Sample records for improved safety performance

  1. Process safety improvement--quality and target zero.

    PubMed

    Van Scyoc, Karl

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  2. The potential application of behavior-based safety in the trucking industry

    DOT National Transportation Integrated Search

    2000-04-01

    Behavior-based safety (BBS) is a set of methods to improve safety performance in the workplace by engaging workers in the improvement process, identifying critical safety behaviors, performing observations to gather data, providing feedback to encour...

  3. A performance improvement plan to increase nurse adherence to use of medication safety software.

    PubMed

    Gavriloff, Carrie

    2012-08-01

    Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011). Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Understanding patient safety performance and educational needs using the 'Safety-II' approach for complex systems.

    PubMed

    McNab, Duncan; Bowie, Paul; Morrison, Jill; Ross, Alastair

    2016-11-01

    Participation in projects to improve patient safety is a key component of general practice (GP) specialty training, appraisal and revalidation. Patient safety training priorities for GPs at all career stages are described in the Royal College of General Practitioners' curriculum. Current methods that are taught and employed to improve safety often use a 'find-and-fix' approach to identify components of a system (including humans) where performance could be improved. However, the complex interactions and inter-dependence between components in healthcare systems mean that cause and effect are not always linked in a predictable manner. The Safety-II approach has been proposed as a new way to understand how safety is achieved in complex systems that may improve quality and safety initiatives and enhance GP and trainee curriculum coverage. Safety-II aims to maximise the number of events with a successful outcome by exploring everyday work. Work-as-done often differs from work-as-imagined in protocols and guidelines and various ways to achieve success, dependent on work conditions, may be possible. Traditional approaches to improve the quality and safety of care often aim to constrain variability but understanding and managing variability may be a more beneficial approach. The application of a Safety-II approach to incident investigation, quality improvement projects, prospective analysis of risk in systems and performance indicators may offer improved insight into system performance leading to more effective change. The way forward may be to combine the Safety-II approach with 'traditional' methods to enhance patient safety training, outcomes and curriculum coverage.

  5. A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional

    PubMed Central

    Karsh, B‐T; Holden, R J; Alper, S J; Or, C K L

    2006-01-01

    The goal of improving patient safety has led to a number of paradigms for directing improvement efforts. The main paradigms to date have focused on reducing injuries, reducing errors, or improving evidence based practice. In this paper a human factors engineering paradigm is proposed that focuses on designing systems to improve the performance of healthcare professionals and to reduce hazards. Both goals are necessary, but neither is sufficient to improve safety. We suggest that the road to patient and employee safety runs through the healthcare professional who delivers care. To that end, several arguments are provided to show that designing healthcare delivery systems to support healthcare professional performance and hazard reduction should yield significant patient safety benefits. The concepts of human performance and hazard reduction are explained. PMID:17142611

  6. 42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

  7. 42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

  8. 42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... improves patient safety by using quality indicators or performance measures associated with improved health... incorporate quality indicator data, including patient care and other relevant data regarding services...

  9. A review on the benchmarking concept in Malaysian construction safety performance

    NASA Astrophysics Data System (ADS)

    Ishak, Nurfadzillah; Azizan, Muhammad Azizi

    2018-02-01

    Construction industry is one of the major industries that propels Malaysia's economy in highly contributes to our nation's GDP growth, yet the high fatality rates on construction sites have caused concern among safety practitioners and the stakeholders. Hence, there is a need of benchmarking in performance of Malaysia's construction industry especially in terms of safety. This concept can create a fertile ground for ideas, but only in a receptive environment, organization that share good practices and compare their safety performance against other benefit most to establish improvement in safety culture. This research was conducted to study the awareness important, evaluate current practice and improvement, and also identify the constraint in implement of benchmarking on safety performance in our industry. Additionally, interviews with construction professionals were come out with different views on this concept. Comparison has been done to show the different understanding of benchmarking approach and how safety performance can be benchmarked. But, it's viewed as one mission, which to evaluate objectives identified through benchmarking that will improve the organization's safety performance. Finally, the expected result from this research is to help Malaysia's construction industry implement best practice in safety performance management through the concept of benchmarking.

  10. 42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii..., patient safety, and quality of care. (2) Performance improvement activities must track adverse patient... care and patient safety, and that all improvement actions are evaluated for effectiveness. (3) That one...

  11. Safety incentive and penalty provisions in Indian construction projects and their impact on safety performance.

    PubMed

    Hasan, Abid; Jha, Kumar Neeraj

    2013-01-01

    Safety incentive and penalty (I/P) provisions in construction contracts are one of the most common forms of I/P. Contradictory opinions on the effectiveness of these provisions have been expressed in the literature. Statistics on safety provisions were collected from 32 construction projects, which include both types of contracts - those with safety I/P provisions and those without them. Although inclusion of safety I/P provisions in contracts helps in improving the overall safety performance in construction projects, further scope for improvement still exists. Literature review and structured personal interviews, coupled with a survey based on preliminary questionnaire, revealed that successful formulation and implementation of such provisions are dependent on 25 attributes which need the attention of both clients and contractors. A questionnaire-based survey was conducted to evaluate these attributes. The six factors extracted by carrying out factor analysis are: incentive distribution method, proper labour training, special attention to risky situations, role of safety committee and sub-contractors, specialised works and safety equipments, and right form of I/P. If taken care of, these attributes have the potential to improve the safety performance in construction projects. The results would be useful to clients and contractors in implementing the safety I/P provisions and thereby improving safety performance.

  12. Impact of individual resilience and safety climate on safety performance and psychological stress of construction workers: A case study of the Ontario construction industry.

    PubMed

    Chen, Yuting; McCabe, Brenda; Hyatt, Douglas

    2017-06-01

    The construction industry has hit a plateau in terms of safety performance. Safety climate is regarded as a leading indicator of safety performance; however, relatively little safety climate research has been done in the Canadian construction industry. Safety climate may be geographically sensitive, thus it is necessary to examine how the construct of safety climate is defined and used to improve safety performance in different regions. On the other hand, more and more attention has been paid to job related stress in the construction industry. Previous research proposed that individual resilience may be associated with a better safety performance and may help employees manage stress. Unfortunately, few empirical research studies have examined this hypothesis. This paper aims to examine the role of safety climate and individual resilience in safety performance and job stress in the Canadian construction industry. The research was based on 837 surveys collected in Ontario between June 2015 and June 2016. Structural equation modeling (SEM) techniques were used to explore the impact of individual resilience and safety climate on physical safety outcomes and on psychological stress among construction workers. The results show that safety climate not only affected construction workers' safety performance but also indirectly affected their psychological stress. In addition, it was found that individual resilience had a direct negative impact on psychological stress but had no impact on physical safety outcomes. These findings highlight the roles of both organizational and individual factors in individual safety performance and in psychological well-being. Construction organizations need to not only monitor employees' safety performance, but also to assess their employees' psychological well-being. Promoting a positive safety climate together with developing training programs focusing on improving employees' psychological health - especially post-trauma psychological health - can improve the safety performance of an organization. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. 42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... patient safety by using quality indicators or performance measures associated with improved health... that includes care and services furnished in the ASC. (b) Standard: Program data. (1) The program must...

  14. Multi-measure Performance Assessment and Benchmarking of the Divisions of the Wyoming Highway Patrol

    DOT National Transportation Integrated Search

    2015-12-01

    With many lives lost every year in traffic related crashes, traffic safety is a major concern all around the world. One way to improve traffic safety is to improve the organizational performance of agencies responsible for enforcing traffic safety. I...

  15. Improving safety culture through the health and safety organization: a case study.

    PubMed

    Nielsen, Kent J

    2014-02-01

    International research indicates that internal health and safety organizations (HSO) and health and safety committees (HSC) do not have the intended impact on companies' safety performance. The aim of this case study at an industrial plant was to test whether the HSO can improve company safety culture by creating more and better safety-related interactions both within the HSO and between HSO members and the shop-floor. A quasi-experimental single case study design based on action research with both quantitative and qualitative measures was used. Based on baseline mapping of safety culture and the efficiency of the HSO three developmental processes were started aimed at the HSC, the whole HSO, and the safety representatives, respectively. Results at follow-up indicated a marked improvement in HSO performance, interaction patterns concerning safety, safety culture indicators, and a changed trend in injury rates. These improvements are interpreted as cultural change because an organizational double-loop learning process leading to modification of the basic assumptions could be identified. The study provides evidence that the HSO can improve company safety culture by focusing on safety-related interactions. © 2013. Published by Elsevier Ltd and National Safety Council.

  16. Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

    PubMed

    McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian

    2017-01-01

    Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P < 0.001), but not technical performance; systems interventions (Lean & SOP, 2 & 3) improved nontechnical skills and technical performance (P < 0.001) but improved WHO compliance less. Combined interventions (4 & 5) improved all performance measures except WHO time-out attempts, whereas single approaches (1 & 2 & 3) improved WHO compliance less (P < 0.001) and failed to improve technical performance. Safety interventions combining teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

  17. Identifying specific beliefs to target to improve restaurant employees' intentions for performing three important food safety behaviors.

    PubMed

    Pilling, Valerie K; Brannon, Laura A; Shanklin, Carol W; Howells, Amber D; Roberts, Kevin R

    2008-06-01

    Current national food safety training programs appear ineffective at improving food safety practices in foodservice operations, given the substantial number of Americans affected by foodborne illnesses after eating in restaurants each year. The Theory of Planned Behavior (TpB) was used to identify important beliefs that may be targeted to improve foodservice employees' intentions for three food safety behaviors that have the most substantial affect on public health: hand washing, using thermometers, and proper handling of food contact surfaces. In a cross-sectional design, foodservice employees (n=190) across three midwestern states completed a survey assessing TpB components and knowledge for the three food safety behaviors. Multiple regression analyses were performed on the TpB components for each behavior. Independent-samples t tests identified TpB beliefs that discriminated between participants who absolutely intend to perform the behaviors and those with lower intention. Employees' attitudes were the one consistent predictor of intentions for performing all three behaviors. However, a unique combination of important predictors existed for each separate behavior. Interventions for improving employees' behavioral intentions for food safety should focus on TpB components that predict intentions for each behavior and should bring all employees' beliefs in line with those of the employees who already intend to perform the food safety behaviors. Registered dietitians; dietetic technicians, registered; and foodservice managers can use these results to enhance training sessions and motivational programs to improve employees' food safety behaviors. Results also assist these professionals in recognizing their responsibility for enforcing and providing adequate resources for proper food safety behaviors.

  18. Li Anode Technology for Improved Performance

    NASA Technical Reports Server (NTRS)

    Chen, Tuqiang

    2011-01-01

    A novel, low-cost approach to stabilization of Li metal anodes for high-performance rechargeable batteries was developed. Electrolyte additives are selected and used in Li cell electrolyte systems, promoting formation of a protective coating on Li metal anodes for improved cycle and safety performance. Li batteries developed from the new system will show significantly improved battery performance characteristics, including energy/power density, cycle/ calendar life, cost, and safety.

  19. Reaping the benefits of task conflict in teams: the critical role of team psychological safety climate.

    PubMed

    Bradley, Bret H; Postlethwaite, Bennett E; Klotz, Anthony C; Hamdani, Maria R; Brown, Kenneth G

    2012-01-01

    Past research suggests that task conflict may improve team performance under certain conditions; however, we know little about these specific conditions. On the basis of prior theory and research on conflict in teams, we argue that a climate of psychological safety is one specific context under which task conflict will improve team performance. Using evidence from 117 project teams, the present research found that psychological safety climate moderates the relationship between task conflict and performance. Specifically, task conflict and team performance were positively associated under conditions of high psychological safety. The results support the conclusion that psychological safety facilitates the performance benefits of task conflict in teams. Theoretical implications and suggestions for future research are discussed.

  20. Safety culture and care: a program to prevent surgical errors.

    PubMed

    Hemingway, Maureen White; O'Malley, Catherine; Silvestri, Sandra

    2015-04-01

    Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  1. Behavior-based safety on construction sites: a case study.

    PubMed

    Choudhry, Rafiq M

    2014-09-01

    This work presents the results of a case study and describes an important area within the field of construction safety management, namely behavior-based safety (BBS). This paper adopts and develops a management approach for safety improvements in construction site environments. A rigorous behavioral safety system and its intervention program was implemented and deployed on target construction sites. After taking a few weeks of safety behavior measurements, the project management team implemented the designed intervention and measurements were taken. Goal-setting sessions were arranged on-site with workers' participation to set realistic and attainable targets of performance. Safety performance measurements continued and the levels of performance and the targets were presented on feedback charts. Supervisors were asked to give workers recognition and praise when they acted safely or improved critical behaviors. Observers were requested to have discussions with workers, visit the site, distribute training materials to workers, and provide feedback to crews and display charts. They were required to talk to operatives in the presence of line managers. It was necessary to develop awareness and understanding of what was being measured. In the process, operatives learned how to act safely when conducting site tasks using the designed checklists. Current weekly scores were discussed in the weekly safety meetings and other operational site meetings with emphasis on how to achieve set targets. The reliability of the safety performance measures taken by the company's observers was monitored. A clear increase in safety performance level was achieved across all categories: personal protective equipment; housekeeping; access to heights; plant and equipment, and scaffolding. The research reveals that scores of safety performance at one project improved from 86% (at the end of 3rd week) to 92.9% during the 9th week. The results of intervention demonstrated large decreases in unsafe behaviors and significant increases in safe behaviors. The results of this case study showed that an approach based on goal setting, feedback, and an effective measure of safety behavior if properly applied by committed management, can improve safety performance significantly in construction site environments. The results proved that the BBS management technique can be applied to any country's culture, showing that it would be a good approach for improving the safety of front-line workers and that it has industry wide application for ongoing construction projects. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Federal Motor Carrier Safety Administration’s Advanced System Testing Utilizing a Data Acquisition System on the Highways (FAST DASH) Safety Technology Evaluation Project #2: Driver Monitoring Final Report.

    DOT National Transportation Integrated Search

    2016-12-01

    An independent evaluation of a non-video-based onboard monitoring system (OBMS) was conducted. The objective was to determine if the OBMS system performed reliably, improved driving safety and performance, and improved fuel efficiency in a commercial...

  3. Federal Motor Carrier Safety Administration’s advanced system testing utilizing a data acquisition system on the highways (FAST DASH) safety technology evaluation project #2 : driver monitoring, final report.

    DOT National Transportation Integrated Search

    2016-11-01

    An independent evaluation of a non-video-based onboard monitoring system (OBMS) was conducted. The objective was to determine if the OBMS system performed reliably, improved driving safety and performance, and improved fuel efficiency in a commercial...

  4. Federal and tribal lands road safety audits : case studies

    DOT National Transportation Integrated Search

    2009-12-01

    A road safety audit (RSA) is a formal safety performance examination by an independent, multidisciplinary team. RSAs are an effective tool for proactively improving the safety performance of a road project during the planning and design stages, and f...

  5. Improving patient safety culture in Saudi Arabia (2012-2015): trending, improvement and benchmarking.

    PubMed

    Alswat, Khalid; Abdalla, Rawia Ahmad Mustafa; Titi, Maher Abdelraheim; Bakash, Maram; Mehmood, Faiza; Zubairi, Beena; Jamal, Diana; El-Jardali, Fadi

    2017-08-02

    Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported. We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA. Areas of strength in 2015 included Teamwork within units, and Organizational Learning-Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites. The Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement.

  6. Federal motor carrier safety administration safety 2010 strategy and performance planning : project description

    DOT National Transportation Integrated Search

    2000-12-01

    The Motor Carrier Safety Improvement Act (MCSIA) of 1999, Pub. L. 106-159, created the Federal Motor Carrier Safety Administration (FMCSA) in January 2000. Section 104 of the Act requires the Secretary to develop a long-term strategy for improving co...

  7. A cross-cultural study of organizational factors on safety: Japanese vs. Taiwanese oil refinery plants.

    PubMed

    Hsu, Shang Hwa; Lee, Chun-Chia; Wu, Muh-Cherng; Takano, Kenichi

    2008-01-01

    This study attempts to identify idiosyncrasies of organizational factors on safety and their influence mechanisms in Taiwan and Japan. Data were collected from employees of Taiwanese and Japanese oil refinery plants. Results show that organizational factors on safety differ in the two countries. Organizational characteristics in Taiwanese plants are highlighted as: higher level of management commitment to safety, harmonious interpersonal relationship, more emphasis on safety activities, higher devotion to supervision, and higher safety self-efficacy, as well as high quality of safety performance. Organizational characteristics in Japanese plants are highlighted as: higher level of employee empowerment and attitude towards continuous improvement, more emphasis on systematic safety management approach, efficient reporting system and teamwork, and high quality of safety performance. The casual relationships between organizational factors and workers' safety performance were investigated using structural equation modeling (SEM). Results indicate that the influence mechanisms of organizational factors in Taiwan and Japan are different. These findings provide insights into areas of safety improvement in emerging countries and developed countries respectively.

  8. Does external evaluation of laboratories improve patient safety?

    PubMed

    Noble, Michael A

    2007-01-01

    Laboratory accreditation and External Quality Assessment (also called proficiency testing) are mainstays of laboratory quality assessment and performance. Both practices are associated with examples of improved laboratory performance. The relationship between laboratory performance and improved patient safety is more difficult to assess because of the many variables that are involved with patient outcome. Despite this difficulty, the argument to continue external evaluation of laboratories is too compelling to consider the alternative.

  9. Relationship between ethical leadership and organisational commitment of nurses with perception of patient safety culture.

    PubMed

    Lotfi, Zahra; Atashzadeh-Shoorideh, Foroozan; Mohtashami, Jamileh; Nasiri, Maliheh

    2018-03-12

    To determine the relationship between ethical leadership, organisational commitment of nurses and their perception of patient safety culture. Patient safety, organisational commitment and ethical leadership styles are very important for improving the quality of nursing care. In this descriptive-correlational study, 340 nurses were selected using random sampling from the hospitals in Tehran in 2016. Data were analysed using descriptive and inferential statistics in SPSS v.20. There was a significant positive relationship between the ethical leadership of nursing managers, perception of patient safety culture and organisational commitment. The regression analysis showed that nursing managers' ethical leadership and nurses' organisational commitment is a predictor of patient safety culture and confirms the relationship between the variables. Regarding the relationship between the nurses' safety performance, ethical leadership and organisational commitment, it seems that the optimisation of the organisational commitment and adherence to ethical leadership by administrators and managers in hospitals could improve the nurses' performance in terms of patient safety. Implementing ethical leadership seems to be one feasible strategy to improve nurses' organisational commitment and perception of patient safety culture. Efforts by nurse managers to develop ethical leadership reinforce organisational commitment to improve patient outcomes. Nurse managers' engagement and performance in this process is vital for a successful result. © 2018 John Wiley & Sons Ltd.

  10. Safety Challenges and Improvement Strategies of Ethnic Minority Construction Workers: A Case Study in Hong Kong.

    PubMed

    Wu, Chunlin; Luo, Xiaowei; Wang, Tao; Wang, Yue; Sapkota, Bibek

    2018-04-18

    Due to cultural differences, ethnic minority construction workers are more difficult to manage and more vulnerable to accidents. This study aims to identify the major barriers faced by ethnic minority workers from their own perspectives and determine potential strategies to enhance safety climate of construction projects, thus ultimately improve their safety performance. A survey with modified Nordic safety climate questionnaire was conducted in a certain sub-contractor in Hong Kong. In-depth interviews, status quo description, major challenge investigation and safety knowledge tests were carried as well. The top three most important safety challenges identified are improper stereotypes from the whole industry, lack of opportunities for job assignment, and language barriers. To improve the safety performance, employers should allocate sufficient personal protective equipment and governments should organize unannounced site visits more frequently. Besides, the higher-level management should avoid giving contradictory instructions to foremen against to the standards of supervisors.

  11. Safety performance functions for intersections : final report, December 2009.

    DOT National Transportation Integrated Search

    2009-12-01

    Road safety management activities include screening the network for sites with a potential for safety improvement (Network : Screening), diagnosing safety problems at specific sites, and evaluating the safety effectiveness of implemented : countermea...

  12. Do clinical safety charts improve paramedic key performance indicator results? (A clinical improvement programme evaluation).

    PubMed

    Ebbs, Phillip; Middleton, Paul M; Bonner, Ann; Loudfoot, Allan; Elliott, Peter

    2012-07-01

    Is the Clinical Safety Chart clinical improvement programme (CIP) effective at improving paramedic key performance indicator (KPI) results within the Ambulance Service of New South Wales? The CIP intervention area was compared with the non-intervention area in order to determine whether there was a statistically significant improvement in KPI results. The CIP was associated with a statistically significant improvement in paramedic KPI results within the intervention area. The strategies used within this CIP are recommended for further consideration.

  13. Work support, psychological well-being and safety performance among nurses in Hong Kong.

    PubMed

    Wong, Kenchi C K

    2018-02-06

    This study investigated the mediating role of psychological well-being between work support and safety performance of 314 Hong Kong nurses, using self-reported questionnaires. Results showed that psychological well-being mediated the effects of work support on safety performance. The findings illustrate that work support was an important element to improve psychological well-being. This could generate better safety performance of the nurses. Implications and limitations are discussed.

  14. Nonlinear effects of team tenure on team psychological safety climate and climate strength: Implications for average team member performance.

