se entre o 2º e o 7º dia de internação e a maior freqüência ocorreu nos pacientes com idade 60 anos. Em 100% dos prontuários não havia registro de enfermagem sobre o risco do paciente para UPP. Havia 39,7% registros corretos de pele íntegra e 85,5% registros corretos da presença de UPP. Quanto ao registro do estadiamento da UPP, a maioria não apresentava conformidade com as recomendações internacionais. Os pacientes admitidos com UPP tiveram maior número de registro de medidas preventivas (57%), com maior freqüência para a hidratação da pele (80,3%) e uso do colchão caixa de ovo (66,9%). Vinte e dois enfermeiros participaram da avaliação da concordância dos dados dos pacientes com a pesquisadora. Tinham tempo médio de profissão de 5 anos e tempo de atuação nas UTIs de 2 anos e oito meses. Houve concordância geral para os escores das subescalas Percepção Sensorial, Mobilidade, Fricção e Cisalhamento. A subescala Umidade, obteve pobre concordância nas UTIs 2 e 4, e não houve concordância na UTI 3. Nas UTIs 3 e 4 não houve concordância para a subescala Atividade e nas UTIs 2 e 4 para a subescala Nutrição. Quanto ao escore total da escala de Braden e classificação em níveis de risco, a concordância ocorreu apenas nas UTIs 1 e 2 (Kappa > 0,5). Os resultados obtidos demonstram a necessidade da avaliação do processo da assistência de enfermagem, de modo a identificar a conformidade das ações de enfermagem e os aspectos que exigem mudanças institucionais, já que podem interferir na ocorrência da UPP visando à melhoria da qualidade e maior segurança para os pacientes internados em Unidades de Terapia Intensiva. / Health institutions seek to improve the quality of care and patient safety by reducing the occurrence of events such as pressure ulcers (PU) by the analysis of the processes that interfere with this result, an quality indicator of nursing and health services. Study aimed to analyze the occurrence of pressure ulcers in Intensive Care Units and the conformity with preventive measures used by nurses. Using an exploratory descriptive design with quantitative methods sociodemographic and clinical data of patients admitted to four ICUs were colected and analyzed, as well as incidence and prevalence of PU, actions for prevention recorded in patient records, agreement among the nurses and researcher related to Braden scale total score and subscores and classification of level of risk for PU development. There were evaluated 346 patients, 68 in ICU 1, 84 in ICU 2, 97 in ICU 3 and 97 in ICU 4. Of the total, 61.8% were male, mean age 56 years, mean lenght of ICU stay 8.51 days. Most ICUs had Braden mean scores in the range of 13 and 16 in the initial evaluation. Fifty-four patients (15,6%) were admitted to the ICU with UPP and 40 (13,69%) patients developed pressure ulcers while hospitalized in ICU. Patients who had higher frequency of UPP were in high risk with a score 10-12. PU were predominantly in the sacral region and stage II. Most ulcers developed between the 2nd and 7th day of hospitalization and occurred more frequently in patients aged 60 years. In 100% of the records nursing records about patient's risk for PU was not documented. There were 39.7% correct records about intact skin and 85.5% correct records about the presence of PU. As for the staging of the PU, the majority of nursing records were not in conformity with international recommendations. Patients admitted with PU had higher registration number of preventive actions (57%), more frequently related to hydration of the skin (80.3%) and use the eggcrate mattress (66.9%). Twenty-two 22 nurses participated in the appraisal of their agreement with the researcher about patient's collected data. Their average time of working in nursing was 5 years and time working in ICU was 2,8 years. There was general agreement for the scores of the subscales Sensory Perception, Mobility, Friction and Shear. Related to subscale humidity, poor agreement was obtained in ICUs 2 and 4, and no agreement was obtained in ICU 3. On ICU 3 and 4 there was no agreement for Activity subscale and in ICUs 2 and 4 for subscale Nutrition. Regarding the total score of the Braden scale and classification of risk levels, the correlation was observed only in ICU 1 and 2 (kappa > 0.5). The results demonstrate the need for evaluation of nursing care process in order to identify the compliance conformity of nursing actions and issues requiring institutional changes that may interfere with detection of the PU to increase quality of care and safety management of patients in intensive care units.