Moral disengagement is the process by which individuals mitigate the consequences of their own violations of moral standards. Although MD is understood to be co-determined by culture norms, no study has yet explored the extent to which MD applied to safety at work fosters safety violations, nor the role of organizational culture as a predictor of JS-MD. The current study seeks to address this gap in the literature by examining individual- and organizational-level factors that explain why (...) employees fail to report workplace accidents. We tested a latent variable structural model positing organizational culture typologies as predictors of JS-MD, which in turn is expected to mediate the relationship with accident underreporting. Using data from 1033 employees in 28 Italian organizations, findings suggest that bureaucratic safety culture was related to lower levels of JS-MD, whereas technocratic safety culture was related to greater JS-MD. In turn, JS-MD positively predicted employee accident underreporting and fully mediated the relationship between culture and underreporting. Theoretical and practical implications are discussed in light of the increasing focus on underreporting as well as the adverse individual and organizational consequences of failing to report workplace accidents. (shrink)

The present paper investigates the potential benefits of a strong safety culture. Specifically, we build on the organizational support theory to explore the direct and indirect effects of SC on firm performance. Partial least squares method is used to analyze the data collected from a survey among 251 Canadian plants. The results show that SC is associated with several performance indicators all linked to sustainable development. Importantly, our findings also suggest that the relationships between SC and environmental/safety (...) performance are mediated by the actual level of implemented environmental/safety practices within plants. We conclude the paper by highlighting the study’s limitations and contributions as well as theoretical and managerial implications. (shrink)

High-profile failures in financial trading have led to interest in how the culture of the industry produces risky and unethical behaviours among traders. Yet, there is no established theoretical framework for studying this: we apply safety culture theory to examine ten recent high-profile trading mishaps investigated by the UK financial regulator. The results show that the dimensions of safety culture used to understand organisational accidents in domains such as aviation also explain failures in Risk Management (...) within financial trading organisations. This counters narratives focusing on traders who are unethical ‘rule breakers’, and emphasises the value of a systemic approach, whereby safety culture theory is used to explain why risky behaviours in financial trading occur. Safety culture therefore provides a conceptual basis for further research on risky and unethical behaviours in financial trading, alongside providing insights for possible intervention. (shrink)

This paper analyses various approaches to the concept of a ‘safety culture’ in terms of their epistemological assumptions regarding the nature of learning. As a result of this analysis, the study proposes a relational-interpretive framework for the promotion of safety in health care, which is based on relational theories and the philosophy of conceptual pragmatism as this can be used to integrate the various strands of current safety research. In particular, the approach based on a relational-interpretive (...) perspective can bridge the apparent dualist gap that exists between the rational objectivist perspective and the relativist perspective on the role of learning in developing a safety culture. According to the relational-interpretive perspective of safety management that is proposed here, organizational members need to give continuous attention to the accepted organizational norms and values, which shape the safety culture. A case study from a health care safety project in Sweden is utilized to illustrate the ideas advanced in this paper. (shrink)

The aim of this paper is discussion of a new middle‐range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety (...) class='Hi'>culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety. (shrink)

We examined a largely ignored but imperative dimension of safety literature by testing the impact of ethical leadership style on organizational safety performance. We also tested dual mediating paths of safety culture and safety consciousness in the relationship between ethical leadership style and organizational safety consciousness. Data were collected from a large public sector telecom company in Pakistan. Confirmatory factor analysis was used to assess the reliability and validity of the study scales and model (...) fit. Preacher and Hayes’s macro of mediation was employed to test the direct and indirect paths proposed in the study. The findings suggest that ethical leadership has a positive impact on organizational safety performance. Partial mediating roles of safety culture and safety consciousness were also found between the dependent and independent variables. Theoretical and practical implications are discussed. (shrink)