    PubMed

    Koopmann, Jaclyn; Lanaj, Klodiana; Wang, Mo; Zhou, Le; Shi, Junqi

    2016-07-01

    The teams literature suggests that team tenure improves team psychological safety climate and climate strength in a linear fashion, but the empirical findings to date have been mixed. Alternatively, theories of group formation suggest that new and longer tenured teams experience greater team psychological safety climate than moderately tenured teams. Adopting this second perspective, we used a sample of 115 research and development teams and found that team tenure had a curvilinear relationship with team psychological safety climate and climate strength. Supporting group formation theories, team psychological safety climate and climate strength were higher in new and longer tenured teams compared with moderately tenured teams. Moreover, we found a curvilinear relationship between team tenure and average team member creative performance as partially mediated by team psychological safety climate. Team psychological safety climate improved average team member task performance only when team psychological safety climate was strong. Likewise, team tenure influenced average team member task performance in a curvilinear manner via team psychological safety climate only when team psychological safety climate was strong. We discuss theoretical and practical implications and offer several directions for future research. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. The effect of safety initiatives on safety performance: a longitudinal study.

    PubMed

    Hoonakker, Peter; Loushine, Todd; Carayon, Pascale; Kallman, James; Kapp, Andrew; Smith, Michael J

    2005-07-01

    Construction industry is one of the most dangerous industries, not only in the USA, but worldwide. In this longitudinal study we examined the effects of safety initiatives on the safety performance of construction companies. One of the measures commonly used in the USA to track a company's safety performance is the experience modification rate (EMR). The EMR is based on the company's safety records (injury claims) from the past three full years and is used to calculate the workers' compensation insurance premiums. In a longitudinal study, we studied the effects of safety efforts and initiatives on the EMR. The results show that safety initiatives and money spent on safety do improve safety performance, but only over time.

  16. Prospective safety performance evaluation on construction sites.

    PubMed

    Wu, Xianguo; Liu, Qian; Zhang, Limao; Skibniewski, Miroslaw J; Wang, Yanhong

    2015-05-01

    This paper presents a systematic Structural Equation Modeling (SEM) based approach for Prospective Safety Performance Evaluation (PSPE) on construction sites, with causal relationships and interactions between enablers and the goals of PSPE taken into account. According to a sample of 450 valid questionnaire surveys from 30 Chinese construction enterprises, a SEM model with 26 items included for PSPE in the context of Chinese construction industry is established and then verified through the goodness-of-fit test. Three typical types of construction enterprises, namely the state-owned enterprise, private enterprise and Sino-foreign joint venture, are selected as samples to measure the level of safety performance given the enterprise scale, ownership and business strategy are different. Results provide a full understanding of safety performance practice in the construction industry, and indicate that the level of overall safety performance situation on working sites is rated at least a level of III (Fair) or above. This phenomenon can be explained that the construction industry has gradually matured with the norms, and construction enterprises should improve the level of safety performance as not to be eliminated from the government-led construction industry. The differences existing in the safety performance practice regarding different construction enterprise categories are compared and analyzed according to evaluation results. This research provides insights into cause-effect relationships among safety performance factors and goals, which, in turn, can facilitate the improvement of high safety performance in the construction industry. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Pre-irradiation testing and analysis to support the LWRS Hybrid SiC-CMC-Zircaloy-04 unfueled rodlet irradiation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Isabella J van Rooyen

    2012-09-01

    Nuclear fuel performance is a significant driver of nuclear power plant operational performance, safety, economics and waste disposal requirements. The Advanced Light Water Reactor (LWR) Nuclear Fuel Development Pathway focuses on improving the scientific knowledge basis to enable the development of high-performance, high burn-up fuels with improved safety and cladding integrity and improved nuclear fuel cycle economics. To achieve significant improvements, fundamental changes are required in the areas of nuclear fuel composition, cladding integrity, and fuel/cladding interaction.

  18. Pre-irradiation testing and analysis to support the LWRS Hybrid SiC-CMC-Zircaloy-04 unfueled rodlet irradiation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Isabella J van Rooyen

    2013-01-01

    Nuclear fuel performance is a significant driver of nuclear power plant operational performance, safety, economics and waste disposal requirements. The Advanced Light Water Reactor (LWR) Nuclear Fuel Development Pathway focuses on improving the scientific knowledge basis to enable the development of high-performance, high burn-up fuels with improved safety and cladding integrity and improved nuclear fuel cycle economics. To achieve significant improvements, fundamental changes are required in the areas of nuclear fuel composition, cladding integrity, and fuel/cladding interaction.

  19. Study of Evaluation OSH Management System Policy Based On Safety Culture Dimensions in Construction Project

    NASA Astrophysics Data System (ADS)

    Latief, Yusuf; Armyn Machfudiyanto, Rossy; Arifuddin, Rosmariani; Mahendra Fira Setiawan, R.; Yogiswara, Yoko

    2017-07-01

    Safety Culture in the construction industry is very influential on the socio economic conditions that resulted in the country’s competitiveness. Based on the data, the accident rate of construction projects in Indonesia is very high. In the era of the Asian Economic Community (AEC) Indonesian contractor is required to improve competitiveness, one of which is the implementation of the project without zero accident. Research using primary and secondary data validated the results of the literature experts and questionnaire respondents were analyzed using methods SmartPLS, obtained pattern of relationships between dimensions of safety culture to improve the performance of Safety. The results showed that the behaviors and Cost of Safety into dimensions that significantly affect the performance of safety. an increase in visible policy-based on Regulation of Public Work and Housing No 5/PRT/M/2014 to improve to lower the accident rate.

  20. Reserve Li/SOC12 Battery Safety Testing

    NASA Technical Reports Server (NTRS)

    Dils, C. T.; Garoutte, K. F.

    1984-01-01

    A reserve Lithium/Thionyl Chloride Battery concept is developed and undergoing feasibility testing in terms of performance, safety and abusive conditions. The feasibility of employing a battery of this type to replace thermal batteries in certain applications is demonstrated. Excellent performance of a Li/SOCl2 reserve battery is obtained across the temperature range from 0 C to +44 C. Performance improvement over the thermal battery usage is greater by a factor of 3 when discharge time and energy density are compared. Performance over an expanded temperature range is also possible. Safety and abusive testing is accomplished successfully on a series of five units. Further performance improvements can be achieved with regard to battery weight and volume reductions.

  1. Concept analysis of safety climate in healthcare providers.

    PubMed

    Lin, Ying-Siou; Lin, Yen-Chun; Lou, Meei-Fang

    2017-06-01

    To report an analysis of the concept of safety climate in healthcare providers. Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. Concept analysis. The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'. The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients. © 2016 John Wiley & Sons Ltd.

  2. Note on evaluating safety performance of road infrastructure to motivate safety competition.

    PubMed

    Han, Sangjin

    2016-01-01

    Road infrastructures are usually developed and maintained by governments or public sectors. There is no competitor in the market of their jurisdiction. This monopolic feature discourages road authorities from improving the level of safety with proactive motivation. This study suggests how to apply a principle of competition for roads, in particular by means of performance evaluation. It first discusses why road infrastructure has been slow in safety oriented development and management in respect of its business model. Then it suggests some practical ways of how to promote road safety between road authorities, particularly by evaluating safety performance of road infrastructure. These are summarized as decision of safety performance indicators, classification of spatial boundaries, data collection, evaluation, and reporting. Some consideration points are also discussed to make safety performance evaluation on road infrastructure lead to better road safety management.

  3. 42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

  4. 42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

  5. 42 CFR 482.21 - Condition of participation: Quality assessment and performance improvement program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... quality improvement and patient safety, including the reduction of medical errors, is defined, implemented... address priorities for improved quality of care and patient safety; and that all improvement actions are... incorporate quality indicator data including patient care data, and other relevant data, for example...

  6. Methods for identifying high collision concentrations for identifying potential safety improvements : development of advanced type 2 safety performance functions.

    DOT National Transportation Integrated Search

    2016-06-30

    This research developed advanced type 2 safety performance functions (SPF) for roadway segments, intersections and ramps on the entire Caltrans network. The advanced type 2 SPFs included geometrics, traffic volume and hierarchical random effects, whi...

  7. Diagnosis of poor safety culture as a major shortcoming in OHSAS 18001-certified companies.

    PubMed

    Ghahramani, Abolfazl

    2017-04-07

    The evaluation of safety performance in occupational health and safety assessment series (OHSAS) 18001-certified companies provides useful information about the quality of the management system. A certified organization should employ an adequate level of safety management and a positive safety culture to achieve a satisfactory safety performance. The present study conducted in six manufacturing companies: three OHSAS 18001-certified, and three non-certified to assess occupational health and safety (OHS) as well as OHSAS 18001 practices. The certified companies had a better OHS practices compared with the non-certified companies. The certified companies slightly differed in OHS and OHSAS 18001 practices and one of the certified companies had the highest activity rates for both practices. The results indicated that the implemented management systems have not developed and been maintained appropriately in the certified companies. The in-depth analysis of the collected evidence revealed shortcomings in safety culture improvement in the certified companies. This study highlights the importance of safety culture to continuously improve the quality of OHSAS 18001 and to properly perform OHS/OHSAS 18001 practices in the certified companies.

  8. Diagnosis of poor safety culture as a major shortcoming in OHSAS 18001-certified companies

    PubMed Central

    GHAHRAMANI, Abolfazl

    2016-01-01

    The evaluation of safety performance in occupational health and safety assessment series (OHSAS) 18001-certified companies provides useful information about the quality of the management system. A certified organization should employ an adequate level of safety management and a positive safety culture to achieve a satisfactory safety performance. The present study conducted in six manufacturing companies: three OHSAS 18001-certified, and three non-certified to assess occupational health and safety (OHS) as well as OHSAS 18001 practices. The certified companies had a better OHS practices compared with the non-certified companies. The certified companies slightly differed in OHS and OHSAS 18001 practices and one of the certified companies had the highest activity rates for both practices. The results indicated that the implemented management systems have not developed and been maintained appropriately in the certified companies. The in-depth analysis of the collected evidence revealed shortcomings in safety culture improvement in the certified companies. This study highlights the importance of safety culture to continuously improve the quality of OHSAS 18001 and to properly perform OHS/OHSAS 18001 practices in the certified companies. PMID:28025422

  9. A performance improvement case study in aircraft maintenance and its implications for hazard identification.

    PubMed

    Ward, Marie; McDonald, Nick; Morrison, Rabea; Gaynor, Des; Nugent, Tony

    2010-02-01

    Aircraft maintenance is a highly regulated, safety critical, complex and competitive industry. There is a need to develop innovative solutions to address process efficiency without compromising safety and quality. This paper presents the case that in order to improve a highly complex system such as aircraft maintenance, it is necessary to develop a comprehensive and ecologically valid model of the operational system, which represents not just what is meant to happen, but what normally happens. This model then provides the backdrop against which to change or improve the system. A performance report, the Blocker Report, specific to aircraft maintenance and related to the model was developed gathering data on anything that 'blocks' task or check performance. A Blocker Resolution Process was designed to resolve blockers and improve the current check system. Significant results were obtained for the company in the first trial and implications for safety management systems and hazard identification are discussed. Statement of Relevance: Aircraft maintenance is a safety critical, complex, competitive industry with a need to develop innovative solutions to address process and safety efficiency. This research addresses this through the development of a comprehensive and ecologically valid model of the system linked with a performance reporting and resolution system.

  10. Abuse Tolerance Improvements

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Orendorff, Christopher J.; Nagasubramanian, Ganesan; Fenton, Kyle R.

    As lithium-ion battery technologies mature, the size and energy of these systems continues to increase (> 50 kWh for EVs); making safety and reliability of these high energy systems increasingly important. While most material advances for lithium-ion chemistries are directed toward improving cell performance (capacity, energy, cycle life, etc.), there are a variety of materials advancements that can be made to improve lithium-ion battery safety. Issues including energetic thermal runaway, electrolyte decomposition and flammability, anode SEI stability, and cell-level abuse tolerance continue to be critical safety concerns. This report highlights work with our collaborators to develop advanced materials to improvemore » lithium-ion battery safety and abuse tolerance and to perform cell-level characterization of new materials.« less

  11. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Shi, X.P.

    Empirical studies on the effectiveness of workplace safety regulations are inconclusive. This study hypothesizes that the asynchronous effects of safety regulations occur because regulations need time to become effective. Safety regulations will work initially by reducing the most serious accidents, and later by improving overall safety performance. The hypothesis is tested by studying a provincial level aggregate panel dataset for China's coal industry using two different models with different sets of dependent variables: a fixed-effects model on mortality rate, which is defined as fatalities per 1,000 employees; and a negative binominal model on the annual number (frequency) of disastrous accidents.more » Safety regulations can reduce the frequency of disastrous accidents, but have not reduced mortality rate, which represents overall safety performance. Policy recommendations are made, including shifting production from small to large mines through industrial consolidation, improving the safety performance of large mines, addressing consequences of decentralization, and facilitating the implementation of regulations through carrying on institutional actions and supporting legislation.« less

  12. A Safety Index and Method for Flightdeck Evaluation

    NASA Technical Reports Server (NTRS)

    Latorella, Kara A.

    2000-01-01

    If our goal is to improve safety through machine, interface, and training design, then we must define a metric of flightdeck safety that is usable in the design process. Current measures associated with our notions of "good" pilot performance and ultimate safety of flightdeck performance fail to provide an adequate index of safe flightdeck performance for design evaluation purposes. The goal of this research effort is to devise a safety index and method that allows us to evaluate flightdeck performance holistically and in a naturalistic experiment. This paper uses Reason's model of accident causation (1990) as a basis for measuring safety, and proposes a relational database system and method for 1) defining a safety index of flightdeck performance, and 2) evaluating the "safety" afforded by flightdeck performance for the purpose of design iteration. Methodological considerations, limitations, and benefits are discussed as well as extensions to this work.

  13. Development of safety performance monitoring procedures.

    DOT National Transportation Integrated Search

    2010-02-01

    Highway safety is an ongoing concern to the Texas Department of Transportation (TxDOT). As part of its : proactive commitment to improving highway safety, TxDOT is moving toward including quantitative safety : analyses earlier in the project developm...

  14. Body-Cooling Paradigm in Sport: Maximizing Safety and Performance During Competition.

    PubMed

    Adams, William M; Hosokawa, Yuri; Casa, Douglas J

    2016-12-01

    Although body cooling has both performance and safety benefits, knowledge on optimizing cooling during specific sport competition is limited. To identify when, during sport competition, it is optimal for body cooling and to identify optimal body-cooling modalities to enhance safety and maximize sport performance. A comprehensive literature search was conducted to identify articles with specific context regarding body cooling, sport performance, and cooling modalities used during sport competition. A search of scientific peer-reviewed literature examining the effects of body cooling on exercise performance was done to examine the influence of body cooling on exercise performance. Subsequently, a literature search was done to identify effective cooling modalities that have been shown to improve exercise performance. The cooling modalities that are most effective in cooling the body during sport competition depend on the sport, timing of cooling, and feasibility based on the constraints of the sports rules and regulations. Factoring in the length of breaks (halftime substitutions, etc), the equipment worn during competition, and the cooling modalities that offer the greatest potential to cool must be considered in each individual sport. Scientific evidence supports using body cooling as a method of improving performance during sport competition. Developing a strategy to use cooling modalities that are scientifically evidence-based to improve performance while maximizing athlete's safety warrants further investigation.

  15. Control of Industrial Safety Based on Dynamic Characteristics of a Safety Budget-Industrial Accident Rate Model in Republic of Korea.

    PubMed

    Choi, Gi Heung; Loh, Byoung Gook

    2017-06-01

    Despite the recent efforts to prevent industrial accidents in the Republic of Korea, the industrial accident rate has not improved much. Industrial safety policies and safety management are also known to be inefficient. This study focused on dynamic characteristics of industrial safety systems and their effects on safety performance in the Republic of Korea. Such dynamic characteristics are particularly important for restructuring of the industrial safety system. The effects of damping and elastic characteristics of the industrial safety system model on safety performance were examined and feedback control performance was explained in view of cost and benefit. The implications on safety policies of restructuring the industrial safety system were also explored. A strong correlation between the safety budget and the industrial accident rate enabled modeling of an industrial safety system with these variables as the input and the output, respectively. A more effective and efficient industrial safety system could be realized by having weaker elastic characteristics and stronger damping characteristics in it. A substantial decrease in total social cost is expected as the industrial safety system is restructured accordingly. A simple feedback control with proportional-integral action is effective in prevention of industrial accidents. Securing a lower level of elastic industrial accident-driving energy appears to have dominant effects on the control performance compared with the damping effort to dissipate such energy. More attention needs to be directed towards physical and social feedbacks that have prolonged cumulative effects. Suggestions for further improvement of the safety system including physical and social feedbacks are also made.

  16. A Multi-Perspective Study on Safety Performance at the Colorado DOT

    DOT National Transportation Integrated Search

    2018-01-01

    This effort focuses on the safety culture within CDOT and the effectiveness of the CDOT safety programs on improving safety culture. The study used a survey approach based on interviews with senior safety officials to determine the scope of the surve...

  17. Analysis of event data recorder data for vehicle safety improvement

    DOT National Transportation Integrated Search

    2008-04-01

    The Volpe Center performed a comprehensive engineering analysis of Event Data Recorder (EDR) data supplied by the National Highway Traffic Safety Administration (NHTSA) to assess its accuracy and usefulness in crash reconstruction and improvement of ...

  18. Reaping the Benefits of Task Conflict in Teams: The Critical Role of Team Psychological Safety Climate

    ERIC Educational Resources Information Center

    Bradley, Bret H.; Postlethwaite, Bennett E.; Klotz, Anthony C.; Hamdani, Maria R.; Brown, Kenneth G.

    2012-01-01

    Past research suggests that task conflict may improve team performance under certain conditions; however, we know little about these specific conditions. On the basis of prior theory and research on conflict in teams, we argue that a climate of psychological safety is one specific context under which task conflict will improve team performance.…

  19. 48 CFR 970.5203-2 - Performance improvement and collaboration.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Solicitation Provisions and Contract Clauses for Management and Operating Contracts 970.5203-2 Performance improvement and... practices, where appropriate, that will improve performance in the areas of environmental and health, safety...

  20. Integrating natural language processing expertise with patient safety event review committees to improve the analysis of medication events.

    PubMed

    Fong, Allan; Harriott, Nicole; Walters, Donna M; Foley, Hanan; Morrissey, Richard; Ratwani, Raj R

    2017-08-01

    Many healthcare providers have implemented patient safety event reporting systems to better understand and improve patient safety. Reviewing and analyzing these reports is often time consuming and resource intensive because of both the quantity of reports and length of free-text descriptions in the reports. Natural language processing (NLP) experts collaborated with clinical experts on a patient safety committee to assist in the identification and analysis of medication related patient safety events. Different NLP algorithmic approaches were developed to identify four types of medication related patient safety events and the models were compared. Well performing NLP models were generated to categorize medication related events into pharmacy delivery delays, dispensing errors, Pyxis discrepancies, and prescriber errors with receiver operating characteristic areas under the curve of 0.96, 0.87, 0.96, and 0.81 respectively. We also found that modeling the brief without the resolution text generally improved model performance. These models were integrated into a dashboard visualization to support the patient safety committee review process. We demonstrate the capabilities of various NLP models and the use of two text inclusion strategies at categorizing medication related patient safety events. The NLP models and visualization could be used to improve the efficiency of patient safety event data review and analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Comparing safety climate in naval aviation and hospitals: implications for improving patient safety.

    PubMed

    Singer, Sara J; Rosen, Amy; Zhao, Shibei; Ciavarelli, Anthony P; Gaba, David M

    2010-01-01

    Evidence of variation in safety climate suggests the need for improvement among at least some hospitals. However, comparisons only among hospitals may underestimate the improvement required. Comparison of hospitals with analogous industries may provide a broader perspective on the safety status of our nation's hospitals. The purpose of this study was to compare safety climate among hospital workers with personnel from naval aviation, an organization that operates with high reliability despite intrinsically hazardous conditions. We surveyed a random sample of health care workers in 67 U.S. hospitals and, for generalizability, 30 veterans affairs hospitals using questions comparable with those posed at approximately the same time (2007) to a census of personnel from 35 squadrons of U.S. naval aviators. We received 13,841 (41%) completed surveys in U.S. hospitals, 5,511 (50%) in veterans affairs hospitals, and 14,854 (82%) among naval aviators. We examined differences in respondents' perceptions of safety climate at their institution overall and for 16 individual items. Safety climate was three times better on average among naval aviators than among hospital personnel. Naval aviators perceived a safer climate (up to seven times safer) than hospital personnel with respect to each of the 16 survey items. Compared with hospital managers, naval commanders perceived climate more like frontline personnel did. When contrasting naval aviators with hospital personnel working in comparably hazardous areas, safety climate discrepancies increased rather than decreased. One individual hospital performed as well as naval aviation on average, and at least one hospital outperformed the Navy benchmark for all but three individual survey items. Results suggest that hospitals have not sufficiently created a uniform priority of safety. However, if each hospital performed as well as the top-performing hospital in each area measured, hospitals could achieve safety climate levels comparable with naval aviation. Major interventions to bolster hospital safety climate continue to be required to improve patient safety.

