Should Probabilistic Design Replace Safety Factors? Content Type Journal Article Pages 151-168 DOI 10.1007/s13347-010-0003-6 Authors Neelke Doorn, Department of Technology, Policy and Management, Delft University of Technology, PO Box 5015, 2600 GA Delft, The Netherlands Sven Ove Hansson, Department of Philosophy and the History of Technology, Royal Institute of Technology, Teknikringen 78 B, 100 44 Stockholm, Sweden Journal Philosophy & Technology Online ISSN 2210-5441 Print ISSN 2210-5433 Journal Volume Volume 24 Journal Issue Volume 24, Number 2.

Safety factor rules are used for drawing putatively reasonable conclusions from incomplete datasets. The paper attempts to provide answers to four questions: “How are safety factors used?”, “When are safety factors used?”, “Why are safety used?” and “How do safety factor rules relate to decision theory?”. The authors conclude that safety factor rules should be regarded as decision methods rather than as criteria of rightness and that they can be used in (...) both practical and theoretical reasoning. Simplicity of application and inability or unwillingness to defer judgment appear to be important factors in explaining why the rules are used. (shrink)

Safety is a concern in almost all branches of engineering. Whereas safety was traditionally introduced by applying safety factors or margins to the calculated maximum load, this approach is increasingly replaced with probabilistic risk assessment (PRA) as a tool for dimensioning safety measures. In this paper, the two approaches are compared in terms of what they aim at and what they can, in fact, achieve. The outcome of this comparison suggests that the two approaches should be (...) seen as complementary rather than mutually exclusive. PRA is particularly useful for priority setting and for the effect evaluation of safety measures; however, in most applications, uncertainties prevent PRA from providing an objective probability of failure or value of damage. Safety factors are indispensible for dealing with dangers that cannot be assigned meaningful probabilities. (shrink)

Firms that wish to be morally responsible in providing products that meet a high standard of safety may face problems competing against firms that make unsafe products and sell these products at cheap prices; these problems may be compounded when consumers do not accurately process information about safety and risk. This paper presents a conceptual argument that the tort system may serve to promulgate information which makes it feasible for firms to market safe products even in the face (...) of these competitive obstacles.To corroborate the conceptual argument, the paper presents the results of an experimental study about the impact of negligence liability information on consumer product safety evaluation. The results show that provision of negligence information heightens consumer concern for safety and firms' ethical behavior, and increases the proportion of consumer choices in favors of the brands sold by manufacturers with a favorable track record for quality. More importantly, they indicate that provision of negligence information reduces the likelihood that brands which conform to inferior safety standards will be chosen by consumers who care about safety standards. (shrink)

Due to the limited work safety resources and the poor awareness of work safety from business owners with absolute decision-making power, safety accidents frequently occur in Chinese micro and small enterprises in high-risk industries. This study identifies the influencing factors of work safety behavior from MSEs, government safety supervision departments, and work safety service agencies. Based on the theory of planned behavior, the mechanism model of work safety behavior is built from the aspects (...) of behavior attitude, subjective norms, behavior control cognition, past behaviors, and risk awareness of the enterprise. Based on the interview with nearly 600 MSEs in the east of China over 6 months, the results show that the work safety awareness of the business owner determines the work safety lever of the enterprise, and the work safety behavior of MSEs is a passive restraint behavior. Our findings provide a new perspective on the formation of MSEs’ work safety behavior in high-risk industries. (shrink)

BackgroundThe complexities of the workplace environment in the downstream oil and gas industry contain several safety-risk factors. In particular, instituting stringent safety standards and management procedures are considered insufficient to address workplace safety risks. Most accident cases attribute to unsafe actions and human behaviors on the job, which raises serious concerns for safety professionals from physical to psychological particularly when the world is facing a life-threatening Pandemic situation, i.e., COVID-19. It is imperative to re-examine the (...) class='Hi'>safety management of facilities and employees’ well-being in the downstream oil and gas production sector to establish a sustainable governance system. Understanding the inherent factors better that contribute to safety behavior management could significantly improve workplace safety features.ObjectiveThis study investigates employees’ safety behavior management model for the downstream oil and gas industry to consolidate the safety, health and wellbeing of employees in times of COVID-19.MethodsNominal Group Technique was first employed to screen primary behavioral factors from 10 workplace health and safety experts from Malaysia’s downstream oil and gas industry. Consequently, 18 significant factors were identified for further inquiry. Next, the interpretive structural modeling technique was used to ascertain the complex interrelationships between these factors and proposed a Safety Behavioral Management Model for cleaner production.ResultsThis model shows that management commitment, employee knowledge and training, leadership, and regulations contribute significantly to several latent factors. Our findings support the Social Cognitive Theory, where employees, their environment, and their behaviors are related reciprocally.ConclusionIt is postulated that identifying safety factors and utilizing the proposed model guides various stakeholder groups in this industry, including practitioners and policymakers, for achieving long-term sustainability. (shrink)

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)