Background Scientific advances have resulted in more complex medical systems, which in turn have led to an increase in the number of patient safety incidents. In this environment, the importance of honest disclosure of PSIs is rising, which highlight the need to settle a reliable system. This study aimed to investigate the effects of patient safety culture and ethical awareness on open disclosure of PSIs. Methods Data were collected from 389 nurses using self-reported perceptions of open disclosure (...) of PSIs, perceptions of patient safety culture, and ethical awareness. Results Perception of open disclosure of PSIs was significantly correlated with ethical awareness and perception of patient safety culture. Ethical awareness had the greatest impact on perception of PSIs, and two components of the perception of patient safety culture, namely overall knowledge about patient safety and staffing, were found to have significant effects. Conclusions To enhance nurses’ perception of open disclosure of PSIs, educational curriculum and programs that teach and practice fundamental ethical values are needed. Furthermore, it also calls for effort on the part of healthcare institutions and the government, as well as people’s trust, to implement a legal safety net and foster patient safety culture to promote honest disclosure of PSIs to patients. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical (...) perspectives that foster a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)

This study described and analysed the circumstances surrounding a fatal car accident involving personnel of a multinational corporation in a developing country. For some companies, road accidents are the leading cause of work-related fatalities in developing countries. This reality highlights the ethical dilemmas encountered in a global workplace. Questions as to how a company addresses safety concerns outside the standard work environment, the ethics of operating in a risky environment and the requirements for international consistency in compensation standards for (...) loss of life were addressed. The authors argued that multinational companies should localize health and safety practices to address the important asymmetries between different regions of the world regarding social, cultural and infrastructural issues. Furthermore, the authors analysed the leadership role that should be played by multinational companies to help and support national governments to reduce traffic fatalities in developing countries. From this perspective, the article represents a contribution for the body of knowledge dealing with the business–society relations. The authors used an action research approach to address these issues, both in response to the particular incident and to contribute to the body of research in this field. (shrink)

What is the right thing to do? -- "You have nothing to fear if you've done nothing wrong" -- Between culpable and blameless -- Are all mistakes equal? -- Report, disclose, protect, learn -- A just culture in your organization -- The criminalization of human error -- Is criminalization bad for safety? -- Without prosecutors, there would be no crime -- Three questions for your just culture -- Why do we blame?

This study will be of interest to anyone concerned with a critical appraisal of mental health service users’ and carers’ participation in research collaboration and with the potential of the postcolonial paradigm of cultural safety to contribute to the service user research (SUR) movement. The history and nature of the mental health field and its relationship to colonial processes provokes a consideration of whether cultural safety could focus attention on diversity, power imbalance, cultural dominance and structural inequality, identified (...) as barriers and tensions in SUR. We consider these issues in the context of state‐driven approaches towards SUR in planning and evaluation and the concurrent rise of the SUR movement in the UK and Australia, societies with an intimate involvement in processes of colonisation. We consider the principles and motivations underlying cultural safety and SUR in the context of the policy agenda informing SUR. We conclude that while both cultural safety and SUR are underpinned by social constructionism constituting similarities in principles and intent, cultural safety has additional dimensions. Hence, we call on researchers to use the explicitly political and self‐reflective process of cultural safety to think about and address issues of diversity, power and social justice in research collaboration. (shrink)

This article explores the social and ethical elements of cultural safety and combines them in a model of culturally safe practice that should be of interest and relevance for nurses, nurse educators and nurse ethicists in other cultures. To achieve this, the article briefly reviews and critiques the main underpinnings of the concept from its origins and development in New Zealand, describes its sociocultural and sociopolitical elements, and provides an in-depth exploration of the key socioethical elements. Finally, a model (...) is presented to illustrate the strong connection between the social and ethical components of cultural safety that combine to produce culturally safe practice through the activities of a ‘socioethical’ nurse. (shrink)

People who identify as members of religious communities, such as the Amish and Low German Mennonites, face challenges obtaining quality health care and engagement in research due in part to stereotypes that are conveyed through media and popular discourses. There is also a growing concern that even when these groups are engaged in research, the guiding frameworks of the research fail to consider the sociocultural or historical relations of power, further skewing power imbalances inherent in the research relationship. This paper (...) aims at discussing the uses of cultural safety in the context of health research and knowledge translation with groups of people that are associated with a specific religion. Research with the Amish and Low German Mennonites is provided as examples to illustrate the use of cultural safety in this context. From these examples, we discuss how the use of cultural safety, grounded in critical theoretical perspectives, offers new insight into health research with populations that are traditionally labeled as minority, vulnerable, or marginalized, especially when a dominant characteristic is a unique religious perspective. (shrink)

