Staff attitudes

Safety and risk management research in healthcare has adopted as its dominant trend the systems oriented approach, modelled largely on previous research in safely critical industries such as aviation and nuclear power. The systems view entails that the focus is not primarily on the mechanisms of individual human error but on the factors that shape human performance (Rasmussen 1986 Reason 1993,1997). In an organisational context, such factors are, of course, those that are within the control of the organisation. For instance, it has been suggested that quahty and safety are affected not only by operators professional and technical competence and skills, but also by their attitudes to and perceptions of their job roles, their organisation and management (Helmreich and Merritt 1998). Such employee attitudes and views are important elements which shape safety cirlture - and its related notion safety climate . Indeed, survey studies have shown that staff attitudes are important indices of safety performance not only in human-machine system domains such as railway operations and constmction (e.g. Itoh and Andersen 1999 Itoh et al. 2004 Silva et al. 2004) but also in healthcare (e.g. Colla et al. 2005 Itoh and Andersen 2010). 

In this subsection, we apply another type of safety performance data, i.e., self-reported staff attitudes to error reporting and interaction with the patient, to the test of criterion validity of the safety culture factors. For this purpose, we used the nurse sample of the Japanese data including more than 17,000 questionnaire responses collected from 82 hospitals (Itoh and Andersen, 2010). An example of resrrlts of correlation analysis is shown in Table 4.10 in terms of Spearman s rho, using the mild outcome case in the three vignettes offered - results for the near-miss and severe cases were quite similar to this case. 

From these resrrlts, it can be seen that a positive safety culture contributes to favorrrable staff attitudes related to patierrt safety. In particular, small power distance arrd blame-free atmosphere appeared as the most effective elements of safety crrlture for positive staff attitrrdes and behaviours to error reporting and interaction with the patierrt after the adverse event. 

Itoh, K., Andersen, H.B., Madsen, M.D., Ostergaard, D. and Ikeno, M. 2006. Patient views of adverse events Comparisons of self-reported healthcare staff attitudes with disclosure of accident information. Applied Ergonomics, 37, 513-23. 

Based on the literature review, key dimensions of hospital patient safety culture were identified and items drafted to measure those dimensions. Items were written to obtain a staff-level perspeetive of the extent to which a hospital organisation s culture supports patient safety and event reporting. In addition, most of the items were foeused on the respondent s own work area or unit beeause unit-level eulture is more salient and relevant and has the most immediate influenee on staff attitudes and behaviors. Sinee eulture varies aeross units, it was important to foeus respondents on their own unit s eulture by asking them to identify and seleet their unit first and then answer the questions in the survey about that unit. However, some patient safety eulture issues cut across units, so the last part of the survey foeused specifically on hospital-wide patient safety eulture, ineluding handoffs and transitions, pereeptions of management support and teamwork aeross units. 

Sorra, J., Nieva, V, Rabin-Fastman, B., Kaplan, H., Schreiber, G. and King, M. 2008. Staff attitudes about event reporting and patient safety cultme in hospital transfusion services. Transfusion, 48, 1934M2. 

Staff attitudes to fire risks and fire risk controis... 

It is important that good toilet and changing facilities are provided to ensure hygiene standards can be maintained. However, foodservige staff attitudes often reflect the quality of accommodation provided. 

On the other hand, institutional features hindering inclusion were associated primarily with a perceived lack of communication and information within the organisation, as Figure 9.2 shows. Although the lack of conununication was primarily noted between staff within the host school, the boundaries of conununication difficulties were often blurred and extended to school-inclusion Project contacts also these are examined in detail in the section below. Buddings, staff attitudes and lack of resources arose conunoidy as impediments to the successful development of the Inclusion Project. These too, though, are complex issues and will be examined in detail in the relevant section below. 

Figure 9.6 shows that there were also positive and negative facets of staff attitude to inclusion in general and the project in particular in partner schools. These were broadly as follows ... 

Although the latter can partly be attributed to the greater embarrassment and self-consciousness usually seen in secondary pupils, it is also the case that staff attitudes are communicated to students, who assimilate them with great sensitivity. The parent s account reveals that, if nothing else, there was no system in place for taking positive action (such as a staff member initiating the applause). 

---