  2. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lower, Mark D; Christopher, Timothy W; Oland, C Barry

    The Facilities and Operations (F&O) Directorate is sponsoring a continuous process improvement (CPI) program. Its purpose is to stimulate, promote, and sustain a culture of improvement throughout all levels of the organization. The CPI program ensures that a scientific and repeatable process exists for improving the delivery of F&O products and services in support of Oak Ridge National Laboratory (ORNL) Management Systems. Strategic objectives of the CPI program include achieving excellence in laboratory operations in the areas of safety, health, and the environment. Identifying and promoting opportunities for achieving the following critical outcomes are important business goals of the CPImore » program: improved safety performance; process focused on consumer needs; modern and secure campus; flexibility to respond to changing laboratory needs; bench strength for the future; and elimination of legacy issues. The Steam Pressure-Reducing Station (SPRS) Safety and Energy Efficiency Improvement Project, which is under the CPI program, focuses on maintaining and upgrading SPRSs that are part of the ORNL steam distribution network. This steam pipe network transports steam produced at the ORNL steam plant to many buildings in the main campus site. The SPRS Safety and Energy Efficiency Improvement Project promotes excellence in laboratory operations by (1) improving personnel safety, (2) decreasing fuel consumption through improved steam system energy efficiency, and (3) achieving compliance with applicable worker health and safety requirements. The SPRS Safety and Energy Efficiency Improvement Project being performed by F&O is helping ORNL improve both energy efficiency and worker safety by modifying, maintaining, and repairing SPRSs. Since work began in 2006, numerous energy-wasting steam leaks have been eliminated, heat losses from uninsulated steam pipe surfaces have been reduced, and deficient pressure retaining components have been replaced. These improvements helped ORNL reduce its overall utility costs by decreasing the amount of fuel used to generate steam. Reduced fuel consumption also decreased air emissions. These improvements also helped lower the risk of burn injuries to workers and helped prevent shrapnel injuries resulting from missiles produced by pressurized component failures. In most cases, the economic benefit and cost effectiveness of the SPRS Safety and Energy Efficiency Improvement Project is reflected in payback periods of 1 year or less.« less

  3. Improved guidelines for estimating the Highway safety manual calibration factors.

    DOT National Transportation Integrated Search

    2016-01-01

    Crash prediction models can be used to predict the number of crashes and evaluate roadway safety. Part C of the first edition of the Highway Safety Manual (HSM) provides safety performance functions (SPFs). The HSM addendum that includes freeway and ...

  4. Development of a Comprehensive Database System for Safety Analyst

    PubMed Central

    Paz, Alexander; Veeramisti, Naveen; Khanal, Indira; Baker, Justin

    2015-01-01

    This study addressed barriers associated with the use of Safety Analyst, a state-of-the-art tool that has been developed to assist during the entire Traffic Safety Management process but that is not widely used due to a number of challenges as described in this paper. As part of this study, a comprehensive database system and tools to provide data to multiple traffic safety applications, with a focus on Safety Analyst, were developed. A number of data management tools were developed to extract, collect, transform, integrate, and load the data. The system includes consistency-checking capabilities to ensure the adequate insertion and update of data into the database. This system focused on data from roadways, ramps, intersections, and traffic characteristics for Safety Analyst. To test the proposed system and tools, data from Clark County, which is the largest county in Nevada and includes the cities of Las Vegas, Henderson, Boulder City, and North Las Vegas, was used. The database and Safety Analyst together help identify the sites with the potential for safety improvements. Specifically, this study examined the results from two case studies. The first case study, which identified sites having a potential for safety improvements with respect to fatal and all injury crashes, included all roadway elements and used default and calibrated Safety Performance Functions (SPFs). The second case study identified sites having a potential for safety improvements with respect to fatal and all injury crashes, specifically regarding intersections; it used default and calibrated SPFs as well. Conclusions were developed for the calibration of safety performance functions and the classification of site subtypes. Guidelines were provided about the selection of a particular network screening type or performance measure for network screening. PMID:26167531

  5. Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute.

    PubMed

    Simons, Pascale A M; Houben, Ruud; Vlayen, Annemie; Hellings, Johan; Pijls-Johannesma, Madelon; Marneffe, Wim; Vandijck, Dominique

    2015-02-01

    The importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute. Patient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis. The workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01). Due to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Performance Measurement and Target-Setting in California's Safety Net Health Systems.

    PubMed

    Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

    Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

  7. Changing Operating Room Culture: Implementation of a Postoperative Debrief and Improved Safety Culture.

    PubMed

    Magill, Stephen T; Wang, Doris D; Rutledge, W Caleb; Lau, Darryl; Berger, Mitchel S; Sankaran, Sujatha; Lau, Catherine Y; Imershein, Sarah G

    2017-11-01

    Patient safety is foundational to neurosurgical care. Postprocedural "debrief" checklists have been proposed to improve patient safety, but data about their use in neurosurgery are limited. Here, we implemented an initiative to routinely perform postoperative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture. A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical OR staff at a major academic medical center before and 18 months after the implementation of a postoperative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey used a Likert scale and analyzed with standard statistical methods. After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than did anesthesiologists and nurses. After implementation of the postoperative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists, and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared with surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases, and prevention of potential adverse events/near misses was reported in 8% of cases. Postoperative debriefing can be effectively introduced into the OR and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. A Team, Case-based Examination and Its Impact on Student Performance in a Patient Safety and Informatics Course

    PubMed Central

    Etheridge, Kierstan; DeLellis, Teresa

    2017-01-01

    Objective. To describe the redesigned assessment plan for a patient safety and informatics course and assess student pharmacist performance and perceptions. Methods. The final examination of a patient safety course was redesigned from traditional multiple choice and short answer to team-based, open-ended, and case-based. Faculty for each class session developed higher level activities, focused on developing key skills or attitudes deemed essential for practice, for a progressive patient case consisting of nine activities. Student performance and perceptions were analyzed with pre- and post-surveys using 5-point scales. Results. Mean performance on the examination was 93.6%; median scores for each assessed course outcome ranged from 90% to 100%. Eighty-five percent of students completed both surveys. Confidence performing skills and demonstrating attitudes improved for each item on post-survey compared with pre-survey. Eighty-one percent of students indicated the experience of taking the examination was beneficial for their professional development. Conclusion. A team, case-based examination was associated with high student performance and improved self-confidence in performing medication safety-related skills. PMID:28970618

  9. Safety and reliability analysis in a polyvinyl chloride batch process using dynamic simulator-case study: Loss of containment incident.

    PubMed

    Rizal, Datu; Tani, Shinichi; Nishiyama, Kimitoshi; Suzuki, Kazuhiko

    2006-10-11

    In this paper, a novel methodology in batch plant safety and reliability analysis is proposed using a dynamic simulator. A batch process involving several safety objects (e.g. sensors, controller, valves, etc.) is activated during the operational stage. The performance of the safety objects is evaluated by the dynamic simulation and a fault propagation model is generated. By using the fault propagation model, an improved fault tree analysis (FTA) method using switching signal mode (SSM) is developed for estimating the probability of failures. The timely dependent failures can be considered as unavailability of safety objects that can cause the accidents in a plant. Finally, the rank of safety object is formulated as performance index (PI) and can be estimated using the importance measures. PI shows the prioritization of safety objects that should be investigated for safety improvement program in the plants. The output of this method can be used for optimal policy in safety object improvement and maintenance. The dynamic simulator was constructed using Visual Modeler (VM, the plant simulator, developed by Omega Simulation Corp., Japan). A case study is focused on the loss of containment (LOC) incident at polyvinyl chloride (PVC) batch process which is consumed the hazardous material, vinyl chloride monomer (VCM).

  10. Evaluation of the food safety training for food handlers in restaurant operations

    PubMed Central

    Park, Sung-Hee; Kwak, Tong-Kyung

    2010-01-01

    This study examined the extent of improvement of food safety knowledge and practices of employee through food safety training. Employee knowledge and practice for food safety were evaluated before and after the food safety training program. The training program and questionnaires for evaluating employee knowledge and practices concerning food safety, and a checklist for determining food safety performance of restaurants were developed. Data were analyzed using the SPSS program. Twelve restaurants participated in this study. We split them into two groups: the intervention group with training, and the control group without food safety training. Employee knowledge of the intervention group also showed a significant improvement in their score, increasing from 49.3 before the training to 66.6 after training. But in terms of employee practices and the sanitation performance, there were no significant increases after the training. From these results, we recommended that the more job-specific and hand-on training materials for restaurant employees should be developed and more continuous implementation of the food safety training and integration of employee appraisal program with the outcome of safety training were needed. PMID:20198210

  11. Improving patient safety and optimizing nursing teamwork using crew resource management techniques.

    PubMed

    West, Priscilla; Sculli, Gary; Fore, Amanda; Okam, Nwoha; Dunlap, Cleveland; Neily, Julia; Mills, Peter

    2012-01-01

    This project describes the application of the "sterile cockpit rule," a crew resource management (CRM) technique, targeted to improve efficacy and safety for nursing assistants in the performance of patient care duties. Crew resource management techniques have been successfully implemented in the aviation industry to improve flight safety. Application of these techniques can improve patient safety in medical settings. The Veterans Affairs (VA) National Center for Patient Safety conducted a CRM training program in select VA nursing units. One unit developed a novel application of the sterile cockpit rule to create protected time for certified nursing assistants (CNAs) while they collected vital signs and blood glucose data at the beginning of each shift. The typical nursing authority structure was reversed, with senior nurses protecting CNAs from distractions. This process led to improvements in efficiency and communication among nurses, with the added benefit of increased staff morale. Crew resource management techniques can be used to improve efficiency, morale, and patient safety in the healthcare setting.

  12. Use of safety management practices for improving project performance.

    PubMed

    Cheng, Eddie W L; Kelly, Stephen; Ryan, Neal

    2015-01-01

    Although site safety has long been a key research topic in the construction field, there is a lack of literature studying safety management practices (SMPs). The current research, therefore, aims to test the effect of SMPs on project performance. An empirical study was conducted in Hong Kong and the data collected were analysed with multiple regression analysis. Results suggest that 3 of the 15 SMPs, which were 'safety committee at project/site level', 'written safety policy', and 'safety training scheme' explained the variance in project performance significantly. Discussion about the impact of these three SMPs on construction was provided. Assuring safe construction should be an integral part of a construction project plan.

  13. From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.

    PubMed

    Austin, J Matthew; Demski, Renee; Callender, Tiffany; Lee, K H Ken; Hoffman, Ann; Allen, Lisa; Radke, Deborah A; Kim, Yungjin; Werthman, Ronald J; Peterson, Ronald R; Pronovost, Peter J

    2017-04-01

    As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  14. Hotspots identification and ranking for road safety improvement: an alternative approach.

    PubMed

    Coll, Bronagh; Moutari, Salissou; Marshall, Adele H

    2013-10-01

    During the last decade, the concept of composite performance index, brought from economic and business statistics, has become a popular practice in the field of road safety, namely for the identification and classification of worst performing areas or time slots also known as hotspots. The overall quality of a composite index depends upon the complexity of phenomena of interest as well as the relevance of the methodological approach used to aggregate the various indicators into a single composite index. However, current aggregation methods used to estimate the composite road safety performance index suffer from various deficiencies at both the theoretical and operational level; these include the correlation and compensability between indicators, the weighting of the indicators as well as their high "degree of freedom" which enables one to readily manipulate them to produce desired outcomes (Munda and Nardo, 2003, 2005, 2009). The objective of this study is to contribute to the ongoing research effort on the estimation of road safety composite index for hotspots' identification and ranking. The aggregation method for constructing the composite road safety performance index introduced in this paper, strives to minimize the aforementioned deficiencies of the current approaches. Furthermore, this new method can be viewed as an intelligent decision support system for road safety performance evaluation, in order to prioritize interventions for road safety improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Use of portable ladders - field observations and self-reported safety performance in the cable TV industry.

    PubMed

    Chang, Wen-Ruey; Huang, Yueng-Hsiang; Brunette, Christopher; Lee, Jin

    2017-11-01

    Portable ladders incidents remain a major cause of falls from heights. This study reported field observations of environments, work conditions and safety behaviour involving portable ladders and their correlations with self-reported safety performance. Seventy-five professional installers of a company in the cable and other pay TV industry were observed for 320 ladder usages at their worksites. The participants also filled out a questionnaire to measure self-reported safety performance. Proper setup on slippery surfaces, correct method for ladder inclination setup and ladder secured at the bottom had the lowest compliance with best practices and training guidelines. The observation compliance score was found to have significant correlation with straight ladder inclined angle (Pearson's r = 0.23, p < 0.0002) and employees' self-reported safety participation (r = 0.29, p < 0.01). The results provide a broad perspective on employees' safety compliance and identify areas for improving safety behaviours. Practitioner Summary: A checklist was used while observing professional installers of a cable company for portable ladder usage at their worksites. Items that had the lowest compliance with best practices and training guidelines were identified. The results provide a broad perspective on employees' safety compliance and identify areas for improving safety behaviours.

  16. Improving staff perception of a safety climate with crew resource management training.

    PubMed

    Kuy, SreyRam; Romero, Ramon A L

    2017-06-01

    Communication failure is one of the top root causes in patient safety adverse events. Crew resource management (CRM) is a team building communication process intended to improve patient safety by improving team dynamics. First, to describe implementation of CRM in a Veterans Affair (VA) surgical service. Second, to assess whether staff CRM training is related to improvement in staff perception of a safety climate. Mandatory CRM training was implemented for all surgical service staff at a VA Hospital at 0 and 12 mo. Safety climate questionnaires were completed by operating room staff at a baseline, 6 and 12 mo after the initial CRM training. Participants reported improvement on all 27 points on the safety climate questionnaire at 6 mo compared with the baseline. At 12 mo, there was sustained improvement in 23 of the 27 areas. This is the first published report about the effect of CRM training on staff perception of a safety climate in a VA surgical service. We demonstrate that CRM training can be successfully implemented widespread in a surgical program. Overall, there was improvement in 100% of areas assessed on the safety climate questionnaire at 6 mo after CRM training. By 1 y, this improvement was sustained in 23 of 27 areas, with the areas of greatest improvement being the performance of briefings, collaboration between nurses and doctors, valuing nursing input, knowledge about patient safety, and institutional promotion of a patient safety climate. Published by Elsevier Inc.

  17. Testing of state roadside safety systems. Volume I, Technical report

    DOT National Transportation Integrated Search

    1999-04-01

    The purpose of this study is to crash test and evaluate new or modified roadside safety hardware and, where necessary, redesign the devices to improve their impact performance. The three major areas addressed in this study are the impact performance ...

  18. Development of safety performance functions for North Carolina.

    DOT National Transportation Integrated Search

    2011-12-06

    "The objective of this effort is to develop safety performance functions (SPFs) for different types of facilities in North Carolina : and illustrate how they can be used to improve the decision making process. The prediction models in Part C of the H...

  19. Applying importance-performance analysis to patient safety culture.

    PubMed

    Lee, Yii-Ching; Wu, Hsin-Hung; Hsieh, Wan-Lin; Weng, Shao-Jen; Hsieh, Liang-Po; Huang, Chih-Hsuan

    2015-01-01

    The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

  20. Westinghouse Hanford Company health and safety performance report. Fourth quarter calendar year 1994

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lansing, K.A.

    1995-03-01

    Detailed information pertaining to As Low As Reasonably Achievable/Contamination Control Improvement Project (ALARA/CCIP) activities are outlined. Improved commitment to the WHC ALARA/CCIP Program was experienced throughout FY 1994. During CY 1994, 17 of 19 sitewide ALARA performance goals were completed on or ahead of schedule. Estimated total exposure by facility for CY 1994 is listed in tables by organization code for each dosimeter frequency. Facilities/areas continue to utilize the capabilities of the RPR tracking system in conjunction with the present site management action-tracking system to manage deficiencies, trend performance, and develop improved preventive efforts. Detailed information pertaining to occupational injuries/illnessesmore » are provided. The Industrial Safety and Hygiene programs are described which have generated several key initiatives that are believed responsible for improved safety performance. A breakdown of CY 1994 occupational injuries/illnesses by type, affected body group, cause, job type, age/gender, and facility is provided. The contributing experience of each WHC division/department in attaining this significant improvement is described along with tables charting specific trends. The Radiological Control Program is on schedule to meet all RL Site Management System milestones and program commitments.« less

  1. Evaluation of US 119 Pine Mountain safety improvements : final report.

    DOT National Transportation Integrated Search

    2007-09-01

    The Transportation Center at the University of Kentucky was requested to perform an evaluation of the safety improvement project over a 7.1-mile section of US 119 on t he Whitesburg side of Pine Mountain in Letcher County to determine whether the typ...

  2. Electrochemical performance and thermal stability analysis of LiNixCoyMnzO2 cathode based on a composite safety electrolyte.

    PubMed

    Jiang, Lihua; Wang, Qingsong; Sun, Jinhua

    2018-06-05

    LiNi x Co y Mn z O 2 (NCM) cathode material with high energy density is one of the best choices for power batteries. But the safety issue also becomes more prominent with higher nickel content. The improvement of thermal stability by material modification is often complex and limited. In this study, a composite safety electrolyte additive consisting of perfluoro-2-methyl-3-pentanone, N, N-Dimethylacetamide (and fluorocarbon surfactant is proved to be effective and simple in improving the thermal stability of NCM materials. Electrochemical compatibility of composite safety electrolyte with various NCM materials is investigated. Uniform interface film, lower impedance and polarization for NCM (622) cycled in composite safety electrolyte are proved to be the main reasons to ensure good cycle performance. Homemade pouch cells (NCM (622)/C) are used to verify the effectiveness for practical application, accelerating rate calorimeter and nail penetration test shows a slower temperature rise and delay of thermal runaway. For heating experiment, no fire appears for pouch cell with composite safety electrolyte. Thus, this composite safety electrolyte is effective to improve the safety of lithium ion batteries with NCM materials.(. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Next generation safety performance monitoring at signalized intersections using connected vehicle technology.

    DOT National Transportation Integrated Search

    2014-08-01

    Crash-based safety evaluation is often hampered by randomness, lack of timeliness, and rarity of crash : occurrences. This is particularly the case for technology-driven safety improvement projects that are : frequently updated or replaced by newer o...

  4. Patient safety in anesthesia: learning from the culture of high-reliability organizations.

    PubMed

    Wright, Suzanne M

    2015-03-01

    There has been an increased awareness of and interest in patient safety and improved outcomes, as well as a growing body of evidence substantiating medical error as a leading cause of death and injury in the United States. According to The Joint Commission, US hospitals demonstrate improvements in health care quality and patient safety. Although this progress is encouraging, much room for improvement remains. High-reliability organizations, industries that deliver reliable performances in the face of complex working environments, can serve as models of safety for our health care system until plausible explanations for patient harm are better understood. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Mines Systems Safety Improvement Using an Integrated Event Tree and Fault Tree Analysis

    NASA Astrophysics Data System (ADS)

    Kumar, Ranjan; Ghosh, Achyuta Krishna

    2017-04-01

    Mines systems such as ventilation system, strata support system, flame proof safety equipment, are exposed to dynamic operational conditions such as stress, humidity, dust, temperature, etc., and safety improvement of such systems can be done preferably during planning and design stage. However, the existing safety analysis methods do not handle the accident initiation and progression of mine systems explicitly. To bridge this gap, this paper presents an integrated Event Tree (ET) and Fault Tree (FT) approach for safety analysis and improvement of mine systems design. This approach includes ET and FT modeling coupled with redundancy allocation technique. In this method, a concept of top hazard probability is introduced for identifying system failure probability and redundancy is allocated to the system either at component or system level. A case study on mine methane explosion safety with two initiating events is performed. The results demonstrate that the presented method can reveal the accident scenarios and improve the safety of complex mine systems simultaneously.

  6. High Energy Density Additives for Hybrid Fuel Rockets to Improve Performance and Enhance Safety

    NASA Technical Reports Server (NTRS)

    Jaffe, Richard L.

    2014-01-01

    We propose a conceptual study of prototype strained hydrocarbon molecules as high energy density additives for hybrid rocket fuels to boost the performance of these rockets without compromising safety and reliability. Use of these additives could extend the range of applications for which hybrid rockets become an attractive alternative to conventional solid or liquid fuel rockets. The objectives of the study were to confirm and quantify the high enthalpy of these strained molecules and to assess improvement in rocket performance that would be expected if these additives were blended with conventional fuels. We confirmed the chemical properties (including enthalpy) of these additives. However, the predicted improvement in rocket performance was too small to make this a useful strategy for boosting hybrid rocket performance.

  7. A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

    PubMed

    El-Jardali, Fadi; Fadlallah, Racha

    2017-08-16

    Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

  8. A Study of Truck Drivers and Their Job Performance Regarding Highway Safety

    ERIC Educational Resources Information Center

    Nafukho, Fredrick M.; Hinton, Barbara E.; Graham, Carroll M.

    2007-01-01

    Limited research has addressed the issue of truck drivers and their performance regarding highway safety in terms of reduced number of crashes per driver. The primary purpose of this study was to determine how tractor trailer truck drivers' job performance could be improved while at the same time ensuring increased revenue for the transportation…

  9. Software Design Improvements. Part 2; Software Quality and the Design and Inspection Process

    NASA Technical Reports Server (NTRS)

    Lalli, Vincent R.; Packard, Michael H.; Ziemianski, Tom

    1997-01-01

    The application of assurance engineering techniques improves the duration of failure-free performance of software. The totality of features and characteristics of a software product are what determine its ability to satisfy customer needs. Software in safety-critical systems is very important to NASA. We follow the System Safety Working Groups definition for system safety software as: 'The optimization of system safety in the design, development, use and maintenance of software and its integration with safety-critical systems in an operational environment. 'If it is not safe, say so' has become our motto. This paper goes over methods that have been used by NASA to make software design improvements by focusing on software quality and the design and inspection process.

