Kathleen L. McFadden

AVIATION HUMAN FACTORS: A FRAMEWORK FOR THE NEW MILLENNIUM

This paper presents a survey of the literature on human factors in airline safety and builds a conceptual framework for designing future safety studies. In our framework, factors are analyzed to determine their association with operational errors rather than accidents. Since operational errors occur with much greater frequency than accidents, our new approach allows for the analysis of the more complex relationships and interactions that occur among various factors. Results generated through the analysis of operational data can enhance the decision-making process and help reduce pilot-error accidents. We also include recommendations for how data should be collected and stored in order for researchers to more effectively analyze flight safety data.

Implementation of patient safety initiatives in US hospitals

Purpose – The purpose of this study is to explore the use of patient safety initiatives (PSIs) at the US hospitals. These PSIs include such approaches as open discussion of errors, education and training, and system redesign. In particular, the paper seeks to examine factors that influence the implementation of PSIs as well as the benefits realized from their implementation.Design/methodology/approach – The paper draws on the TQM and medical safety literatures to develop a conceptual framework for improving patient safety. Extensive survey data were gathered from 252 hospitals throughout the US to test McFadden et al.s model of the factors influencing successful implementation of PSIs.Findings – Certain barriers (lack of top management support, lack of resources, lack of incentives and lack of knowledge) significantly impeded implementation while other factors (perceived importance of PSIs) facilitated implementation. It was also found that implementation of PSIs was associated with benefits to the hospi...

Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

Background: Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. Purpose: We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. Methodology/Approach: The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. Findings: The results provide empirical evidence that a safety climate, which is connected to the chief executive officer’s transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. Practical Implications: The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

Student and Employer Perceptions of Desirable Entry-level Operations Management Skills

The purpose of this study is to determine whether there is a significant difference between employers and students on their perceptions of the importance of skills and traits critical for securing entry‐level employment in operations management. Another major concern in this study is whether employers value general skills more than technical abilities. To address our research questions, a two‐page questionnaire was developed. We found significant differences in mean scores between employers and students in their perceptions of the importance of general skills, technical skills, and personality characteristics. In addition, our findings indicate that employers value general skills significantly higher than technical skills. The results of this study provide a foundation for operations management programs in curricula reengineering and ultimately provide the business community with more qualified applicants.

Knowledge management as a mediator for the efficacy of transformational leadership and quality management initiatives in U.S. health care

Background: The health care industry has become one of the largest sectors of the U.S. economy and provides the greatest job growth of any industry. With such growth, effective leadership, knowledge management, and quality programs can ameliorate patient safety outcomes and improve organizational performance. Purposes: This exploratory study examines the efficacy of transformational leadership, knowledge management, and quality initiatives, each of which has been proven effective in health care organizations. The literature has neglected the relationships among these three types of programs, although they are increasingly implemented simultaneously now. This research tests the degree to which knowledge management could act as a mediator of the effects transformational leadership and quality management have on organizational performance for hospitals. Methodology: Our survey of U.S. hospitals utilizes validated scales from the literature. By calling and e-mailing quality and other department directors, the data set includes responses from all 50 states in our sample of 370 U.S. hospitals. Statistical tests confirmed acceptable regional distribution, interrater reliability, and control variable characteristics for our sample. Structural equation modeling is used to test the research hypotheses. Findings: These preliminary results reveal that transformational leadership and quality management improve knowledge management. In addition, transformational leadership is fully mediated by knowledge responsiveness and quality management is partially mediated by knowledge responsiveness for their effects on organizational performance. Practice Implications: The unique contribution of this study includes the suggestion that greater transformational leadership skills are important for health care executives to motivate successful knowledge management initiatives. Secondly, continuous improvements in quality management programs have significant positive impacts on knowledge management and organizational outcomes in hospitals. Finally, successful knowledge management initiatives are more closely tied to patient and organizational outcomes through the enhancement of knowledge responsiveness than by knowledge acquisition and dissemination alone.

Operations safety: an assessment of a commercial aviation safety program

Abstract Operations safety is an important issue in operations management. While prior studies have focused on the operational performance of various airlines and airports, few have assessed the efficacy of government airline safety programs. This empirical study evaluates a commercial aviation safety program that sanctions pilots with alcohol-related motor vehicle convictions. We compare a 5-year period prior to the implementation of the program against a 5-year period after implementation using data on over 160,000 commercial pilots. We conclude that the FAA’s handling of pilots with motor vehicle convictions has had a negligible effect on airline safety. These results have operational as well as public policy implications.

