Garry C. Gray

Socially constructing safety

Social scientific perspectives on occupational safety largely characterize it as a disembodied, tangible, and easily quantifiable phenomenon. Recent research efforts have focused on exploring organizational conditions that predict occupational safety outcomes, resulting in top-down, often de-contextualized prescriptions about how to control safety in the workplace (e.g. ‘management should promote a culture of safety’). There is growing interest in how social processes of organizing, wider socio-cultural considerations, and the situated production of safety can contribute to the appreciation of the ‘lived experience’ of life and death at work. This Special Issue focuses on the socially constructed nature of occupational safety and the insight it provides in understanding broader social and organizational processes. In this article, we first describe how various social scientific disciplines share an interest in occupational safety and organizational behavior, yet rarely speak to another. We provide an overview of the five articles that comprise the Special Issue, and briefly highlight some ways forward for studying safety in organizations.

Governing Inside the Organization: Interpreting Regulation and Compliance

Looking inside organizations at the different positions, expertise, and autonomy of the actors, the authors use multisite ethnographic data on safety practices to develop a typology of how the regulator, as the focal actor in the regulatory process, is interpreted within organizations. The findings show that organizational actors express constructions of the regulator as an ally, threat, and obstacle that vary with organizational expertise, authority, and continuity of relationship between the organizational member and the regulator. The article makes three contributions to the current understandings of organizational governance and regulatory compliance, thereby extending both institutional and ecological accounts of organizations’ behavior with respect to their environments. First, the authors document not only variation across organizations but variable compliance within an organization. Second, the variations described do not derive from alternative institutional logics, but from variations in positions, autonomy, and expertise within each organization. From their grounded theory, the authors hypothesize that these constructions carry differential normative interpretations of regulation and probabilities for compliance, and thus the third contribution, the typology, when correlated with organizational hierarchy provides the link between microlevel action and discourse and organizational performance.

A qualitative narrative policy framework? Examining the policy narratives of US campaign finance regulatory reform:

In 2010, the narrative policy framework was introduced as a positivist, quantitative, and structuralist approach to the study of policy narratives. Deviating from this central tenet of the narrative policy framework, in this article we show that the framework is quite compatible with qualitative methods—and the various epistemologies associated with them. To demonstrate compatibility between qualitative methods and the Narrative Policy Framework, we apply classic qualitative criteria to an illustrative case examining policy narratives in US campaign finance reform. Drawing on elite interviews, we illuminate competing policy narratives rooted in distinct democratic values that exhibit variation in how victims and harm are defined, how blame is attributed to villains, what policy solutions are put forth, and policy narrative communication strategies. Our incorporation of qualitative methods within the narrative policy framework is critical for the frameworks overall development as it provides opportunities for more detailed description, inductive forms of inquiry, and grounded theory development in policy areas where sample sizes, access, and salience may limit quantitative approaches.

The Ethics of Pharmaceutical Research Funding: A Social Organization Approach

This paper advances a social organization approach to examining unethical behavior. While unethical behaviors may stem in part from failures in individual morality or psychological blind spots, they are both generated and performed through social interactions among individuals and groups. To illustrate the value of a social organization approach, a case study of a medical school professors first experience with pharmaceutical-company-sponsored research is provided in order to examine how funding arrangements can constrain research integrity. The case illustrates three significant ways that institutional corruption can occur in the research process. First, conflicts of norms between pharmaceutical companies, universities, and affiliated teaching hospitals can result in compromises and self-censorship. Second, normal behavior is shaped through routine interactions. Unethical behaviors can be (or can become) normal behaviors when they are produced and reproduced through a network of social interactions. Third, funding arrangements can create networks of dependency that structurally distort the independence of the academic researcher in favor of the funders interests. More broadly, the case study demonstrates how the social organization approach deepens our understanding of the practice of ethics.