There is considerable support for the idea that an atmosphere of safety can foster learning in groups, especially during ethics training courses. However, the question how safety dynamics works during ethics courses is still understudied. This article aims to investigate safety dynamics by examining a critical incident during a military ethics train-the trainer course during which safety was threatened. We examine this incident by means of a four-factor analysis model from the field of Theme-Centered Interaction (...) (TCI). We show that during ethics training courses a safety paradox can occur, involving a tension between honesty and openness to other perspectives and values. Finally, we discuss how trainers can foster safety during ethics training. (shrink)

The effect of arousal safety has been analyzed on purchase intention, then attitude towards the advertisement and attitude towards the brand have been incorporated as intervening variables between the relationships. The interaction effect of self-monitoring and message arguments have also been taken in to consideration for better understanding of the consumer’s response. The data has been gathered from 206 respondents by using purposive sampling method. The research instrument was comprised of summated rating/additive scale and semantic differential scaling. Confirmatory (...) class='Hi'>Factor Analysis has been applied after the application of preliminary tests on the data. Structure Equation Modeling and moderation and mediation analysis have also been applied to test the hypotheses. Arousal safety in the advertisements shape consumers response and it proved to be a fully mediated model. Self-monitoring also probes the relationship. Message arguments haven’t had any affect as moderator, hence can be used as a focal predictor. The study is a starting point for future research to provide a coherent methodology for capturing the necessary data, processing the underlying information and evaluating the effects of arousal safety in advertisements. The study extends the field of advertising in the direction of arousal safety effects. In comparison to previous research, empirical evidence on the arousal safety in television advertising and purchase intention in relation with moderating and mediating variables is provided. (shrink)

Existing studies have highlighted the importance of informal safety communication among workers at construction sites. However, there is still a lack of empirically tested theoretical models with valid and reliable scales for describing and measuring construction workers’ informal safety communication. Accordingly, this study aimed to fill this need by developing an instrument to assess the communication performance of construction workers. Four stages of scale development were described: construct formation, item generation, factor extraction through the exploratory factor (...) analysis, and scale assessment through the confirmatory factor analysis. Using questionnaire data drawn from construction workers in China, the CWISC was verified to be a three-dimensional construct including citizenship safety communication, self-needed safety communication, and participatory safety communication. The corresponding CWISC scale with 12 items was shown to have acceptable internal consistency reliability, as well as content, convergent, and discriminant validity. The CWISC scale could serve as an instrument to assess and identify the weaknesses in informal safety communication performance of construction workers. In turn, this information could help supervisors implement appropriate management practices to those workers to enhance workplace informal safety communication. Related studies taking a multidimensional CWISC into account were expected to be carried out. (shrink)

As an important influencing factor of construction workers' safety performance, safety stressor has received increasing attention. However, no consensus has been reached on the relationship between different types of safety stressors and the subdimensions of safety performance, and the mechanism by which safety stressors influence safety performance remains unclear. This study proposed a multiple mediation model with ego depletion and self-efficacy as mediators between safety stressors and workers' safety performance. Data were (...) collected from 335 construction workers in China. Results demonstrated that: the three types of safety stressors all had negative effects on workers' safety performance ; self-efficacy mediated all the relationships between the three safety stressors and safety performance; ego depletion only mediated part of the relationships between the three safety stressors and safety performance; and only part of the multiple-step mediating effects through ego depletion and self-efficacy were supported. This study made contributions by shedding light on the mechanism by which safety stressors influence workers' safety performance and providing more empirical evidence for the relationship between various safety stressors and the subdimensions of safety performance. Additionally, targeted strategies for improving workers' safety performance were proposed according to the findings. (shrink)

This study identifies global factors conditioning the global problematics of the direction of social development. Global threats were evaluated and defined as dangerous processes, phenomena, and situations that cause harm to health, safety, well-being, and the lives of all humanity, and require removal. The essence of global risks was defined. These risks were defined as events or conditions that may cause a significant negative effect for several countries or spheres within a strategic period if they occur. Global problems were (...) conceptualized. These problems were defined as phenomena, matters, and situations that are not completely understandable, interesting, actual, require solving and regulation, and in addition do not have unified solutions. Current global challenges were analyzed, defined as strategic guidelines that cause transformational changes and are receiving attention from humanity. Global trends were defined as courses of social development. The composition and role of global actors were described, and defined as international organizations, leading states, regional organizations, powerful corporations, institutional investors, large cities, and well-known personalities. The directions of positive courses of social development were developed by means of using the authors’ mechanism of solving the global problematics. (shrink)

