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During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer., (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)

Background: Hospitals should adopt multiple methods to monitor incidents for a comprehensive review of the types of incidents that occur. Contrary to traditional incident reporting systems, the Green Cross (GC) method is a simple visual method to recognise incidents based on teamwork and safety briefings. Its longitudinal effect on patient safety culture has not been previously assessed. This study aimed to explore whether the implementation of the GC method in a postanaesthesia care unit changed nurses' perceptions of different factors associated with patient safety culture over 4 years., Methods: A longitudinal quasi-experimental pre-post intervention design with a comparison group was used. The intervention unit and the comparison group, which consisted of nurses, were recruited from the surgical department of a Norwegian university hospital. The intervention unit implemented the GC method in February 2019. Both groups responded to the staff survey before and then annually between 2019 and 2022 on the factors 'work engagement', 'teamwork climate' and 'safety climate'. The data were analysed using logistic regression models., Results: Within the intervention unit, relative to the changes in the comparison group, the results indicated significant large positive changes in all factor scores in 2019, no changes in 2020, significant large positive changes in 'work engagement' and 'safety climate' scores in 2021 and a significant medium positive change in 'work engagement' in 2022. At baseline, the comparison group had a significantly lower score in 'safety climate' than the intervention unit, but no significant baseline differences were found between the groups regarding 'work engagement' and 'teamwork climate'., Conclusion: The results suggest that the GC method had a positive effect on the nurses' perception of factors associated with patient safety culture over a period of 4 years. The positive effect was completely sustained in 'work engagement' but was somewhat less persistent in 'teamwork climate' and 'safety climate'., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aims to investigate the influence of teamwork and safety climate on nurses' speaking up for patient safety concerns and unprofessional behaviors., Design: This study incorporates a cross-sectional research design., Methods: The study included 217 surgical nurses employed in a Turkish university hospital. The research data were collected between April and June 2023 using the Teamwork Climate, Safety Climate Survey, Speaking Up Climate for Patient Safety, and Speaking Up Climate for Professionalism instruments. The relationships between these scales were assessed using Pearson correlation analysis. The Turkish validity and reliability of the Speaking Up Climate for Patient Safety and Speaking Up Climate for Professionalism scales were verified. The research model was tested using path analysis., Findings: The mean age of the 217 surgical nurses was 25.88 ± 5.64 years. Teamwork climate showed a positive effect on safety climate and speaking up climate about patient safety concerns and unprofessional behaviors. Safety climate showed a positive association with nurses' speaking up climate about patient safety concerns and unprofessional behaviors., Conclusions: Teamwork climate and safety climate both positively affect the speaking up climate about patient safety concerns and unprofessional behaviors. Nurse managers who wish to promote a culture of speaking up about patient safety and unprofessional behaviors should prioritize improvements in the teamwork climate and safety climate., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Huddles are brief team meetings designed to communicate essential information. Safety huddles provide a forum to identify and review patient safety events. In a just culture, everyone is accountable for patient safety., Purpose: The purpose of this project is to discuss safety issues/events at the twice daily bed capacity huddles in a Level IV Neonatal Intensive Care Unit (NICU) utilizing a just culture model. Having daily discussions of patient safety and the escalation process for follow-up promotes a just culture. The aims are to improve the unit's culture of safety and learn from patient safety issues., Methods: A just culture model was adopted to promote discussion of safety events during the huddles. A structured checklist of safety events was utilized along with a script of ground rules. Twice a day, a multidisciplinary group gathers to huddle. Nurse leaders facilitate the discussion, track the results, and provide follow-up., Results: The structured safety huddle began in May of 2020 and continues twice daily. All required staff attend. The escalation process is defined and has prevented recurrence of some safety issues. The NICU experienced a 14% increase in favorable results on the Agency for Healthcare Research and Quality (AHRQ) culture of safety survey since the inception of the structured safety huddles., Implications for Practice and Research: Safety huddle discussions have impacted the culture of safety on this unit. Tracking of discussions can help to identify trends, improve processes, and impact patient safety., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by The National Association of Neonatal Nurses.)

Introduction: Tower cranes are commonly employed in construction projects, despite presenting significant hazards to the workforce involved., Method: To address these safety concerns, a Knowledge-Based Decision-Support System for Safety Risk Assessment (KBDSS-SRA) has been developed. The system's capacity to thoroughly evaluate associated risks is illustrated through its utilization in various construction endeavors., Results: The system accomplishes the following goals: (1) compiles essential risk factors specific to tower crane operations, (2) identifies critical safety risks that jeopardize worker well-being, (3) examines and assesses the identified safety risks, and (4) automates the labor-intensive and error-prone processes of safety risk assessment. The KBDSS-SRA assists safety management personnel in formulating well-grounded decisions and implementing effective measures to enhance the safety of tower crane operations., Practical Applications: This is facilitated by an advanced computerized tool that underscores the paramount significance of safety risks and suggests strategies for their future mitigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Considering the high-risk, stressful, and fast-paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up-an interaction between perioperative team members to address a concern-requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking-up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole-team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted., (© AORN, Inc, 2024.)

Objectives: to assess patient safety culture during the COVID-19 pandemic and identify the dimensions that need to be improved in hospital settings and which sector, open or closed, direct or indirect care, exhibits a higher level of safety culture., Methods: a descriptive and cross-sectional study. The validated version for Brazil of the Hospital Survey on Patient Safety Culture instrument was applied to assess patient safety culture. Those dimensions with 75% positive responses were considered strengthened., Results: all dimensions presented results lower than 75% of positive responses. Closed sectors showed a stronger safety culture compared to open ones. Indirect care sectors had a low general perception of patient safety when compared to direct care sectors., Conclusions: with the pandemic, points of weakness became even more evident, requiring attention and incisive interventions from the institution's leaders.