Something Might be Missing From Occupational Health and Safety Audits: Findings From a Content Validity Analysis of Five Audit Instruments

Objective: The objective was to examine the content validity of occupational health and safety (OHS) management audit methods. Methods: The documentation used by five broader public sector service organizations to audit OHS management in workplaces was analyzed with reference to a recent OHS management standard (CSA Z1000). Results: A relatively high proportion of CSA Z1000s content (74%) was partially or fully represented on average in the audit methods. However, six management elements were found to be incompletely represented in three or more of the methods. The most extreme example is the Internal Audits element whose content was completely missing for three of the audit methods. Conclusion: Some OHS management audit instruments in current use are incomplete relative to a recent OHS management standard. It may be that some instruments warrant revision to better reflect current expert consensus.

Making time for learning-oriented leadership in multidisciplinary hospital management groups.

Background: Although the clinical requirements of health care delivery imply the need for interdisciplinary management teams to work together to promote frontline learning, such interdisciplinary, learning-oriented leadership is atypical. Purpose: We designed this study to identify behaviors enabling groups of diverse managers to perform as learning-oriented leadership teams on behalf of quality and safety. Approach: We randomly selected 12 of 24 intact groups of hospital managers from one hospital to participate in a Safety Leadership Team Training program. We collected primary data from March 2008 to February 2010 including pre- and post-staff surveys, multiple interviews, observations, and archival data from management groups. We examined the level and trend in frontline perceptions of managers’ learning-oriented leadership following the intervention and ability of management groups to achieve objectives on targeted improvement projects. Among the 12 intervention groups, we identified higher- and lower-performing intervention groups and behaviors that enabled higher performers to work together more successfully. Findings: Management groups that achieved more of their performance goals and whose staff perceived more and greater improvement in their learning-oriented leadership after participation in Safety Leadership Team Training invested in structures that created learning capacity and conscientiously practiced prescribed learning-oriented management and problem-solving behaviors. They made the time to do these things because they envisioned the benefits of learning, valued the opportunity to learn, and maintained an environment of mutual respect and psychological safety within their group. Practice Implications: Learning in management groups requires vision of what learning can accomplish; will to explore, practice, and build learning capacity; and mutual respect that sustains a learning environment.

A Model for Development and Delivery of a Graduate Course in Transdisciplinary Research.

Health problems arise as a result of extremely complex processes and interactions, and finding a solution often requires going beyond traditional unidisciplinary approaches. Transdisciplinary (TD) approaches— where one integrates multiple disciplinary approaches and perspectives—provide a unique lens through which to view emerging complex health problems.1 Transdisciplinarity does not refer to a method but, rather, to an approach toward research.2 It requires the use of a common conceptual framework that goes beyond disciplinary boundaries in research concepts and methods, and involves collaborations not only among researchers from different disciplines, but also between researchers and nonacademic stakeholders. The desired result is a shared understanding that is broader and deeper than one likely to emerge from within a single discipline alone. Furthermore, transdisciplinarity does not end when knowledge is produced. Rather, it facilitates a constant flow between knowledge and practical application.3 The TD approach is particularly well suited to the field of occupational health as well as public health research and practice given the diverse and complex pathways through which the work environment influences worker health and safety.4 TD research has a further advantage in that it has the potential to overcome the obstacles of implementing research findings into practice and public policy. Implementation is done through the action-research approach that characterizes transdisciplinarity.5 The action-research approach involves a dual commitment to study a system (e.g., a workplace) and to concurrently collaborate with members of the system in changing it into what is together regarded as a desirable direction. In other words, the end product of a project is not only the publication of research findings, but also the implementation of those findings into real-world, tangible solutions. Health-care literature emphasizes that undergraduateand graduate-level education is the most critical time to receive TD experience,6,7 and at least one prestigious university (Harvard University) correspondingly includes transdisciplinarity in its teaching philosophy. However, this teaching philosophy has not become translational given that the university offers no courses that focus directly on the integration of different disciplinary approaches.8 Previous attempts at one university to apply an interdisciplinary approach to nursing education by simply combining students into groups of various disciplines proved unsuccessful9 and illustrated the need for adequate curriculum adaptation, preparation, and planning. Additionally, few resources in general provide information or guidelines on how to design, implement, and teach a TD-oriented program.9 In this article, we describe and discuss the development and delivery of the first TD course at the Harvard School of Public Health (HSPH), and present the argument that such a course provides a positive and lasting contribution to students of occupational health and the academic field in general.