ABSTRACT Objectives: To develop and validate in an Australian setting, an instrument to effectively measure patient safety culture; to survey health care workers (HCWs) in a large public healthcare system to establish baseline patient safety culture; and, using the Theory of Planned Behaviour (TPB), to use behavioural modelling to identify the factors that predict and influence Patient Safety Behavioural Intent (PSBI) Eg. Reporting clinical incidents and speaking up when a colleague makes an error. Design: Cross sectional survey analysed with multiple logistic regression (MLR). Setting: Metropolitan, regional and rural public hospitals in Queensland, Australia. Participants: 5294 clinical and managerial staff. Main outcome measures: 1) Behavioural models for high-level Patient Safety Behavioural Intent (PSBI) for senior and junior doctors, senior and junior nurses, and allied health professionals. 2) Odds ratios to compare levels of PSBI between professional groups. Results: 1) The factors that influence high-level PSBI for each professional group give rise to unique predictive models. Two factors stand out as influencing high-level PSBI for all HCWs (R2 0.21). These are: i) Preventive Action Beliefs (Adjusted Odds Ratio (AOR) 2.38) (HCWs??? belief that engaging in the target behaviour(s) will lead to improved patient safety) and ii) Professional Peer Behaviour (AOR 1.79) (HCWs??? perceptions of the safety behaviour(s) of one???s professional peers). 2) There was a six-fold difference in the level of target behaviour (PSBI) across the clinical groups with few (29.6%) junior doctors having a high-level of PSBI. When compared with the junior doctors, the senior doctors were nearly 1.5 times more likely (Odds Ratio (OR) 1.46, 95% Confidence Interval (CI) 1.01-2.13), allied health staff 2.7 times more likely (OR 2.71, 95%CI 1.91-3.73), junior nurses 3.9 times more likely (OR 3.86, 95%CI 2.83-5.26), and senior nurses 6.0 times more likely (OR 6.01, 95%CI 4.78-9.16) to have high-level PSBI. Conclusions: This is the first published study to develop behavioural models of factors that influence HCWs??? intention to engage in behaviours known to be associated with improved patient safety. The findings of this study will greatly assist in the future design and implementation of targeted and cost-effective patient safety improvement initiatives.