Simultaneous implementation of Six Sigma and knowledge management in hospitals

Six Sigma programmes aspire to reduce variation in organizational processes and achieve clear financial results. Six Sigma initiatives have proven to be an effective technique for improving quality in manufacturing. Similarly, the importance of knowledge management has grown considerably in recent years and has emerged as a major source of competitive advantage for manufacturing firms. From the perspective of a decision support system, knowledge management is concerned with information acquisition, dissemination, and responsiveness. Little research has examined simultaneous applications of Six Sigma and knowledge management. The purpose of this paper is to explore the usefulness of knowledge management for the implementation of Six Sigma in hospitals. We hypothesize that knowledge management will enhance the implementation of Six Sigma by leading to improvements of quality programme results and sustainable competitive advantage. The results of hierarchical regression analysis demonstrate that knowledge management does ameliorate the success of Six Sigma initiatives, specifically for knowledge dissemination and responsiveness. These results are discussed in terms of the contributions to existing theory and for managers of Six Sigma and knowledge management initiatives.

Contrasting continuous quality improvement, Six Sigma, and lean management for enhanced outcomes in US hospitals

Purpose - Rapidly rising healthcare costs, partially due to preventable medical errors, have led hospitals to redouble their process improvement (PI) efforts. The purpose of this paper is to examine how PI initiatives mediate the effect of medical error sources to enhance three hospital outcomes (patient safety, operational effectiveness, and competitiveness). Design/methodology/approach - Drawing from Dynamic Capabilities Theory, the authors develop a framework to explore three PI initiatives: Continuous Quality Improvement (CQI), Six Sigma Initiatives (SSI), and Lean Management Initiatives (LMI). Hierarchical regression analysis is employed to test the proposed model, using data from a nationwide survey of 210 US hospitals. Findings - For enhancing patient safety outcomes, it was found that CQI and LMI were significant in mediating hospital error sources; however, SSI was not significant after accounting for the other two PI types. For improving organizational effectiveness, CQI and SSI were significant; whereas LMI was not significant over and above the other two PI types. Finally, only SSI was significant for superior sustainable competitive advantage. Research limitations/implications - The paper provides insight into which PI initiatives were most effective for various hospital outcomes. The findings can benefit healthcare practitioners as they select among different PI programs for enhancing healthcare results. Limitations of the study include the use of perceptual measures, relatively small sample size, and potential alternate relationships relevant to the outcome variables. Originality/value - This is the first study to explore the mediating effects of three PI programs for the impact of medical errors on each of three hospital outcomes.

Comparing pilot-error accident rates of male and female airline pilots

This study analyzes whether differences existed in the pilot-error accident rates of male and female United States airline pilots. Results are based on data of aviation accidents in the years 1986-1992, obtained from the Federal Aviation Administration. The study found that females employed by major airlines had significantly higher accident rates than their male counterparts overall. However, female airline pilots, on average, were less experienced and much younger than males. Male pilot-error accidents were modeled using logistic regression, regressing on age, experience (total flying hours), risk exposure (flying hours in the last 6 months), and employer (major/non-major airline). The male model provided a good fit for female airline pilots as well as for males. After adjusting for variables included in the model, accident rates of males and females were not significantly different. These findings suggest that neither males nor females are a safer pilot group. Airlines should make every effort to recruit and retain experienced females. The key challenge for managers of airline flight operations is to learn how to manage diversity in the workplace, while maintaining the highest level of safety.

PREDICTING PILOT-ERROR INCIDENTS OF US AIRLINE PILOTS USING LOGISTIC REGRESSION

In a population of 70,164 airline pilots obtained from the Federal Aviation Administration, 475 males and 22 females had pilot-error incidents in the years 1986-1992. A simple chi-squared test revealed that female pilots employed by major airlines had a significantly greater likelihood of pilot-error incidents than their male colleagues. In order to control for age, experience (total flying hours), risk exposure (recent flying hours) and employer (major/non-major airline) simultaneously, the author built a model of male pilot-error incidents using logistic regression. The regression analysis indicated that youth, inexperience and non-major airline employer were independent contributors to the increased risk of pilot-error incidents. The results also provide further support to the literature that pilot performance does not differ significantly between male and female airline pilots.