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be ‘culturally safe’. The ways in (...) which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the ‘nuts and bolts’ of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation. (shrink)

The purpose of the study was to develop an understanding of how nursing students gained perspective on nursing care of diverse populations through watching documentaries in a cultural diversity course. The basis of this paper is our analyses of students’ written responses and reactions to documentaries viewed in class. The guiding theoretical frameworks for the course content and the study included postcolonial feminism, Foucauldian thought, and cultural safety. Krathwohl's Taxonomy of the Affective Domain was used to identify themes and (...) determine how undergraduate nursing students were progressing in achieving learning outcomes. Our findings suggest that while the use of documentaries serves as a tool for deepening students’ understanding of the realities of various populations, this activity, in the absence of critical reflection, may inadvertently promote stereotypes and further marginalize different people groups. Even though nursing students reflected on the importance of cultural safety in nursing, our findings indicate that their actions may not reflect this, especially since these students are in the early stages of the nursing program. Students need to be provided with a space where they can explore implicit biases evoked by exposure to new information about different people groups as a way of enhancing culturally safe care. (shrink)

Food safety, ultimately, is a human-centred work. No matter how regulations are coercively released and implemented, the free will and behaviors of human actors (e.g., employees) leads to a real result in food safety. A real motivator of such free will and behaviors is organizational culture that stimulates meaningful organizational actions. Based on such rationale, this conceptual paper with Walmart as an example case sets to discuss the relationships between green organizational culture, corporate social responsibility, and (...) food safety. As organizational culture has been largely discussed in Management and Business literature, green organizational culture and its impacts on socially and environmentally friendly organizational behaviors, as well as public health outcomes like food safety, is wanted. With the clarification of the relationships between these three important constructs, theoretical implications for future research and practical implications for governance and policy-making are well generated. (shrink)

The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems (...) of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety—not state compulsion—must remain the first principles of any engagement—including vaccination—with First Nations Peoples, families, and communities. (shrink)

The concept of cultural safety offers a unique approach to nursing practice, based on recognition of the power differentials inherent in any interaction. It is from within the context of nursing in Aoteaoroa/New Zealand (A/NZ) that the concept developed and was subsequently integrated into nursing education. Cultural safety is based within a framework of biculturalism, and is congruent with the tenets of the nation's founding document, the Treaty of Waitangi. Clarification of the concept is offered, together with a (...) review of the historical shift in nursing attitudes that has led to the emergence of ‘cultural safety’ as a viable and valued component of nursing practice.The argument is made that cultural safety has allowed for a more reflective, critical understanding of the actions of nursing to develop. This includes recognition that nurses’ attitudes and values have inevitably been influenced by social and political forces, and as such are in part reflective of those within the wider community. Comparison between the support given by nurses in the early 1900s to the theory of eugenics and the current acceptance of cultural safety is used to highlight this point. An examination of the literature identifies that ideological and conceptual changes have occurred in the approach of A/NZ nurses to issues with cultural implications for practice. A review of background factors relating to Maori health status and the Treaty of Waitangi is presented as a necessary context to the overall discussion.The discussion concludes with an acknowledgement that while the rhetoric of cultural safety is now part of nursing culture in New Zealand, there is no firm evidence to evaluate its impact in practice. Issues identified as impacting on the ability to assess/research a concept, such as cultural safety, are discussed. For cultural safety to become recognised as a credible (and indispensable) tool, it is necessary to further examine the ‘end-point’ or ‘outcomes’ of the process. (shrink)

