Given the high number of errors and negative events committed within medical settings, the emphasis on patient safety culture is becoming more prevalent. Despite this effort, underreporting has been and continues to be an issue in this area. Some research has shown a link between underreporting and lack of management responsiveness, but more work is necessary to identify reasons for underreporting and potential mitigating solutions. The objective of the present research is to answer questions regarding the impact supervisors have on staff’s patient safety perceptions and event reporting, through the use of archival survey data collected with the AHRQ Hospital Safety Culture Survey (2004). Probable moderators and mediators of key relationships were explored as well. Results are presented and their implications are discussed herein.

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This study investigates developing the psychosocial safety climate in manufacturing companies in Sweden, by offering insights into following questions: How can organizations work to promote a positive psychosocial safety climate? & How can change management possibly help to develop a psychosocial safety climate? The study employed a qualitative research strategy, specifically a case study, which included various interviews. The study investigated three different departments consisting of office-based personnel. The topics emphasized in this study are psychosocial hazards, psychosocial safety climate, and the factors that help in developing the psychosocial safety climate. Moreover, the topic of leadership in relation to developing psychosocial safety climate, and change management as a tool that may help in developing psychosocial safety climate were also highlighted. The study concluded that: leadership & management is the key factor in promoting a positive psychosocial safety climate, since it impacts other factors investigated in the study, supportive policies, effective communication, work design, training & awareness, and support, resources & employee participation. Moreover, while viewing the development of psychosocial safety climate as a change, three phases with unique activities in each are essential to achieve the goal of a positive psychosocial safety climate. The phases investigated are planning, implementing and reinforcing.

O presente estudo tratou da validação do instrumento ICOS- Inventário de clima organizacional de segurança, no Brasil. Para tanto, o tema \"clima organizacional de segurança no trabalho\" foi estudado, a partir de pesquisas internacionais, onde já possui mais de 20 anos de estudo. Clima organizacional de segurança no trabalho é entendido como uma medida temporal da cultura de segurança e corresponde ao compartilhamento das percepções individuais sobre a organização. Tem caráter situacional e refere-se a um estado de segurança percebido em um local particular e em um determinado tempo. No Brasil, trata-se de um assunto em que não foram identificados estudos, mas que mostra sua relevância nos números de acidentes de trabalho e suas conseqüências financeiras, organizacionais e pessoais, cada vez mais preocupantes em nossa realidade. A amostra do estudo reuniu 334 trabalhadores da área industrial de uma usina de álcool e açúcar da região de Ribeirão Preto. Tratou-se de um estudo descritivo e quantitativo, que utilizou o método de levantamento de dados, através de 44 questões do questionário referido. O objetivo foi realizar a validação de constructo e preditiva da escala de medida, relacionando o clima organizacional de segurança no trabalho com as taxas de acidente de trabalho. Ao final, concluiu-se que a escala é válida, mas precisa de adaptações para ser aplicada para a realidade brasileira. Contudo, não mostrou correlações significativas na validação preditiva, quando comparada às taxas de acidente de trabalho da usina. A análise dos fatores de teste mostrou que variáveis como o setor e o tempo de empresa podem ter relação com o clima de segurança e com as taxas de acidente de trabalho. O estudo buscou contribuir para a implantação de melhorias na gestão de segurança do trabalho das empresas, fornecendo a análise de uma ferramenta de gerenciamento do ambiente de segurança organizacional. / The present study deals with the validation of instrument OSCI- Organizational Safety Climate Inventory in Brazil. The subject \"organizational safety climate\" is studied, from international research, where already it has been studied for more than 20 years. Organizational safety climate in the work is understood as a temporary measure of the safety culture and corresponds to the sharing of the individual perceptions on organization. It has situational character and one mentions a state of safety perceived in a particular place and one determined time. It is relatively unstable and subject to changes, depending on the characteristics of the current environment or predominant conditions. In Brazil, this is a subject not yet studied, but it demonstrates its relevance due the numbers of industrial accidents and its financial, organizational and personal consequences, each time more preoccupying in our reality. The sample of the study was the 334 workers of the industrial area of an alcohol and sugar plant in the region of Ribeirão Preto. The present study was characterized as descriptive and quantitative, with the data-collection method, using the 44 questions of the questionnaire. The purpose was to realize the construct and criterion validation of the measure scale, and can relate the organizational safety climate with the rates of occupational accident. It will expect to relate the organizational safety climate in the work environment with the rates of occupational accidents, what can lead to improvements of safety programs. At the end, it is concluded that the scale is valid but needs adjustments to be applied to the Brazilian reality, and showed no significant correlations in validating predictive. The analysis of the factors of test showed that variables such as section and time of work may have relationship with safety climate and with the rates of accidents. Anyway, the study sought to provide the analysis of a tool for managing the security environment organization.