Patient safety reporting and learning systems (PSRLS) are tools to promote patient safety culture in healthcare organisations (HCO). Many PRSLS are locally developed. WHO Global Action Plan on Patient Safety 2021-2030 urges governments to deploy policies for healthcare risk management including PSRLS. The Ministry of Health of Catalonia (MHC) faced challenges in addressing quality and patient safety (Q&PS) issues due to disparate information systems. To address these challenges, the MHC developed a territorial PSRLS and embedded it in the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027 (QPSS Plan Cat)., Methods: Four-step process: (1) creation of a governance model, a web platform and reporting forms for a PSRLS in Catalonia (SNiSP Cat); (2) SNiSP Cat roll out; (3) embed SNiSP Cat information in the accreditation model for HCO and the PS scorecard; (4) Development of SNiSP Cat within the QPSS Plan Cat 2023-2027., Results: The SNiSP Cat is in use by 63/64 acute care hospital (ACH), 376/376 primary healthcare teams (PCT) and 17/98 long-term care facilities (LTCF). 1335/109 273 professionals were trained. Until 2022, 127 051 incidents have been migrated and reported (2013-2022). The system has generated three comprehensive risk maps for HCO: one for ACH, including patients' falls, medication, clinical process and procedures; second for PCT, including clinical process and procedures, clinical administration and medication; and a third for LTCF, included patients' falls, medication, digital/analogical documentation. SNiSP Cat provided information to support 53 standards out of 1312 of the ACH accreditation model and 14 standards out of 379 of PCT one. Regarding the MHC patient safety scorecard, 14 indicators out of 147 of ACH and 4 out of 41 of PCT are supported by SNiSP Cat data., Conclusions: The availability of a territorial PSRLS (SNiSP Cat) allows MHC leads the Q&PS policy with direct information, risk maps and data support to the standards for the Catalan accreditation models and PS scorecard linked to incentivisation, turning the SNiSP Cat into a driven tool to implement the Quality and Patient Safety Strategic Plan of Catalonia 2023-2027., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study looks into the effectiveness of the authorisation procedure as a regulatory instrument within the framework of the European REACH regulation. It highlights its impact on enhancing occupational safety and health for both applicants and companies utilising the substances. This procedure encompasses manufacturers, importers, and downstream users of substances, as well as representatives of foreign manufacturers who are also eligible to seek authorisation. When applying for authorisation, the ECHA Risk Assessment Committee (RAC) assesses the risks associated with the intended uses of the substance, including the appropriateness and effectiveness of the Occupational Conditions (OCs) and Risk Management Measures (RMMs) described in the application and the risks posed by potential alternatives. If the RAC determines that the OCs/RMMs are inadequate for managing or controlling the risk, or if the measures to protect workers are deemed insufficient, it may recommend additional measures to enhance occupational safety and health or environmental protection. The 398 processed Applications for Authorisation (AfA) that have been submitted to date were examined to determine these recommended measures, categorised as Conditions for use, Monitoring arrangements, and Recommendations for Review Reports. Overall, a significant improvement concerning occupational safety and health seems necessary, as indicated by the large number of measures recommended by the ECHA Committee for Risk Assessment (RAC) and ECHA Committee for Socio-economic Analysis (SEAC) or supplemented by the European Commission. In addition to the proposed measures, a short assessment provided by the committees as to whether the operational conditions and risk management measures are adequate in controlling the risks is also included in the study., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment., Methods: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback., Findings: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations., Application to Practice: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector., Competing Interests: Conflict of InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors are employed by the organization at which the quality improvement initiative was conducted.

Patient falls within the hospital setting continue to be a significant challenge globally with almost one million hospital falls occurring in the U.S. annually. Recent calculations showed that the average total cost of a hospitalized patient fall was $62,521. One evidenced-based tool that has been shown to be effective is a colorful laminated poster, Fall TIPS poster, that was designed to engage and involve the patient in their fall prevention. One academic medical center utilized this implementation showing a successful return on investment (ROI). This project used a pre-post implementation design. After a successful pilot using the poster on one unit, the implementation was spread to all Adult Acute Care units (n = 10) within the institution. The outcome measures were fall and fall with injury counts and rates. The process measure was the completion of the fall prevention poster measured via audits. The calculation of ROI was completed using a four-step framework. The outcome data of fall and fall with injury showed a decrease from the pre-intervention months with both the fall count and rate decreasing by 23% and the fall with injury count and rate decreasing by 40%. The overall ROI calculation estimated an ROI of $982,700. The successful results from this project support the evidence that shows this program and the use of the Fall TIPS poster helps reduce patient falls within the hospital and yields a favorable ROI., Competing Interests: Theauthor declares no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patient safety learning systems play a critical role in supporting safety culture in healthcare organisations. A lack of explicit standards leads to inconsistent implementation across organisations, causing uncertainty about their roles and impact. Organisations can address inconsistent implementation by using a self-assessment tool based on agreed-on best practices. Therefore, we aimed to create a survey instrument to assess an organisation's approach to learning from safety events., Methods: The foundation for this work was a recent systematic review that defined features associated with the performance of a safety learning system. We organised features into themes and rephrased them into questions (items). Face validity was checked, which included independent pre-testing to ensure comprehensibility and parsimony. It also included clinical sensibility testing in which a representative sample of leaders in quality at a large teaching hospital (The Ottawa Hospital) answered two questions to judge each item for clarity and necessity. If more than 20% of respondents judged a question unclear or unnecessary, we modified or removed that question accordingly. Finally, we checked the internal consistency of the questionnaire using Cronbach's alpha., Results: We initially developed a 47-item questionnaire based on a prior systematic review. Pre-testing resulted in the modification of 15 of the questions, 2 were removed and 2 questions were added to ensure comprehensiveness and relevance. Face validity was assessed through yes/no responses, with over 80% of respondents confirming the clarity and 85% the necessity of each question, leading to the retention of all 47 questions. Data collected from the five-point responses (strongly disagree to strongly agree) for each question were used to assess the questionnaire's internal consistency. The Cronbach's alpha was 0.94, indicating a high internal consistency., Conclusion: This self-assessment questionnaire is evidence-based and on preliminary testing is deemed valid, comprehensible and reliable. Future work should assess the range of survey responses in a large sample of respondents from different hospitals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Increasingly, information technology facilitates the storage and management of data useful for risk analysis and event prediction. Studies on data extraction related to occupational health and safety are increasingly available; however, due to its variability, the construction sector warrants special attention. This review is conducted under the research programs of the National Institute for Occupational Accident Insurance (Inail)., Objectives: The research question focuses on identifying which data mining (DM) methods, among supervised, unsupervised, and others, are most appropriate for certain investigation objectives, types, and sources of data, as defined by the authors., Methods: Scopus and ProQuest were the main sources from which we extracted studies in the field of construction, published between 2014 and 2023. The eligibility criteria applied in the selection of studies were based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). For exploratory purposes, we applied hierarchical clustering, while for in-depth analysis, we used principal component analysis (PCA) and meta-analysis., Results: The search strategy based on the PRISMA eligibility criteria provided us with 63 out of 2234 potential articles, 206 observations, 89 methodologies, 4 survey purposes, 3 data sources, 7 data types, and 3 resource types. Cluster analysis and PCA organized the information included in the paper dataset into two dimensions and labels: "supervised methods, institutional dataset, and predictive and classificatory purposes" (correlation 0.97-8.18 × 10 -1 ; p -value 7.67 × 10 -55 -1.28 × 10 -22 ) and the second, Dim2 "not-supervised methods; project, simulation, literature, text data; monitoring, decision-making processes; machinery and environment" (corr. 0.84-0.47; p -value 5.79 × 10 -25 --3.59 × 10 -6 ). We answered the research question regarding which method, among supervised, unsupervised, or other, is most suitable for application to data in the construction industry., Conclusions: The meta-analysis provided an overall estimate of the better effectiveness of supervised methods (Odds Ratio = 0.71, Confidence Interval 0.53-0.96) compared to not-supervised methods.