  10. 77 FR 57949 - Federal Acquisition Regulation; Positive Law Codification of Title 41

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-18

    ..., environmental, public health and safety effects, distributive impacts, and equity). E.O. 13563 emphasizes the... Work Hours and 40 U.S.C. chapter 37 Contract Work Hours Safety Standards Act. and Safety Standards... at improving performance, reliability, quality, safety, and life-cycle costs 41 U.S.C. 1711). For use...

  11. A conceptual framework to development of construction safety culture in Indonesia

    NASA Astrophysics Data System (ADS)

    Armyn Machfudiyanto, Rossy; Latief, Yusuf

    2017-12-01

    Working accidents in the construction industry are among the highest in the world, affecting the three levels of both macro (National) mezzo (Enterprise) and micro (Projects) that need to be integrated in building a safety culture. The purpose of this research is to develop a conceptual framework in improving safety culture in the construction industry in Indonesia. The methodology was developed using literature study and deductive analysis which then performed expert validation to ensure the concept developed. The result of this research is that policy and institution as input to build safety culture which need to be followed up with increasing of company maturity which have implication to safety performance and construction project performance.

  12. Simulating geriatric home safety assessments in a three-dimensional virtual world.

    PubMed

    Andrade, Allen D; Cifuentes, Pedro; Mintzer, Michael J; Roos, Bernard A; Anam, Ramanakumar; Ruiz, Jorge G

    2012-01-01

    Virtual worlds could offer inexpensive and safe three-dimensional environments in which medical trainees can learn to identify home safety hazards. Our aim was to evaluate the feasibility, usability, and acceptability of virtual worlds for geriatric home safety assessments and to correlate performance efficiency in hazard identification with spatial ability, self-efficacy, cognitive load, and presence. In this study, 30 medical trainees found the home safety simulation easy to use, and their self-efficacy was improved. Men performed better than women in hazard identification. Presence and spatial ability were correlated significantly with performance. Educators should consider spatial ability and gender differences when implementing virtual world training for geriatric home safety assessments.

  13. Factors Influencing Implementation of OHSAS 18001 in Indian Construction Organizations: Interpretive Structural Modeling Approach

    PubMed Central

    Rajaprasad, Sunku Venkata Siva; Chalapathi, Pasupulati Venkata

    2015-01-01

    Background Construction activity has made considerable breakthroughs in the past two decades on the back of increases in development activities, government policies, and public demand. At the same time, occupational health and safety issues have become a major concern to construction organizations. The unsatisfactory safety performance of the construction industry has always been highlighted since the safety management system is neglected area and not implemented systematically in Indian construction organizations. Due to a lack of enforcement of the applicable legislation, most of the construction organizations are forced to opt for the implementation of Occupational Health Safety Assessment Series (OHSAS) 18001 to improve safety performance. Methods In order to better understand factors influencing the implementation of OHSAS 18001, an interpretive structural modeling approach has been applied and the factors have been classified using matrice d'impacts croises-multiplication appliqué a un classement (MICMAC) analysis. The study proposes the underlying theoretical framework to identify factors and to help management of Indian construction organizations to understand the interaction among factors influencing in implementation of OHSAS 18001. Results Safety culture, continual improvement, morale of employees, and safety training have been identified as dependent variables. Safety performance, sustainable construction, and conducive working environment have been identified as linkage variables. Management commitment and safety policy have been identified as the driver variables. Conclusion Management commitment has the maximum driving power and the most influential factor is safety policy, which states clearly the commitment of top management towards occupational safety and health. PMID:26929828

  14. Job Demands-Control-Support model and employee safety performance.

    PubMed

    Turner, Nick; Stride, Chris B; Carter, Angela J; McCaughey, Deirdre; Carroll, Anthony E

    2012-03-01

    The aim of this study was to explore whether work characteristics (job demands, job control, social support) comprising Karasek and Theorell's (1990) Job Demands-Control-Support framework predict employee safety performance (safety compliance and safety participation; Neal and Griffin, 2006). We used cross-sectional data of self-reported work characteristics and employee safety performance from 280 healthcare staff (doctors, nurses, and administrative staff) from Emergency Departments of seven hospitals in the United Kingdom. We analyzed these data using a structural equation model that simultaneously regressed safety compliance and safety participation on the main effects of each of the aforementioned work characteristics, their two-way interactions, and the three-way interaction among them, while controlling for demographic, occupational, and organizational characteristics. Social support was positively related to safety compliance, and both job control and the two-way interaction between job control and social support were positively related to safety participation. How work design is related to employee safety performance remains an important area for research and provides insight into how organizations can improve workplace safety. The current findings emphasize the importance of the co-worker in promoting both safety compliance and safety participation. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  15. Macroergonomic analysis and design for improved safety and quality performance.

    PubMed

    Kleiner, B M

    1999-01-01

    Macroergonomics, which emerged historically after sociotechnical systems theory, quality management, and ergonomics, is presented as the basis for a needed integrative methodology. A macroergonomics methodology was presented in some detail to demonstrate how aspects of microergonomics, total quality management (TQM), and sociotechnical systems (STS) can be triangulated in a common approach. In the context of this methodology, quality and safety were presented as 2 of several important performance criteria. To demonstrate aspects of the methodology, 2 case studies were summarized with safety and quality performance results where available. The first case manipulated both personnel and technical factors to achieve a "safety culture" at a nuclear site. The concept of safety culture is defined in INSAG-4 (International Atomic Energy Agency, 1991). as "that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance." The second case described a tire manufacturing intervention to improve quality (as defined by Sink and Tuttle, 1989) through joint consideration of technical and social factors. It was suggested that macroergonomics can yield greater performance than can be achieved through ergonomic intervention alone. Whereas case studies help to make the case, more rigorous formative and summative research is needed to refine and validate the proposed methodology respectively.

  16. Improving compliance with Occupational Safety and Health Administration standards.

    PubMed

    Cuming, Richard; Rocco, Tonette S; McEachern, Adriana G

    2008-02-01

    Health care facilities can be dangerous places. The mission of the Occupational Safety and Health Administration (OSHA) is to improve the safety of the American workplace by developing and implementing standards that prevent occupational injury, illness, and death. Perioperative services are performed in environments where exposure to bloodborne pathogens is a daily occurrence, making implementation and compliance with OSHA standards very important. Employees and employers must remain current with workplace safety requirements, including use of personal protective equipment. This article presents implications of the OSHA standards for employers, educators, and employees.

  17. Testing of state roadside safety systems. Volume XI, Appendix J -- Crash testing and evaluation of existing guardrail systems

    DOT National Transportation Integrated Search

    1999-04-01

    The purpose of this study is to crash test and evaluate new or modified roadside safety hardware and, where necessary, redesign the devices to improve their impact performance. The three major areas addressed in this study are the impact performance ...

  18. Multi-objective decoupling algorithm for active distance control of intelligent hybrid electric vehicle

    NASA Astrophysics Data System (ADS)

    Luo, Yugong; Chen, Tao; Li, Keqiang

    2015-12-01

    The paper presents a novel active distance control strategy for intelligent hybrid electric vehicles (IHEV) with the purpose of guaranteeing an optimal performance in view of the driving functions, optimum safety, fuel economy and ride comfort. Considering the complexity of driving situations, the objects of safety and ride comfort are decoupled from that of fuel economy, and a hierarchical control architecture is adopted to improve the real-time performance and the adaptability. The hierarchical control structure consists of four layers: active distance control object determination, comprehensive driving and braking torque calculation, comprehensive torque distribution and torque coordination. The safety distance control and the emergency stop algorithms are designed to achieve the safety and ride comfort goals. The optimal rule-based energy management algorithm of the hybrid electric system is developed to improve the fuel economy. The torque coordination control strategy is proposed to regulate engine torque, motor torque and hydraulic braking torque to improve the ride comfort. This strategy is verified by simulation and experiment using a forward simulation platform and a prototype vehicle. The results show that the novel control strategy can achieve the integrated and coordinated control of its multiple subsystems, which guarantees top performance of the driving functions and optimum safety, fuel economy and ride comfort.

  19. Operator performance-enhancing technologies to improve safety. A US DOT safety initiative for meeting the human-centered systems challenge.

    DOT National Transportation Integrated Search

    1999-11-01

    The program implements DOT Human Factors Coordinating Committee (HFCC) recommendations for a coordinated Departmental Human Factors Research Program to advance the human-centered systems approach for enhancing transportation safety. Human error is a ...

  20. 77 FR 72435 - Pipeline Safety: Using Meaningful Metrics in Conducting Integrity Management Program Evaluations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket No... Evaluations AGENCY: Pipeline and Hazardous Materials Safety Administration (PHMSA), DOT. ACTION: Notice... improve performance. For gas transmission pipelines, Sec. Sec. 192.911(i) and 192.945 define the...

  1. 23 CFR 924.13 - Evaluation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Ensure the accuracy and currency of the safety data; (ii) Identify factors that affect the priority of... HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HIGHWAY SAFETY HIGHWAY SAFETY IMPROVEMENT PROGRAM... reaching the performance goals identified in § 924.9(a)(3)(ii)(G). (2) Include a process to evaluate the...

  2. Can Leader–Member Exchange Contribute to Safety Performance in An Italian Warehouse?

    PubMed Central

    Mariani, Marco G.; Curcuruto, Matteo; Matic, Mirna; Sciacovelli, Paolo; Toderi, Stefano

    2017-01-01

    Introduction: The research considers safety climate in a warehouse and wants to analyze the Leader–Member Exchange (LMX) role in respect to safety performance. Griffin and Neal’s safety model was adopted and Leader-Member Exchange was inserted as moderator in the relationships between safety climate and proximal antecedents (motivation and knowledge) of safety performance constructs (compliance and participation). Materials and Methods: Survey data were collected from a sample of 133 full-time employees in an Italian warehouse. The statistical framework of Hayes (2013) was adopted for moderated mediation analysis. Results: Proximal antecedents partially mediated the relationship between Safety climate and safety participation, but not safety compliance. Moreover, the results from the moderation analysis showed that the Leader–Member Exchange moderated the influence of safety climate on proximal antecedents and the mediation exist only at the higher level of LMX. Conclusion: The study shows that the different aspects of leadership processes interact in explaining individual proficiency in safety practices. Practical Implications: Organizations as warehouses should improve the quality of the relationship between a leader and a subordinate based upon the dimensions of respect, trust, and obligation for high level of safety performance. PMID:28553244

  3. Can Leader-Member Exchange Contribute to Safety Performance in An Italian Warehouse?

    PubMed

    Mariani, Marco G; Curcuruto, Matteo; Matic, Mirna; Sciacovelli, Paolo; Toderi, Stefano

    2017-01-01

    Introduction: The research considers safety climate in a warehouse and wants to analyze the Leader-Member Exchange (LMX) role in respect to safety performance. Griffin and Neal's safety model was adopted and Leader-Member Exchange was inserted as moderator in the relationships between safety climate and proximal antecedents (motivation and knowledge) of safety performance constructs (compliance and participation). Materials and Methods: Survey data were collected from a sample of 133 full-time employees in an Italian warehouse. The statistical framework of Hayes (2013) was adopted for moderated mediation analysis. Results: Proximal antecedents partially mediated the relationship between Safety climate and safety participation, but not safety compliance. Moreover, the results from the moderation analysis showed that the Leader-Member Exchange moderated the influence of safety climate on proximal antecedents and the mediation exist only at the higher level of LMX. Conclusion: The study shows that the different aspects of leadership processes interact in explaining individual proficiency in safety practices. Practical Implications: Organizations as warehouses should improve the quality of the relationship between a leader and a subordinate based upon the dimensions of respect, trust, and obligation for high level of safety performance.

  4. Multilevel Safety Climate and Safety Performance in the Construction Industry: Development and Validation of a Top-Down Mechanism

    PubMed Central

    Gao, Ran; Chan, Albert P.C.; Utama, Wahyudi P.; Zahoor, Hafiz

    2016-01-01

    The character of construction projects exposes front-line workers to dangers and accidents. Safety climate has been confirmed to be a predictor of safety performance in the construction industry. This study aims to explore the underlying mechanisms of the relationship between multilevel safety climate and safety performance. An integrated model was developed to study how particular safety climate factors of one level affect those of other levels, and then affect safety performance from the top down. A questionnaire survey was administered on six construction sites in Vietnam. A total of 1030 valid questionnaires were collected from this survey. Approximately half of the data were used to conduct exploratory factor analysis (EFA) and the remaining data were submitted to structural equation modeling (SEM). Top management commitment (TMC) and supervisors’ expectation (SE) were identified as factors to represent organizational safety climate (OSC) and supervisor safety climate (SSC), respectively, and coworkers’ caring and communication (CCC) and coworkers’ role models (CRM) were identified as factors to denote coworker safety climate (CSC). SEM results show that OSC factor is positively related to SSC factor and CSC factors significantly. SSC factor could partially mediate the relationship between OSC factor and CSC factors, as well as the relationship between OSC factor and safety performance. CSC factors partially mediate the relationship between OSC factor and safety performance, and the relationship between SSC factor and safety performance. The findings imply that a positive safety culture should be established both at the organizational level and the group level. Efforts from all top management, supervisors, and coworkers should be provided to improve safety performance in the construction industry. PMID:27834823

  5. Multilevel Safety Climate and Safety Performance in the Construction Industry: Development and Validation of a Top-Down Mechanism.

    PubMed

    Gao, Ran; Chan, Albert P C; Utama, Wahyudi P; Zahoor, Hafiz

    2016-11-08

    The character of construction projects exposes front-line workers to dangers and accidents. Safety climate has been confirmed to be a predictor of safety performance in the construction industry. This study aims to explore the underlying mechanisms of the relationship between multilevel safety climate and safety performance. An integrated model was developed to study how particular safety climate factors of one level affect those of other levels, and then affect safety performance from the top down. A questionnaire survey was administered on six construction sites in Vietnam. A total of 1030 valid questionnaires were collected from this survey. Approximately half of the data were used to conduct exploratory factor analysis (EFA) and the remaining data were submitted to structural equation modeling (SEM). Top management commitment (TMC) and supervisors' expectation (SE) were identified as factors to represent organizational safety climate (OSC) and supervisor safety climate (SSC), respectively, and coworkers' caring and communication (CCC) and coworkers' role models (CRM) were identified as factors to denote coworker safety climate (CSC). SEM results show that OSC factor is positively related to SSC factor and CSC factors significantly. SSC factor could partially mediate the relationship between OSC factor and CSC factors, as well as the relationship between OSC factor and safety performance. CSC factors partially mediate the relationship between OSC factor and safety performance, and the relationship between SSC factor and safety performance. The findings imply that a positive safety culture should be established both at the organizational level and the group level. Efforts from all top management, supervisors, and coworkers should be provided to improve safety performance in the construction industry.

  6. Determining the causal relationships among balanced scorecard perspectives on school safety performance: case of Saudi Arabia.

    PubMed

    Alolah, Turki; Stewart, Rodney A; Panuwatwanich, Kriengsak; Mohamed, Sherif

    2014-07-01

    In the public schools of many developing countries, numerous accidents and incidents occur because of poor safety regulations and management systems. To improve the educational environment in Saudi Arabia, the Ministry of Education seeks novel approaches to measure school safety performance in order to decrease incidents and accidents. The main objective of this research was to develop a systematic approach for measuring Saudi school safety performance using the balanced scorecard framework philosophy. The evolved third generation balanced scorecard framework is considered to be a suitable and robust framework that captures the system-wide leading and lagging indicators of business performance. The balanced scorecard architecture is ideal for adaptation to complex areas such as safety management where a holistic system evaluation is more effective than traditional compartmentalised approaches. In developing the safety performance balanced scorecard for Saudi schools, the conceptual framework was first developed and peer-reviewed by eighteen Saudi education experts. Next, 200 participants, including teachers, school executives, and Ministry of Education officers, were recruited to rate both the importance and the performance of 79 measurement items used in the framework. Exploratory factor analysis, followed by the confirmatory partial least squares method, was then conducted in order to operationalise the safety performance balanced scorecard, which encapsulates the following five salient perspectives: safety management and leadership; safety learning and training; safety policy, procedures and processes; workforce safety culture; and safety performance. Partial least squares based structural equation modelling was then conducted to reveal five significant relationships between perspectives, namely, safety management and leadership had a significant effect on safety learning and training and safety policy, procedures and processes, both safety learning and training and safety policy, procedures and processes had significant effects on workforce safety culture, and workforce safety culture had a significant effect on safety performance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. The Decision Making Trial and Evaluation Laboratory (Dematel) and Analytic Network Process (ANP) for Safety Management System Evaluation Performance

    NASA Astrophysics Data System (ADS)

    Rolita, Lisa; Surarso, Bayu; Gernowo, Rahmat

    2018-02-01

    In order to improve airport safety management system (SMS) performance, an evaluation system is required to improve on current shortcomings and maximize safety. This study suggests the integration of the DEMATEL and ANP methods in decision making processes by analyzing causal relations between the relevant criteria and taking effective analysis-based decision. The DEMATEL method builds on the ANP method in identifying the interdependencies between criteria. The input data consists of questionnaire data obtained online and then stored in an online database. Furthermore, the questionnaire data is processed using DEMATEL and ANP methods to obtain the results of determining the relationship between criteria and criteria that need to be evaluated. The study cases on this evaluation system were Adi Sutjipto International Airport, Yogyakarta (JOG); Ahmad Yani International Airport, Semarang (SRG); and Adi Sumarmo International Airport, Surakarta (SOC). The integration grades SMS performance criterion weights in a descending order as follow: safety and destination policy, safety risk management, healthcare, and safety awareness. Sturges' formula classified the results into nine grades. JOG and SMG airports were in grade 8, while SOG airport was in grade 7.

  8. Continuing education for performance improvement: a creative approach.

    PubMed

    Collins, Patti-Ann; Hardesty, Ilana; White, Julie L; Zisblatt, Lara

    2012-10-01

    In an effort to improve patient safety and health care outcomes, continuing medical education has begun to focus on performance improvement initiatives for physician practices. Boston University School of Medicine's (BUSM) Continuing Nursing Education Accredited Provider Unit has begun a creative project to award nursing contact hours for nurses' participation in performance improvement activities. This column highlights its initial efforts. Copyright 2012, SLACK Incorporated.

  9. Improving Performance of the System Safety Function at Marshall Space Flight Center

    NASA Technical Reports Server (NTRS)

    Kiessling, Ed; Tippett, Donald D.; Shivers, Herb

    2004-01-01

    The Columbia Accident Investigation Board (CAIB) determined that organizational and management issues were significant contributors to the loss of Space Shuttle Columbia. In addition, the CAIB observed similarities between the organizational and management climate that preceded the Challenger accident and the climate that preceded the Columbia accident. To prevent recurrence of adverse organizational and management climates, effective implementation of the system safety function is suggested. Attributes of an effective system safety program are presented. The Marshall Space Flight Center (MSFC) system safety program is analyzed using the attributes. Conclusions and recommendations for improving the MSFC system safety program are offered in this case study.

  10. VVER Reactor Safety in Eastern Europe and Former Soviet Union

    NASA Astrophysics Data System (ADS)

    Papadopoulou, Demetra

    2012-02-01

    VVER Soviet-designed reactors that operate in Eastern Europe and former Soviet republics have heightened international concern for years due to major safety deficiencies. The governments of countries with VVER reactors have invested millions of dollars toward improving the safety of their nuclear power plants. Most of these reactors will continue to operate for the foreseeable future since they provide urgently-needed electrical power. Given this situation, this paper assesses the radiological consequences of a major nuclear accident in Eastern Europe. The paper also chronicles the efforts launched by the international nuclear community to improve the safety of the reactors and notes the progress made so far through extensive collaborative efforts in Armenia, Bulgaria, the Czech Republic, Hungary, Kazakhstan, Lithuania, Russia, Slovakia, and Ukraine to reduce the risks of nuclear accidents. Western scientific and technical staff collaborated with these countries to improve the safety of their reactor operations by strengthening the ability of the regulator to perform its oversight function, installing safety equipment and technologies, investing time in safety training, and working diligently to establish an enduring safety culture. Still, continued safety improvement efforts are necessary to ensure safe operating practices and achieve timely phase-out of older plants.

  11. 49 CFR 350.105 - What definitions are used in this part?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Administrative Takedown, and Incentive Funds. Commercial motor vehicle (CMV) means a motor vehicle that has any...) means the document outlining the State's CMV safety objectives, strategies, activities and performance... projects that improve CMV safety and compliance with CMV safety regulations (including activities and...

  12. 49 CFR 350.105 - What definitions are used in this part?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Administrative Takedown, and Incentive Funds. Commercial motor vehicle (CMV) means a motor vehicle that has any...) means the document outlining the State's CMV safety objectives, strategies, activities and performance... projects that improve CMV safety and compliance with CMV safety regulations (including activities and...