This paper examines evidence regarding neoliberalization of the social organization of Canadian food safety from a series of documents produced in response to the Canadian listeriosis outbreak in 2008. The outbreak is described, then interpreted within a neoliberal context, where: (1) neoliberalism operates as an ideology (2) that enables a socio-political and economic strategy within (3) a project pursued by coalitions seeking to consolidate power through (4) a process of neoliberalization. Following Gramsci’s work on power, it is argued that (...) food safety serves as an attractor, organizing consent within a neoliberal context. Testimony before a parliamentary subcommittee, official reviews, an independent investigation, food inspection records, and media reports have been examined to identify the key factors associated with the outbreak and the process of neoliberalization. The events associated with the outbreak are described first, as activities and practices in organizational settings (governance, sanitation, and production), and secondly, as components in a food production network where consent is organized around food safety. (shrink)

The South-to-North Water Diversion Project consists of long-distance water delivery channels and a complicated geological environment along the way. To deal with the operation safety of the water conveyance channels in the middle route of the South-to-North Water Diversion Project, this study analyzes six failure modes: structural cracks, poor water delivery during ice periods, instability of canal slopes, material aging, abnormal leakage, and foundation defects. Based on FMEA, a multigranularity language evaluation method that can be converted into interval intuitionistic (...) fuzzy numbers is used to evaluate the severity, occurrence, and detection difficulty of the six failure modes. Interval intuitionistic fuzzy entropy is used to calculate the weights of the risk factors. Finally, a ranking model of each failure mode is built based on the TODIM method. The final ranking results show that the risk of abnormal leakage is the largest, and the risk of poor water delivery during ice periods is the smallest. The feasibility and validity of the calculation results are verified by comparing them with the ranking results of the traditional RPN and TOPSIS methods. The TODIM-FMEA risk assessment model offers a new solution to the problem of risk assessment for water transfer projects. (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)

Avalanche studies have undergone a transition in recent years. Early research focused mainly on environmental factors. More recently, attention has turned to human factors in decision making, such as behavioural and cognitive biases. This article adds a social component to this human turn in avalanche studies. It identifies lessons for decision making by groups of skiers from the perspective of social choice theory, a sub-field of economics, decision theory, philosophy and political science that investigates voting methods and other forms of (...) collective decision making. In the first part, we outline the phenomenon of wisdom of crowds, where groups make better decisions than their individual members. Drawing on the conceptual apparatus of social choice theory and using idealised scenarios, we identify conditions under which wisdom of crowds arises and also explain how and when deciding together can instead result in worse decisions than may be expected from individual group members. In the second part, we use this theoretical understanding to offer practical suggestions for decision making in avalanche terrain. Finally, we make several suggestions for risk management in other outdoor and adventure sports and for outdoor sports education. (shrink)

Accidents involving large trucks result in significant economic and social costs. As technological solutions have improved, behavioral factors contributing to accidents have risen in importance. The purpose of this research is to investigate how norms, consequences, and personal attitudes influence safety-related ethical judgments and behavioral intentions. The Hunt–Vitell’s theory of ethical decision-making is adapted to test how these factors influence truck drivers’ decisions containing ethical content. Professional truck drivers evaluated decisions presented in two scenarios that included the situation, the (...) decision, and the results. The research found that drivers rely heavily on evaluations of safety norms when forming ethical judgments and behavioral intentions. Further, drivers’ attitudes toward compliance and the effectiveness of safety regulations also influenced decision-making to an extent. Overall, evidence of a refutation of the assumption that a tradeoff exists between operational productivity and safety was discovered. Drivers in this study intended to behave in a certain manner irrespective of time or money pressures. The perceived ethical component of the decision outweighed regulatory and economic consequences under a range of parameters. (shrink)

Evolutionary game theory and public goods games offer an important framework to understand cooperation during pandemics. From this perspective, the COVID-19 situation can be conceptualized as a dilemma where people who neglect safety precautions act as free riders, because they get to enjoy the benefits of decreased health risk from others’ compliance with policies despite not contributing to or even undermining public safety themselves. At the same time, humans appear to carry a suite of evolved psychological mechanisms aimed (...) at curbing free riding in order to ensure the continued provision of public goods, which can be leveraged to develop more effective measures to promote compliance with regulations. We also highlight factors beyond free riding that reduce compliance rates, such as the emergence of conspiratorial thinking, which seriously undermine the effectiveness of measures to suppress free riding. Together, the current paper outlines the social dynamics that occur in public goods dilemmas involving the spread of infectious disease, highlights the utility and limits of evolutionary game-theoretic approaches for COVID-19 management, and suggests novel directions based on emerging challenges to cooperation. (shrink)

Background: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. Aim: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. Design: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze (...) the data. Methods: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. Ethical consideration: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. Results: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses’ negative feelings about restraint use and uncertainty over the decision on physical restraint use. Conclusion: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use. (shrink)