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

Made available in DSpace on 2014-10-09T12:55:15Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:07:14Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2015-10-22T17:03:19Z No. of bitstreams: 0 / Made available in DSpace on 2015-10-22T17:03:19Z (GMT). No. of bitstreams: 0 / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:55:15Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:07:14Z (GMT). No. of bitstreams: 0 / Este trabalho tem como objetivo contribuir com o grupo de operadores do reator de pesquisa IEA-R1, localizado no IPEN CNEN/SP, com um estudo de fatores humanos, e possíveis causas que podem ocasionar falha humana propiciando a ocorrência de incidentes, acidentes e exposições de trabalhadores, aliado aos riscos inerentes à profissão. Acidentes no campo tecnológico, incluindo o setor nuclear, têm mostrado que a causa raiz está muito mais voltada à falha humana do que às falhas de sistemas e equipamentos, o que tem chamado a atenção de órgãos reguladores. A pesquisa proposta é quantitativa/qualitativa, e também, descritiva. Os dados foram coletados através da aplicação de dois questionários. O primeiro deles elaborado a partir dos atributos de cultura de segurança, descritos pela International Atomic Energy Agency IAEA. O segundo considerou fatores individuais e situacionais que compõem categorias classificadas como podendo afetar as pessoas no ambiente de trabalho. Utilizou-se também a transcrição, cuidadosamente selecionada, da fundamentação teórica, atendendo aos estudos de fatores humanos que podem desencadear acidentes. A metodologia demonstrou um bom grau de confiabilidade. O resultado deste trabalho indicou que fatores mediatos necessitam de atuação direta nas necessidades do grupo e do indivíduo. Esta pesquisa mostra que é necessário ter uma unidade de planejamento e organização, que seja realmente efetiva, tanto para questões da saúde, física e psicológica, como também, para a segurança no trabalho. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2015-10-22T17:03:19Z No. of bitstreams: 0 / Made available in DSpace on 2015-10-22T17:03:19Z (GMT). No. of bitstreams: 0 / A operação segura e confiável de usinas nucleares não depende só da excelência técnica do projeto e construção, mas também das pessoas e da organização. Por essa razão, a importância dos fatores organizacionais nos mecanismos causais de acidentes tem sido reconhecida por uma série de organizações de pesquisas na Europa, EUA e Japão. Deficiências nesses fatores revelam fragilidades na cultura de segurança da organização. Uma preocupação básica na avaliação de uma cultura de segurança é garantir que os instrumentos de pesquisa sejam válidos e confiáveis. Nas áreas de saúde e de segurança do trabalho há uma série de instrumentos para avaliar a cultura de segurança, para os quais são apresentados estudos de suas proporiedades psicométricas (confiabilidade e validade), mas muito pouco com essas qualidades na área nuclear. No caso específico do Brasil, nenhum. Portanto, o principal objetivo deste trabalho foi desenvolver um modelo capaz de avaliar com medidas válidas e confiáveis a cultura de segurança de instalações nucleares. O instrumento de pesquisa foi desenvolvido com base em princípios psicométricos estabelecidos para pesquisas quantitativas e, portanto, foram realizadas a análise da confiabilidade e as validações de conteúdo, de face e de construto. O instrumento foi aplicado nos institutos de pesquisa da Comissão Nacional de Energia Nuclear (CNEN), obtendo-se um total de 226 questionários respondidos. Os resultados da pesquisa possibilitaram caracterizar demograficamente os respondentes e identificar muitos aspectos fortalecidos, mas também algumas fragilidades na cultura de segurança dos institutos avaliados. O instrumento apresentou boas evidências de confiabilidade com o coeficiente alpha de Cronbach de 0,95 para o instrumento como um todo. A validação de construto foi realizada por meio de uma análise fatorial utilizando-se a Análise de Componentes Principais (ACP) e rotação fatorial ortogonal Varimax. Os resultados da análise fatorial permitiram concluir que o instrumento possui boas evidências de validade de construto, mas também sugeriram alguns ajustes no caso de uma nova aplicação do instrumento. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Background: Preventable medical error accounts for approximately 98,000 deaths in the hospital setting each year. A proposed solution to decreasing medical error encompasses the development of a culture of safety. Safety culture has been defined as a common set of values and beliefs that are shared by individuals within an organization that influence their actions and behaviors. In 2015, the safety culture of Registered Nurses (RN) and Patient Care Technicians (PCT) who regularly worked in the Intensive Care Unit (ICU) and Cardiovascular Intensive Care Unit (CVICU) at Flagstaff Medical Center (FMC) was assessed using the Hospital Survey on Patient Safety Culture. This survey functioned as a needs assessment and demonstrated that ICU/CVICU staff had negative reactions to safety culture and error reporting on eight of twelve composites tested. Based off these results, the Incident Decision Tree (IDT) was selected as an intervention to help improve the areas identified in the needs assessment. Purpose: The aims of this quality improvement project included: 1) Development of a protocol for IDT use by ICU/CVICU managers; 2) Implementing the IDT; and 3) Administering a post IDT implementation survey. Methods: The IDT was implemented during a 4-week period in the ICU/CVICU at FMC. During this time, managers used the IDT when processing reported error. Post implementation, an online survey was administered over the course of two weeks to ICU/CVICU managers and unit based RNs and PCTs to reassess their perceptions on the IDT, error reporting, and safety culture. Results: During the implementation period, 23 errors were reported in the ICU/CVICU at FMC with management utilizing the IDT a total of 12 times. Analysis of the reportable data demonstrated that of the 12 incidents, seven were attributed to system failures. The remaining five incidents were processed using the “foresight test.” Conclusions: Results from the post implementation survey demonstrated that ICU/CVICU staff felt the IDT contributed to a non-punitive environment. Staff also reported the IDT helped to increase communication after an error occurred. Lastly, the majority of staff felt the IDT increased transparency in the error reporting process.

Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis. Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV). Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety. / Baksidestext Intensive care represents potential patient safety challenges for critically ill patients. Human errors are the most common cause of incidents, and failures in team performance are identified as contributory factors. The measurements of patient safety culture and simulation-based team training are recommended initiatives to improve patient safety. The aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. The nurses had a positive perception of the overall patient safety culture. A potential for improvements were found in incident reporting, feedback and communication about errors and organizational learning. The RNs evaluated the simulation-based team training programme in a positive way. The assessments of nurses’ team performance with respect to communication, leadership and decision-making in a simulation-based emergency situation showed a variation in competencies from advanced novice to competent. There were differences between expert raters’ assessments and nurses’ self-assessments. The nurses perceived that simulation-based team training on a regular basis increases the awareness of clinical practice and acknowledges the importance of structured teamwork.

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

Studien har utförts på uppdrag av en avdelning som arbetar med säkerhet och kvalitet på ett svenskt kärnkraftverk. Avdelningen ansvarar bland annat för analys och värdering av säkerhetskulturen samt kunskapsspridning inom området. Bristande säkerhetskultur har vid flera tillfällen varit orsaken till kärnkraftsolyckor och ledarskap anses vara en viktig faktor för att utveckla och upprätthålla en stark säkerhetskultur. På kärnkraftverket arbetar skiftlag dygnet runt. Skiftlagen har i uppdrag att leda den operativa driften och varje skiftlag har en skiftchef. Denna studie har syftat till att undersöka skiftchefens beteenden och erfarenheter som ledare inom organisationen samt identifiera eventuella utveklingsområden gällande ledarskapet och dess förutsättningar.  Studien är kvalitativ och datainsamlingen består av nio intervjuer som analyserats via tematisk analys. Skiftcheferna som grupp uppvisar flera beteenden som enligt ledarskapsmodellen Stärkande ledarskap bidrar till mer säkra beteenden hos medarbetarna. Arbetsmetoder och de nära relationerna i skiftlaget är en möjlig faktor till att vissa beteenden som en stärkande ledare bör uppvisa främjas. Däremot framgår det att beteenden kopplade till bland annat att förklara företagsbeslut och mål, vilket är en viktig del i att upprätthålla en stark säkerhetskultur, inte uppvisas.  Skiftcheferna uttrycker flera utmaningar i sin roll och det framgår även en skillnad i hur skiftcheferna upplever att vara ledare och vad ett ledarskap innebär. Kärnkraftverket uppmanas att undersöka vidare hur man kollektivt kan arbeta med ledarskapsutveckling och vem som är i behov av att utveckla ledarskapskompetenser. / This study has been carried out on behalf of a unit working with safety and quality at a Swedish nuclear power plant. The unit is responsible for tasks such as analyzing and evaluating safety culture, as well as spreading knowledge within the field. Insufficient safety culture has been identified as a contributing factor to nuclear accidents, and leadership is considered an important factor in developing and maintaining a strong safety culture. The nuclear power plant is operated by shift teams on a round-the-clock basis, with each team being led by a shift manager. This study aims to investigate the behaviors and experiences of shift managers in their role as a leader within the organization and identify areas for development regarding leadership and its prerequisities.  The study is qualitative, and the data collection consists of nine interviews that have been analyzed using thematic analysis. The shift managers as a group show several behaviors that according to the leadership model of Empowering leadership contribute to safer behaviors from the employees. It is possible that the work methods and close relationships within the shift team promote certain behaviors that an empowering leader should demonstrate. However, it appears that behaviors linked to explaining company decisions and goals, which is an important aspect of maintaining a strong safety culture, are not shown.  The shift managers express sedveral challenges in their role and there is also a distinction in their perception of leadership and its implications. The nuclear power plant is encouraged to durther examine how they can collectively work on leadership development and identify indiciduals in need of developing leadership competencies.