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BackgroundNumerous studies have been conducted over the past 15 years to assess safety culture within healthcare facilities; in general, these studies have shown the pivotal role that managers play in its development. However, little is known about what healthcare managers actually do to support this development, and how caregivers and managers represent managers’role. Thus the objectives of this study were to explore: i) caregivers and managers’ perceptions and representations of safety, ii) the role of managers in the development of safety culture as perceived by themselves and by caregivers, iii) managers’ activities related to the development of safety culture.MethodsAn exploratory, multicentre, qualitative study was conducted from May 2014 to March 2015 in seven healthcare facilities in France. Semi-structured interviews were conducted with managers (frontline, middle and top level) and caregivers (doctors, nurses and nurse assistants) and on-site observations of two managers were carried out in all facilities. A thematic analysis of semi-structured interviews was performed. Observed activities were categorised using Luthans’ typology of managerial activities.ResultsParticipants in semi-structured interviews (44 managers and 21 caregivers) expressed positive perceptions of the level of safety in their facility. Support from frontline management was particularly appreciated, while support from top managers was identified as an area for improvement. Six main categories of safety-related activities were both observed among managers and regularly expressed by participants. However, caregivers’ expectations of their managers and managerial perceptions of these expectations only partially overlapped.ConclusionsThe present study highlights current categories of managerial activities that foster safety culture, and points out an important gap between caregivers’ expectations of their managers, and managerial perceptions of these expectations. The findings underline the need to allow more time for managers and caregivers to talk about safety issues. The results could be used to develop training programs to help healthcare managers to understand their role in the development of safety culture.

We extend the hybridization procedure proposed in [Arnold, Brezzi, 1985, ESAIM: M2AN] to the Virtual Element Method for linear elasticity problems based on the Hellinger-Reissner principle. To illustrate such a technique, we focus on the 2D case, but other methods and 3D problems can be considered as well. We also show how to design a better approximation of the displacement field using a straightforward post-processing procedure. The numerical experiments confirm the theory for both two and three-dimensional problems., submitted to M3AS

We present a Virtual Element Method for the 3D linear elasticity problems, based on Hellinger-Reissner variational principle. In the framework of the small strain theory, we propose a low-order scheme with a-priori symmetric stresses and continuous tractions across element interfaces. A convergence and stability analysis is developed and we confirm the theoretical predictions via some numerical tests., Comment: submitted to CMAME