Normal accidents. Living with high-risk technologies

Recent conceptual and methodological advances in behavioral safety research afford an opportunity to integrate past and recent research findings. Building on theoretical models of worker performance and work climate, this study quantitatively integrates the safety literature by meta-analytically examining person- and situation-based antecedents of safety performance behaviors and safety outcomes (i.e., accidents and injuries). As anticipated, safety knowledge and safety motivation were most strongly related to safety performance behaviors, closely followed by psychological safety climate and group safety climate. With regard to accidents and injuries, however, group safety climate had the strongest association. In addition, tests of a meta-analytic path model provided support for the theoretical model that guided this overall investigation. The implications of these findings for advancing the study and management of workplace safety are discussed.

Workplace safety: a meta-analysis of the roles of person and situation factors.

This is the first handbook where the world’s foremost “experts on expertise” review our scientific knowledge on expertise and expert performance and how experts may differ from non-experts in terms of their development, training, reasoning, knowledge, social support, and innate talent. Methods are described for the study of experts’ knowledge and their performance of representative tasks from their domain of expertise. The development of expertise is also studied by retrospective interviews and the daily lives of experts are studied with diaries. In 15 major domains of expertise, the leading researchers summarize our knowledge of the structure and acquisition of expert skill and knowledge and discuss future prospects. General issues that cut across most domains are reviewed in chapters on various aspects of expertise, such as general and practical intelligence, differences in brain activity, self-regulated learning, deliberate practice, aging, knowledge management, and creativity.

The Cambridge Handbook of Expertise and Expert Performance

BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Organizational climates have been investigated separately at organization and subunit levels. This article tests a multilevel model of safety climate, covering both levels of analysis. Results indicate that organization-level and group-level climates are globally aligned, and the effect of organization climate on safety behavior is fully mediated by group climate level. However, the data also revealed meaningful group-level variation in a single organization, attributable to supervisory discretion in implementing formal procedures associated with competing demands like safety versus productivity. Variables that limit supervisory discretion (i.e., organization climate strength and procedural formalization) reduce both between-groups climate variation and within-group variability (i.e., increased group climate strength), although effect sizes were smaller than those associated with cross-level climate relationships. Implications for climate theory are discussed.

A multilevel model of safety climate: cross-level relationships between organization and group-level climates.

Measuring safety climate: identifying the common features☆

Many 21st century operations are characterised by teams of workers dealing with significant risks and complex technology, in competitive, commercially-driven environments. Informed managers in such sectors have realised the necessity of understanding the human dimension to their operations if they hope to improve production and safety performance. While organisational safety culture is a key determinant of workplace safety, it is also essential to focus on the non-technical skills of the system operators based at the 'sharp end' of the organisation. These skills are the cognitive and social skills required for efficient and safe operations, often termed Crew Resource Management (CRM) skills. In industries such as civil aviation, it has long been appreciated that the majority of accidents could have been prevented if better non-technical skills had been demonstrated by personnel operating and maintaining the system. As a result, the aviation industry has pioneered the development of CRM training. Many other organisations are now introducing non-technical skills training, most notably within the healthcare sector. Safety at the Sharp End is a general guide to the theory and practice of non-technical skills for safety. It covers the identification, training and evaluation of non-technical skills and has been written for use by individuals who are studying or training these skills on CRM and other safety or human factors courses. The material is also suitable for undergraduate and post-experience students studying human factors or industrial safety programmes.

Safety at the Sharp End: A Guide to Non-Technical Skills

The aviation industry recognised the significance of human error in accidents in the 1970s, and has been instrumental in the development of special training, designed to reduce error and increase the effectiveness of flight crews. These crew resource management (CRM) programmes focus on “non‐technical skills” critical for enhanced operational performance, such as leadership, situation awareness, decision making, team work and communication. More recently CRM has been adopted by other “high reliability” team environments including anaesthesiology, air traffic control, the Merchant Navy, the nuclear power industry, aviation maintenance, and the offshore oil industry. This review paper describes the basic principles of crew resource management, then outlines recent developments in aviation and other high reliability work environments.

Crew resource management: improving team work in high reliability industries

Large national reviews of patient charts estimate that approximately 10% of hospital admissions are associated with an adverse event (defined as an injury resulting in prolonged hospitalization, disability or death, caused by healthcare management). Apart from having a significant impact on patient morbidity and mortality, adverse events also result in increased healthcare costs due to longer hospital stays. Furthermore, a substantial proportion of adverse events are preventable. Through identifying the nature and rate of adverse events, initiatives to improve care can be developed. A variety of methods exist to gather adverse event data both retrospectively and prospectively but these do not necessarily capture the same events and there is variability in the definition of an adverse event. For example, hospital incident reporting collects only a very small fraction of the adverse events found in retrospective chart reviews. Until there are systematic methods to identify adverse events, progress in patient safety cannot be reliably measured. This review aims to discuss the need for a safety culture that can learn from adverse events, describe ways to measure adverse events, and comment on why current adverse event monitoring is unable to demonstrate trends in patient safety.

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Adverse events in healthcare: learning from mistakes

Empirical studies of crew resource management (CRM) training effectiveness were subjected to meta-analysis. Sixteen CRM evaluation studies were found to fulfill the a priori criteria for inclusion in the meta-analysis. The metrics of CRM training effectiveness analyzed were reactions, attitudes, knowledge, and behaviors. CRM-trained participants responded positively to CRM (a mean of 4 on a 5—point Likert scale). The training had large effects on the participants' attitudes and behaviors and a medium effect on their knowledge. The findings from the meta-analysis are encouraging for the effectiveness of CRM training. However, there is a need for researchers and reviewers to be more rigorous about the data included in research reporting CRM evaluation to allow effect sizes to be calculated.

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Paul O'Connor

Papers

Measuring safety climate: identifying the common features☆

Safety at the Sharp End: A Guide to Non-Technical Skills

Crew resource management: improving team work in high reliability industries

Adverse events in healthcare: learning from mistakes

Crew Resource Management Training Effectiveness: A Meta-Analysis and Some Critical Needs