A vulnerabilidade dos pacientes, que se submetem ao procedimento cirúrgico, e a complexidade de atividades e das relações interpessoais entre as equipes cirúrgicas são consideradas elementos intervenientes na segurança do paciente. Nesse sentido, pesquisas vêm sendo conduzidas visando mensurar o clima de segurança percebido pelos profissionais, com vistas a avaliar a cultura de segurança nos serviços de saúde. Objetivo: Realizar a adaptação transcultural e a validação do Safety Attitudes Questionnaire/Operating Room Version (SAQ/OR) para o contexto brasileiro. Método: Trata-se de um estudo de cunho metodológico, de adaptação e validação de um questionário destinado a mensurar o clima de segurança em centro cirúrgico, desenvolvido em duas etapas: a primeira consistiu na tradução linguística e na adaptação cultural e a segunda na validação do instrumento. Para a tradução e adaptação transcultural o método empregado foi constituído pelas fases: tradução, síntese, retrotradução, avaliação por comitê de juízes, pré-teste com 30 sujeitos e submissão e avaliação dos relatórios pelos autores do instrumento original. Doze juízes realizaram a validação das equivalências experiencial, conteúdo, conceitual, semântica e idiomática; o índice de Validade de Conteúdo estabelecido foi a 80%. Os dados desta etapa foram coletados de agosto de 2013 a abril de 2014. A validação de constructo do instrumento foi realizada pela análise fatorial exploratória e a análise da confiabilidade por meio do alpha de Cronbach. O questionário foi aplicado a uma amostra de 590 profissionais de saúde atuantes em centro cirúrgico, em quatro hospitais do Município de São Paulo. O período de coleta de dados foi de maio a agosto de 2014. Resultados: As etapas de tradução e retrotradução foram consideradas adequadas e a avaliação pelos juízes apresentou os seguintes resultados para as equivalências: experiencial 82,3%, de conteúdo 82,8%, conceitual 85%, de semântica 85,2% e idiomática 85,5%. A análise fatorial exploratória resultou em um questionário com 40 assertivas, sendo 30 alocadas em seis domínios, a saber: clima de segurança, percepção da gerência, percepção do estresse, condição do trabalho, comunicação no ambiente cirúrgico e percepção do desempenho profissional. Dez assertivas foram agrupadas em fatores que apresentaram alpha de Cronbach inferior a 0,50 e baixa correlação ao item total; assim não foram descritas como domínio. A versão adaptada mostrou-se confiável, obtendo o valor geral do alpha de Cronbach de 0,87. O domínio comunicação no ambiente cirúrgico apresentou o menor valor de alpha 0,59; nos outros cinco domínios os valores variaram de 0,71 a 0,82. Conclusões: Os achados desta pesquisa produziram a versão brasileira do questionário, denominada SAQ/Centro Cirúrgico, a qual foi adaptada e validada na amostra estudada. Contudo, recomenda-se a aplicação do questionário em outras instituições do país para proceder a novas análises psicométricas. / The vulnerability of patients, who have underwent a surgical procedure, the complexity of activities and the interpersonal relationships between surgical teams are considered intervening elements for patient safety. Thus, researches are being conducted aiming to measure the safety climate perceived by professionals, directed towards evaluation of the safety climate in healthcare services. Objective: Do the transcultural adaptation and validation of Safety Attitudes Questionnaire/Operating Room Version to Brazilian context. Method: This is a study, with methodological emphasis, of the adaptation and validation of a questionnaire intended for measuring the safety climate in surgical centers, and developed in two stages: the first was the linguistics translation and cultural adaptation, and the second was instrument validation. For the translation and transcultural adaptation, the method employed was constituted by the steps: translation, synthesis, retrotranslation, evaluation by a judges committee, pretesting with 30 subjects, and submittal to and evaluation of the reports by the authors of the original instrument. Twelve judges have executed the experiential, content, conceptual, semantics and idiomatic equivalences; the index defined for content validity was 80%. The data for this stage was collected from August 2013 to April 2014. The instrument construct validation was done through exploratory factor analysis and the reliability analysis through Cronbachs alpha. The questionnaire was applied to a sample of 590 health professionals working in surgical centers in four hospitals of the municipality of São Paulo. The data collection period went from May to August 2014. Results: The stages of translation and retrotranslation were considered proper, and the judges evaluation presented the following results for