Introduction: Advancements in the modern construction industry have contributed to the development of a range of technology-based interventions to improve the safety behavior of front-line construction workers. Notwithstanding the extensive research on safety behavior, there is still a paucity of research on assessing technology interventions of safety behavior to provide an overview of their strengths and limitations. The present study aims to bridge this gap in the literature and identify the main trends of research., Method: A systematic review and critical content analysis are adopted to capture an overview of the state of knowledge on safety behavior technologies. As a result of searching Scopus, Web of Science, and Google Scholar databases in the period from Jan 2010 to Feb 2023, a total of 359 potential studies went through the systematic screening process and finally, 48 representative studies were selected followed by an assessment of the feasibility and applicability of the safety behavior technologies., Results: It was found that safety behavior technology is characterized by seven technologies including virtual-reality simulation (T1), eye-tracking technology (T2), prediction modeling of safety behavior (T3), computer-based training (T4), drone/sensor-based hazard monitoring (T5), vision-based behavior monitoring (T6), and real-time positioning (T7)., Conclusions: This research improves understanding of the status of safety behavior technologies and provides a critical review of their feasibility from the perspective of four assessment criteria including application, limitation, benefit, and feasibility., Practical Applications: The categorizations of technologies add value to the body of knowledge in terms of generic requirements for their implementation and adaptation on construction sites., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives . The unique properties of nanomaterials have turned them into an emerging threat for humans and the environment. This study therefore aimed to review exposure control measures proposed for nanomaterial-involved activities. Methods . This study is based on the published guidelines of different organizations on safe handling of nanomaterials. The search for documents was provided using the keywords 'Exposure controls', 'Good practices', 'Working safely', 'Safe practices', 'Handling safely', 'Safety guide' and 'Safety and health', combined with 'Nanomaterials', 'Nanotechnology' and 'Nanoparticles' on different databases and websites. Results . Thirty-one guidelines from 27 organizations were included. Most of the guidelines recommended engineering controls, administrative controls and personal protective equipment (PPE). Changing the physical form of nanomaterials or the process, using prevention through design (PtD) and using green chemistry principals were other suggestions to reduce exposure to nanomaterials. Conclusions . Considering the difficulty of implementation and case specificity of the solutions of the first two priorities of the hierarchy of controls (elimination and substitution), the emphasis of the guidelines on the next three priorities for controlling exposure to nanomaterials is understood. The type and method of using PPE and engineering controls should be resolved by referring to cutting-edge articles.

The use of data analytics has seen widespread application in fields such as medicine and supply chain management, but their application in occupational safety has only recently become more common. The purpose of this scoping review was to summarize studies that employed analytics within establishments to reveal insights about work-related injuries or fatalities. Over 300 articles were reviewed to survey the objectives, scope and methods used in this emerging field. We conclude that the promise of analytics for providing actionable insights to address occupational safety concerns is still in its infancy. Our review shows that most articles were focused on method development and validation, including studies that tested novel methods or compared the utility of multiple methods. Many of the studies cited various challenges in overcoming barriers caused by inadequate or inefficient technical infrastructures and unsupportive data cultures that threaten the accuracy and quality of insights revealed by the analytics.

Introduction: Workers operating on high-speed roads (i.e., incident responders and emergency service workers) are at significant risk of being fatally injured while working. An identified gap in current prevention strategies is training focused on developing the skills of workers to effectively communicate and coordinate safety responses when operating on roads., Methods: This study discusses the development of a program designed to optimize communication and coordination of safety practices at the scene of an incident on a high-speed road. The program is referred to as 'Safety in the Grey Zone.' The goal of the study is to present the results from an evaluation on its implementation across 23 sessions involving 158 participants from 7 incident response agencies in 1 state in Australia., Results: The results of this study provide support for effectiveness in implementing the program as planned. The results also provide preliminary support for effectiveness of the program in achieving its learning outcomes as demonstrated by feedback received from participants following completion of the program., Conclusions: The findings of this study provide recommendations to consider in the program's future roll-out, as well as suggestions for future evaluations to assess the program's effectiveness in improving the safety of incident responders operating on high-speed roads., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives : Healthcare facilities are complex systems due to the interaction between different factors (human, environmental, management, and technological). As complexity increases, it is known that the possibility of error increases; therefore, it becomes essential to be able to analyze the processes that occur within these contexts to prevent their occurrence, which is the task of risk management. For this purpose, in this feasibility study, we chose to evaluate the application of a new safety walkaround (SWA) model. Materials and Methods : A multidisciplinary working group made up of experts was established and then the subsequent phases of the activity were divided into three stages, namely the initial meeting, the operational phase, and the final meeting, to investigate knowledge regarding patient safety before and subsequently through visits to the department: the correct compilation of the medical record, adherence to evidence-based medicine (EBM) practices, the overall health and the degree of burnout of the various healthcare professionals, as well as the perception of empathy of staff by patients. Results : This working group chose to start this pilot project in the vascular surgery ward, demonstrating the ability of the tool used to capture the different aspects it set out to collect. In detail, the new version of SWA proposed in this work has made it possible to identify risk situations and system vulnerabilities that have allowed the introduction of corrective tools; detect adherence to existing company procedures, reschedule training on these specific topics after reviewing, and possibly update the same procedures; record the patient experience about the doctor-patient relationship and communication to hypothesize thematic courses on the subject; evaluate workers' perception of their health conditions about work, and above all reassure operators that their well-being is in the interest of the management of the healthcare company, which is maintained. Conclusions: Therefore, the outcome of the present study demonstrates the versatility and ever-present usefulness of the SWA tool.