There is an inextricable link between cultural and clinical safety. In Australia high‐profile Aboriginal deaths in custody, publicised institutional racism in health services and the international Black Lives Matter movement have cemented momentum to ensure culturally safe care. However, racism within health professionals and health professional students remains a barrier to increasing the number of Aboriginal and Torres Strait Islander Health professionals. The Australian Health Practitioner Regulation Agency's Aboriginal and Torres Strait Islander Health Strategy's objective to ‘eliminate racism from (...) the health system’, and the recent adoption of the Aboriginal and Torres Strait Islander peoples led cultural safety definition, has instigated systems level reflections on decolonising practice. This article explores cultural safety as the conceptual antithesis to racism, examining its origins, and contemporary evolution led by Aboriginal and Torres Strait Islander peoples in Australia, including its development in curriculum innovation. The application of cultural safety is explored using in‐depth reflection, and the crucial development of integrating critical consciousness theory, as a precursor to culturally safe practice, is discussed. Novel approaches to university curriculum development are needed to facilitate culturally safe and decolonised learning and working environments, including the key considerations of non‐Indigenous allyship and collaborative curriculum innovations and initiatives. (shrink)

Holistic thinking involves four subconstructs: causality, contradiction, attention to the whole, and change. This holistic perspective varies across Eastern–Western cultures and genders. We theorize that holistic thinking reduces three domain-specific risk-taking behavioral intentions (ethical, financial, and health/safety) directly and indirectly through enhanced risk-taking attitudes. Our formative theoretical model treats the four subconstructs of holistic thinking as yoked antecedents and frames it in a proximal context of causes and consequences. We simultaneously explore the direct and indirect paths and test our (...) model across cultures, genders, and the combination of the two. For the entire sample (N = 531), holistic thinking negatively relates to risk intentions via enhanced risk perceptions. Across cultures, the indirect paths prevail among Chinese people (n = 284), and both direct and indirect paths triumph for Americans (n = 247). Across genders, the indirect paths exist for females, whereas the negative direct path (risk-raking attitudes → behavioral intentions) succeeds for males. Across cultures and genders, holistic thinking negatively relates to American males’ ethical risks the most but Chinese males’ financial risks the least. Risk-taking perceptions are negatively related to Chinese males’ ethical risks the most, but Chinese people’s (males/females) financial risks the least. Causality and change are vital for all contexts, attention to the whole for all males and Chinese males, and contradiction for Americans and all females. Holistic thinking has limits and is less robust than risk-taking perceptions in reducing risky behavioral intentions. Our practical implications help people make ethical, healthy, and wealthy decisions. (shrink)

This article presents and evaluates arguments supporting that an approval procedure for genome-edited organisms for food or feed should include a broad assessment of societal, ethical and environmental concerns; so-called non-safety assessment. The core of analysis is the requirement of the Norwegian Gene Technology Act that the sustainability, ethical and societal impacts of a genetically modified organism should be assessed prior to regulatory approval of the novel products. The article gives an overview how this requirement has been implemented in (...) the regulatory practice, demonstrating that such assessment is feasible and justified. Even in situations where genome-edited organisms are considered comparable to non-modified organisms in terms of risk, the technology may have—in addition to social benefits—negative impacts that warrant assessments of the kind required in the Act. The main reason is the disruptive character of the genome editing technologies due to their potential for novel, ground-breaking solutions in agriculture and aquaculture combined with the economic framework shaped by the patent system. Food is fundamental for a good life, biologically and culturally, which warrants stricter assessment procedures than what is required for other industries, at least in countries like Norway with a strong tradition for national control over agricultural markets and breeding programs. (shrink)

Living in modern biopolitical risk culture might be seen as synonymous with living in prognosis time, in the sense that risk of illness is endlessly forecast (prognosticated) in the broad social arena. ‘Safety,’ in this context, is framed as the anticipatory guarding against risk or disease in order to ‘make live.’ Thinking of risk and safety in these ways is limited, however, in that the prognosis cannot account for the individual’s life or death drama. This paper asks: (...) how are we to understand the constellation of risk, prognosis, and safety in relation to ‘the subject in breast cancer prognosis’? (shrink)

Too often in a hospital setting, forgiveness is thought to be automatic—given if a physician makes the apology. But this is cheap grace: a forgiveness achieved without the participation of the injured party. We must remember that forgiveness must be given, and devise new practices to see that it can be.

