Questionário Atitudes de Segurança: adaptação transcultural do Safety Attitudes Questionnaire - Short Form 2006 para o Brasil

O objetivo deste estudo foi realizar a adaptação transcultural do Safety Attitudes Questionnaire - Short Form 2006 para o Brasil. O instrumento foi aplicado em seis hospitais de três Regiões do Brasil. Foi realizada a validade de conteúdo, face e de construto. A análise da confiabilidade do instrumento foi realizada por meio da análise da consistência interna dos itens por meio do alfa de Cronbach. A amostra do estudo foi composta por 1.301 profissionais das enfermarias clínicas e cirúrgicas de seis hospitais. A análise confirmatória mostrou que o ajuste do modelo final dos 41 itens foi considerado satisfatório. Aversão do instrumento em Português apresentou alfa de 0,89. As correlações item/total entre os domínios foram consideradas de moderada a forte, com exceção do domínio percepção do estresse. Conclui-se, portanto, que a versão do instrumento adaptada para o Português é considerada válida e confiável nesta amostra.

Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

Governing the Local: Sovereignty, Social Governance and Community Safety

There has been much commentary about the re-ordering of the relations between nation state government, geographical territory, and populations in the advanced liberal democracies. This is seen as a product of: increasing demographic and cultural diversity due to legal and illegal migration; economic, cultural, and political global interdependence; footloose mobility of capital and the outsourcing of jobs to poorer countries; the growing power of international corporations and financial markets; and the growth of supra-national bodies like the European Union and The North Atlantic Free Trade Association, the World Trade Organisation, and (debatably), the UN. These developments are held to be associated with the gradual demise of the model of the increasingly secular nation state first crystallised by the Treaty of Westphalia in 1648. This conception provided a mutual, guarantee of states’ jurisdiction over territory and populations through their legitimated attempts to monopolise the use of force. Though, the relations between these states have always been asymmetrical and often challenged (Hunter 1998).

Comments on Kevin Stenson’s ‘Governing the Local: Sovereignty, Social Governance and Community Safety’

It is a challenging time to be a social scientist. Many of the concepts and categories we took for granted have been revealed as temporally and geographically specific. It is now widely accepted that the nation-state is no longer the sole container for economic, political and social processes, if indeed it ever was. This is where Kevin Stenson begins his paper. He traces the re-ordering of both state and nation, highlighting recent discussions about the unbundling and rescaling of the state and outlining how increasing ethnic and cultural diversity challenge homogeneous conceptions of the nation. In Stenson’s account these are largely empirical processes that are the basis for the important questions he raises about changing understandings of publics and social order, and their implications for the local governance of community safety. He contrasts two alternative positions; the ‘universal human rights position’ which refuses to privilege the interests of majority populations, and a more ‘communitarian and nationalistic position’ which he argues is most likely to be deployed by right wing politicians and interests groups. Drawing from extensive research in the Thames Valley region of the United Kingdom, he shows how these two understandings have both shaped the local policy response to crime and disorder.

Individual and Organizational Factors Influencing Technology Adoption for Construction Safety

Thesis (Master's)--University of Washington, 2016-06

Safety culture during major organisational change

This research examines the effect of major changes, in the external context, on the safety culture of a UK generating company. It was focused on an organisation which was originally part of the state owned Central Electricity Generating Board and which, by the end of the research period, was a self-contained generating company, operating in a competitive market and a wholly owned subsidiary of a US utility. The research represents an attempt to identify the nature and culture of the original organisation and to identify, analyse and explain the effects of the forces of change in moulding the final organisation. The research framework employed a qualitative methodology to investigate the effects of change, supported by a safety culture questionnaire, based on factors identified in the third report of the ACSNI Human Factors Study Group; Organising for Safety, as being indicators of safety culture. An additional research objective was to assess the usefulness of the ACSNI factors as indicators of safety culture. Findings were that the original organisation was an engineering dominated technocracy with a technocentric safety culture. Values and beliefs were very strongly held and resistant to change and much of the original safety culture survived unchanged into the new organisation. The effects of very long periods of uncertainty about the future were damaging to management/worker relationships but several factors were identified which effectively insulated the organisation from any of the effects of change. The forces of change had introduced a beneficial appreciation of the crucial relationship between safety risk assessment and commercial risk assessment.Although the technical strength of the original safety culture survived, so did the essential weakness of a low level of appreciation of the human behavioural aspects of safety. This led to a limited, functionalist world view of safety culture, which assumed that cultural change was simpler to achieve than was the case and an inability to make progress in certain areas which were essentially behavioural problems.The factors identified by ACSNI provided a useful basis for the site research methodology and for identifying areas of relative strength and weakness in the site safety arrangements.