Objectives: The study aimed to study the association of leadership practices and patient safety culture in a dental hospital., Design: Hospital-based, cross-sectional study SETTING: Riphah Dental Hospital (RDH), Islamabad, Pakistan., Participants: All dentists working at RDH were invited to participate., Main Outcome Measures: A questionnaire comprised of the Transformational Leadership Scale (TLS) and the Dental adapted version of the Medical Office Survey of Patient Safety Culture (DMOSOPS) was distributed among the participants. The response rates for each dimension were calculated. The positive responses were added to calculate scores for each of the patient safety and leadership dimensions and the Total Leadership Score (TLS) and total patient safety score (TPSS). Correlational analysis is performed to assess any associations., Results: A total of 104 dentists participated in the study. A high positive response was observed on three of the leadership dimensions: inspirational communication (85.25%), intellectual stimulation (86%), and supportive leadership (75.17%). A low positive response was found on the following items: 'acknowledges improvement in my quality of work' (19%) and 'has a clear sense of where he/she wants our unit to be in 5 years' (35.64%). The reported positive responses in the patient safety dimensions were high on three of the patient safety dimensions: organisational learning (78.41%), teamwork (82.91%), and patient care tracking/follow-up (77.05%); and low on work pressure and pace (32.02%). A moderately positive correlation was found between TLS and TPSS (r=0.455, p<0.001)., Conclusions: Leadership was found to be associated with patient safety culture in a dental hospital. Leadership training programmes should be incorporated during dental training to prepare future leaders who can inspire a positive patient safety culture., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified?, Methods and Analysis: We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects., Results: We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units., Discussion: This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Preventing and reducing risks and harm to patients is of critical importance as unsafe care is a leading cause of death and disability globally. However, the lack of consolidated information on patient safety policies and initiatives at regional levels represents an evidence gap with implications for policy and planning. The aim of the study was to answer the question of what patient safety policies and initiatives are currently in place in the Middle East and Asian regions and what were the main strengths, weaknesses, opportunities and threats in developing these. A qualitative approach using online focus groups was adopted. Participants attended focus groups beginning in August 2022. A topic guide was developed using a strengths, weaknesses, opportunities and threats framework analysis approach. The Consolidated Criteria for Reporting Qualitative Research checklist was used to ensure the recommended standards of qualitative data reporting were met. 21 participants from 11 countries participated in the study. Current patient safety policies identified were categorised across 5 thematic areas and initiatives were categorised across a further 10 thematic areas. Strengths of patient safety initiatives included enabling healthcare worker training, leadership commitment in hospitals, and stakeholder engagement and collaboration. Weaknesses included a disconnect between health delivery and education, implementation gaps, low clinical awareness and buy-in at the facility level, and lack of leadership engagement. Just culture, safety by design and education were considered opportunities, alongside data collection and reporting for research and shared learning. Future threats were low leadership commitment, changing leadership, poor integration across the system, a public-private quality gap and political instability in some contexts. Undertaking further research regionally will enable shared learning and the development of best practice examples. Future research should explore the development of policies and initiatives for patient safety at the provider, local and national levels that can inform action across the system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings., (© AORN, Inc, 2024.)

Background: Examine how Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can be used to manage patient safety and improve the standard of care for patients., Methods: In order to improve key medical training in areas like surgical safety management, blood transfusion closed-loop management, drug safety management and identity recognition, we apply the TeamSTEPPS teaching methodology. We then examine the effects of this implementation on changes in pertinent indicators., Results: Our hospital's perioperative death rate dropped to 0.019%, unscheduled reoperations dropped to 0.11%, and defined daily doses fell to 24.85. Antibiotic usage among hospitalised patients declined to 40.59%, while the percentage of antibacterial medicine prescriptions for outpatient patients decreased to 13.26%. Identity recognition requirements were implemented at a rate of 94.5%, and the low-risk group's death rate dropped to 0.01%. Critical transfusion episodes were less common, with an incidence of 0.01%. The physician's TeamSTEPPS Teamwork Perceptions Questionnaire and Teamwork Attitudes Questionnaire scores dramatically improved following the TeamSTEPPS team instruction course., Conclusion: An evidence-based team collaboration training programme called TeamSTEPPS combines clinical practice with team collaboration skills to enhance team performance in the healthcare industry and raise standards for medical quality, safety, and effectiveness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The goal of this human factors engineering-led improvement initiative was to examine whether the independent double check (IDC) during administration of high alert medications afforded improved patient safety when compared with a single check process., Methods: The initiative was completed at a 24-bed pediatric intensive care unit and included all patients who were on the unit and received a medication historically requiring an IDC. The total review examined 37,968 high-risk medications administrations to 4417 pediatric intensive care unit patients over a 40-month period. The following 5 measures were reviewed: (1) rates of reported medication administration events involving IDC medications; (2) hospital length of stay; (3) patient mortality; (4) nurses' favorability toward single checking; and (5) nursing time spent on administration of IDC medications., Results: The rate of reported medication administration events involving IDC medications was not significantly different across the groups (95% confidence interval, 0.02%-0.08%; P = 0.4939). The intervention also did not significantly alter mortality ( P = 0.8784) or length of stay ( P = 0.4763) even after controlling for the patient demographic variables. Nursing favorability for single checking increased from 59% of nurses in favor during the double check phase, to 94% by the end of the single check phase. Each double check took an average of 9.7 minutes, and a single check took an average of 1.94 minutes., Conclusions: Our results suggest that performing independent double checks on high-risk medications administered in a pediatric ICU setting afforded no impact on reported medication events compared with single checking., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Jalali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Virtual reality (VR) gains attention in construction safety training because it allows users to simulate real activities without the risks of real activities. However, a literary work comprehensively describing the effectiveness of VR in construction safety training and education (CSTE) is lacking., Method: This study provides a systematic review of the research related to VR applications for CSTE over the past decade using meta-analysis techniques. Standardized mean differences between traditional training methods and VR training were grouped by measurement. Potential moderators possibly affecting the effectiveness of VR in CSTE were analyzed., Results: Results showed that VR is significantly more effective in construction training and education than traditional methods. The effectiveness of VR was 0.593, 0.432, and 0.777 higher than that of traditional methods for behaviors, skills, and experience measurements, respectively. The training context and mean work experience of trainees were two important moderators that significantly affected the effectiveness of VR in CSTE (p < 0.001)., Practical Applications: The presented results suggested the need for targeted development and management of VR technology in the construction industry and the early promotion of VR for general safety training among young, inexperienced construction workers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 National Safety Council and Elsevier Ltd. All rights reserved.)