In this issue of the Hastings Center Report, Joshua Rager and Peter Schwartz suggest using opioid treatment agreements as public health monitoring tools to inform patients about “the requirements entailed by undergoing opioid therapy,” rather than as contractual agreements to alter patients’ individual behavior or to benefit them directly. Because Rager and Schwartz's argument presents suspected OTA violations as a justification to stop providing opioids yet does not highlight the broader epistemic and systemic context within which clinicians prescribe these medications, (...) their proposal may perpetuate a climate of distrust and stigmatization without correcting systemic factors that may have placed patients and others at risk in the first place. Given the context of epistemic uncertainty regarding opioid safety and efficacy, insufficient training for opioid prescribers, and inadequate patient education, I propose replacing OTAs, which have a narrow focus on patient behaviors, with opioid treatment plans, which would promote mutual, collaborative, and shared decision-making on the most appropriate pain management program. An OTP can be ethically justified as a tool to prevent and treat iatrogenic addiction under a specific paradigm—one that adopts a default position of professional epistemic humility and holds all collaborative parties accountable in chronic pain management. (shrink)

In Part 1 of this article, the legal and scientific origins of the concept of psychological safety are examined as background to, and support for, the new Canadian National Standard on Psychological Health and Safety in the Workplace (CSA Z1003/bnq 9700). It is shown that five factors influencing psychological safety can be identified as being common to both legal and scientific perspectives: job demands and requirements of effort, job control or influence, reward, fairness, and support. This convergence (...) of evidence from legal and scientific perspectives creates a powerful case for the development of a national standard built around these five factors. In Part 2, it is proposed that the introduction of a national standard can be expected in the long run to have positive social benefits since the health or harm that is generated in the workplace does not remain there but migrates into families, communities, and society at large in the form of either social capital or social exhaust. Consequently, psychological safety is a concept that connects the dynamics of the workplace to the health, resilience, and well-being of society at large. (shrink)

Robotic and Autonomous Agricultural Technologies (RAAT) are increasingly available yet may fail to be adopted. This paper focusses specifically on cognitive factors that affect adoption including: inability to generate trust, loss of farming knowledge and reduced social cognition. It is recommended that agriculture develops its own framework for the performance and safety of RAAT drawing on human factors research in aerospace engineering including human inputs (individual variance in knowledge, skills, abilities, preferences, needs and traits), trust, situational awareness and cognitive (...) load. The kinds of cognitive impacts depend on the RAATs level of autonomy, ie whether it has automatic, partial autonomy and autonomous functionality and stage of adoption, ie adoption, initial use or post-adoptive use. The more autonomous a system is, the less a human needs to know to operate it and the less the cognitive load, but it also means farmers have less situational awareness about on farm activities that in turn may affect strategic decision-making about their enterprise. Some cognitive factors may be hidden when RAAT is first adopted but play a greater role during prolonged or intense post-adoptive use. Systems with partial autonomy need intuitive user interfaces, engaging system information, and clear signaling to be trusted with low level tasks; and to compliment and augment high order decision-making on farm. (shrink)

The concept of the method based on the behavioural approach as the method minimizing hazardous behaviours of employees has been discussed in this article. The main focus has been laid upon one of the largest economic sectors, i.e. is the construction industry. Thereby, risks arising from an improper behaviour of construction workers, and also a factor contributing to it, have been described here. The influence of employee’s age and day time have been analysed in terms of accident rates. The (...) attention was also paid to alcohol consumed by workers during and after their work and to the influence that it has on dangerous behaviours. Different ways of approaches to the worker to improve safety and hygiene at work, as well as the manner in which the approach to employee should change depending on the situation, have been presented too. (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)

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)

The acquisition of a nuclear power reactor from the North American company Westinghouse in 1964 not only brought atomic practices and knowledge to Spain but also introduced new methods of industrial organization and management, as well as regulations created by organizations such as the US Atomic Energy Commission and the International Atomic Energy Agency. This article analyzes the history of the knowledge, regulations and experimental practices relating to radiation safety and protection that traveled with this reactor to an industrial (...) space: the Zorita nuclear power plant. Within this space, the appropriation, use, and coproduction of knowledge and practices were conditioned by political, economic, industrial and social factors, and by the engineers, researchers and other professionals who contributed expert knowledge. Material held in the Tecnatom Historical Archive—the engineering company that coordinated construction of the plant—is the main source for this work, which delves into the history of knowledge and atomic technologies and adds to the historiography of radiological protection in Spain. (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)

The study of voice behavior examines the inclination of staff and team members to speak up and contribute ideas to the team. In this article, we investigate how factors such as leader-member exchange (LMX), psychological safety and psychological empowerment influence such behavior. Our findings, which are based on a sample of 308 employees working for a state-owned telecommunications company on the Chinese mainland, indicate that ethical leadership promotes employees’ voice behavior through enhanced leader-member exchange, which also leads to greater (...) feelings of psychological safety and psychological empowerment. The theoretical and practical implications of these results are discussed. (shrink)

How well can institutional guidelines help ensure the dignity, rights, safety and well being of research participants in an underdeveloped country? In this paper I describe the limits of informed consent as an instrument for the protection of participants in the context of the Philippines. I bring to this paper my experiences as an advocate of rights, a member of an ethics review board, a researcher on the ethics of research and as an observer of the dynamics of clinical (...) practice in an academic public teaching hospital of the University of the Philippines where I am professor. (shrink)