  13. 49 CFR 350.105 - What definitions are used in this part?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., Administrative Takedown, and Incentive Funds. Commercial motor vehicle (CMV) means a motor vehicle that has any...) means the document outlining the State's CMV safety objectives, strategies, activities and performance... projects that improve CMV safety and compliance with CMV safety regulations (including activities and...

  14. Do code of conduct audits improve chemical safety in garment factories? Lessons on corporate social responsibility in the supply chain from Fair Wear Foundation.

    PubMed

    Lindholm, Henrik; Egels-Zandén, Niklas; Rudén, Christina

    2016-10-01

    In managing chemical risks to the environment and human health in supply chains, voluntary corporate social responsibility (CSR) measures, such as auditing code of conduct compliance, play an important role. To examine how well suppliers' chemical health and safety performance complies with buyers' CSR policies and whether audited factories improve their performance. CSR audits (n = 288) of garment factories conducted by Fair Wear Foundation (FWF), an independent non-profit organization, were analyzed using descriptive statistics and statistical modeling. Forty-three per cent of factories did not comply with the FWF code of conduct, i.e. received remarks on chemical safety. Only among factories audited 10 or more times was there a significant increase in the number of factories receiving no remarks. Compliance with chemical safety requirements in garment supply chains is low and auditing is statistically correlated with improvements only at factories that have undergone numerous audits.

  15. Do code of conduct audits improve chemical safety in garment factories? Lessons on corporate social responsibility in the supply chain from Fair Wear Foundation

    PubMed Central

    2016-01-01

    Background In managing chemical risks to the environment and human health in supply chains, voluntary corporate social responsibility (CSR) measures, such as auditing code of conduct compliance, play an important role. Objectives To examine how well suppliers’ chemical health and safety performance complies with buyers’ CSR policies and whether audited factories improve their performance. Methods CSR audits (n = 288) of garment factories conducted by Fair Wear Foundation (FWF), an independent non-profit organization, were analyzed using descriptive statistics and statistical modeling. Results Forty-three per cent of factories did not comply with the FWF code of conduct, i.e. received remarks on chemical safety. Only among factories audited 10 or more times was there a significant increase in the number of factories receiving no remarks. Conclusions Compliance with chemical safety requirements in garment supply chains is low and auditing is statistically correlated with improvements only at factories that have undergone numerous audits. PMID:27611103

  16. Delivering safety

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Baldwin, N.D.; Spooner, K.G.; Walkden, P.

    2007-07-01

    In the United Kingdom there have been significant recent changes to the management of civil nuclear liabilities. With the formation in April 2005 of the Nuclear Decommissioning Authority (NDA), ownership of the civil nuclear licensed sites in the UK, including the Magnox Reactor Stations, passed to this new organisation. The NDAs mission is to seek acceleration of the nuclear clean up programme and deliver increased value for money and, consequently, are driving their contractors to seek more innovative ways of performing work. British Nuclear Group manages the UK Magnox stations under contract to the NDA. This paper summarises the approachmore » being taken within its Reactor Sites business to work with suppliers to enhance working arrangements at sites, improve the delivery of decommissioning programmes and deliver improvements in safety and environmental performance. The UK Magnox stations are 1. generation gas-graphite reactors, constructed in the 1950's and 1960's. Two stations are currently still operating, three are shut-down undergoing defueling and the other five are being decommissioned. Despite the distractions of industry restructuring, an uncompromising policy of demanding improved performance in conjunction with improved safety and environmental standards has been adopted. Over the past 5 years, this policy has resulted in step-changes in performance at Reactor Sites, with increased electrical output and accelerated defueling and decommissioning. The improvements in performance have been mirrored by improvements in safety (DACR of 0 at 5 sites); environmental standards (reductions in energy and water consumption, increased waste recycling) and the overall health of the workforce (20% reduction in sickness absence). These achievements have, in turn, been recognised by external bodies, resulting in several awards, including: the world's first ISRS and IERS level 10 awards (Sizewell, 2006), the NUMEX plant maintenance award (Bradwell, 2006), numerous RoSPA awards at site and sector level and nomination, at Company level, for the RoSPA George Earle trophy for outstanding performance in Health and Safety (Reactor Sites, 2006). After 'setting the scene' and describing the challenges that the company has had to respond to, the paper explains how these improvements have been delivered. Specifically it explains the process that has been followed and the parts played by sites and suppliers to deliver improved performance. With the experience of already having transitioned several Magnox stations from operations to defueling and then to decommissioning, the paper describes the valuable experience that has been gained in achieving an optimum change process and maintaining momentum. (authors)« less

  17. An Anesthesia Preinduction Checklist to Improve Information Exchange, Knowledge of Critical Information, Perception of Safety, and Possibly Perception of Teamwork in Anesthesia Teams.

    PubMed

    Tscholl, David W; Weiss, Mona; Kolbe, Michaela; Staender, Sven; Seifert, Burkhardt; Landert, Daniel; Grande, Bastian; Spahn, Donat R; Noethiger, Christoph B

    2015-10-01

    An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked). A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork. One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60). This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.

  18. A literature review of safety culture.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cole, Kerstan Suzanne; Stevens-Adams, Susan Marie; Wenner, Caren A.

    2013-03-01

    Workplace safety has been historically neglected by organizations in order to enhance profitability. Over the past 30 years, safety concerns and attention to safety have increased due to a series of disastrous events occurring across many different industries (e.g., Chernobyl, Upper Big-Branch Mine, Davis-Besse etc.). Many organizations have focused on promoting a healthy safety culture as a way to understand past incidents, and to prevent future disasters. There is an extensive academic literature devoted to safety culture, and the Department of Energy has also published a significant number of documents related to safety culture. The purpose of the current endeavormore » was to conduct a review of the safety culture literature in order to understand definitions, methodologies, models, and successful interventions for improving safety culture. After reviewing the literature, we observed four emerging themes. First, it was apparent that although safety culture is a valuable construct, it has some inherent weaknesses. For example, there is no common definition of safety culture and no standard way for assessing the construct. Second, it is apparent that researchers know how to measure particular components of safety culture, with specific focus on individual and organizational factors. Such existing methodologies can be leveraged for future assessments. Third, based on the published literature, the relationship between safety culture and performance is tenuous at best. There are few empirical studies that examine the relationship between safety culture and safety performance metrics. Further, most of these studies do not include a description of the implementation of interventions to improve safety culture, or do not measure the effect of these interventions on safety culture or performance. Fourth, safety culture is best viewed as a dynamic, multi-faceted overall system composed of individual, engineered and organizational models. By addressing all three components of safety culture, organizations have a better chance of understanding, evaluating, and making positive changes towards safety within their own organization.« less

  19. Are health care provider organizations ready to tackle diagnostic error? A survey of Leapfrog-participating hospitals.

    PubMed

    Newman-Toker, David E; Austin, J Matthew; Derk, Jordan; Danforth, Melissa; Graber, Mark L

    2017-06-27

    A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality. This study is an anonymous online survey of safety professionals from US hospitals and health systems in July-August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188). The instrument was focused on knowledge, attitudes, and capability to address diagnostic errors at the institutional level. Overall, 61 (32%) responded, including community hospitals (42%), integrated health networks (25%), and academic centers (21%). Awareness was high, but commitment and capability were low (31% of leaders understand the problem; 28% have sufficient safety resources; and 25% have made diagnosis a top institutional safety priority). Ongoing efforts to improve diagnostic safety were sparse and mostly included root cause analysis and peer review feedback around diagnostic errors. The top three barriers to addressing diagnostic error were lack of awareness of the problem, lack of measures of diagnostic accuracy and error, and lack of feedback on diagnostic performance. The top two tools viewed as critically important for locally tackling the problem were routine feedback on diagnostic performance and culture change to emphasize diagnostic safety. Although hospitals and health systems appear to be aware of diagnostic errors as a major safety imperative, most organizations (even those that appear to be making a strong commitment to patient safety) are not yet doing much to improve diagnosis. Going forward, efforts to activate health care organizations will be essential to improving diagnostic safety.

  20. Li-Ion Electrolytes with Improved Safety and Tolerance to High-Voltage Systems

    NASA Technical Reports Server (NTRS)

    Smart, Marshall C.; Bugga, Ratnakumar V.; Prakash, Surya; Krause, Frederick C.

    2013-01-01

    Given that lithium-ion (Li-ion) technology is the most viable rechargeable energy storage device for near-term applications, effort has been devoted to improving the safety characteristics of this system. Therefore, extensive effort has been devoted to developing nonflammable electrolytes to reduce the flammability of the cells/battery. A number of promising electrolytes have been developed incorporating flame-retardant additives, and have been shown to have good performance in a number of systems. However, these electrolyte formulations did not perform well when utilizing carbonaceous anodes with the high-voltage materials. Thus, further development was required to improve the compatibility. A number of Li-ion battery electrolyte formulations containing a flame-retardant additive [i.e., triphenyl phosphate (TPP)] were developed and demonstrated in high-voltage systems. These electrolytes include: (1) formulations that incorporate varying concentrations of the flame-retardant additive (from 5 to 15%), (2) the use of mono-fluoroethylene carbonate (FEC) as a co-solvent, and (3) the use of LiBOB as an electrolyte additive intended to improve the compatibility with high-voltage systems. Thus, improved safety has been provided without loss of performance in the high-voltage, high-energy system.

  1. Improvements in safety testing of lithium cells

    NASA Astrophysics Data System (ADS)

    Stinebring, R. C.; Krehl, P.

    1985-07-01

    A systematic approach was developed for evaluating the basic safety parameters of high power lithium soluble cathode cells. This approach consists of performing a series of tests on each cell model during the design, prototype and production phases. Abusive testing is performed in a facility where maximum protection is given to test personnel.

  2. Improvements in safety testing of lithium cells

    NASA Technical Reports Server (NTRS)

    Stinebring, R. C.; Krehl, P.

    1985-01-01

    A systematic approach was developed for evaluating the basic safety parameters of high power lithium soluble cathode cells. This approach consists of performing a series of tests on each cell model during the design, prototype and production phases. Abusive testing is performed in a facility where maximum protection is given to test personnel.

  3. Errors in laboratory medicine: practical lessons to improve patient safety.

    PubMed

    Howanitz, Peter J

    2005-10-01

    Patient safety is influenced by the frequency and seriousness of errors that occur in the health care system. Error rates in laboratory practices are collected routinely for a variety of performance measures in all clinical pathology laboratories in the United States, but a list of critical performance measures has not yet been recommended. The most extensive databases describing error rates in pathology were developed and are maintained by the College of American Pathologists (CAP). These databases include the CAP's Q-Probes and Q-Tracks programs, which provide information on error rates from more than 130 interlaboratory studies. To define critical performance measures in laboratory medicine, describe error rates of these measures, and provide suggestions to decrease these errors, thereby ultimately improving patient safety. A review of experiences from Q-Probes and Q-Tracks studies supplemented with other studies cited in the literature. Q-Probes studies are carried out as time-limited studies lasting 1 to 4 months and have been conducted since 1989. In contrast, Q-Tracks investigations are ongoing studies performed on a yearly basis and have been conducted only since 1998. Participants from institutions throughout the world simultaneously conducted these studies according to specified scientific designs. The CAP has collected and summarized data for participants about these performance measures, including the significance of errors, the magnitude of error rates, tactics for error reduction, and willingness to implement each of these performance measures. A list of recommended performance measures, the frequency of errors when these performance measures were studied, and suggestions to improve patient safety by reducing these errors. Error rates for preanalytic and postanalytic performance measures were higher than for analytic measures. Eight performance measures were identified, including customer satisfaction, test turnaround times, patient identification, specimen acceptability, proficiency testing, critical value reporting, blood product wastage, and blood culture contamination. Error rate benchmarks for these performance measures were cited and recommendations for improving patient safety presented. Not only has each of the 8 performance measures proven practical, useful, and important for patient care, taken together, they also fulfill regulatory requirements. All laboratories should consider implementing these performance measures and standardizing their own scientific designs, data analysis, and error reduction strategies according to findings from these published studies.

  4. Maryland motor carrier program performance enhancement : [research summary].

    DOT National Transportation Integrated Search

    2014-02-01

    The Maryland Motor Carrier Program (MMCP) involves the regulation of : commercial vehicle safety inspections. This includes roadside inspections : programs which have a goal of improving safety and reducing crashes : involving commercial vehicles. Th...

  5. A Process-Centered Tool for Evaluating Patient Safety Performance and Guiding Strategic Improvement

    DTIC Science & Technology

    2005-01-01

    next patient safety steps in individual health care organizations. The low priority given to Category 3 (Focus on patients , other customers , and...presents a patient safety applicator tool for implementing and assessing patient safety systems in health care institutions. The applicator tool consists...the survey rounds. The study addressed three research questions: 1. What critical processes should be included in health care patient safety systems

  6. Advanced reactors and associated fuel cycle facilities: safety and environmental impacts.

    PubMed

    Hill, R N; Nutt, W M; Laidler, J J

    2011-01-01

    The safety and environmental impacts of new technology and fuel cycle approaches being considered in current U.S. nuclear research programs are contrasted to conventional technology options in this paper. Two advanced reactor technologies, the sodium-cooled fast reactor (SFR) and the very high temperature gas-cooled reactor (VHTR), are being developed. In general, the new reactor technologies exploit inherent features for enhanced safety performance. A key distinction of advanced fuel cycles is spent fuel recycle facilities and new waste forms. In this paper, the performance of existing fuel cycle facilities and applicable regulatory limits are reviewed. Technology options to improve recycle efficiency, restrict emissions, and/or improve safety are identified. For a closed fuel cycle, potential benefits in waste management are significant, and key waste form technology alternatives are described. Copyright © 2010 Health Physics Society

  7. Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety.

    PubMed

    Horowitz, Beverly P; Almonte, Tiffany; Vasil, Andrea

    2016-10-01

    This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.

  8. Data protection and the patient's right to safety.

    PubMed

    Herveg, Jean

    2014-06-01

    The article investigates the issue of knowing whether or not the proposal for a general data protection regulation could improve the patient's safety. This has been analyzed through the four main contributions that should be expected at least from data protection to the patient's safety. In our view, data protection should help supporting efficient information systems in healthcare, increasing data quality, strengthening the patient's rights and drawing the legal framework for performing quality control procedures. Compared to the current legal framework, it is not sure that the proposal might improve any of these contributions to the patient's safety.

  9. Rethinking healthcare as a safety--critical industry.

    PubMed

    Lwears, Robert

    2012-01-01

    The discipline of ergonomics, or human factors engineering, has made substantial contributions to both the development of a science of safety, and to the improvement of safety in a wide variety of hazardous industries, including nuclear power, aviation, shipping, energy extraction and refining, military operations, and finance. It is notable that healthcare, which in most advanced societies is a substantial sector of the economy (eg, 15% of US gross domestic product) and has been associated with large volumes of potentially preventable morbidity and mortality, has heretofore not been viewed as a safety-critical industry. This paper proposes that improving safety performance in healthcare must involve a re-envisioning of healthcare itself as a safety-critical industry, but one with considerable differences from most engineered safety-critical systems. This has implications both for healthcare, and for conceptions of safety-critical industries.

  10. Enhancing surgical safety using digital multimedia technology.

    PubMed

    Dixon, Jennifer L; Mukhopadhyay, Dhriti; Hunt, Justin; Jupiter, Daniel; Smythe, William R; Papaconstantinou, Harry T

    2016-06-01

    The purpose of this study was to examine whether incorporating digital and video multimedia components improved surgical time-out performance of a surgical safety checklist. A prospective pilot study was designed for implementation of a multimedia time-out, including a patient video. Perceptions of the staff participants were surveyed before and after intervention (Likert scale: 1, strongly disagree to 5, strongly agree). Employee satisfaction was high for both time-out procedures. However, employees appreciated improved clarity of patient identification (P < .05) and operative laterality (P < .05) with the digital method. About 87% of the respondents preferred the digital version to the standard time-out (75% anesthesia, 89% surgeons, 93% nursing). Although the duration of time-outs increased (49 and 79 seconds for standard and digital time-outs, respectively, P > .001), there was significant improvement in performance of key safety elements. The multimedia time-out allows improved participation by the surgical team and is preferred to a standard time-out process. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Improving health care quality and safety: the role of collective learning.

    PubMed

    Singer, Sara J; Benzer, Justin K; Hamdan, Sami U

    2015-01-01

    Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation), internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological safety, appreciation of differences, openness to new ideas social motivation, and team autonomy; team contextual factors including learning resources like time for reflection, access to knowledge, organizational capabilities; incentives; and organizational culture, strategy, and structure; and external environmental factors including institutional pressures, environmental dynamism and competitiveness and learning collaboratives. Lastly learning in the context of quality and safety improvement requires leadership that reinforces learning through actions and behaviors that affect people, such as coaching and trust building, and through influencing contextual factors, including providing resources, developing culture, and taking strategic actions that support improvement. Our review highlights the importance of leadership in both promoting a supportive learning environment and implementing learning processes.

  12. Improving health care quality and safety: the role of collective learning

    PubMed Central

    Singer, Sara J; Benzer, Justin K; Hamdan, Sami U

    2015-01-01

    Despite decades of effort to improve quality and safety in health care, this goal feels increasingly elusive. Successful examples of improvement are infrequently replicated. This scoping review synthesizes 76 empirical or conceptual studies (out of 1208 originally screened) addressing learning in quality or safety improvement, that were published in selected health care and management journals between January 2000 and December 2014 to deepen understanding of the role that collective learning plays in quality and safety improvement. We categorize learning activities using a theoretical model that shows how leadership and environmental factors support collective learning processes and practices, and in turn team and organizational improvement outcomes. By focusing on quality and safety improvement, our review elaborates the premise of learning theory that leadership, environment, and processes combine to create conditions that promote learning. Specifically, we found that learning for quality and safety improvement includes experimentation (including deliberate experimentation, improvisation, learning from failures, exploration, and exploitation), internal and external knowledge acquisition, performance monitoring and comparison, and training. Supportive learning environments are characterized by team characteristics like psychological safety, appreciation of differences, openness to new ideas social motivation, and team autonomy; team contextual factors including learning resources like time for reflection, access to knowledge, organizational capabilities; incentives; and organizational culture, strategy, and structure; and external environmental factors including institutional pressures, environmental dynamism and competitiveness and learning collaboratives. Lastly learning in the context of quality and safety improvement requires leadership that reinforces learning through actions and behaviors that affect people, such as coaching and trust building, and through influencing contextual factors, including providing resources, developing culture, and taking strategic actions that support improvement. Our review highlights the importance of leadership in both promoting a supportive learning environment and implementing learning processes. PMID:29355197

  13. Occupational safety of different industrial sectors in Khartoum State, Sudan. Part 1: Safety performance evaluation.

    PubMed

    Zaki, Gehan R; El-Marakby, Fadia A; H Deign El-Nor, Yasser; Nofal, Faten H; Zakaria, Adel M

    2012-12-01

    Safety performance evaluation enables decision makers improve safety acts. In Sudan, accident records, statistics, and safety performance were not evaluated before maintenance of accident records became mandatory in 2005. This study aimed at evaluating and comparing safety performance by accident records among different cities and industrial sectors in Khartoum state, Sudan, during the period from 2005 to 2007. This was a retrospective study, the sample in which represented all industrial enterprises in Khartoum state employing 50 workers or more. All industrial accident records of the Ministry of Manpower and Health and those of different enterprises during the period from 2005 to 2007 were reviewed. The safety performance indicators used within this study were the frequency-severity index (FSI) and fatal and disabling accident frequency rates (DAFR). In Khartoum city, the FSI [0.10 (0.17)] was lower than that in Bahari [0.11 (0.21)] and Omdurman [0.84 (0.34)]. It was the maximum in the chemical sector [0.33 (0.64)] and minimum in the metallurgic sector [0.09 (0.19)]. The highest DAFR was observed in Omdurman [5.6 (3.5)] and in the chemical sector [2.5 (4.0)]. The fatal accident frequency rate in the mechanical and electrical engineering industry was the highest [0.0 (0.69)]. Male workers who were older, divorced, and had lower levels of education had the lowest safety performance indicators. The safety performance of the industrial enterprises in Khartoum city was the best. The safety performance in the chemical sector was the worst with regard to FSI and DAFR. The age, sex, and educational level of injured workers greatly affect safety performance.

  14. A system of safety management practices and worker engagement for reducing and preventing accidents: an empirical and theoretical investigation.

    PubMed

    Wachter, Jan K; Yorio, Patrick L

    2014-07-01

    The overall research objective was to theoretically and empirically develop the ideas around a system of safety management practices (ten practices were elaborated), to test their relationship with objective safety statistics (such as accident rates), and to explore how these practices work to achieve positive safety results (accident prevention) through worker engagement. Data were collected using safety manager, supervisor and employee surveys designed to assess and link safety management system practices, employee perceptions resulting from existing practices, and safety performance outcomes. Results indicate the following: there is a significant negative relationship between the presence of ten individual safety management practices, as well as the composite of these practices, with accident rates; there is a significant negative relationship between the level of safety-focused worker emotional and cognitive engagement with accident rates; safety management systems and worker engagement levels can be used individually to predict accident rates; safety management systems can be used to predict worker engagement levels; and worker engagement levels act as mediators between the safety management system and safety performance outcomes (such as accident rates). Even though the presence of safety management system practices is linked with incident reduction and may represent a necessary first-step in accident prevention, safety performance may also depend on mediation by safety-focused cognitive and emotional engagement by workers. Thus, when organizations invest in a safety management system approach to reducing/preventing accidents and improving safety performance, they should also be concerned about winning over the minds and hearts of their workers through human performance-based safety management systems designed to promote and enhance worker engagement. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Dimensions of Safety Climate among Iranian Nurses.

