Rhona Flin

Measuring safety climate: identifying the common features

Abstract In UK industry, particularly in the energy sector, there has been a movement away from ‘lagging’ measures of safety based on retrospective data, such as lost time accidents and incidents, towards ‘leading’ or predictive assessments of the safety climate of the organisation or worksite. A number of different instruments have been developed by industrial psychologists for this purpose, resulting in a proliferation of scales with distinct developmental histories. Reviewing the methods and results from a sample of industrial surveys, the thematic basis of 18 scales used to assess safety climate is examined. This suggests that the most typically assessed dimensions relate to management (72% of studies), the safety system (67%), and risk (67%), in addition themes relating to work pressure and competence appear in a third of the studies.

Safety climate, safety management practice and safety performance in offshore environments

Safety climate surveys were conducted on 13 offshore oil and gas installations in separate years (N=682 and 806, respectively), with nine installations common to both years. In addition, data on safety management practices were collected by questionnaire from senior management on eight installations in each year. The associations between management practices and climate scores with official accident statistics and self-reported accident involvement were tested via a series of hypotheses. Associations were found between certain safety climate scales and official accident statistics and also the proportion of respondents reporting an accident in the previous 12 months. Proficiency in some safety management practices was associated with lower official accident rates and fewer respondents reporting accidents.

Safety culture: Philosopher's stone or man of straw?

Abstract This introductory paper to the special issue on Safety Culture considers some of the key issues relating to the nature, measurement and utility of this concept. It argues that there are many important questions still unanswered: what is safety culture and what is its theoretical basis (the question of definition), is it synonymous with safety climate, what are the essential characteristics of a ‘good’ safety culture and how might they be best measured, what are the reliability, validity and utility of existing measures of safety culture, and how does the concept contribute-if at all-to good safety systems and performance? Can an organizations safety culture be related to additional parameters (such as accident and incident performance) which are judged both within and outside the organization by the full range of stake-holders? Finally, the authors consider future issues and the future direction of work in this area.

Identifying and training non-technical skills for teams in acute medicine

The aviation domain provides a better analogy for the ”temporary” teams that are found in acute medical specialities than industrial or military teamwork research based on established teams. Crew resource management (CRM) training, which emphasises portable skills (for whatever crew a pilot is rostered to on a given flight), has been recognised to have potential application in medicine, especially for teams in the operating theatre, intensive care unit, and emergency room. Drawing on research from aviation psychology that produced the behavioural marker system NOTECHS for rating European pilots’ non-technical skills for teamwork on the flightdeck, this paper outlines the Anaesthetists Non-Technical Skills behavioural rating system for anaesthetists working in operating theatre teams. This taxonomy was used as the design basis for a training course, Crisis Avoidance Resource Management for Anaesthetists used to develop these skills, based in an operating theatre simulator. Further developments of this training programme for teams in emergency medicine are outlined.

Measuring safety climate in health care

Aim: To review quantitative studies of safety climate in health care to examine the psychometric properties of the questionnaires designed to measure this construct. Method: A systematic literature review was undertaken to study sample and questionnaire design characteristics (source, no of items, scale type), construct validity (content validity, factor structure and internal reliability, concurrent validity), within group agreement, and level of analysis. Results: Twelve studies were examined. There was a lack of explicit theoretical underpinning for most questionnaires and some instruments did not report standard psychometric criteria. Where this information was available, several questionnaires appeared to have limitations. Conclusions: More consideration should be given to psychometric factors in the design of healthcare safety climate instruments, especially as these are beginning to be used in large scale surveys across healthcare organisations.

Measuring safety climate on offshore installations

Abstract The human and organizational factors affecting safety were examined on 10 offshore installations using the Offshore Safety Questionnaire. The questionnaire contained scales measuring work pressure and work clarity, job communication, safety behaviour, risk perception, satisfaction with safety measures and safety attitudes. A total of 722 UK offshore workers (33% response rate) from a range of occupations completed and returned the questionnaire. The ‘safety climates’ on the various installations were characterized by most respondents feeling ‘safe’ with respect to a range of offshore hazards and expressing ‘satisfaction’ with safety measures. Respondents reported little risk-taking behaviour and felt positive about levels of work clarity and job communication. There was a wider diversity of opinions on the safety attitudes scale, indicating a lack of a positive, concerted ‘safety culture’ and more evidence for a range offragmented ‘safety subcultures’, which varied mainly as a function of seniori...

Developing a team performance framework for the intensive care unit

Objective:There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources:Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection:Studies investigating the relationship between aspects of teamwork and ICU outcomes, or studies testing factors that are found to influence team working in the ICU. Data Extraction:Teamwork behaviors associated with patient or staff-related outcomes in the ICU were identified. Data Synthesis:Teamwork behaviors were grouped according to the team process categories of “team communication,” “team leadership,” “team coordination,” and “team decision making.” A prototype framework explaining the team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature and to guide the development and testing of interventions for improving teamwork. Conclusions:Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others.

Leadership for safety: industrial experience

The importance of leadership for effective safety management has been the focus of research attention in industry for a number of years, especially in energy and manufacturing sectors. In contrast, very little research into leadership and safety has been carried out in medical settings. A selective review of the industrial safety literature for leadership research with possible application in health care was undertaken. Emerging findings show the importance of participative, transformational styles for safety performance at all levels of management. Transactional styles with attention to monitoring and reinforcement of workers’ safety behaviours have been shown to be effective at the supervisory level. Middle managers need to be involved in safety and foster open communication, while ensuring compliance with safety systems. They should allow supervisors a degree of autonomy for safety initiatives. Senior managers have a prime influence on the organisation’s safety culture. They need to continuously demonstrate a visible commitment to safety, best indicated by the time they devote to safety matters.

Anaesthetists' attitudes to teamwork and safety.

Summary A questionnaire survey was conducted with 222 anaesthetists from 11 Scottish hospitals to measure their attitudes towards human and organisational factors that can have an impact on effective team performance and consequently on patient safety. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. This measures attitudes to leadership, communication, teamwork, stress and fatigue, work values, human error and organisational climate. The respondents generally demonstrated positive attitudes towards the interpersonal aspects of their work, such as team behaviours and they recognised the importance of communication skills, such as assertiveness. However, the results suggest that some anaesthetists do not fully appreciate the debilitating effects of stress and fatigue on performance. Their responses were comparable with (and slightly more favourable than) those reported in previous ORMAQ surveys of anaesthetists and surgeons in other countries.

Rating non-technical skills: developing a behavioural marker system for use in anaesthesia

Studies of performance in medicine are often based on observation. Videotape provides a valuable tool for recording events from both real environments and simulators. When analysing observational data it is important that robust tools are used, particularly when investigating non-technical (cognitive and social) skills. This paper describes the method used to identify the key non-technical skills required in anaesthesia and to develop a behavioural marker system for their measurement. A prototype taxonomy was designed on the basis of a literature review; an examination of existing marker systems; cognitive task analysis interviews; an iterative development process involving workshops; and cross-checking in theatre. The resulting anaesthetists’ non-technical skills (ANTS) system comprises four skill categories (task management, team working, situation awareness, and decision making) that divide into 15 elements, each with example behaviours. Preliminary evaluation using ratings of videotaped scenarios indicated that the skills were observable and could be rated with reasonable agreement.