Drowning has been the cause of over 2.5 million preventable deaths in the past decade. Despite the fact that the majority of drownings occur in open water, assessment of water safety competency typically occurs in swimming pools. The assessment of water safety competency in open water environments brings with it a few difficulties, but also promises tremendous benefits. The aim of this position paper is to discuss the benefits and caveats of conducting assessments in open water environments as (...) opposed to closed and controlled environments, and to provide recommendations for evidence-based practice. The first theoretical section discusses the effects of the environment and key variables on various factors of assessment. These discussions are linked to the two perspectives of representative learning design and information processing theory. The second section presents two pilot studies of relevance and provides practical implications for assessment of water safety competency. It seems that a combination of pool-based practice and open water education may be ideal in assessing aquatic skills competency. Assessment in open water presents clear benefits regarding validity, but often poses seemingly unsurmountable barriers, which providers may have reservations about in the absence of clear evidence. Hence this article provides a robust discussion about competency assessment and signals the practical importance of faithfully reproducing the environment in which skilled behavior is most relevant. (shrink)

Large-scale social media services have been challenged due to their lack of ethical principles, which has resulted in allegations of user manipulation such as propagation of fake news related to COVID-19 vaccination and biased algorithmic curations that lead to social polarization. We studied current social media community guidelines and conducted a systematic literature review to identify the core values needed for the establishment of guidelines for responsible social media services. Through expert interviews, a framework and guidelines are proposed for each (...) of three areas: protecting privacy, raising awareness, and controlling abuse. We present each set of guidelines with executable principles and relevant design interventions that practitioners can use to offer responsible social media services. Our expert interviews surfaced tensions between the three areas that need to be addressed in developing responsible social media, such as privacy vs. sharing information, pseudonymity vs. safety, and spreading information vs. safety. (shrink)

To enable microbial colonisation of the gut mucosa, the intestinal immune system must not only react to danger signals but also recognize cues that indicate safety. Safety recognition, paradoxically, is mediated by the same environmental sensors that are involved in signalling danger. Indeed, in addition to their well established role in inducing inflammation in response to stress signals, pattern recognition receptors (PRRs) and a variety of metabolic sensors also promote gut-microbiota symbiosis by responding to "microbial symbiosis factors", "resolution-associated (...) molecular patterns", markers of energy extraction and other signals indicating the absence of pathogenic infection and tissue damage. Here we focus on how the paradoxical role of immune receptors and other environmental sensors define the microbiota signature of the individual. (shrink)

In the near future, vehicles will gradually gain more autonomous functionalities. Drivers’ activity will be less about driving than about monitoring intelligent systems to which driving action will be delegated. Road safety, therefore, remains dependent on the human factor and we should identify the limits beyond which driver’s functional state (DFS) may no longer be able to ensure safety. Depending on the level of automation, estimating the DFS may have different targets, e.g. assessing driver’s situation awareness in (...) lower levels of automation and his ability to respond to emerging hazard or assessing driver’s ability to monitor the vehicle performing operational tasks in higher levels of automation. Unfitted DFS (e.g., drowsiness) may impact the driver ability respond to taking over abilities. This paper reviews the most appropriate psychophysiological indices in naturalistic driving while considering the DFS through exogenous sensors, providing the more efficient trade-off between reliability and intrusiveness. The DFS also originates from kinematic data of the vehicle, thus providing information that indirectly relates to drivers behaviour. The whole data should be synchronously processed, providing a diagnosis on the DFS, and bringing it to the attention of the decision maker in real time. Next, making the information available can be permanent or intermittent (or even undelivered), and may also depend on the automation level. Such interface can include recommendations for decision support or simply give neutral instruction. Mapping of relevant psychophysiological and behavioural indicators for DFS will enable practitioners and researchers provide reliable estimates, fitted to the level of automation. (shrink)

The political shift toward an economic liberalism in many developed market economies, emphasizing the importance of the marketplace rather than government intervention in the economy and society (Dorman, Systematic Occupational Health and Safety Management: Perspectives on an International Development, 2000; Tombs, Policy and Practice in Health and Safety 3(1): 24-25, 2005; Walters, Policy and Practice in Health and Safety 03(2):3-19, 2005), featured a prominent discourse centered on the need for business flexibility and competitiveness in a global economy (...) (Dorman, 2000; Tombs, 2005). Alongside these developments was an increasing pressure for corporate social responsibility (CSR). The business case for CSR - that corporations would benefit from voluntarily being socially responsible — was increasingly promoted by governments and corporations as part of the justification for self-regulation. The aim of the article is to examine more closely the proposition that self-regulation is effective, with particular reference to the business case for workplace equality and safety. Based on a comprehensive literature review and documentary analysis, it was found that current predominant management discourse and practice focusing on diversity and safety management systems (OHSMS) resonate well with a government and corporate preference for the business case and self-regulation. However, the centrality of individual rather than organizational factors in diversity and OHSMS means that systemic discrimination and inherent workplace hazards are downplayed, making it less likely that employers will initiate structural remedies needed for real change. Thus, reliance on the business case in the argument for self-regulation is problematic. In terms of government policy and management practice, the business case needs to be supplemented by strong, proactive legislation, and worker involvement. (shrink)