    PubMed

    Konjin, Z Naghavi; Shokoohi, Y; Zarei, F; Rahimzadeh, M; Sarsangi, V

    2015-10-01

    Workplace safety has been a concern of workers and managers for decades. Measuring safety climate is crucial in improving safety performance. It is also a method of benchmarking safety perception. To develop and validate a psychometrics scale for measuring nurses' safety climate. Literature review, subject matter experts and nurse's judgment were used in items developing. Content validity and reliability for new tool were tested by content validity index (CVI) and test-retest analysis, respectively. Exploratory factor analysis (EFA) with varimax rotation was used to improve the interpretation of latent factors. A 40-item scale in 6 factors was developed, which could explain 55% of the observed variance. The 6 factors included employees' involvement in safety and management support, compliance with safety rules, safety training and accessibility to personal protective equipment, hindrance to safe work, safety communication and job pressure, and individual risk perception. The proposed scale can be used in identifying the needed areas to implement interventions in safety climate of nurses.

  16. Evaluation of safety and mobility of two-lane roundabouts : final report.

    DOT National Transportation Integrated Search

    2017-07-01

    When looking at measures of fatal and severe-injury crashes, roundabouts have demonstrated improved safety performance compared to traditional signalized intersections. Despite this, when it comes to less severe crashes, multilane roundabouts fail to...

  17. Adaptive control of 5 DOF upper-limb exoskeleton robot with improved safety.

    PubMed

    Kang, Hao-Bo; Wang, Jian-Hui

    2013-11-01

    This paper studies an adaptive control strategy for a class of 5 DOF upper-limb exoskeleton robot with a special safety consideration. The safety requirement plays a critical role in the clinical treatment when assisting patients with shoulder, elbow and wrist joint movements. With the objective of assuring the tracking performance of the pre-specified operations, the proposed adaptive controller is firstly designed to be robust to the model uncertainties. To further improve the safety and fault-tolerance in the presence of unknown large parameter variances or even actuator faults, the adaptive controller is on-line updated according to the information provided by an adaptive observer without additional sensors. An output tracking performance is well achieved with a tunable error bound. The experimental example also verifies the effectiveness of the proposed control scheme. © 2013 ISA. Published by ISA. All rights reserved.

  18. Electrochemical performance evaluations and safety investigations of pentafluoro(phenoxy)cyclotriphosphazene as a flame retardant electrolyte additive for application in lithium ion battery systems using a newly designed apparatus for improved self-extinguishing time measurements

    NASA Astrophysics Data System (ADS)

    Dagger, Tim; Lürenbaum, Constantin; Schappacher, Falko M.; Winter, Martin

    2017-02-01

    A modified self-extinguishing time (SET) device which enhances the reproducibility of the results is presented. Pentafluoro(phenoxy)cyclotriphosphazene (FPPN) is investigated as flame retardant electrolyte additive for lithium ion batteries (LIBs) in terms of thermal stability and electrochemical performance. SET measurements and adiabatic reaction calorimetry are applied to determine the flammability and the reactivity of a standard LIB electrolyte containing 5% FPPN. The results reveal that the additive-containing electrolyte is nonflammable for 10 s whereas the commercially available reference electrolyte inflames instantaneously after 1 s of ignition. The onset temperature of the safety enhanced electrolyte is delayed by ≈ 21 °C. Compatibility tests in half cells show that the electrolyte is reductively stable while the cyclic voltammogram indicates oxidative decomposition during the first cycle. Cycling experiments in full cells show improved cycling performance and rate capability, which can be attributed to cathode passivation during the first cycle. Post-mortem analysis of the electrolyte by gas chromatography-mass spectrometry confirms the presence of the additive in high amounts after 501 cycles which ensures enhanced safety of the electrolyte. The investigations present FPPN as stable electrolyte additive that improves the intrinsic safety of the electrolyte and its cycling performance at the same time.

  19. Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency.

    PubMed

    Schleyer, Anneliese M; Robinson, Ellen; Dumitru, Roxana; Taylor, Mark; Hayes, Kimberly; Pergamit, Ronald; Beingessner, Daphne M; Zaros, Mark C; Cuschieri, Joseph

    2016-12-01

    Hospital-acquired venous thromboembolism (HA-VTE) is a potentially preventable cause of morbidity and mortality. Despite high rates of venous thromboembolism (VTE) prophylaxis in accordance with an institutional guideline, VTE remains the most common hospital-acquired condition in our institution. To improve the safety of all hospitalized patients, examine current VTE prevention practices, identify opportunities for improvement, and decrease rates of HA-VTE. Pre/post assessment. Urban academic tertiary referral center, level 1 trauma center, safety net hospital; all patients. We formed a multidisciplinary VTE task force to review all HA-VTE events, assess prevention practices relative to evidence-based institutional guidelines, and identify improvement opportunities. The task force developed an electronic tool to facilitate efficient VTE event review and designed decision-support and reporting tools, now integrated into the electronic health record, to bring optimal VTE prevention practices to the point of care. Performance is shared transparently across the institution. Harborview benchmarks process and outcome performance, including patient safety indicators and core measures, against hospitals nationally using Hospital Compare and Vizient data. Our program has resulted in >90% guideline-adherent VTE prevention and zero preventable HA-VTEs. Initiatives have resulted in a 15% decrease in HA-VTE and a 21% reduction in postoperative VTE. Keys to success include the multidisciplinary approach, clinical roles of task force members, senior leadership support, and use of quality improvement analytics for retrospective review, prospective reporting, and performance transparency. Ongoing task force collaboration with frontline providers is critical to sustained improvements. Journal of Hospital Medicine 2016;11:S38-S43. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  20. Idaho National Laboratory Integrated Safety Management System FY 2013 Effectiveness Review and Declaration Report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hunt, Farren

    2013-12-01

    Idaho National Laboratory (INL) performed an Annual Effectiveness Review of the Integrated Safety Management System (ISMS), per 48 Code of Federal Regulations (CFR) 970.5223 1, “Integration of Environment, Safety and Health into Work Planning and Execution.” The annual review assessed Integrated Safety Management (ISM) effectiveness, provided feedback to maintain system integrity, and identified target areas for focused improvements and assessments for Fiscal Year (FY) 2014. Results of the FY 2013 annual effectiveness review demonstrate that the INL’s ISMS program is “Effective” and continually improving and shows signs of being significantly strengthened. Although there have been unacceptable serious events in themore » past, there has also been significant attention, dedication, and resources focused on improvement, lessons learned and future prevention. BEA’s strategy of focusing on these improvements includes extensive action and improvement plans that include PLN 4030, “INL Sustained Operational Improvement Plan, PLN 4058, “MFC Strategic Excellence Plan,” PLN 4141, “ATR Sustained Excellence Plan,” and PLN 4145, “Radiological Control Road to Excellence,” and the development of LWP 20000, “Conduct of Research.” As a result of these action plans, coupled with other assurance activities and metrics, significant improvement in operational performance, organizational competence, management oversight and a reduction in the number of operational events is being realized. In short, the realization of the fifth core function of ISMS (feedback and continuous improvement) and the associated benefits are apparent.« less

  1. Impact of the time-out process on safety attitude in a tertiary neurosurgical department.

    PubMed

    McLaughlin, Nancy; Winograd, Deborah; Chung, Hallie R; Van de Wiele, Barbara; Martin, Neil A

    2014-11-01

    In July 2011, the UCLA Health System released its current time-out process protocol used across the Health System. Numerous interventions were performed to improve checklist completion and time-out process observance. This study assessed the impact of the current protocol for the time-out on healthcare providers' safety attitude and operating room safety climate. All members involved in neurosurgical procedures in the main operating room of the Ronald Reagan UCLA Medical Center were asked to anonymously complete an online survey on their overall perception of the time-out process. The survey was completed by 93 of 128 members of the surgical team. Overall, 98.9% felt that performing a pre-incision time-out improves patient safety. The majority of respondents (97.8%) felt that the team member introductions helped to promote a team spirit during the case. In addition, 93.5% felt that performing a time-out helped to ensure all team members were comfortable to voice safety concerns throughout the case. All respondents felt that the attending surgeon should be present during the time-out and 76.3% felt that he/she should lead the time-out. Unanimously, it was felt that the review of anticipated critical elements by the attending surgeon was helpful to respondents' role during the case. Responses revealed that although the time-out brings the team together physically, it does not necessarily reinforce teamwork. The time-out process favorably impacted team members' safety attitudes and perception as well as overall safety climate in neurosurgical ORs. Survey responses identified leadership training and teamwork training as two avenues for future improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Investigating ethnic minorities' perceptions of safety climate in the construction industry.

    PubMed

    Chan, Albert P C; Wong, Francis K W; Hon, Carol K H; Lyu, Sainan; Javed, Arshad Ali

    2017-12-01

    An increasing number of ethnic minorities (EMs) have been employed in the construction industry to alleviate severe labor shortages in many countries. Unfortunately, statistics show that EMs have higher fatal and non-fatal occupational injury rates than their local counterparts. However, EMs are often underrepresented in safety climate (SC) research as they are difficult to reach and gauge their perception. A positive relationship has been widely found between SC and safety performance. Understanding the safety perceptions of EMs helps to reduce injuries and improve their safety performance. Based on a sample of 320 EMs from 20 companies in the construction industry, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the SC factors of EMs, and validate the extracted factors, respectively. Multivariate analysis of variance was undertaken to examine mean differences in perceptions of SC by personal characteristics. Three SC factors for EMs encapsulating 16 variables were identified through EFA. The hypothesized CFA model for a three-factor structure derived from EFA showed a satisfactory goodness-of-fit, composite reliability, and construct validity. Three SC factors were identified, namely: (a) safety management commitment, safety resources, and safety communication; (b) employee's involvement and workmate's influence; and (c) perception of safety rules, procedures and risks. The perceptions of SC differed significantly by nationality, marital status, the number of family members supported, and drinking habit. This study reveals the perception of EMs toward SC. The findings highlight the areas for safety improvement and provide leading indicators for safety performance of EMs. The findings are also enlightening for countries with a number of EMs, such as the United Sates, the United Kingdom, Australia, Singapore, and the Middle East. Copyright © 2017. Published by Elsevier Ltd.

  3. Causal Relationship Analysis of the Patient Safety Culture Based on Safety Attitudes Questionnaire in Taiwan.

    PubMed

    Lee, Yii-Ching; Zeng, Pei-Shan; Huang, Chih-Hsuan; Wu, Hsin-Hung

    2018-01-01

    This study uses the decision-making trial and evaluation laboratory method to identify critical dimensions of the safety attitudes questionnaire in Taiwan in order to improve the patient safety culture from experts' viewpoints. Teamwork climate, stress recognition, and perceptions of management are three causal dimensions, while safety climate, job satisfaction, and working conditions are receiving dimensions. In practice, improvements on effect-based dimensions might receive little effects when a great amount of efforts have been invested. In contrast, improving a causal dimension not only improves itself but also results in better performance of other dimension(s) directly affected by this particular dimension. Teamwork climate and perceptions of management are found to be the most critical dimensions because they are both causal dimensions and have significant influences on four dimensions apiece. It is worth to note that job satisfaction is the only dimension affected by the other dimensions. In order to effectively enhance the patient safety culture for healthcare organizations, teamwork climate, and perceptions of management should be closely monitored.

  4. Causal Relationship Analysis of the Patient Safety Culture Based on Safety Attitudes Questionnaire in Taiwan

    PubMed Central

    Zeng, Pei-Shan; Huang, Chih-Hsuan

    2018-01-01

    This study uses the decision-making trial and evaluation laboratory method to identify critical dimensions of the safety attitudes questionnaire in Taiwan in order to improve the patient safety culture from experts' viewpoints. Teamwork climate, stress recognition, and perceptions of management are three causal dimensions, while safety climate, job satisfaction, and working conditions are receiving dimensions. In practice, improvements on effect-based dimensions might receive little effects when a great amount of efforts have been invested. In contrast, improving a causal dimension not only improves itself but also results in better performance of other dimension(s) directly affected by this particular dimension. Teamwork climate and perceptions of management are found to be the most critical dimensions because they are both causal dimensions and have significant influences on four dimensions apiece. It is worth to note that job satisfaction is the only dimension affected by the other dimensions. In order to effectively enhance the patient safety culture for healthcare organizations, teamwork climate, and perceptions of management should be closely monitored. PMID:29686825

  5. An observational analysis of surgical team compliance with perioperative safety practices after crew resource management training.

    PubMed

    France, Daniel J; Leming-Lee, Susie; Jackson, Tom; Feistritzer, Nancye R; Higgins, Michael S

    2008-04-01

    Acknowledging the need to improve team communication and coordination among health care providers, health care administrators and improvement officers have been quick to endorse and invest in aviation crew resource management (CRM). Despite the increased interest in CRM there exists limited data on the effectiveness of CRM to change team behavior and performance in clinical settings. Direct observational analyses were performed on 30 surgical teams (15 neurosurgery cases and 15 cardiac cases) to evaluate surgical team compliance with integrated safety and CRM practices after extensive CRM training. Observed surgical teams were compliant with only 60% of the CRM and perioperative safety practices emphasized in the training program. The results highlight many of the challenges the health care industry faces in its efforts to adapt CRM from aviation to medicine. Additional research is needed to develop and test new team training methods and performance feedback mechanisms for clinical teams.

  6. Efficacies of roadway safety improvements across functional subclasses of rural two-lane highways.

    PubMed

    Labi, Samuel

    2011-08-01

    Highway crash occurrence is a leading cause of unnatural deaths, and highway agencies continually seek to identify engineering measures to reduce crashes and to assess the efficacy of such measures. Most past studies on the effectiveness of roadway improvements in terms of crash reduction considered all rural two-lane sections as a single category of roads. However, it may be hypothesized that the differences in the mobility and accessibility characteristics that are reflected in (and due to) the different design standards between different functional subclasses in the rural two-lane highway system can lead to differences in efficacies of safety improvements at these subclasses. This paper investigates the efficacy of roadway improvements, in terms of crash reduction, at the various subclasses of rural two-lane highways. An empirical analysis of safety performance at each of the three subclasses of rural two-lane highways was carried out using the negative binomial modeling technique. For each subclass, crash prediction models were developed separately for the three levels of crash severity: property-damage only, injury, and fatal/injury. The crash factors that were considered include lane width, shoulder width, pavement surface friction, pavement condition, and horizontal and vertical alignments. After having developed the safety performance functions, the effectiveness (in terms of the extent of crash reduction, for different levels of crash severity) of highway safety enhancements at each highway subclass were determined using the theoretical concepts established in past literature. These enhancements include widening lanes, widening shoulders, enhancing pavement surface friction, and improving the vertical or horizontal alignment. The study found that there is empirical evidence to justify the decomposition of the family of rural two-lane roads into its constituent subclasses for purposes of analyzing the effectiveness of safety enhancement projects and thus to avoid underestimation or overestimation of benefits of safety improvements at this class of highways. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Impact of Performance Obstacles on Intensive Care Nurses‘ Workload, Perceived Quality and Safety of Care, and Quality of Working Life

    PubMed Central

    Gurses, Ayse P; Carayon, Pascale; Wall, Melanie

    2009-01-01

    Objectives To study the impact of performance obstacles on intensive care nurses‘ workload, quality and safety of care, and quality of working life (QWL). Performance obstacles are factors that hinder nurses‘ capacity to perform their job and that are closely associated with their immediate work system. Data Sources/Study Setting Data were collected from 265 nurses in 17 intensive care units (ICUs) between February and August 2004 via a structured questionnaire, yielding a response rate of 80 percent. Study Design A cross-sectional study design was used. Data were analyzed by correlation analyses and structural equation modeling. Principal Findings Performance obstacles were found to affect perceived quality and safety of care and QWL of ICU nurses. Workload mediated the impact of performance obstacles with the exception of equipment-related issues on perceived quality and safety of care as well as QWL. Conclusions Performance obstacles in ICUs are a major determinant of nursing workload, perceived quality and safety of care, and QWL. In general, performance obstacles increase nursing workload, which in turn negatively affect perceived quality and safety of care and QWL. Redesigning the ICU work system to reduce performance obstacles may improve nurses‘ work. PMID:19207589

  8. Safety Management Status among Nurses Handling Anticancer Drugs: Nurse Awareness and Performance Following Safety Regulations.

    PubMed

    Jeong, Kyeong Weon; Lee, Bo-Young; Kwon, Myung Soon; Jang, Ji-Hye

    2015-01-01

    This study identified the actual conditions for safe anticancer drug management among nurses and the relationship between level of awareness and performance of anticancer drug safety regulations in terms of preparation, administration, and disposal. The respondents were 236 nurses working with chemotherapy in wards and outpatient clinics in five hospitals in and near Seoul. Safety regulations provided for the anticancer drug the Occupational Safety Health Administration (OSHA, 1999), as modified for an earlier study, were used. The results showed that the level of awareness and performance on the anticancer drug safety regulations indicate their preparation (3.38±0.55, 2.38±0.98), administration (3.52±0.46, 3.17±0.70), general handling and disposal (3.33±0.54, 2.42±0.90) on a scale 0 to 5. Also, there were significant differences in job positions, work experience, type of preparation, and continuing education and a positive relationship between the level of awareness and nursing performance. Thus, nurses should receive continuing education on the handling of anticancer drugs to improve the level of performance following safety regulations.

  9. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hagen, E.W.

    This report reviews and evaluates the performance of the compressed-air and pressurized-nitrogen gas systems in commercial nuclear power units. The information was collected from readily available operating experiences, licensee event reports, system designs in safety analysis reports, and regulatory documents. The results are collated and analyzed for significance and impact on power plant safety performance. Under certain circumstances, the fail-safe philosophy for a piece of equipment or subsystem of the compressed-air systems initiated a series of actions culminating in reactor transient or unit scram. However, based on this study of prevailing operating experiences, reclassifying the compressed-gas systems to a highermore » safety level will neither prevent (nor mitigate) the reoccurrences of such happenings nor alleviate nuclear power plant problems caused by inadequate maintenance, operating procedures, and/or practices. Conversely, because most of the problems were derived from the sources listed previously, upgrading of both maintenance and operating procedures will not only result in substantial improvement in the performance and availability of the compressed-air (and backup nitrogen) systems but in improved overall plant performance.« less

  10. Improving driver decisions and performance in high-speed, multilane, complex conditions.

    DOT National Transportation Integrated Search

    2009-01-01

    In an effort to reduce fatalities resulting from traffic collisions, Californias Strategic Highway Safety Plan identified : 16 Challenge Areas under the State Highway Safety Plan. Improper driving decisions about the right of way and : turning bec...

  11. Performance and accountability : challenges facing the Department of Transportation

    DOT National Transportation Integrated Search

    2001-02-14

    For surface transportation safety, DOT continues to face challenges in improving the safety of highways and pipelines. While the Department of Transportation appears to be making progress on some initiatives to reduce the number of large truck crashe...

  12. The effects of Crew Resource Mangement (CRM) training in airline maintenance: Results following three years' experience

    NASA Technical Reports Server (NTRS)

    Taylor, J. C.; Robertson, M. M.

    1995-01-01

    This report describes three years' evaluation of the effects of one airline's Crew Resources Management (CRM) training operation for maintenance. This evaluation focuses on the post-training attitudes of maintenance managers' and technical support professionals, their reported behaviors, and the safety, efficiency and dependable maintenance performance of their units. The results reveal a strong positive effect of the training. The overall program represents the use of CRM training as a long-term commitment to improving performance through effective communication at all levels in airline maintenance operations. The initial findings described in our previous progress reports are reinforced and elaborated here. The current results benefit from the entire pre-post training survey, which now represents total attendance of all managers and staff professionals. Additionally there are now full results from the two-month, six-month, and 12-month follow-up questionnaires, together with as many as 33 months of post-training performance data, using several indicators. In this present report, we examine participants' attitudes, their reported behaviors following the training, the performance of their work units, and the relationships among these variables. Attitudes include those measured immediately before and after the training as well as participants' attitudes months after their training. Performance includes measures, by work units, of on-time flight departures, on-schedule maintenance releases, occupational and aircraft safety, and efficient labor costs. We report changes in these performance measures following training, as well their relationships with the training participants' attitudes. Highlights of results from this training program include increased safety and improved costs associated with positive attitudes about the use of more assertive communication, and the improved management of stress. Improved on-time performance is also related to those improved attitudes, as well as favorable attitudes about participative management.

  13. An Organizational Learning Framework for Patient Safety.

    PubMed

    Edwards, Marc T

    Despite concerted effort to improve quality and safety, high reliability remains a distant goal. Although this likely reflects the challenge of organizational change, persistent controversy over basic issues suggests that weaknesses in conceptual models may contribute. The essence of operational improvement is organizational learning. This article presents a framework for identifying leverage points for improvement based on organizational learning theory and applies it to an analysis of current practice and controversy. Organizations learn from others, from defects, from measurement, and from mindfulness. These learning modes correspond with contemporary themes of collaboration, no blame for human error, accountability for performance, and managing the unexpected. The collaborative model has dominated improvement efforts. Greater attention to the underdeveloped modes of organizational learning may foster more rapid progress in patient safety by increasing organizational capabilities, strengthening a culture of safety, and fixing more of the process problems that contribute to patient harm.