the equivalences: experiential 82.3%, content 82.8%, conceptual 85%, semantics 85.2%, and idiomatic 85.5%. The exploratory factor analysis resulted in a questionnaire with 40 statements, 30 of them assigned to six domains, that is: safety climate, management perception, stress perception, working conditions, communications in the surgical environment and professional performance perception. Ten statements were grouped in factors presenting Cronbachs alpha less than 0.50 and low correlation with the total item; thus, they were not described as a domain. The adapted version has proven reliable, reaching a general value of 0.87 for Cronbachs Alpha. The domain Communications on Surgical Environment presented the less value of 0.59 for Alpha; on the other domains the values varied from 0.71 to 0.82. Conclusions: The findings of this research resulted in a Brazilian version of the questionnaire, called SAQ/Centro Cirúrgico (SAQ/Surgical Center), which was adapted and validated through the studied sample. However, we recommend applying the questionnaire in other institutions of the country to do new psychometric analyses.

Introdução: A segurança do paciente tornou-se uma preocupação formal em diversos sistemas de saúde no mundo nas últimas décadas. Em 2004 a Organização Mundial da Saúde (OMS) propõe a Aliança para segurança do paciente e aponta a avaliação da cultura de segurança nas instituições de saúde como um dos aspectos chave para esse processo. Método: pesquisa transversal de abordagem quantitativa, realizada em um hospital de ensino no interior do estado de são Paulo entre os meses de março e abril de 2014. A população de estudo foi composta por todos os profissionais que faziam parte da escala de trabalho das unidades de terapia intensiva (UTI) adulto, pediátrica e neonatal e não se enquadravam no critério de exclusão (menos de 6 meses na unidade). Foram aplicados dois instrumentos para avaliação da cultura e clima de segurança do paciente, o Hospital Survey on Patient Safety (HSOPSC) e o Safety Attitudes Questionnaire (SAQ), e um instrumento para levantamento das informações sociodemográficas e profissionais. Para a análise de dados utilizou-se o teste de confiabilidade das escalas pelo Alfa de Cronbach. Foi verificada a presença de associações das escalas com variáveis de estudo pelo qui-quadrado de Pearson ou teste exato de Fischer nas variáveis qualitativas, a ANOVA para as variáveis quantitativas. A presença de correlação entre os instrumentos SAQ e HPSOPSC foi verificada pelo teste de correlação de Pearson. Resultado: os dados sociodemográficos quanto a sexo e idade e cargo foram homogêneos nas três UTI. A UTI Neonatal possuía profissionais com mais tempo de trabalho na unidade e na especialidade quando comparada as demais unidades. Ambas as escalas apresentaram boa confiabilidade pelo alfa de Cronbach, 0,853 para o SAQ e 0,889 para o HSPOSC. Na análise dos domínios do SAQ, observou-se pontuação 62 para as Condições de Trabalho e para Percepções da Gerência, enquanto para o HSPOSC a dimensão Resposta não punitiva aos erros obteve o menor percentual de repostas positivas (29,6%), e as dimensões Abertura da comunicação e Retorno da comunicação e das informações sobre o erro uma proporção de neutros maior de 30%. A nota total de segurança do paciente pelo HSPOSC foi de 85% (somados ótima e muito boa). Analisando-se o comportamento das UTIs através de cada escala, a UTI Neonatal apresentou maior satisfação no trabalho do que as demais UTIs. A UTI Adulto apresentou menores pontuações em cada domínio quando comparada com as demais e para os domínios do HSPOSC somente o domínio Abertura de comunicação obteve uma proporção de respostas positivas discretamente superior às demais UTIs. A correlação entre as escalas através da correlação de Pearson foi de força moderada (coeficiente de Pearson de 0,656). As respostas abertas evidenciaram que as mudanças ocorridas no hospital em decorrência dos processos de acreditação, contribuíram para a melhor percepção dos profissionais sobre a segurança do paciente. Conclusões: há diferenças de percepções quanto a segurança do paciente entre as UTIs dentro de um mesmo hospital, o que corrobora com a existência de microculturas locais. As escalas de avaliação de clima/ cultura de segurança do paciente parecem medir fenômenos semelhantes. / Introduction: Patient safety has become a formal concern in several health systems in the world, in the last decades. In 2004 the World Health Organization (WHO) proposes the Alliance for patient safety and aims safety culture evaluation in healthcare institutions as one of the key aspects to this process. Method: Cross-sectional quantitative research approach, performed in a teaching hospital in São Paulo State between the months of March and April 2014. The