In the context of Ukraine’s membership in the WTO, the functioning of a free trade area with the EU, the opportunity for agricultural producers to obtain a larger share of the value added is primarily linked to the intensification of trade in domestic livestock products and their processing products. However, their production is one of the high-risk areas and requires a set of measures aimed at ensuring proper quality. Without effective solution of the problem of quality of livestock products it (...) is impossible to ensure its competitiveness in the world market, to guarantee the rational nutrition of the population of the country, the availability of the necessary components for the vital activity of the human body. The aim of the research is to determine the socio-economic factors for ensuring the quality of livestock products in Ukraine. The scientific and specific research methods were used to solve the tasks set in the work: the historical method; abstraction method; method of comparative analysis; system-structural method. The main producer of livestock products in Ukraine are households. They do not have the capabilities to implement technologies of keeping, feeding, veterinary services, programs prerequisites for guaranteeing the safety of products, adherence to the HACCP principles. In Ukraine, real technical, economic and organizational-economic prerequisites for ensuring the safety and quality of livestock products are created only in the poultry meat sector. During 2015-2017, the trends in production of almost all types of livestock products except poultry and honey were identified. One of the reasons for this situation was, firstly, decreasing in capital investment in the livestock sector, and secondly, the low profitability of production of livestock products in the context of accelerated growth in prices for resources. It is proved that insignificant market (price) incentives should be supplemented with instruments of state assistance to improve the quality parameters of products on the basis of specialized enterprises. The necessity of state support for the production of livestock products based on small and medium-sized enterprises is substantiated. This will effectively combine the processes of increasing the production of livestock products with the environmental friendliness of production and steady improvement of quality. It is shown that the low quality of certain livestock products in Ukraine is caused by insufficient living standards of the population and low incomes of the majority of households, which cause them to consume low quality products. It is determined that the problem of guaranteeing the quality of livestock products in Ukraine has deep roots cause due to the influence of socio-economic factors. Therefore, a comprehensive approach is needed to solve it, which is not limited to improving the efficiency of the state control system and successfully harmonizing of the Ukrainian technical regulation system with the European one. The problem of low quality and the danger of livestock production requires a systematic approach for its solution, which is not limited, in particular, by measures to improve the system of state control and ensure approximation of the domestic technical regulation system to the European one. In Ukraine, major high-quality animal products are economically inaccessible to a large part of households. The projected increase in safety parameters and a certain improvement in the quality of livestock products as a result of the implementation of regulations adopted in 2014-2017, will necessarily lead to an increase in its value, and therefore may lead to a decrease in market demand and even greater inaccessibility of these products to people. All this can only aggravate the situation with guaranteeing the food security of the country, forming the prerequisites for increasing the intellectual capacity of the nation. (shrink)

This article examines the regulation of nonsteroidal anti-inflammatory drugs, with particular focus on products approved for marketing in the United Kingdom, while denied marketing approval in the United States on safety grounds, and then subsequently withdrawn from the UK market on those grounds. Using international comparison of regulatory data never before accessed outside government and companies, together with interviews with relevant industry scientists and regulators, the article demonstrates the importance of regulatory expectations, deficits and paradigms. It is argued both (...) that these sociological concepts can be enriched by their application to detailed comparative case study of regulatory science, and that they provide an important policy-relevant framework with which to understand discrepant drug regulatory processes in a sociohistorical context. It is found that regulatory expectations and paradigms may be regarded as mediating factors between political culture and structural interests, on the one hand, and the outcomes of regulatory science, on the other. (shrink)

Under the influence of social changes, latent factors in campus safety are increasing, and dealing with them is becoming more difficult. Facing the challenges in the pluralistic society, students need to cope with the changes of external and internal environments in the dynamic society. Additionally, there are new events on campus at any time, which may lead to campus risk. The frequent events that have occurred on campus in recent years have created difficulties for school administrative units. Implementing campus (...) risk management strategies and conducting risk awareness education campaigns are, therefore, necessary. The fact that we are in a technologically dynamic age is another factor that makes risk awareness and proper risk management essential for individual survival and sustainable development of organizations. The participants of the study were university students in Nanchang, Jiangxi Province. Three hundred copies of the questionnaire were distributed, and 238 valid copies were retrieved, representing a retrieval rate of 79%. The results of the survey show that “life education” is the most emphasized dimension, followed by “curriculum and instruction,” and “environmental planning.” The five most emphasized indicators among the 14 indicators are opportunity education, physical activity, role-play, team competition, and learning area planning. The results suggest that school administrative units can take control in an emergency and reduce the likelihood of school members being threatened or harmed by the risk factor, and educators can make a quick decision to turn risk into opportunity. (shrink)