Purpose: The research purpose is to improve the management of occupational risks associated with hazards as well as the organization's capabilities to identify hazardous factors (HFs) using the "BOW-TIE" method in accordance with the provisions of the ISO 45001:2019 standard., Methods: To improve occupational risk management, the "BOW-TIE" method has been introduced into occupational health and safety management systems. This approach facilitates a comprehensive description and analysis of potential risk development from identifying hazardous factors to studying the consequences. It visually integrates fault and event trees to provide a holistic view of risk dynamics., Results: The improvement of the occupational hazard risk management process considers both internal and external factors affecting the organization, thereby increasing the probability and severity of potential hazardous events. The revised approach categorizes risk levels as acceptable, unacceptable, or verifiable. In addition, occupational risk management requires an in-depth analysis of the organization's external and internal environment to identify hazards that affect the probability and severity of potential hazardous events., Conclusion: This research proposes an innovative approach to occupational risk management by determining the magnitude of occupational risk as the cumulative result of assessing risks associated with all external and internal factors influencing the probability of hazardous event occurring. The introduction of the "BOW-TIE" method, combined with a comprehensive analysis of the organizational environments, facilitates a more effective and nuanced approach to occupational risk management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bazaluk, Tsopa, Okrasa, Pavlychenko, Cheberiachko, Yavorska, Deryugin and Lozynskyi.)

Background: In the context of smart mine construction, coal mine safety management is imposing stringent requirements on the safety competence of miners. To meet these demands, coal mine enterprises have initiated proactive measures to recruit a new generation of knowledge-based miners who possess high qualifications and specialized backgrounds., Objective: This study aims to explore the underlying mechanisms of identity conflict (IC) and its influence on unsafe behavior (USB) among KBMs within the context of China's smart mining initiatives, as well as to identify the role of potential mediating and moderating variables in this relationship., Methods: An empirical study was conducted on a sample of 304 KBMs with a college degree or above, selected from multiple coal mines in Shanxi Province, China. Hierarchical regression analysis and the Bootstrap method were employed for data analysis. This model incorporated IC as the antecedent variable and meticulously investigated the mediating effects of role breadth self-efficacy (RBSE) and psychosocial resources (PSR), along with the moderating effect of positive explanatory bias (PEB)., Results: The findings indicate a significant positive correlation between IC and USB among KBMs. RBSE and PSR were found to mediate the relationship between IC and USB. Moreover, this mediating effect further influenced the relationship between IC and USB through a chain mediating effect. Additionally, PEB strengthened the positive impact of KBMs' RBSE on PSR., Conclusion: These results provide a broader perspective on the antecedent variables associated with KBMs' USB and provide valuable insights and practical management strategies enhancing the safety management practices within coal mining enterprise.

Background: Safety design covers proactive actions as it analyzes accident risks early in the enterprise life cycle, and considers the designer acting on accident prevention as a member of the construction team., Objective: This paper proposes an accident investigation to establish links between accident causes and design to support Prevention through Design (PtD) tools., Methods: This article analyzed more than a thousand severe and fatal accident cases in the construction sector. A systematic analysis method was structured based on descriptions of accident causes and measures that could be taken to avoid accidents., Results: Analyzing the severe and fatal accidents, the safety measures implemented in the project design could avoid at least 23.6% of the events. As a result, the architectural and structural designs were more effective in accident prevention. The reference percentages and the design types that are more effective in preventing accidents are analyzed through a representative sample of the analysis of the accident., Conclusions: This research contributes to applying safety guidelines in design projects, directly assisting in project and construction management.

Background: Like other things, psychological safety has a too-much-of-a-good-thing effect on the risk prevention process. There are warranted systematic and theoretical discussions on both positive and negative influences of psychological safety, which provide useful guides to handling potential risks for workers., Objective: This study focuses on the psychological safety analysis of work safety for workers in high-risk industries through the construction of a theoretical model, illustrating that a higher level of psychological safety is not better., Method: This study explores the impact of workers' psychological safety on the potential risk of work safety by conducting a comprehensive analysis of relevant literature and employing inductive reasoning and analogy methodology., Results: We systematically reviewed the research background and several hypotheses of psychological safety, described the relationship between psychological safety and risk prevention from three levels, and constructed the threshold initial, special, and extended model of psychological safety to reveal the importance of workers' psychological safety when handling potential risks., Conclusion: This research effectively describes the influence of high, moderate, and low levels of psychological safety on the risk prevention of work safety, which provides a psychological model guide to developing measures for the improvement of work safety management.