study population was composed of all the professional who were part of the work schedule of intensive care unit (ICU) adult, pediatric and neonatal and did not fit the exclusion criteria (less than six months in the unit). Two instruments for assessing the culture environment and patient safety, the Hospital Survey on Patient Safety (HSOPSC) the Safety Attitudes Questionnaire (SAQ), and an instrument for survey of demographic and professional information were applied. For data analysis, the test of reliability of the scales by Cronbachs alpha was used. The presence of associations of scales with study variables was checked by Pearsons chi-square test or Fishers exact test in the qualitative variables, the ANOVA for quantitative variables. The presence of correlation between the SAQ and the HPSOPSC instruments was tested by Pearson correlation test. Result: sociodemographic data regarding gender and age and position were homogenous in the three ICUs. Professional of the Neonatal ICU had worked longer time in this unit and specialty when compared to other units. Both scales showed good reliability by Cronbachs alpha, 0.853 for SAQ and 0.889 for HSPOSC. In the analysis of the SAQ domains, it was observed score 62 for Working Conditions and Perceptions of Management, while for HSPOSC dimension Non-punitive Response to Error had the lowest percentage of positive responses (29.6%), the dimension Open Communication and Return of Communication and Information on the Error a proportion of neutral responses more than 30%. The total score of patient safety by HSPOSC was 85% (summed up great and very good). Analyzing the behavior of ICUs through each scale, Neonatal ICU had higher job satisfaction than the other ICUs. Adult ICU had lower scores in each domain compared to other domains and for HSPOSC only the area Open Communication obtained the proportion of positive responses slightly superior to the other ICUs. The correlation between the scales through Pearson correlation was of moderate strength (Pearson correlation coefficient of 0.656). The open responses showed that changes in hospital as a result of accreditation processes, contributed to a better perception of professionals about patient safety. Conclusions: There are differences in perceptions of patient safety among ICUs within the same hospital, which corroborates the existence of local microcultures. Rating scales of climate/culture of patient safety seems to measure similar phenomena.

Il est préconisé de développer le climat de sécurité (CS) pour améliorer la sécurité des soins. Dans cette thèse, nous essaierons de préciser l’utilisation du concept de CS pour l’évaluation d'interventions d’amélioration de la sécurité des soins.Les objectifs des travaux présentés étaient d’élaborer un questionnaire de CS en français et d’évaluer l’impact de l’analyse de vignettes d’événements indésirables associés aux soins (EIAS) sur le CS d’unités de soins en milieu hospitalier.Ces travaux ont montré la faisabilité de mesurer le CS avec une version française du questionnaire américain, le Hospital Survey On Patient Safety Culture (HSOPSC). Ils ont permis de proposer une version française aux performances psychométriques suffisantes. Ils ont montré l’importance du rôle de l’encadrement, de l’organisation apprenante et du travail d’équipe entre services. La version française de l’HSOPSC a été utilisée pour évaluer l’effet de l’analyse de vignettes d’EIAS. Testée dans un essai contrôlé randomisé en clusters, cette intervention a amélioré les perceptions des professionnels sur l’organisation apprenante et l’amélioration continue, sans modifier les autres dimensions.Face à la difficulté de modifier dans un temps court l’ensemble des dimensions, le CS devrait être utilisé pour caractériser le contexte d'implémentation des interventions afin de les adapter et de mieux en comprendre l’impact, plutôt que pour servir de critère de résultat.Les pistes de recherche sont d’étudier la pérennité d’une intervention au-delà de son évaluation initiale au travers du maintien ou du développement de la culture de sécurité ; et d’étudier les perceptions des patients en matière de sécurité de soins / It is recommended to develop the safety climate (SC) to improve patient safety. In this thesis, we will try to clarify the use of the CS concept for the evaluation of interventions aiming to improve patient safety.The objectives of the articles presented were to develop a French version of a SC questionnaire and to assess the impact of a vignette-based analysis of adverse events (AEs) on the SC of care units.The studies demonstrated the feasibility of measuring the SC with a French version of the American questionnaire, the Hospital Survey On Patient Safety Culture (HSOPSC). They made it possible to propose a