A system of description, identification and classification of factors determining driving style is proposed in the article; stable and variable factors determining driving style are studied. Driving style is analyzed within the framework of structural approach. The variable factor are: specifications and technical condition of the vehicle, class of the car, its prestige, training of the driver, social regulators, features of the road environment, psychophysiological condition of the driver. The stable factors are: individual-typological properties, the level of suitability for (...) driver”s activities, personal features of a driver and sources of activity. Five main characteristics of driving style are selected and presented: safety-risk, confidence with parking, relation to the means of security; planning-impulsivity; driving culture. There are results of empirical research directed on discovery of relationship between styles of driving activities as one characteristic of driving style, emotions typical for driver while driving and accidents. Increase of safety as a result of planning style of activities is shown. The paper offers direction of work for optimizing driving style: the formation of compensating planning style of activities, psychotherapeutic work, modeling training, psychological selection, training and education work in driving schools. (shrink)

This study was administrated to undergraduate students living in the various hostels of Universiti Sains Malaysia. The primary purpose of this study was to identify the most important factors that predict undergraduate students’ level of satisfaction with the student hostels they are living in. This paper also explored the difference in the satisfaction levels of students living in hostels within the campus and those living in hostels outside the campus. Based on literature review, it was hypothesized that there would be (...) a difference in the satisfaction level between these two groups of hostel residents due to the different characteristics that these hostels have. Additionally, this study investigated the most preferred hostels among students and identified the reasons for the preference. A sample population of 288 students (220 females; and 68 males) was involved in this study with 48.3% living in hostels inside the campus and 51.7% living in hostels located outside the main campus area. The result of the study suggests that satisfaction with fees, distance from university facilities, room safety, room size, hostel security, and hostel facilities are the most important factors which predict undergraduate students’ satisfaction with their hostel. There was also a significant difference in the satisfaction level between inside-campus and outside-campus hostels students. The most important factors that influenced that students satisfaction levels were distance from the university facilities, the exterior condition of the hostel, hostel population, satisfaction with transport, hostel security, room size, and room safety. The study also found that the most preferred hostel among the students was Cahaya Gemilang due to its strategic location, close distance to lecture halls and other main facilities in the campus and, good internet network connection. Keywords: satisfaction, hostels, predicting factors, undergraduate students. (shrink)

In September 2012, news broke of a developing drug disaster in the United States. Health authorities had linked a fungal meningitis outbreak to a contaminated steroid made by a company called the New England Compounding Center. The contaminated steroid was a compounded drug that had not been approved by the Food and Drug Administration, differing from three others that had been approved in that it lacked preservatives present in those agents. Factory inspections revealed unsanitary conditions at NECC's drug production facility. (...) By the time the source of the outbreak was identified, an estimated fourteen thousand people had been injected with the drug. As of December 2012, thirty‐nine had died of meningitis, and hundreds more had been diagnosed with meningitis and other drug‐related conditions. Many factors contributed to this disaster. One was a 2002 Supreme Court decision holding that a law prohibiting providers of compounded drugs from promoting their products through advertising and other means impermissibly restricted commercial speech. (shrink)

How well can institutional guidelines help ensure the dignity, rights, safety and well being of research participants in an underdeveloped country? In this paper I describe the limits of informed consent as an instrument for the protection of participants in the context of the Philippines. I bring to this paper my experiences as an advocate of rights, a member of an ethics review board, a researcher on the ethics of research and as an observer of the dynamics of clinical (...) practice in an academic public teaching hospital of the University of the Philippines where I am professor. (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)

The question of when people may impose risks on each other is of fundamental moral importance. Forms of “quantified risk assessment,” especially risk cost-benefit analysis, provide one powerful approach to providing a systematic answer. It is also well known that such techniques can show that existing resources could be used more effectively to reduce risk overall. Thus it is often argued that some current practices are irrational. On the other hand critics of quantified risk assessment argue that it cannot adequately (...) capture all relevant features, such as “societal concern” and so should be abandoned. In this paper I argue that current forms of quantified risk assessment are inadequate, and in themselves, therefore, insufficient to demonstrate that current practices are irrational. In particular, I will argue that insufficient attention has been given to the cause of a hazard, which needs to be treated as a primary variable in its own right. However rather than reject quantified risk assessment I wish to supplement it by proposing a framework to make explicit the role causation plays in the understanding of risk, and how it interacts with factors which influence perception of risks and other attitudes to risk control. Once an improved description of risk perception is available it will become possible to have a more informed debate about the normative question: how safety should be regulated. (shrink)

This paper provides a conceptual framework to explain why disparities may exist in food safety code compliance by food stores in different neighborhoods. Explanations include market dynamics, community characteristics, retailer attributes, inspector characteristics, and enforcement approaches, and interactions among the factors. A preliminary and limited empirical test of some of these relationships in Detroit, Michigan shows a higher rate of food safety violations by stores in poorer neighborhoods and in neighborhoods with higher concentrations of African-American residents. Stores inspected (...) by female inspectors also scored higher numbers of critical violations, suggesting a need for greater examination of the social relations associated with enforcement interactions in food safety studies. (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)