Objective: Road traffic crashes are mainly caused by three concurrent factors: infrastructure, vehicle, and human factors. Regarding infrastructure, in recent decades, a series of management tools and procedures called Road Infrastructure Safety Management (RISM) have been proposed. The aim of RISM procedures is to support road authorities in the prevention and mitigation of future road traffic crashes. One of these procedures is the In-built Road Safety Assessment (IRSA) methodology. The peculiarity of an IRSA methodology is the underpinning method used to assign a score to a road section with the aim of identifying those road sections in a network with safety-related infrastructure deficiencies. The objective of this paper is to provide an overall literature review of existing methodologies used worldwide for network-wide road safety assessment for rural road., Methods: The review was conducted following the guidelines provided by Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) checklist 2020. The characteristics of these methodologies were compared with respect to the following research questions: What are the general characteristics of IRSA methodologies? What risk method/index is applied? Which data collection method/technique is used? What types of road parameters are considered for the assessment? What is the level of expertise needed to implement the methodology? Where and how are the results validated?, Results: As a result, 14 IRSA methodologies were identified. Also, the review showed that similar road parameters were used including: operating speed, road surface, low curve radius, poor sight distance (horizontal and vertical curves), lane width, undivided road (median type), shoulder width, sight obstructions (landscape, obstacles and vegetation), absence of traffic signs and road markings, traffic flow (AADT), intersection quality and density of intersections/lateral accesses., Conclusions: Despite these similarities, some differences were observed in risk formulation, safety quantities of parameters, level of expertise required, and validation of studies. Researchers may use these findings to develop future road safety assessment methodologies, while road practitioners can make use of this in identifying suitable network-wide assessment methods for safety assessments of road infrastructures. Finally, a series of recommendations for future research work on IRSA methodologies is suggested.

Background: Strengthening safety compliance behaviour can reduce the organizations' unexpected financial losses and prevent employees from continuous COVID-19. It drives this study to create a research framework involved by organizational, individual and social factors to predict employees' safety compliance behaviour., Objective: This study examines how risk perceptions of COVID-19, employee well-being, workplace health and safety training, safety motivation and safety related stigma impact safety compliance behavior in times COVID-19 pandemic., Methods: A self-administered questionnaire was disseminated to healthcare workers. In all, 344 acceptable questionnaires were derived for further analysis., Results: The results revealed that the risk perception of COVID-19 and employee well-being has no significant relationship with safety compliance behavior. Similarly, safety related stigma also has no moderating effect on safety motivation and safety compliance behavior. However, workplace health and safety training and safety motivation have significant relationships with safety compliance behavior., Conclusion: This study contributes to the literature by illuminating on the importance of organizational, individual, social factors and how they can interact with safety compliance behaviour. Additionally, knowing the unique function of safety related stigma in building safety compliance behaviour may help guide future efforts and training initiatives to enhance workplace safety.

Safety management is a key issue in the railroad industry that needs to be continuously focused on. And it is essential to study causes of accidents for preventing accidents. However, there is a limited academic discussion on the systematic study of organizations and accidents, as well as their safety-related interactions and accidents, as opposed to human-caused disasters. Thus, the model of China's railway safety supervision and management system by sorting out the existing organizations involved in management in China is established in this paper. Firstly, social forces and auxiliary enterprises are specifically added to the model. And then, the relationship between organizations and accidents, as well as the relationship between safety interactions among organizations and accidents are explored by analyzing 224 accident reports, which led to 4 principles for accident prevention. Finally, based on these principles, measures to secure organizational nodes, as well as measures to promote safe interactions among organizations are proposed. The results showed that: (1) China Railway node is not only the most critical node in the safety supervision and management system but also the most vulnerable to the influence of other nodes. (2) The accident occurred due to the simultaneous occurrence of an accident at the China Railway node and the social force node. (3) When there are often safety risks in auxiliary enterprises and social forces simultaneously, the government's management is likely to be defective. The findings in this study can provide helpful references not only for improvement of safety management system structure and supervision and management mechanism but also for the formulation of safety supervision and management policies in China and other countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study analyzes what has changed in the road safety management systems (RSMS) of local governments after evaluating the related indicators continuously from 2015 to 2019. It has evaluated 24 indicators in four areas of RSMS such as institutional management, intervention, intermediate outcome, and the final outcome, according to Han and Lee (2020). It seems that continuous evaluation of indicators of RSMSs in local governments for five years has helped to improve road safety performance in local governments. The result shows that the average overall scores have increased from 77.92 to 83.89, a 7.7% increase. This improvement should have resulted from the competition between local governments, which do not want to be at the bottom in the score comparison. The most remarkable increase has been identified in the areas of institutional management and intervention. They have increased by 13.3% and 16.0%, respectively. In terms of types of local governments, it has been found that the increase in overall scores is higher in provinces which include most rural areas than in metropolitans. However, it has been found that the improvement of institutional management and interventions are not directly associated with the increase of the intermediate and final outcomes, at least during the five years. Further studies examining the relationship between the four areas of RSMS are needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The construction industry is one of the hazardous fields due to its exceptional environment. Therefore, this work aimed to assess the essential drivers needed for employing safety management in the Palestinian construction industry. The drivers for safety management were recognized from earlier literature, where the questionnaires were dispersed to professionals from construction projects. The exploratory factor analysis (EFA) technique was then performed to contextually adjust the identified drivers. The results showed that safety management drivers could be categorized into three constructs: management, awareness and policy. In addition, partial least squares structural equation modelling (PLS-SEM) was performed to generate the safety management driver's model. The results indicated that management drivers were vital drivers for adopting safety management. The study's findings would act as a reference for construction stakeholders to decrease danger and enhance the construction project's success via implementing safety management drivers.

Objectives. This article describes the reduction of unsafe behaviors observed at a fertilizer complex by implementation of a behavior-based safety (BBS) program via a behavior observation form developed by a multidisciplinary team. Methods. Six observation categories, i.e., position of people, reaction of people, personal protective equipment (PPE), tools used, operating procedures and housekeeping, are used to monitor safe and unsafe behaviors for a period of 18 months. Results . Safe behaviors increased from 57 to 70% and unsafe behaviors reduced from 40 to 26%. Behaviors of employees working in various sections of fertilizer complex such as ammonia, urea, utility, bagging/shipping and workshop were also observed. Non-compliance with PPE, housekeeping and standard operating procedures was also monitored in individual sections. Non-operational areas including the administration block, housing colony, maintenance workshop, warehouse, fire station and electrical substation were also observed. Among these, the maximum unsafe behaviors are for the housing colony and minimum for the electrical substation. Conclusion . It has been concluded that working on the housing colony, administration block and fire station areas will address 74% unsafe behaviors of non-operational areas. For practical applications , worldwide industries can implement this BBS program to enhance BBS, thus reducing unsafe behaviors and increasing employee morale.