French version with sufficient psychometric performance. They showed the importance of the role of supervision, the organisational learning and teamwork between units. The French version of the HSOPSC was used to evaluate the effect of the vignette-based analysis of AEs. Tested in a randomized controlled cluster trial, this intervention improved professionals' perceptions of the organisational learning and continuous improvement, without modifying other dimensions.Given the difficulty of modifying all dimensions in a short period of time, SC should be used to characterize the context in which interventions are implemented in order to adapt them and better understand their impact, rather than being used as an outcome criterion.The research areas are to study the sustainability of an intervention beyond its initial evaluation through the maintenance or development of a safety culture; and to study patients' perceptions of care safety

Understanding safety factors in construction is critical to reducing accident frequency and severity. Grounded in the safety performance model, this study was conducted to examine the impact of psychological capital (PsyCap), which consists of the shared variance of hope, efficacy, resilience and optimism, and Past, Present, and Future thinking perspectives, on safety climate and performance. A nonexperimental quantitative design was used to determine whether PsyCap and thinking perspectives of construction project employees predicted safety performance and/or moderated the relationship between safety climate and performance across construction sites in different countries. 411 construction employees were recruited via a multistage and clustering strategy and took part in the study. The PsyCap Questionnaire, MindTime Profile Inventory, Group-Level Safety Climate Scale, and Safety Performance Measure were used to assess PsyCap, thinking perspectives, safety climate, and safety performance. Multiple regression was used to determine the effects of PsyCap and thinking perspectives on safety climate and safety performance. Results showed that Future and Present thinking predicted PsyCap as well as safety climate and safety performance in the construction industry. Further, safety performance accounted for variations in hope and efficacy, two PsyCap components. Findings might be used to influence thinking perspectives of team leaders in designing training, developing employees' efficacy levels, and preventing accidents and fatalities on construction sites.

Canadian statistics on patient safety in acute care hospitals are alarming. Hospital safety concerns are not isolated to patient safety. Occupational safety is also important. With increasing shortages of nurses, stress in the work place is growing. Nurses report high levels of absenteeism of 14.5 days per year. The importance of a just and fair culture and the role of nurse leaders have been emphasized in safety literature. Although deemed important, studies of nurse leaders and patient outcomes are limited. The influence of interactional justice in the workplace on nurse and patient safety has not been studied. The purpose of this study was to test and refine a model developed from the literature which explains the impact of perceived interactional justice, relational leadership, and quality of nurse manager – clinical nurse relationships on the nursing work environment and ultimately patient and nurse safety outcomes. The model was tested on a random sample of 266 Ontario acute care registered nurses. Findings indicated the model reasonably fit the observed data, however could benefit from further refinement. The addition of 2 pathways (span of control to nurses’ intent to leave and number of medication errors to nurse emotional exhaustion) and trimming of the insignificant paths improved the overall model fit. The resulting model indicates that resonant leadership style and interactional justice improves the quality of nurse leader-nurse relationships which in turn improves quality of the nurses’ work environment and safety climate. A positive safety climate led to a decrease in the number medication errors and nurses’ intentions to leave their unit. A higher quality work environment predicted lower nurse emotional exhaustion. Additionally, higher numbers of medication errors led to an increase in nurse emotional exhaustion. This suggests that distress may be associated with making a medication error or fear of consequences. As well, larger manager spans were associated with less nurse intent to leave. As the span increased, the number of support personnel also increased. Contrary to other research findings, this result suggests that supportive personnel may mitigate the effect of large manager spans of control on nurses’ intent to leave their units.