Culture measured dimensions

In the next chapter we will explore the nine dimensions of organizational culture—measurable dimensions that have been shown to influence and predict organizational safety most reliably. 

Finally, improvement efforts are most successful when the organizational culture is well understood by leaders. It is then possible to build upon favorable dimensions and undertake targeted improvement where the culture is weak. It is also possible for the administrative leadership to measure dimensions of the culture in tangible terms and report the results over time as a means of communicating the tone at the top, in the middle, and at the bedside in order to fulfill the board s responsibility to monitor the culture and oversee the emergence of safety hazards and ethical risks. 

Thus, for companies with strongly contrasting corporate cultures, a new and shared performance culture has to be actively created (Fig. 15.4). Performance cultures can be measured in two dimensions. The first of these assesses the quality of direction . If it is high, there is considerable consistency in the objectives of the group s individuals, and the objectives are challenging. Indicators are usually a common vision, a well-defined strategy, and aspirational targets. 

In this paper, we describe an onsite weathering experiment designed to identify acid-rain increased dissolution of carbonate rock. This experiment is based on the measurement of the change in rainfall-runoff composition from the interaction of a rock surface with incident acid rain 2. The experiment involves conducting long-term exposures of two commercially and culturally important calcium carbonate dimension stones (i.e., Indiana Limestone (commercial name for Salem Limestone) and Vermont Marble (commercial name for Shelburne Marble)) (3-5). This technique appears to give a direct measurement of the chemical dissolution of carbonate rock from the combined reactions of wet and dry deposition. Preliminary results from the initial months of onsite operation are presented to illustrate the technique. 

All the criteria so far discussed are certainly important but it is also crucial that what is provided meets the patient s reasonable expectations with regard to quality in the broad sense [10]. The meaning of quality at one level may be to equate it to effectiveness, but the definition of quality certainly goes beyond a reflection of how patients perceive the effectiveness of the services they receive. The definition of quality is also likely to differ depending on cultural expectations and values, as well as the nature of the health care system through which pharmaceutical services are delivered. For example, a US patient may equate quality to freedom of choice, while a patient in the UK may equate it to shorter waiting times or to reduced variations in services across the system. Expert definitions of quality include the dimensions of access, appropriateness, and technical and/or interpersonal excellence as measured by the health outcomes achieved [3,10]. Therefore access to pharmaceutical services (i.e. availability of prescribers, pharmacies and medicines) should be appropriate to what patients need and delivered in a manner that displays good levels of professional practice. 

The last proposed dimension of RSDI is the road safety organisational index that measures how much is the cooperation between the key bodies responsible for road safety actions in the country, how much funding is spent on road safety measures. It shows the level of development of national road safety council and NGOs. It shows how far each country is from the goal of national road safely programs (if there is any). This index can be developed further and benefit from other available indices especially those used to assess the management development and organisational culture between countries. This index is not used here because of lack of data. 

Filho et al. (2010) developed a framework to measure safety culture in the Brazilian oil and gas companies. They applied a five level safety culture maturity model (e.g., pathological, reactive, bureaucratic, proactive and sustainable) using five dimensions (e.g., information, organizational learning, involvement, communication and commitment) to identify current state of safety practices in petrochemical companies. 

Halligan, M. and Zecevic, A. 2011. Safety culture in healthcare A review of concepts, dimensions, measures and progress. BMJ Quality Safety, 20(4), 338-43. doi 10.1136/bmjqs.2010.040964. 

Of conrse, this approach is based on the assumption that safety culture correlates with safety outcomes. Therefore, it is of critical importance to confirm the cnltnre-ontcome link, which is one of the requirements for a safety culture scale, understood as criterion validity - a more comprehensive summary of the required properties can be found in other literature (e.g. Itoh et al. 2012). For this applied purpose of safety culture, this chapter specifically looks at dimensions of safety culture, how to measure safety outcomes, and the safety culture-outcome link through an examination of case studies, primarily drawn from Japanese hospitals. Before stating these issues in detail, we will, in the rest of this section, briefly argue notions of safety culture (and safety climate). 

As pointed out by Lazar et al. (2013) outcome measures need to be harmonised. They must be rehable, valid and consistent Most outcome measures reflect a single dimension but rrltimately they must be developed to reflect the continuum of care. While we might ideally want and even require measures of safety climate and culture to correlate with outcome measures, we have tried to describe in this section the many factors that will tend to cover or weaken such correlations. 

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