Despite longstanding traditional construction health and safety management (CHSM) methods, the construction industry continues to face persistent challenges in this field. Neuroscience tools offer potential advantages in addressing these safety and health issues by providing objective data to indicate subjects' cognition and behavior. The application of neuroscience tools in the CHSM has received much attention in the construction research community, but comprehensive statistics on the application of neuroscience tools to CHSM is lacking to provide insights for the later scholars. Therefore, this study applied bibliometric analysis to examine the current state of neuroscience tools use in CHSM. The development phases; the most productive journals, regions, and institutions; influential scholars and articles; author collaboration; reference co-citation; and application domains of the tools were identified. It revealed four application domains: monitoring the safety status of construction workers, enhancing the construction hazard recognition ability, reducing work-related musculoskeletal disorders of construction workers, and integrating neuroscience tools with artificial intelligence techniques in enhancing occupational safety and health, where magnetoencephalography (EMG), electroencephalography (EEG), eye-tracking, and electrodermal activity (EDA) are four predominant neuroscience tools. It also shows a growing interest in integrating the neuroscience tools with artificial intelligence techniques to address the safety and health issues. In addition, future studies are suggested to facilitate the applications of these tools in construction workplaces by narrowing the gaps between experimental settings and real situations, enhancing the quality of data collected by neuroscience tools and performance of data processing algorithms, and overcoming user resistance in tools adoption.

Objectives: Patient safety incident reporting in our institution's intensive care units (ICUs) had fallen 30% below national benchmarks during the COVID-19 pandemic. Underreporting diminishes awareness of risks and precludes organizational learning from near misses. We aimed to increase the ICU number of patient safety incident reports by 30% from 27 to 35 reports/1000 patient-days without negatively impacting culture of safety as measured by patient-care staff surveys., Methods: Single-institution prospective interventional study with 9 ICUs receiving a multifaceted intervention developed using quality improvement methodology during February-April 2022. Study intervention involved creation of patient safety peer-leadership role, feedback process, interactive dashboards for patient safety data, and education resources accessible via quick response codes. Primary outcome was patient safety incident reports/1000 patient-days. Intensive care unit patient-care staff culture of safety was assessed with surveys., Results: Intensive care unit patient safety incident reporting increased by 48% after intervention (40 versus 27 reports/1000 patient-days [ P = 0.136]). Near misses were the most common incident report. Intensive care unit patient-care staff ratings of patient safety did not change; 80% rated patient safety as good or better after intervention versus 78% at baseline ( P = 0.465). However, significant improvement was observed for subcomponents related to learning culture and support for staff involved in patient safety incidents. Most reports (>80%) were submitted by nurses., Conclusions: This multifaceted quality improvement intervention increased patient safety incident reporting in the ICUs. Increases in ratings of learning culture and support for staff underline the importance of a well-functioning patient safety incident reporting system in an institutional culture of safety., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

It is widely accepted that positive safety culture improves organizations' safety performance and reduces the number of injuries and deaths. Safety culture has been well researched in high-risk industries; however, the hospitality industry until recently had no research of the concept unless related to food safety. This article explores theoretical grounds for research of safety culture in hospitality, based on the aviation safety culture body of knowledge. Using aviation as a foundation is motivated by the similarities in operations between aviation and hospitality, especially when hospitality is compared to other high-risk industries. The article proposes that aviation safety culture models and their dimensions could be valuable for hospitality industry's safety culture improvements. It's goal and aspiring contribution is to begin a discussion and build a theoretical base for future research about advancement of safety in hospitality operations and reduction of the industry's relatively high numbers of employee injuries.

The construction industry is accident-prone, and unsafe behaviors of construction workers have been identified as a leading cause of accidents. One important countermeasure to prevent accidents is monitoring and managing those unsafe behaviors. The most popular way of detecting and identifying workers' unsafe behaviors is the computer vision-based intelligent monitoring system. However, most of the existing research or products focused only on the workers' behaviors (i.e., motions) recognition, limited studies considered the interaction between man-machine, man-material or man-environments. Those interactions are very important for judging whether the workers' behaviors are safe or not, from the standpoint of safety management. This study aims to develop a new method of identifying construction workers' unsafe behaviors, i.e., unsafe interaction between man-machine/material, based on ST-GCN (Spatial Temporal Graph Convolutional Networks) and YOLO (You Only Look Once), which could provide more direct and valuable information for safety management. In this study, two trained YOLO-based models were, respectively, used to detect safety signs in the workplace, and objects that interacted with workers. Then, an ST-GCN model was trained to detect and identify workers' behaviors. Lastly, a decision algorithm was developed considering interactions between man-machine/material, based on YOLO and ST-GCN results. Results show good performance of the developed method, compared to only using ST-GCN, the accuracy was significantly improved from 51.79% to 85.71%, 61.61% to 99.11%, and 58.04% to 100.00%, respectively, in the identification of the following three kinds of behaviors, throwing (throwing hammer, throwing bottle), operating (turning on switch, putting bottle), and crossing (crossing railing and crossing obstacle). The findings of the study have some practical implications for safety management, especially workers' behavior monitoring and management.