The present study scrutinizes the role of societal culture in cases of sexual violence in Greek sport, as presented in the media after a two times Olympic medalist of Greece fired up the “‘me too’ Movement” in the country. Specifically, data for this study consisted of 36 media articles, reporting multiple cases of sexual abuse and harassment in Greek sport and were published between January 2021 and January 2022. We drew on the cultural praxis heuristic to explore how the (...) cultural setting operates as an underlying factor in priming athletes for harassment and abuse and in oppressing them into not speaking up. Our thematic analysis of media data revealed two overarching themes, namely, keeping the home intact and failed negotiations with power. Based on these findings, we discuss how subtle manifestations of patriarchy and collectivism perpetuate sexualized violence in Greek sport as they promote a climate of silence, prevent safeguarding, maintain underreporting of sexual violence, and delayed the arrival of the #metoo. We conclude that under the current circumstances, change seems to be a threat to all involved in Greek sport, yet for different reasons. For the coaches, sport officials, stakeholders, state system, change would require them to relinquish male powers and authority, find new meaning of what it means to be and do as a man, and allow women to be seen as counterparts. For the female athletes-survivors, it would require them to prioritize the self and their self-care and let go of the in-group loyalty and subordination learned and exhibited from infancy. We also contend that mere translations of international and regional safeguarding guidelines and toolkits cannot foster awareness raising, nor the implementation of measures within cultural settings that divert from the Global North. If we care to combat the universal phenomenon of sexualized violence in sport, a glocal approach is needed, where local socio-cultural factors are acknowledged, their role is addressed, and violence is understood within its context. (shrink)

We make many decisions in our livesand we weigh the benefits against thedrawbacks. Our decisions are based on whatbenefits are most important to us and whatdrawbacks we are willing to accept. Decisionsabout what we eat are made in the same way; butwhen it comes to safety, our decisions areusually made more carefully. Food containsnatural chemicals and it can come into contactwith many natural and artificial substancesduring harvest, production, processing, andpreparation. They include microorganisms,chemicals, either naturally present or producedby cooking, environmental (...) contaminants, andpesticides. Since the chance of being harmed bythese potential hazards is called risk, riskanalysis might be better termed as the scienceof safety, because risk management is anessential part of it. It would, however, bedifficult and shortsighted to maintain thatquestions about risk and safety can have nomoral dimension. Risk and safety become mattersof moral concern when they raise furtherquestions about responsibility, accountability,and justifiability. The question of risk cannotbe ignored in any ethical investigation ofgenetic engineering, novel foods, animalwelfare, and individual choices. However, foodis more than metabolic fuel. It hasphysiological, psychological, social, cultural,and aesthetic associations that merge to form agestalt that people endanger and maintain. Thecontribution of any food towards anindividual's well being is as complex as theindividual himself. In this context, thebenefits of consuming food that containshazards may outweigh the risk. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a (...) risk management framework which requires researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

Although inclusion in formal value chains extends the prospect of improving the livelihoods of rural small-scale producers, such a step is often contingent on compliance with internationally-promoted food safety standards. Limited research has addressed the challenges this represents for small rural producers who, grounded in culturally-embedded food safety conceptions, face difficulties in complying. We address this gap here through a multiple case study involving four public school feeding programs that source meals from local rural providers in the Bolivian (...) Altiplan. Institutional logics theory is used to describe public food safety regulations and to compare them to food safety conceptions in the local indigenous Aymara rural setting. We identify a value-based conflict that leads to non-compliance of formal food safety rules that jeopardizes the participation of small farmers in the market. These include: partial adoption of formal rules; selective adoption of convenient rules; and ceremonial adoption to avoid compliance. Decoupling strategies allow local actors to largely disregard the formal food safety regulations while accommodating traditional cultural practices and continuing to access the market. However, these practices put the long-term sustainability of the farmers’ participation in potentially favorable opportunities at risk. (shrink)

LIU W, MANIAS E and GERDTZ M. Nursing Inquiry 2011; 18: 290–302 Understanding medication safety in healthcare settings: a critical review of conceptual modelsCommunication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations (...) of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision‐Making Model, the Medication Decision‐Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. (...) Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. (...) Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