Organisational change and safety culture: the impact of communication

This research examines and explains the links between safety culture and communication. Safety culture is a concept that in recent years has gained prominence but there has been little applied research conducted to investigate the meaning of the concept in 'real life' settings. This research focused on a Train Operating Company undergoing change in a move towards privatisation. These changes were evident in the management of safety, the organisation of the industry and internally in their management. The Train Operating Company's management took steps to improve their safety culture and communications through the development of a cascade communication structure. The research framework employed a qualitative methodology in order to investigate the effect of the new system on safety culture. Findings of the research were that communications in the organisation failed to be effective for a number of reasons, including both cultural and logistical problems. The cultural problems related to a lack of trust in the organisation by the management and the workforce, the perception of communications as management propaganda, and asyntonic communications between those involved, whilst logistical problems related to the inherent difficulties of communicating over a geographically distributed network. An organisational learning framework was used to explain the results. It is postulated that one of the principal reasons why change, either to the safety culture or to communications, did not occur was because of the organisation's inability to learn. The research has also shown the crucial importance of trust between the members of the organisation, as this was one of the fundamental reasons why the safety culture did not change, and why safety management systems were not fully implemented. This is consistent with the notion of mutual trust in the HSC (1993) definition of safety culture. This research has highlighted its relevance to safety culture and its importance for organisational change.

Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

Organisational and systems factors impacting on patient safety in acute care organisations: lessons from four multi-site research studies

Background Patient safety is concerned with preventable harm in healthcare, a subject that became a focus for study in the UK in the late 1990s. How to improve patient safety, presented both a practical and a research challenge in the early 2000s, leading to the eleven publications presented in this thesis. Research question The overarching research question was: What are the key organisational and systems factors that impact on patient safety, and how can these best be researched? Methods Research was conducted in over 40 acute care organisations in the UK and Europe between 2006 and 2013. The approaches included surveys, interviews, documentary analysis and non-participant observation. Two studies were longitudinal. Results The findings reveal the nature and extent of poor systems reliability and its effect on patient safety; the factors underpinning cases of patient harm; the cultural issues impacting on safety and quality; and the importance of a common language for quality and safety across an organisation. Across the publications, nine key organisational and systems factors emerged as important for patient safety improvement. These include leadership stability; data infrastructure; measurement capability; standardisation of clinical systems; and creating an open and fair collective culture where poor safety is challenged. Conclusions and contribution to knowledge The research presented in the publications has provided a more complete understanding of the organisation and systems factors underpinning safer healthcare. Lessons are drawn to inform methods for future research, including: how to define success in patient safety improvement studies; how to take into account external influences during longitudinal studies; and how to confirm meaning in multi-language research. Finally, recommendations for future research include assessing the support required to maintain a patient safety focus during periods of major change or austerity; the skills needed by healthcare leaders; and the implications of poor data infrastructure.

Robin Hood: de leyenda a mito cultural

[es] A lo largo de la historia, los villanos, ya sean reales o imaginarios, han tenido funciones útiles para la sociedad y a menudo han actuado como «válvulas de seguridad» para aliviar las presiones sociales. Esta es probablemente la razón por la que muchos «villanos» han sido definidos como «bandidos sociales», término utilizado originalmente por Eric Hobsbawm para referirse a un forajido quizás mejor ejemplificado por el personaje de Robin Hood en la tradición inglesa. Este bandido social, admirado por todos y en todas partes, que roba a los ricos y reparte el botín entre los pobres, actúa al margen de la ley y personifica asimismo la resistencia a la opresión social y una serie de virtudes más personales. En este artículo, vamos a analizar la forma en que el bandido inglés se ha convertido en un héroe mítico más que legendario. De hecho, el personaje de Robin Hood ha trascendido el tiempo y la cultura, y se ha convertido en el arquetipo del proscrito benevolente, un héroe popular nacido de las frustraciones de una clase inferior que considera que no hay leyes ni reglas en una sociedad injusta, sino la voluntad y el capricho de quien detenta el poder. [en] Throughout history, villains -whether real or imaginary- have served useful functions, especially those of “safety valves” for society. This is probably why many “villains” have been defined as “social bandits”, a term originally used by Eric Hobsbawm to refer to a type best exemplified in the Anglo-Saxon tradition by Robin Hood. This true and widely admired social bandit who steals from the rich and gives to the poor operates outside the law but at the same time personifies both group resistance to oppression and a number of more personal virtues. In this paper, we shall analyse the way in which the English bandit has become a mythical rather than a legendary hero. Indeed, the Robin Hood figure has transcended time and culture, and has become the archetype of the benevolent outlaw, a folk hero born of the frustrations of an underclass that sees the law as the will and whim of the privileged classes above them.