Andrew Weyman

Critical trust: understanding lay perceptions of health and safety risk regulation

The binary opposition of trusting or not trusting is inadequate to understand the often ambiguous and contradictory ideas people possess about risk regulators, particularly when knowledge and experience of such institutions is limited. The paper reports qualitative and quantitative data from a major study of public perceptions (n = 30 focus groups) of UK risk regulators. We compare the complex and widely different ‘trust profiles’ of two regulatory organisations which are institutionally related (the Health and Safety Executive and the Railways Inspectorate) but very separate in the minds of our participants. The paper develops the notion of critical trust to interrogate the various ways in which people make sense of such organisations, as well as discussing the modes of reasoning that people deploy. The paper argues that views of participants are the outcome of a reconciliation of diverse perceptions concerning the role of the organisation, structural factors and the nature of the regulated risk.

Optimising workplace interventions for health and well-being:A commentary on the limitations of the public health perspective within the workplace health arena

Purpose – The purpose of this paper is to discuss contemporary approaches to workplace health and well‐being, articulating key differences in the intervention architecture between public and workplace health contexts and implications for intervention design.Design/methodology/approach – Contemporary practice is discussed in light of calls for a paradigm shift in occupational health from a treatment orientation to an holistic approach focused on mitigation of the causes of ill health and the promotion of well‐being. In practice, relatively few organizations have or seem able to engage with a broader perspective that encompasses challenges to health and well‐being associated with contextual organizational drivers, e.g. job design/role, workload, systems of reward, leadership style and the underpinning climate. Drawing upon insights from public health and the workplace safety tradition, the scope for broadening the perspective on intervention (in terms of vectors of harm addressed, theory of change and inter...

A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety

Objectives Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. Methods An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. Results Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. Conclusions Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).

Exploring Comparative Ratings and Constituent Facets of Public Trust in Risk Regulatory Bodies and Related Stakeholder Groups

This paper reports on two comparative ranking tasks performed by a sample of the British citizens (N = 304). The first was designed to compare levels of relative trust vested in a sample of UK risk regulatory bodies and associated stakeholder groups. The second sought to elicit a ranking of a range of previously identified facets of social trust referenced to their desirability as attributes of a government funded risk regulatory body. The ranking tasks were embedded within a broader programme of research focused on “Evaluating public understandings of and trust in the Health and Safety Executive” (Pidgeon et al., 2003). It is argued that deriving rankings of multi‐faceted phenomena using the method of paired comparisons offers a more robust approach to rating social trust entities than the direct ranking techniques used in previous studies in this area. Results are discussed with reference to qualitative findings from the broader programme of work on public trust in HSE (Pidgeon et al., 2003) and the wider literature on public trust in risk regulation.

Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

BackgroundParamedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making.MethodsThe study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified.ResultsThe use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas.ConclusionCombining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.

Extending working life and the management of change. Is the workplace ready for the ageing worker

Abstract Increasing longevity and the strain on state and occupational pensions have brought into question long-held assumptions about the age of retirement, and raised the prospect of a workplace populated by ageing workers. In the United Kingdom the default retirement age has gone, incremental increases in state pension age are being implemented and ageism has been added to workplace anti-discrimination laws. These changes are yet to bring about the anticipated transformation in workplace demographics, but it is coming, making it timely to ask if the workplace is ready for the ageing worker and how the extension of working life will be managed. We report findings from qualitative case studies of five large organisations located in the United Kingdom. Interviews and focus groups were conducted with employees, line managers, occupational health staff and human resources managers. Our findings reveal a high degree of uncertainty and ambivalence among workers and managers regarding the desirability and feasibility of extending working life; wide variations in how older workers are managed within workplaces; a gap between policies and practices; and evidence that while casualisation might be experienced negatively by younger workers, it may be viewed positively by financially secure older workers seeking flexibility. We conclude with a discussion of the challenges facing employers and policy makers in making the modern workplace fit for the ageing worker.

Workforce Management and the Retention of Older Staff: Macro and Organisational-Level Processes in the United Kingdom and South Korea

Abstract We discuss workforce management, related to those aged 50+ , in the United Kingdom and the Republic of Korea. With international competitiveness becoming increasingly crucial, retaining the ‘right’ mix of employees to achieve strategic organisational goals is likely to determine organisational success. However, we argue that workforce management is not only influenced by organisational-level strategy but also by national institutional and sectoral policies. Decisions on whether and how to retain older workers are therefore (co-)determined by institutional incentives and barriers to doing so. We find that British and Korean governments have legislated in favour of extended working lives and, hence, the retention of ageing workforces. In the United Kingdom, pension eligibility ages are being increased and in Korea mandatory retirement age has been raised to age 60. While changes to the UK pension systems leave individuals with the (financial) risks associated with extended working lives, the Korean government tries to protect individuals from financial hardship by enabling them to remain longer in their primary career. However, whether and how government regulation plays out depends on how organisations react to it. The Korean discussion, in fact, shows that there might be leeway: organisations might continue to externalise their employees early framed as honourable, or voluntary, early retirement, which might not be in the interest of the individual but very much in the interest of the organisation. It therefore appears as if the retention of ageing staff is not (yet) considered to be of strategic importance by many organisations in these countries.

PERCEIVED AREAS FOR FUTURE INTERVENTION AND RESEARCH ADDRESSING CONVEYANCE DECISIONS AND POTENTIAL THREATS TO PATIENT SAFETY: STAKEHOLDER WORKSHOPS

Background As part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention. Methods A total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample. Findings The two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety. Conclusions Feedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda.

Managing Work-Related Musculoskeletal Disorders – Socio-technical ‘Solutions’ and Unintended Psychosocial Consequences

Conducting a well-designed observational study within a dynamic and vibrant workplace presents unique challenges. In the case of musculoskeletal symptom reporting, difficulties of identifying appropriate interventions are amplified by the multifactorial nature of contributory risk factors. We report on our own observations of how seemingly well-matched work sites can suffer unintended and differing psychosocial consequences from implementing “ergonomics” interventions. Despite the apparent similarity in the four garment manufacturing companies included in this study, one stood out in terms of its musculoskeletal reporting rate; approximately seven times higher than any of the other sites. After conducting extensive assessments of work systems and work practices, it was evident that management and organizational culture was having a significant impact on the legitimacy and likelihood of symptoms reporting. Barriers to reporting were evident at the low incidence sites, but whether the high incidence site was a social amplification of symptom reporting or stemmed from a more receptive climate of reporting remains unclear.