  14. DASHBOARDS & CONTROL CHARTS EXPERIENCES IN IMPROVING SAFETY AT HANFORD WASHINGTON

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    PREVETTE, S.S.

    2006-02-27

    The aim of this paper is to demonstrate the integration of safety methodology, quality tools, leadership, and teamwork at Hanford and their significant positive impact on safe performance of work. Dashboards, Leading Indicators, Control charts, Pareto Charts, Dr. W. Edward Deming's Red Bead Experiment, and Dr. Deming's System of Profound Knowledge have been the principal tools and theory of an integrated management system. Coupled with involved leadership and teamwork, they have led to significant improvements in worker safety and protection, and environmental restoration at one of the nation's largest nuclear cleanup sites.

  15. High-performance work systems in health care management, part 2: qualitative evidence from five case studies.

    PubMed

    McAlearney, Ann Scheck; Garman, Andrew N; Song, Paula H; McHugh, Megan; Robbins, Julie; Harrison, Michael I

    2011-01-01

    : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. : Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. : In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). : These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management.

  16. A study of 6S workplace improvement in Ergonomic Laboratory

    NASA Astrophysics Data System (ADS)

    Sari, AD; Suryoputro, MR; Rahmillah, FI

    2017-12-01

    This article discusses 6S implementation in Ergonomic Laboratory, Department of Industrial Engineering, Islamic University of Indonesia. This research is improvement project of 5S implementation in Ergonomic laboratory. Referring to the 5S implementation of the previous year, there have been improvements from environmental conditions or a more organized workplace however there is still a lack of safety aspects. There are several safeties problems such as equipment arrangement, potential hazards of room dividers that cause injury several times, placement of fire extinguisher, no evacuation path and assembly point in case of fire, as well as expired hydrant condition and lack of awareness of stakeholders related to safety. Therefore, this study aims to apply the 6S kaizen method to the Ergonomic laboratory to facilitate the work process, reduce waste, improve work safety and improve staff performance. Based on the score 6S assessment increased audit results by 32 points, before implementation is 75 point while after implementation is 107 point. This has implications for better use for mitigate people in laboratory area, save time when looking for tools and materials, safe workplace, as well as improving the culture and spirit of ‘6S’ on staff due to better and safetier working environment.

  17. The Safety Attitudes of Senior Managers in the Chinese Coal Industry

    PubMed Central

    Zhang, Jiangshi; Chen, Na; Fu, Gui; Yan, Mingwei; Kim, Young-Chan

    2016-01-01

    Introduction: Senior managers’ attitudes towards safety are very important regarding the safety practices in an organization. The study is to describe the current situation of senior managers′ attitudes towards safety in the Chinese coal industry. Method: We evaluated the changing trends as well as the reasons for these changes in the Chinese coal industry in 2009 and in 2014 with 168 senior manager samples from large Chinese state-owned coal enterprises. Evaluations of 15 safety concepts were performed by means of a questionnaire. Results and Conclusions: Results indicate that, in 2014, three concepts were at a very high level (mean > 4.5), and six were at a relatively high level (4.5 > mean > 4.0). Analyses of changing trends revealed that nine concepts improved significantly, while four greatly declined in 2014 compared to those in 2009. The data reported here suggest that the reasons for the significant improvement with respect to the nine concepts include the improvement in social and legal environments, the improvement of the culture of social safety, workers′ safety demands being met, and scientific and technical advances in the coal industry. The decline of the four concepts seemed to be caused by a poor awareness of managers in the coal industry that safety creates economic benefits, insufficient information on safety, inadequate attention to the development of a safety culture and safety management methods, and safety organizations and workers′ unions not playing their role effectively. Practical Applications: We therefore recommend strengthening the evidence that safety creates economic benefits, providing incentives for employees to encourage their participation in safety management, and paying more attention to the prevention of accidents in coal mines via safety organizations and unions. These results can provide guidelines for workers, industrialists, and government regarding occupational safety in the whole coal industry. PMID:27869654

  18. The Safety Attitudes of Senior Managers in the Chinese Coal Industry.

    PubMed

    Zhang, Jiangshi; Chen, Na; Fu, Gui; Yan, Mingwei; Kim, Young-Chan

    2016-11-17

    Introduction: Senior managers' attitudes towards safety are very important regarding the safety practices in an organization. The study is to describe the current situation of senior managers' attitudes towards safety in the Chinese coal industry. Method : We evaluated the changing trends as well as the reasons for these changes in the Chinese coal industry in 2009 and in 2014 with 168 senior manager samples from large Chinese state-owned coal enterprises. Evaluations of 15 safety concepts were performed by means of a questionnaire. Results and Conclusions : Results indicate that, in 2014, three concepts were at a very high level (mean > 4.5), and six were at a relatively high level (4.5 > mean > 4.0). Analyses of changing trends revealed that nine concepts improved significantly, while four greatly declined in 2014 compared to those in 2009. The data reported here suggest that the reasons for the significant improvement with respect to the nine concepts include the improvement in social and legal environments, the improvement of the culture of social safety, workers' safety demands being met, and scientific and technical advances in the coal industry. The decline of the four concepts seemed to be caused by a poor awareness of managers in the coal industry that safety creates economic benefits, insufficient information on safety, inadequate attention to the development of a safety culture and safety management methods, and safety organizations and workers' unions not playing their role effectively. Practical Applications : We therefore recommend strengthening the evidence that safety creates economic benefits, providing incentives for employees to encourage their participation in safety management, and paying more attention to the prevention of accidents in coal mines via safety organizations and unions. These results can provide guidelines for workers, industrialists, and government regarding occupational safety in the whole coal industry.

  19. Relationships between Climate, Process, and Performance in Continuous Quality Improvement Groups

    ERIC Educational Resources Information Center

    Wilkens, Roxanne; London, Manuel

    2006-01-01

    This study examined relationships between group climate (participants' learning orientation, feelings of psychological safety, and self-disclosure), process (feedback and conflict), and performance in continuous quality improvement groups. Forty-nine participants in eight hospital groups were surveyed as the groups neared completion. Groups were…

  20. Measurement, Standards, and Peer Benchmarking: One Hospital's Journey.

    PubMed

    Martin, Brian S; Arbore, Mark

    2016-04-01

    Peer-to-peer benchmarking is an important component of rapid-cycle performance improvement in patient safety and quality-improvement efforts. Institutions should carefully examine critical success factors before engagement in peer-to-peer benchmarking in order to maximize growth and change opportunities. Solutions for Patient Safety has proven to be a high-yield engagement for Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, with measureable improvement in both organizational process and culture. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Improving health, safety and energy efficiency in New Zealand through measuring and applying basic housing standards.

    PubMed

    Gillespie-Bennett, Julie; Keall, Michael; Howden-Chapman, Philippa; Baker, Michael G

    2013-08-02

    Substandard housing is a problem in New Zealand. Historically there has been little recognition of the important aspects of housing quality that affect people's health and safety. In this viewpoint article we outline the importance of assessing these factors as an essential step to improving the health and safety of New Zealanders and household energy efficiency. A practical risk assessment tool adapted to New Zealand conditions, the Healthy Housing Index (HHI), measures the physical characteristics of houses that affect the health and safety of the occupants. This instrument is also the only tool that has been validated against health and safety outcomes and reported in the international peer-reviewed literature. The HHI provides a framework on which a housing warrant of fitness (WOF) can be based. The HHI inspection takes about one hour to conduct and is performed by a trained building inspector. To maximise the effectiveness of this housing quality assessment we envisage the output having two parts. The first would be a pass/fail WOF assessment showing whether or not the house meets basic health, safety and energy efficiency standards. The second component would rate each main assessment area (health, safety and energy efficiency), potentially on a five-point scale. This WOF system would establish a good minimum standard for rental accommodation as well encouraging improved housing performance over time. In this article we argue that the HHI is an important, validated, housing assessment tool that will improve housing quality, leading to better health of the occupants, reduced home injuries, and greater energy efficiency. If required, this tool could be extended to also cover resilience to natural hazards, broader aspects of sustainability, and the suitability of the dwelling for occupants with particular needs.

  2. Activities of the DOE Nuclear Criticality Safety Program (NCSP) at the Oak Ridge Electron Linear Accelerator (ORELA)

    NASA Astrophysics Data System (ADS)

    Valentine, Timothy E.; Leal, Luiz C.; Guber, Klaus H.

    2002-12-01

    The Department of Energy established the Nuclear Criticality Safety Program (NCSP) in response to the Recommendation 97-2 by the Defense Nuclear Facilities Safety Board. The NCSP consists of seven elements of which nuclear data measurements and evaluations is a key component. The intent of the nuclear data activities is to provide high resolution nuclear data measurements that are evaluated, validated, and formatted for use by the nuclear criticality safety community to provide improved and reliable calculations for nuclear criticality safety evaluations. High resolution capture, fission, and transmission measurements are performed at the Oak Ridge Electron Linear Accelerator (ORELA) to address the needs of the criticality safety community and to address known deficiencies in nuclear data evaluations. The activities at ORELA include measurements on both light and heavy nuclei and have been used to identify improvements in measurement techniques that greatly improve the measurement of small capture cross sections. The measurement activities at ORELA provide precise and reliable high-resolution nuclear data for the nuclear criticality safety community.

  3. The role of the ward manager in promoting patient safety.

    PubMed

    Pinnock, David

    In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

  4. Efficacy and Safety of Bendamustine and Ibrutinib in Previously Untreated Patients With Chronic Lymphocytic Leukemia: Indirect Comparison.

    PubMed

    Andrasiak, Iga; Rybka, Justyna; Knopinska-Posluszny, Wanda; Wrobel, Tomasz

    2017-05-01

    Bendamustine and ibrutinib are commonly used in the treatment of patients suffering from chronic lymphocytic leukemia (CLL). In this study we compare efficacy and safety bendamustine versus ibrutinib therapy in previously untreated patients with CLL. Because there are no head-to-head comparisons between bendamustine and ibrutinib, we performed indirect comparison using Bucher method. A systematic literature review was performed and 2 studies published before June 2016 were taken into analysis. Treatment with ibrutinib significantly improves PFS determined by investigator (HR of 0.3; P = .01) and OS (HR of 0.21; P < .001. Our study indicates that ibrutinib therapy improves PFS, OS and is superior in terms of safety comparing with bendamustine therapy in CLL patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Safety management by walking around (SMBWA): a safety intervention program based on both peer and manager participation.

    PubMed

    Luria, Gil; Morag, Ido

    2012-03-01

    "Management by walking around" (MBWA) is a practice that has aroused much interest in management science and practice. The purpose of this study is to demonstrate adaptation of this practice to safety management. We describe a three-year long case study that collected empirical data in which a modified MBWA was practiced in order to improve safety in a semiconductor fabrication facility. The main modification involved integrating an information system with the MBWA in order to create a practice that would generate safety leadership development and an organizational safety learning mechanism, while promoting employee safety participation. The results of the case study demonstrate that the SMBWA practice facilitated thousands of tours in which safety leadership behaviors were practiced by managers and by employees (employees performed five times as many tours as managers). The information system collected information about safety behaviors and safety conditions that could not otherwise be obtained. Thus, this study presents a new organizational safety practice SMBWA, and demonstrates the ways in which SMBWA may improve safety in organizations. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. JHR Project: a future Material Testing Reactor working as an International user Facility: The key-role of instrumentation in support to the development of modern experimental capacity

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bignan, G.; Gonnier, C.; Lyoussi, A.

    2015-07-01

    Research and development on fuel and material behaviour under irradiation is a key issue for sustainable nuclear energy in order to meet specific needs by keeping the best level of safety. These needs mainly deal with a constant improvement of performances and safety in order to optimize the fuel cycle and hence to reach nuclear energy sustainable objectives. A sustainable nuclear energy requires a high level of performances in order to meet specific needs such as: - Pursuing improvement of the performances and safety of present and coming water cooled reactor technologies. This will require a continuous R and Dmore » support following a long-term trend driven by the plant life management, safety demonstration, flexibility and economics improvement. Experimental irradiations of structure materials are necessary to anticipate these material behaviours and will contribute to their optimisation. - Upgrading continuously nuclear fuel technology in present and future nuclear power plants to achieve better performances and to optimise the fuel cycle keeping the best level of safety. Fuel evolution for generation II, III and III+ is a key stake requiring developments, qualification tests and safety experiments to ensure the competitiveness and safety: experimental tests exploring the full range of fuel behaviour determine fuel stability limits and safety margins, as a major input for the fuel reliability analysis. To perform such accurate and innovative progress and developments, specific and ad hoc instrumentation, irradiation devices, measurement methods are necessary to be set up inside or beside the material testing reactor (MTR) core. These experiments require beforehand in situ and on line sophisticated measurements to accurately determine different key parameters such as thermal and fast neutron fluxes and nuclear heating in order to precisely monitor and control the conducted assays. The new Material Testing Reactor JHR (Jules Horowitz Reactor) currently under construction at CEA Cadarache research centre in the south of France will represent a major Research Infrastructure for scientific studies regarding material and fuel behavior under irradiation. It will also be devoted to medical isotopes production. Hence JHR will offer a real opportunity to perform R and D programs regarding needs above and hence will crucially contribute to the selection, optimization and qualification of these innovative materials and fuels. The JHR reactor objectives, principles and main characteristics associated to specific experimental devices associated to measurement techniques and methodology, their performances, their limitations and field of applications will be presented and discussed. (authors)« less

  7. Human performance cognitive-behavioral modeling: a benefit for occupational safety.

    PubMed

    Gore, Brian F

    2002-01-01

    Human Performance Modeling (HPM) is a computer-aided job analysis software methodology used to generate predictions of complex human-automation integration and system flow patterns with the goal of improving operator and system safety. The use of HPM tools has recently been increasing due to reductions in computational cost, augmentations in the tools' fidelity, and usefulness in the generated output. An examination of an Air Man-machine Integration Design and Analysis System (Air MIDAS) model evaluating complex human-automation integration currently underway at NASA Ames Research Center will highlight the importance to occupational safety of considering both cognitive and physical aspects of performance when researching human error.

  8. Health, Safety and Performance in High Altitude Observatories: A Sustainable Approach

    NASA Astrophysics Data System (ADS)

    Böcker, Michael; Vogt, Joachim; Christ, Oliver; Müller-Leonhardt, Alice

    2009-09-01

    The research project “Optimising Performance, Health and Safety in High Altitude Observatories” was initiated by ESO to establish an approach to promote the well-being of staff working at its high altitude observatories, and in particular at the Antiplano de Chajnantor. A survey by a questionnaire given to both workers and visitors was employed to assess the effects of working conditions at high altitude. Earlier articles have outlined the project and reported early results. The final results and conclusions are presented, together with a concept for sustainable development to improve the performance, health and safety at high altitude employing Critical Incident Stress Management.

  9. Human performance cognitive-behavioral modeling: a benefit for occupational safety

    NASA Technical Reports Server (NTRS)

    Gore, Brian F.

    2002-01-01

    Human Performance Modeling (HPM) is a computer-aided job analysis software methodology used to generate predictions of complex human-automation integration and system flow patterns with the goal of improving operator and system safety. The use of HPM tools has recently been increasing due to reductions in computational cost, augmentations in the tools' fidelity, and usefulness in the generated output. An examination of an Air Man-machine Integration Design and Analysis System (Air MIDAS) model evaluating complex human-automation integration currently underway at NASA Ames Research Center will highlight the importance to occupational safety of considering both cognitive and physical aspects of performance when researching human error.

  10. Advanced Computational Thermal Fluid Physics (CTFP) and Its Assessment for Light Water Reactors and Supercritical Reactors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    D.M. McEligot; K. G. Condie; G. E. McCreery

    2005-10-01

    Background: The ultimate goal of the study is the improvement of predictive methods for safety analyses and design of Generation IV reactor systems such as supercritical water reactors (SCWR) for higher efficiency, improved performance and operation, design simplification, enhanced safety and reduced waste and cost. The objective of this Korean / US / laboratory / university collaboration of coupled fundamental computational and experimental studies is to develop the supporting knowledge needed for improved predictive techniques for use in the technology development of Generation IV reactor concepts and their passive safety systems. The present study emphasizes SCWR concepts in the Generationmore » IV program.« less

  11. Fire Safety Aspects of Polymeric Materials. Volume 6. Aircraft. Civil and Military

    DTIC Science & Technology

    1977-01-01

    resistance of the existing Polyurethane foam- based seating sys- tems be improved through design, construction, and selection of covering materials. 12. A...aircraft interiors under real fire conditions. To provide the data base for developing improved fire safety standards for aircraft, four types of...the determination of immobilizing effect was based on performance in the swimming test, a simple exercise method also favored by Kimmerle to provide

  12. Image-Directed Fine-needle Aspiration Biopsy of the Thyroid with Safety-engineered Devices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sibbitt, Randy R., E-mail: THESIBB2@aol.com; Palmer, Dennis J., E-mail: lyonscreek@aol.com; Sibbitt, Wilmer L., E-mail: wsibbitt@salud.unm.edu

    2011-10-15

    Purpose: The purpose of the present study was to integrate safety-engineered devices into outpatient fine-needle aspiration (FNA) biopsy of the thyroid in an interventional radiology practice. Materials and Methods: The practice center is a tertiary referral center for image-directed FNA thyroid biopsies in difficult patients referred by the primary care physician, endocrinologist, or otolaryngologist. As a departmental quality of care and safety improvement program, we instituted integration of safety devices into our thyroid biopsy procedures and determined the effect on outcome (procedural pain, diagnostic biopsies, inadequate samples, complications, needlesticks to operator, and physician satisfaction) before institution of safety devices (54more » patients) and after institution of safety device implementation (56 patients). Safety devices included a patient safety technology-the mechanical aspirating syringe (reciprocating procedure device), and a health care worker safety technology (antineedlestick safety needle). Results: FNA of thyroid could be readily performed with the safety devices. Safety-engineered devices resulted in a 49% reduction in procedural pain scores (P < 0.0001), a 56% reduction in significant pain (P < 0.002), a 21% increase in operator satisfaction (P < 0.0001), and a 5% increase in diagnostic specimens (P = 0.5). No needlesticks to health care workers or patient injuries occurred during the study. Conclusions: Safety-engineered devices to improve both patient and health care worker safety can be successfully integrated into diagnostic FNA of the thyroid while maintaining outcomes and improving safety.« less

  13. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Farren Hunt

    Idaho National Laboratory (INL) performed an Annual Effectiveness Review of the Integrated Safety Management System (ISMS), per 48 Code of Federal Regulations (CFR) 970.5223 1, “Integration of Environment, Safety and Health into Work Planning and Execution.” The annual review assessed Integrated Safety Management (ISM) effectiveness, provided feedback to maintain system integrity, and identified target areas for focused improvements and assessments for fiscal year (FY) 2013. Results of the FY 2012 annual effectiveness review demonstrated that the INL’s ISMS program was significantly strengthened. Actions implemented by the INL demonstrate that the overall Integrated Safety Management System is sound and ensures safemore » and successful performance of work while protecting workers, the public, and environment. This report also provides several opportunities for improvement that will help further strengthen the ISM Program and the pursuit of safety excellence. Demonstrated leadership and commitment, continued surveillance, and dedicated resources have been instrumental in maturing a sound ISMS program. Based upon interviews with personnel, reviews of assurance activities, and analysis of ISMS process implementation, this effectiveness review concludes that ISM is institutionalized and is “Effective”.« less

  14. Safety culture among pediatric surgeons: A national survey of attitudes and perceptions of patient safety.

    PubMed

    Berman, Loren; Rangel, Shawn; Goldin, Adam; Skarda, David; Ottosen, Madelene; Bliss, David; Valusek, Patricia; Fallat, Mary; Tsao, KuoJen

    2018-03-01

    Improving the culture of safety within health care is an essential component of preventing errors and improving overall health care quality. The purpose of this study was to characterize the attitudes and perceptions of patient safety among pediatric surgeons. We conducted a cross-sectional online survey of American Pediatric Surgery Association members. Survey items assessed surgeons' knowledge, attitudes, and perceptions of patient safety. We performed descriptive statistics and evaluated associations between respondent characteristics and survey responses. Response rate was 38% (353/928). Surgeons in academic practice (96% vs 83% private, P=0.01) and in leadership positions (98% vs 92%, P=0.03) were more likely to feel actively engaged in patient safety initiatives. Surgeons in private practice were less likely to feel safe having their own children undergo surgery at their institution (80% vs 96% academic, P<0.005). Pediatric surgeons have disparate attitudes and perceptions of patient safety within their hospitals. Significant variation exists based on surgeon characteristics. These findings underscore the need to identify barriers to surgeon engagement and develop educational initiatives to empower surgeons as leaders in improving patient safety culture. V. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Abusive behavior is barrier to high-reliability health care systems, culture of patient safety.