Psychological safety is important for the well-being and productivity of people in the workplace. Psychological safety becomes even more important and even more difficult to maintain in times of uncertainty. Previous research mainly focused on the influence of and on interpersonal relationships. This study applies an individual perspective by investigating what is needed on an individual level in order to build psychological safety. The expectation was that self-compassion induces an individual to experience higher positive affect, and this (...) advances the development of positive relations and social acceptance. Moreover, we assumed that the mediation of the relationship between self-compassion and positive relations and social acceptance by positive affect is moderated by the level of basic need satisfaction. Participants from the Netherlands and Belgium completed an online questionnaire about their level of self-compassion, basic need satisfaction, positive affect and positive relations and social acceptance. Using hierarchical regression analyses for moderated mediation analysis, results showed that self-compassion and positive affect had a significant positive effect on positive relations and social acceptance. Positive affect significantly mediated the relationship between self-compassion and positive relations and social acceptance, when basic need satisfaction was low, but not when basic need satisfaction was high. Our research showed that individuals need either their basic needs satisfied or self-compassion so they can build the high-quality relations needed to stimulate psychological safety. This finding shifts attention from the dyadic relationship to the individual and highlights important factors at the individual level which advance the development of high-quality relationships with others. (shrink)

The acquisition of a nuclear power reactor from the North American company Westinghouse in 1964 not only brought atomic practices and knowledge to Spain but also introduced new methods of industrial organization and management, as well as regulations created by organizations such as the US Atomic Energy Commission and the International Atomic Energy Agency. This article analyzes the history of the knowledge, regulations and experimental practices relating to radiation safety and protection that traveled with this reactor to an industrial (...) space: the Zorita nuclear power plant. Within this space, the appropriation, use, and coproduction of knowledge and practices were conditioned by political, economic, industrial and social factors, and by the engineers, researchers and other professionals who contributed expert knowledge. Material held in the Tecnatom Historical Archive—the engineering company that coordinated construction of the plant—is the main source for this work, which delves into the history of knowledge and atomic technologies and adds to the historiography of radiological protection in Spain.ZusammenfassungMit dem Kauf des ersten Kernreaktors von der nordamerikanischen Firma Westinghouse im Jahre 1964 gelangten neue atomare Praktiken und Kenntnisse nach Spanien, ebenso wie neue Formen der Organisation und des Managements dieses Industriezweigs und bis dahin in Spanien unbekannte Regelungen, wie z. B. die der US Atomenergiekommission und der Internationalen Atomenergiebehörde. Der vorliegende Artikel analysiert die Geschichte des – angeeigneten, genutzten und koproduzierten – Wissens, der Vorschriften und der experimentellen Praktiken hinsichtlich der Strahlensicherheit und des Strahlenschutzes, die mit der Inbetriebnahme des Reaktors im industriellen Komplex des Kernkraftwerks Zorita einhergingen. Dort, wo Wissen und Praktiken durch politische, wirtschaftliche, industrielle und soziale Faktoren bedingt waren, waren neben den Ingenieuren und Forschern auch andere Fachleute beteiligt, die gleichermaßen kompetentes Wissen beisteuerten. Das Material, das im Historischen Archiv von Tecnatom, dem Ingenieurbüro, das den Bau der Anlage koordinierte, aufbewahrt wird, ist die Hauptquelle dieser Arbeit, die versucht, die Geschichte des Atomwissens und der Atomtechnologien zu vertiefen und die Darstellungen zur Geschichte des Strahlenschutzes in Spanien zu erweitern. (shrink)

This study reports the findings of a 2.5 year intervention project to reduce psychosocial risks and increase employee well-being in 15 emergency departments in the Netherlands. The project uses the psychosocial risk management approach “PRIMA” which includes cycles of risk assessment, designing and implementing changes, evaluating changes and adapting the approach if necessary. In addition, principles of participative action research were used to empower the departments in designing and implementing their own actions during the project. Next to determining overall effects, (...) the study aims to assess potential moderators including the level of intervening, process variables and partaking in a Psychosocial Safety Climate intervention offered during the second half of the project. The results of linear mixed-model analyses showed that all job factors improved with the exception of autonomy, which did increase halfway the project but not when considering the entire timeframe. In addition, work engagement decreased and symptoms of burnout remained stable. Emergency departments that implemented more fitting actions, communicated better and involved their employees more in the process, had more favorable changes in job factors and more stable well-being. More activity and a multilevel approach regarding stress management did not lead to greater improvements. The Psychosocial Safety Climate intervention was effective in improving Psychosocial Safety Climate, but a longer follow-up period seems required to evaluate its effect on job factors and well-being. Overall, the project resulted in positive changes in most job factors, and its findings emphasize the importance of process variables in stress management interventions. Longer follow-up and higher quality multilevel interventions seem essential to also improve well-being. (shrink)