BackgroundCritical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS.MethodsA six-step approach combined (...) the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts’ experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics.ResultsFour main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance.ConclusionThe developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations’ presence and effectiveness. The proposed enhancement could contribute to hospitals’ ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction. (shrink)

The article offers an insight into road traffic accidents by unravelling both the internal elements and the social context of the so-called car–driver hybrid. It takes a critical perspective on the art of designing road safety. More importantly, it seeks to contribute to social studies of transport and mobility through development of analytical concepts within the discipline. The points of departure are the inherent ambiguities of mobility. The author suggests that ‘being in traffic’ is always determined by coexisting forms (...) of mobility and immobility. This ambivalent stage is then called motility. The author discusses car-drivers as motile hybrids, as they are mobile and immobile, as well as subjects and objects at the same time. In order to apply these concepts, the question of what happens to hybrids in crashes is addressed, employing Bruno Latour’s concept of ‘immutable mobiles’. The article concludes with a discussion of the social role of road safety experts, arguing that transport safety experts create a specific kind of spatio-temporal order within which the motile hybrid exists. It is the safety professional who decides when to take agency away from the subject and give it to the object, and it s/he who determines where to slow down and where to speed up the car–driver hybrid. (shrink)

Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four (...) main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture. (shrink)

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 the 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 (multi-component) 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 from 17% (63) to 13% (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. (shrink)

Background Despite the great benefits of intelligent assistive technology (IAT) for dementia care – for example, the enhanced safety and increased independence of people with dementia and their caregivers – its practical adoption is still limited. The social and ethical issues pertaining to IAT in dementia care, shaped by factors such as culture, may explain these limitations. However, most studies have focused on understanding these issues within one cultural setting only. Therefore, the aim of this study was to (...) explore and compare the attitudes of Israeli and German dementia experts toward IAT in dementia care, to contribute to a more cultural-comparative perspective. Methods Semi-structured interviews were conducted with 35 experts (15 Israelis and 20 Germans) in key roles in health and community services for people with dementia as well as in the fields of dementia and IAT (e.g., computer science, electrical/biomedical engineering, ethics, nursing, and gerontology). Thematic content analysis was used to analyze the data. Findings Israeli and German experts identified the same social accelerators in the development and implementation of IAT in dementia care (i.e., changes in family structure and social digitization) and benefits of adopting IAT (e.g., enhancing the safety of people with dementia and increasing their independence). However, there were differences in inhibitor/risk assessments between the two groups. Namely, economic considerations and the cognitive capacity of people with dementia were identified by both groups as inhibitors, while Israeli experts additionally reported stigma and ageism. Whereas both groups agreed that IAT might reduce human connection, and that the technology is not yet reliable enough, German experts highlighted concerns regarding privacy; in contrast, Israeli experts prioritized safety over privacy. Conclusions Our research findings allow for the identification of relevant similarities but also important differences between German and Israeli experts’ perspectives. As such, an important basis has been provided for a more in-depth discussion regarding where, why, and how culturally-sensitive technology development is needed. (shrink)

Over the past several decades, nurses have been increasingly theorizing about the relationships between culture, health, and nursing practice. This culture theorizing has changed over time and has recently been subject to much critical examination. The purpose of this paper is to identify the challenges impeding nurses' ability to build theory about the relationships between culture and health. Through a historical overview, I argue that continued support for the essentialist view of culture can maintain a limited (...) view of complex race relations. I also argue that attempts to apply culture theory, without knowledge of important historical, political, and economic factors, has often resulted in oversimplified versions of what was originally intended. Furthermore, I argue that individual-level interventions alone will be insufficient to address health inequities related to culture. Despite new critical conceptualizations of culture and the uptake of cultural safety, nursing scholars must better address the broader organizational, population, and political interventions needed to address inequities in health. I conclude with suggestions for how nurses might proceed with culture theorizing given these challenges. (shrink)