Safety reporting systems are widely used in healthcare to identify risks to patient safety. But, their effectiveness is undermined if staff do not notice or report incidents. Patients, however, might observe and report these overlooked incidents because they experience the consequences, are highly motivated, and independent of the organization. Online patient feedback may be especially valuable because it is a channel of reporting that allows patients to report without fear of consequence (e.g., anonymously). Harnessing this potential is challenging because online feedback is unstructured and lacks demonstrable validity and added value. Accordingly, we developed an automated language analysis method for measuring the likelihood of patient-reported safety incidents in online patient feedback. Feedback from patients and families (n = 146,685, words = 22,191,427, years = 2013-2019) about acute NHS trusts (hospital conglomerates; n = 134) in England were analyzed. The automated measure had good precision (0.69) and excellent recall (0.98) in identifying incidents; was independent of staff-reported incidents (r = -0.04 to 0.19); and was associated with hospital-level mortality rates (z = 3.87; p < 0.001). The identified safety incidents were often reported as unnoticed (89%) or unresolved (21%), suggesting that patients use online platforms to give visibility to safety concerns they believe have been missed or ignored. Online stakeholder feedback is akin to a safety valve; being independent and unconstrained it provides an outlet for reporting safety issues that may have been unnoticed or unresolved within formal channels., (© 2022 The Authors. Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Background: Reporting a near-miss event has been associated with better patient safety culture., Purpose: To examine the relationship between patient safety culture and nurses' intention to report a near-miss event during COVID-19, and factors predicting that intention., Methods: This mixed-methods study was conducted in a tertiary medical center during the fourth COVID-19 waves in 2020-2021 among 199 nurses working in COVID-19-dedicated departments., Results: Mean perception of patient safety culture was low overall. Although 77.4% of nurses intended to report a near-miss event, only 20.1% actually did. Five factors predicted nurses' intention to report a near-miss event; the model explains 20% of the variance. Poor departmental organization can adversely affect the intention to report a near-miss event., Conclusions: Organizational learning, teamwork between hospital departments, transfers between departments, and departmental disorganization can affect intention to report a near-miss event and adversely affect patient safety culture during a health crisis., Competing Interests: The authors declare no conflict of interests., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Empirical and anecdotal evidence show that construction projects are delivered on work sites where unsafe acts and conditions abound. Researchers have investigated the strategies that can be adopted to effectively implement health and safety (H&S) in projects so as to reduce the high rates of accidents, injuries and fatalities. However, the effectiveness of these strategies have not been marginally established. Therefore, this study established the effectiveness of H&S implementation strategies on accidents, injuries, and fatalities reduction in Nigerian construction projects., Method: A mixed-method research design was adopted for data collection in the study. Physical observations, interviews, and a questionnaire were the instruments used for data collection in the mixed-method research design., Results: The resultant data identified six appropriate strategies for enabling the desired levels of H&S program implementation on construction sites. Setting up statutory bodies such as the Health and Safety Executive to promote awareness, good practices, and standardization was adjudged pertinent as one of the effective H&S implementation programs that can be used to reduce accidents, incidents, and fatalities in projects. It is expected that the adoption of these strategies would culminate in effective H&S program implementation and subsequently a reduction in the prevalence of accidents, injuries, and fatalities in projects., (Copyright © 2023 National Safety Council and Elsevier Ltd. All rights reserved.)

Formal risk assessment is a component of safety management relating to hazardous manual tasks (HMT). Systems thinking approaches are currently gaining interest for supporting safety management. Existing HMT risk assessment methods have been found to be limited in their ability to identify risks across the whole work system; however, systems thinking-based risk assessment (STBRA) methods were not designed for the HMT context and have not been tested in this area. The aim of this study was to compare the performance of four state-of-the-art STBRA methods: Net-HARMS, EAST-BL, FRAM and STPA to determine which would be most useful for identifying HMT risks. Each method was independently applied by one of four analysts to assess the risks associated with a hypothetical HMT system. The outcomes were assessed for alignment with a benchmark analysis. Using signal detection theory (SDT), overall STPA was found to be the best performing method having the highest hit rate, second lowest false alarm rate and highest Matthews Correlation Coefficient of the four methods. Practitioner summary: A comparison of four systems thinking risk assessment methods found that STPA had the highest level of agreement with the benchmark analysis and is the most suitable for practitioners to use to identify the risks associated with HMT systems.

In modern safety management, it is very important to study the influence of the whole safety system on unsafe acts in order to prevent accidents. However, theoretical research in this area is sparse. In order to obtain the influence law of various factors in the safety system on unsafe acts, this paper used system dynamics simulation to carry out theoretical research. First, based on a summary of the causes of the coal and gas outburst accidents, a dynamic simulation model for unsafe acts was established. Second, the system dynamics model is applied to investigate the influence of various safety system factors on unsafe acts. Third, the mechanism and the control measures of unsafe acts in the enterprise safety system are studied. This study's main result and conclusions are as follows: (1) In the new coalmines, the influence of the safety culture, safety management system, and safety ability on the safety acts were similar. The order of influence on the safety acts in production coalmines is as follows: safety management system > safety ability > safety culture. The difference is most evident in months ten to eighteen. The higher the safety level and safety construction standard of the company, the greater the difference. (2) In the construction of the safety culture, the order of influence was as follows: safety measure elements > safety responsibility elements = safety discipline elements > safety concept elements. It shows the difference in influence from the 6th month and attains its maximum value from the 12th month to the 14th month. (3) In the construction of the safety management system, the degree of influence in new coalmines was as follows: safety policy > safety management organization structure > safety management procedures. Among them, especially in the first 18 months, the impact of the safety policy was most apparent. However, in the production mine, the degree of influence was as follows: safety management organization structure > safety management procedures > safety policy, but the difference is very small. (4) The degree of influence on the construct of safety ability was as follows: safety knowledge > safety psychology = safety habits > safety awareness, but the difference on the impact was small.

It is common for companies that are in the process of implementing the Last Planner System (LPS) journey to attempt an increase in productive work and a reduction in waste, such as contributory and noncontributory work. Even though the LPS has proven to have a synergy with the health and safety requirements, companies with deficient health and safety management systems tend to classify work involving substandard acts or conditions as standard, and then pretend to benchmark against other companies that are indeed performing safe work. The following work introduces a framework to simultaneously register and analyze productive, contributory, and noncontributory work, with the substandard acts and conditions in a construction site, allowing for the measurement of production and health & safety indicators simultaneously. In the absence of technology that automatically captures these indicators, it is proposed that simultaneous measurements be made through direct inspections and photo and video recording by means of a handheld camera. The proposed continuous improvement framework follows the steps indicated below: (1) defining the productive, contributory, and noncontributory work with surveys performed on the most representative stakeholders of the industry; (2) proposing a new classification of production and safety work; (3) assessing the level of application of the LPS in the company; (4) measuring the indicators; (5) improving the use of the LPS and performing new measurements; (6) statistically linking deadly, serious, and minor accidents, standard and substandard acts, standard and substandard conditions, and productive, contributory, and noncontributory work. This framework was applied to a case study of a building project in Lima and the results were improved simultaneous indicators, especially the health and safety indicators. Automated classification of productive and nonproductive work using technology still represents a challenge.