There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under‐explored, especially in the Australian context. This two‐phased qualitative study used Interpretive Description to explore 53 pre‐registration nursing students’ perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by (...) describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students’ decisions to speak up or remain silent. Understanding students’ perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up. (shrink)

Disasters in sociotechnical systems are caused by many factors. For example, the tragic chemical disaster in Bhopal, India, was caused by a leaky valve and a maintenance error. Safety scientists and investigators call these proximate factors. But the tragedy was also caused by what experts call systemic factors, which include the facility’s design, the organization of its workforce, and the safety culture of the plant and surrounding community. Other disasters share a similarly complex causality, depending on a (...) multitude of proximate and systemic factors. Investigators and scientists distinguish between these different types of factors because they think each has distinctive causal features and also because they often think some factors are more significant causes of disasters than others. In this dissertation, I analyze these distinctions and the reasoning experts use when selecting important causes of disasters in cases like the Bhopal gas tragedy and the Challenger shuttle loss. Using James Woodward’s interventionist theory of causation, I explicate three causal concepts that can be used to distinguish among causal factors: amplifying/damping, causal inertia, and causal delay. I employ these concepts to elaborate and clarify the causal features safety scientists identify to draw distinctions among different types of causal factors, and their reasons for thinking some causes are more important than others for understanding disasters. My dissertation takes a pragmatic approach to causal selection. Although philosophers have emphasized John Stuart Mill’s remark that selecting individual causal factors is “capricious,” I base my approach on Mill’s deeper thinking about the logic of causal selection and the philosophical challenge it poses. I show that selections of causal factors in investigations of disasters and the surrounding discussions of safety are motivated primarily by the dual aim of preventing future disasters and making systems safer. Considering these purposes is essential to understand why investigators single out causes with certain features. Analyzing causal selection in terms of why certain types of causes with certain kinds of features are more useful than others for particular purposes clarifies vital reasoning about the important causes of disasters and enriches our understanding of causal knowledge. (shrink)

Background Ethical challenges constitute an inseparable part of daily decision-making processes in all areas of healthcare. Ethical challenges are associated with moral distress that can lead to burnout. Clinical ethics support has proven useful to address and manage such challenges. This paper explores how prehospital emergency personnel manage ethical challenges. The study is part of a larger action research project to develop and test an approach to clinical ethics support that is sensitive to the context of emergency medicine. Methods We (...) explored ethical challenges and management strategies in three focus groups, with 15 participants in total, each attended by emergency medical technicians, paramedics, and prehospital anaesthesiologists. Focus groups were audio-recorded and transcribed verbatim. The approach to data analysis was systematic text condensation approach. Results We stratified the management of ethical challenges into actions before, during, and after incidents. Before incidents, participants stressed the importance of mutual understandings, shared worldviews, and a supportive approach to managing emotions. During an incident, the participants employed moral perception, moral judgments, and moral actions. After an incident, the participants described sharing ethical challenges only to a limited extent as sharing was emotionally challenging, and not actively supported by workplace culture, or organisational procedures. The participants primarily managed ethical challenges informally, often using humour to cope. Conclusion Our analysis supports and clarifies that confidence, trust, and safety in relation to colleagues, management, and the wider organisation are essential for prehospital emergency personnel to share ethical challenges and preventing moral distress turning into burnout. (shrink)

Large organisations are especially advised to consider the possibility of an Ethics Helpdesk in which all employees and managers can report with all suspected cases of unethical conduct, critical comments, dilemmas and advice for which there is insufficient room within the organisational hierarchy. A helpdesk is a central contact point where it is decided who the most appropriate person is to dealing with a given case. The helpdesk model is characterised by low barriers in its easy accessibility, positive approach and (...) the simple procedures employees need to follow. It offers employees consistent support while relying on the responsibilities of the individual employee as much as possible and it facilitates adequate monitoring and reporting. A helpdesk increases the chances of detecting unethical conduct which enables management to take adequate and timely measures against improper conduct. This article formulates principles, discusses critical factors and considers three models for adopting a sound and integrated ethics safety net. It also presents a case study and shows why organisational openness needs to be institutionalised. (shrink)