    PubMed

    Cassirer, C; Anderson, D; Hanson, S; Fraser, H

    2000-11-01

    Addressing abusive behavior in the medical workplace presents an important opportunity to deliver on the national commitment to improve patient safety. Fundamentally, the issue of patient safety and the issue of abusive behavior in the workplace are both about harm. Undiagnosed and untreated, abusive behavior is a barrier to creating high reliability service delivery systems that ensure patient safety. Health care managers and clinicians need to improve their awareness, knowledge, and understanding of the issue of workplace abuse. The available research suggests there is a high prevalence of workplace abuse in medicine. Both administrators at the blunt end and clinicians at the sharp end should consider learning new approaches to defining and treating the problem of workplace abuse. Eliminating abusive behavior has positive implications for preventing and controlling medical injury and improving organizational performance.

  16. Enhanced Time Out: An Improved Communication Process.

    PubMed

    Nelson, Patricia E

    2017-06-01

    An enhanced time out is an improved communication process initiated to prevent such surgical errors as wrong-site, wrong-procedure, or wrong-patient surgery. The enhanced time out at my facility mandates participation from all members of the surgical team and requires designated members to respond to specified time out elements on the surgical safety checklist. The enhanced time out incorporated at my facility expands upon the safety measures from the World Health Organization's surgical safety checklist and ensures that all personnel involved in a surgical intervention perform a final check of relevant information. Initiating the enhanced time out at my facility was intended to improve communication and teamwork among surgical team members and provide a highly reliable safety process to prevent wrong-site, wrong-procedure, and wrong-patient surgery. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  17. Safety and performance benefits of arginine supplements for military personnel: a systematic review.

    PubMed

    Brooks, James R; Oketch-Rabah, Hellen; Low Dog, Tieraona; Gorecki, Dennis K J; Barrett, Marilyn L; Cantilena, Louis; Chung, Mei; Costello, Rebecca B; Dwyer, Johanna; Hardy, Mary L; Jordan, Scott A; Maughan, Ronald J; Marles, Robin J; Osterberg, Robert E; Rodda, Bruce E; Wolfe, Robert R; Zuniga, Jorge M; Valerio, Luis G; Jones, Donnamaria; Deuster, Patricia; Giancaspro, Gabriel I; Sarma, Nandakumara D

    2016-11-01

    Dietary supplements are widely used by military personnel and civilians for promotion of health. The objective of this evidence-based review was to examine whether supplementation with l-arginine, in combination with caffeine and/or creatine, is safe and whether it enhances athletic performance or improves recovery from exhaustion for military personnel. Information from clinical trials and adverse event reports were collected from 17 databases and 5 adverse event report portals. Studies and reports were included if they evaluated the safety and the putative outcomes of enhanced performance or improved recovery from exhaustion associated with the intake of arginine alone or in combination with caffeine and/or creatine in healthy adults aged 19 to 50 years. Information related to population, intervention, comparator, and outcomes was abstracted. Of the 2687 articles screened, 62 articles meeting the inclusion criteria were analyzed. Strength of evidence was assessed in terms of risk of bias, consistency, directness, and precision. Most studies had few participants and suggested risk of bias that could negatively affect the results. l-Arginine supplementation provided little enhancement of athletic performance or improvements in recovery. Short-term supplementation with arginine may result in adverse gastrointestinal and cardiovascular effects. No information about the effects of arginine on the performance of military personnel was available. The available information does not support the use of l-arginine, either alone or in combination with caffeine, creatine, or both, to enhance athletic performance or improve recovery from exhaustion. Given the information gaps, an evidence-based review to assess the safety or effectiveness of multi-ingredient dietary supplements was not feasible, and therefore the development of a computational model-based approach to predict the safety of multi-ingredient dietary supplements is recommended. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Benchmarking road safety performance: Identifying a meaningful reference (best-in-class).

    PubMed

    Chen, Faan; Wu, Jiaorong; Chen, Xiaohong; Wang, Jianjun; Wang, Di

    2016-01-01

    For road safety improvement, comparing and benchmarking performance are widely advocated as the emerging and preferred approaches. However, there is currently no universally agreed upon approach for the process of road safety benchmarking, and performing the practice successfully is by no means easy. This is especially true for the two core activities of which: (1) developing a set of road safety performance indicators (SPIs) and combining them into a composite index; and (2) identifying a meaningful reference (best-in-class), one which has already obtained outstanding road safety practices. To this end, a scientific technique that can combine the multi-dimensional safety performance indicators (SPIs) into an overall index, and subsequently can identify the 'best-in-class' is urgently required. In this paper, the Entropy-embedded RSR (Rank-sum ratio), an innovative, scientific and systematic methodology is investigated with the aim of conducting the above two core tasks in an integrative and concise procedure, more specifically in a 'one-stop' way. Using a combination of results from other methods (e.g. the SUNflower approach) and other measures (e.g. Human Development Index) as a relevant reference, a given set of European countries are robustly ranked and grouped into several classes based on the composite Road Safety Index. Within each class the 'best-in-class' is then identified. By benchmarking road safety performance, the results serve to promote best practice, encourage the adoption of successful road safety strategies and measures and, more importantly, inspire the kind of political leadership needed to create a road transport system that maximizes safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. LWRS ATR Irradiation Testing Readiness Status

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kristine Barrett

    2012-09-01

    The Light Water Reactor Sustainability (LWRS) Program was established by the U.S. Department of Energy Office of Nuclear Energy (DOE-NE) to develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the life of the current reactors. The LWRS Program is divided into four R&D Pathways: (1) Materials Aging and Degradation; (2) Advanced Light Water Reactor Nuclear Fuels; (3) Advanced Instrumentation, Information and Control Systems; and (4) Risk-Informed Safety Margin Characterization. This report describes an irradiation testing readiness analysis in preparation of LWRS experiments for irradiation testing at the Idaho National Laboratory (INL) Advanced Testmore » Reactor (ATR) under Pathway (2). The focus of the Advanced LWR Nuclear Fuels Pathway is to improve the scientific knowledge basis for understanding and predicting fundamental performance of advanced nuclear fuel and cladding in nuclear power plants during both nominal and off-nominal conditions. This information will be applied in the design and development of high-performance, high burn-up fuels with improved safety, cladding integrity, and improved nuclear fuel cycle economics« less

  20. Improving Patient Safety Culture in Primary Care: A Systematic Review.

    PubMed

    Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

    2016-09-01

    Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effect interventions have on the safety culture. To review literature on the use of interventions that effect patient safety culture in primary care. Searches were performed in PubMed, EMBASE, CINAHL, and PsychINFO on March 4, 2013. Terms defining safety culture were combined with terms identifying intervention and terms indicating primary care. Inclusion followed if the intervention effected patient safety culture, and effect measures were reported. The search yielded 214 articles from which two were eligible for inclusion. Both studies were heterogeneous in their interventions and outcome; we present a qualitative summary. One study described the implementation of an electronic medical record system in general practices as part of patient safety improvements. The other study facilitated 2 workshops for general practices, one on risk management and another on significant event audit. Results showed signs of improvement, but the level of evidence was low because of the design and methodological problems. These studies in general practice provide a first understanding of improvement strategies and their effect in primary care. As the level of evidence was low, no clear preference can be determined. Further research is needed to help practices make an informed choice for an intervention.

  1. ATV Engineering Support Team Safety Console Preparation for the Johannes Kepler Mission

    NASA Astrophysics Data System (ADS)

    Chase, R.; Oliefka, L.

    2010-09-01

    This paper describes the improvements to be implemented in the Safety console position of the Engineering Support Team(EST) at the Automated Transfer Vehicle(ATV) Control Centre(ATV-CC) for the upcoming ATV Johannes Kepler mission. The ATV missions to the International Space Station are monitored and controlled from the ATV-CC in Toulouse, France. The commanding of ATV is performed by the Vehicle Engineering Team(VET) in the main control room under authority of the Flight Director. The EST performs a monitoring function in a room beside the main control room. One of the EST positions is the Safety console, which is staffed by safety engineers from ESA and the industrial prime contractor, Astrium. The function of the Safety console is to check whether the hazard controls are available throughout the mission as required by the Hazard Reports approved by the ISS Safety Review Panel. Safety console preparation activities were limited prior to the first ATV mission due to schedule constraints, and the safety engineers involved have been working to improve the readiness for ATV 2. The following steps have been taken or are in process, and will be described in this paper: • review of the implementation of Operations Control Agreement Documents(OCADs) that record the way operational hazard controls are performed to meet the needs of the Hazard Reports(typically in Flight Rules and Crew Procedures), • crosscheck of operational control needs and implementations with respect to ATV's first flight observations and post flight evaluations, with a view to identifying additional, obsolete or revised operational hazard controls, • participation in the Flight Rule review and update process carried out between missions, • participation in the assessment of anomalies observed during the first ATV mission, to ensure that any impacts are addressed in the ATV 2 safety documentation, • preparation of a Safety console handbook to provide lists of important safety aspects to be monitored at various stages of the mission, including links to relevant Hazard Reports, Flight Rules, and supporting documentation, • participation to training courses conducted in the frame of the ATV Training Academy(ATAC), and provision of courses related to safety for the other members of the VET and EST, • participation to simulations conducted at ATV-CC, including off-nominal cases. The result of these activities will be an improved level of readiness for the ATV 2 mission.

  2. Safety climate in OHSAS 18001-certified organisations: antecedents and consequences of safety behaviour.

    PubMed

    Fernández-Muñiz, Beatriz; Montes-Peón, José Manuel; Vázquez-Ordás, Camilo José

    2012-03-01

    The occupational health and safety standard OHSAS 18001 has gained considerable acceptance worldwide, and firms from diverse sectors and of varying sizes have implemented it. Despite this, very few studies have analysed safety management or the safety climate in OHSAS 18001-certified organisations. The current work aims to analyse the safety climate in these organisations, identify its dimensions, and propose and test a structural equation model that will help determine the antecedents and consequences of employees' safety behaviour. For this purpose, the authors carry out an empirical study using a sample of 131 OHSAS 18001-certified organisations located in Spain. The results show that management's commitment, and particularly communication, have an effect on safety behaviour and on safety performance, employee satisfaction, and firm competitiveness. These findings are particularly important for management since they provide evidence about the factors that should be encouraged to reduce risks and improve performance in this type of organisation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Early Engagement of Safety and Mission Assurance Expertise Using Systems Engineering Tools: A Risk-Based Approach to Early Identification of Safety and Assurance Requirements

    NASA Technical Reports Server (NTRS)

    Darpel, Scott; Beckman, Sean

    2016-01-01

    Decades of systems engineering practice have demonstrated that the earlier the identification of requirements occurs, the lower the chance that costly redesigns will needed later in the project life cycle. A better understanding of all requirements can also improve the likelihood of a design's success. Significant effort has been put into developing tools and practices that facilitate requirements determination, including those that are part of the model-based systems engineering (MBSE) paradigm. These efforts have yielded improvements in requirements definition, but have thus far focused on a design's performance needs. The identification of safety & mission assurance (S&MA) related requirements, in comparison, can occur after preliminary designs are already established, yielding forced redesigns. Engaging S&MA expertise at an earlier stage, facilitated by the use of MBSE tools, and focused on actual project risk, can yield the same type of design life cycle improvements that have been realized in technical and performance requirements.

  4. Impact of a Simulated Clinical Day With Peer Coaching and Deliberate Practice: Promoting a Culture of Safety.

    PubMed

    Badowski, Donna M; Oosterhouse, Kimberly J

    Nursing education is challenged to shift from task-based proficiencies to higher level competencies with patient safety as a priority. Using a quasi-experimental pretest/posttest design, a simulation-based, peer-coached, deliberate practice clinical substitution was implemented to compare nursing students' knowledge, skills, and attitudes for promoting safety. Our findings demonstrated improved knowledge and skill acquisition in the intervention and control groups. The former trended toward improved team communication attitudes and enteral medication skill performance. Additional research with larger samples is needed to further investigate this innovative strategy.

  5. Relative effectiveness of worker safety and health training methods.

    PubMed

    Burke, Michael J; Sarpy, Sue Ann; Smith-Crowe, Kristin; Chan-Serafin, Suzanne; Salvador, Rommel O; Islam, Gazi

    2006-02-01

    We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries). Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training). As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements. Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

  6. Relative Effectiveness of Worker Safety and Health Training Methods

    PubMed Central

    Burke, Michael J.; Sarpy, Sue Ann; Smith-Crowe, Kristin; Chan-Serafin, Suzanne; Salvador, Rommel O.; Islam, Gazi

    2006-01-01

    Objectives. We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries). Methods. Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners’ participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training). Results. As training methods became more engaging (i.e., requiring trainees’ active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements. Conclusions. Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce. PMID:16380566

  7. The Research on Safety Management Information System of Railway Passenger Based on Risk Management Theory

    NASA Astrophysics Data System (ADS)

    Zhu, Wenmin; Jia, Yuanhua

    2018-01-01

    Based on the risk management theory and the PDCA cycle model, requirements of the railway passenger transport safety production is analyzed, and the establishment of the security risk assessment team is proposed to manage risk by FTA with Delphi from both qualitative and quantitative aspects. The safety production committee is also established to accomplish performance appraisal, which is for further ensuring the correctness of risk management results, optimizing the safety management business processes and improving risk management capabilities. The basic framework and risk information database of risk management information system of railway passenger transport safety are designed by Ajax, Web Services and SQL technologies. The system realizes functions about risk management, performance appraisal and data management, and provides an efficient and convenient information management platform for railway passenger safety manager.

  8. Analysis of factors influencing safety management for metro construction in China.

    PubMed

    Yu, Q Z; Ding, L Y; Zhou, C; Luo, H B

    2014-07-01

    With the rapid development of urbanization in China, the number and size of metro construction projects are increasing quickly. At the same time, and increasing number of accidents in metro construction make it a disturbing focus of social attention. In order to improve safety management in metro construction, an investigation of the participants' perspectives on safety factors in China metro construction has been conducted to identify the key safety factors, and their ranking consistency among the main participants, including clients, consultants, designers, contractors and supervisors. The result of factor analysis indicates that there are five key factors which influence the safety of metro construction including safety attitude, construction site safety, government supervision, market restrictions and task unpredictability. In addition, ANOVA and Spearman rank correlation coefficients were performed to test the consistency of the means rating and the ranking of safety factors. The results indicated that the main participants have significant disagreement about the importance of safety factors on more than half of the items. Suggestions and recommendations on practical countermeasures to improve metro construction safety management in China are proposed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Human factors and ergonomics as a patient safety practice

    PubMed Central

    Carayon, Pascale; Xie, Anping; Kianfar, Sarah

    2014-01-01

    Background Human factors and ergonomics (HFE) approaches to patient safety have addressed five different domains: usability of technology; human error and its role in patient safety; the role of healthcare worker performance in patient safety; system resilience; and HFE systems approaches to patient safety. Methods A review of various HFE approaches to patient safety and studies on HFE interventions was conducted. Results This paper describes specific examples of HFE-based interventions for patient safety. Studies show that HFE can be used in a variety of domains. Conclusions HFE is a core element of patient safety improvement. Therefore, every effort should be made to support HFE applications in patient safety. PMID:23813211

  10. Safety concerns related to modular/prefabricated building construction.

    PubMed

    Fard, Maryam Mirhadi; Terouhid, Seyyed Amin; Kibert, Charles J; Hakim, Hamed

    2017-03-01

    The US construction industry annually experiences a relatively high rate of fatalities and injuries; therefore, improving safety practices should be considered a top priority for this industry. Modular/prefabricated building construction is a construction strategy that involves manufacturing of the whole building or some of its components off-site. This research focuses on the safety performance of the modular/prefabricated building construction sector during both manufacturing and on-site processes. This safety evaluation can serve as the starting point for improving the safety performance of this sector. Research was conducted based on Occupational Safety and Health Administration investigated accidents. The study found 125 accidents related to modular/prefabricated building construction. The details of each accident were closely examined to identify the types of injury and underlying causes. Out of 125 accidents, there were 48 fatalities (38.4%), 63 hospitalized injuries (50.4%), and 14 non-hospitalized injuries (11.2%). It was found that, the most common type of injury in modular/prefabricated construction was 'fracture', and the most common cause of accidents was 'fall'. The most frequent cause of cause (underlying and root cause) was 'unstable structure'. In this research, the accidents were also examined in terms of corresponding location, occupation, equipment as well as activities during which the accidents occurred. For improving safety records of the modular/prefabricated construction sector, this study recommends that future research be conducted on stabilizing structures during their lifting, storing, and permanent installation, securing fall protection systems during on-site assembly of components while working from heights, and developing training programmes and standards focused on modular/prefabricated construction.

  11. Risk Informed Margins Management as part of Risk Informed Safety Margin Characterization

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Curtis Smith

    2014-06-01

    The ability to better characterize and quantify safety margin is important to improved decision making about Light Water Reactor (LWR) design, operation, and plant life extension. A systematic approach to characterization of safety margins and the subsequent margin management options represents a vital input to the licensee and regulatory analysis and decision making that will be involved. In addition, as research and development in the LWR Sustainability (LWRS) Program and other collaborative efforts yield new data, sensors, and improved scientific understanding of physical processes that govern the aging and degradation of plant SSCs needs and opportunities to better optimize plantmore » safety and performance will become known. To support decision making related to economics, readability, and safety, the Risk Informed Safety Margin Characterization (RISMC) Pathway provides methods and tools that enable mitigation options known as risk informed margins management (RIMM) strategies.« less

  12. Measuring and improving performance in incident management.

    DOT National Transportation Integrated Search

    2010-03-01

    Traffic incidents account for about 25 percent of traffic congestion and delay. Clearing incidents rapidly is crucial in : minimizing congestion, reducing secondary crashes and improving safety for both emergency responders and : travelers. Especiall...

  13. TeamSTEPPS Improves Operating Room Efficiency and Patient Safety.

    PubMed

    Weld, Lancaster R; Stringer, Matthew T; Ebertowski, James S; Baumgartner, Timothy S; Kasprenski, Matthew C; Kelley, Jeremy C; Cho, Doug S; Tieva, Erwin A; Novak, Thomas E

    2016-09-01

    The objective was to evaluate the effect of TeamSTEPPS on operating room efficiency and patient safety. TeamSTEPPS consisted of briefings attended by all health care personnel assigned to the specific operating room to discuss issues unique to each case scheduled for that day. The operative times, on-time start rates, and turnover times of all cases performed by the urology service during the initial year with TeamSTEPPS were compared to the prior year. Patient safety issues identified during postoperative briefings were analyzed. The mean case time was 12.7 minutes less with TeamSTEPPS (P < .001). The on-time first-start rate improved by 21% with TeamSTEPPS (P < .001). The mean room turnover time did not change. Patient safety issues declined from an initial rate of 16% to 6% at midyear and remained stable (P < 0.001). TeamSTEPPS was associated with improved operating room efficiency and diminished patient safety issues in the operating room. © The Author(s) 2015.

  14. Relationship among team dynamics, care coordination and perception of safety culture in primary care.

    PubMed

    Blumenthal, Karen J; Chien, Alyna T; Singer, Sara J

    2018-05-18

    There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care. To examine how team dynamics relate to perceptions of safety culture in primary care and whether care coordination plays an intermediating role. This is a cross-sectional survey study with 63% response (n = 1082). The study participants were attending clinicians, resident physicians and other staff who interacted with patients from 19 primary care practices affiliated with Harvard Medical School. Three domains corresponding with our main measures: team dynamics, care coordination and safety culture. All items were measured on a 5-point Likert scale. We used linear regression clustered by practice site to assess the relationship between team dynamics and perceptions of safety culture. We also performed a mediation analysis to determine the extent to which care coordination explains the relationship between perceptions of team dynamics and of safety culture. For every 1-point increase in overall team dynamics, there was a 0.76-point increase in perception of safety culture [95% confidence interval (CI) 0.70-0.82, P < 0.001]. Care coordination mediated the relationship between team dynamics and the perception of safety culture. Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.

  15. An empirical survey of the benefits of implementing pay for safety scheme (PFSS) in the Hong Kong construction industry.

    PubMed

    Chan, Daniel W M; Chan, Albert P C; Choi, Tracy N Y

    2010-10-01

    The Government of the Hong Kong Special Administrative Region (SAR) has implemented different safety initiatives to improve the safety performance of the construction industry over the past decades. The Pay for Safety Scheme (PFSS), which is one of the effective safety measures launched by the government in 1996, has been widely adopted in the public works contracts. Both the accident rate and fatality rate of public sector projects have decreased noticeably over this period. This paper aims to review the current state of application of PFSS in Hong Kong, and attempts to identify and analyze the perceived benefits of PFSS in construction via an industry-wide empirical questionnaire survey. A total of 145 project participants who have gained abundant hands-on experience with the PFSS construction projects were requested to complete a survey questionnaire to indicate the relative importance of those benefits identified in relation to PFSS. The perceived benefits were measured and ranked from the perspectives of the client and contractor for crosscomparison. The survey findings suggested the most significant benefits derived from adopting PFSS were: (a) Increased safety training; (b) Enhanced safety awareness; (c) Encouragement of developing safety management system; and (d) Improved safety commitment. A wider application of PFSS should be advocated so as to achieve better safety performance within the construction industry. It is recommended that a similar scheme to the PFSS currently adopted in Hong Kong may be developed for implementation in other regions or countries for international comparisons. Copyright © 2010 Elsevier Ltd and National Safety Council. All rights reserved.

  16. 42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Quality assessment and performance improvement. 418.58 Section 418.58 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...

  17. Evaluating the Safety In Numbers effect for pedestrians at urban intersections.

    PubMed

    Murphy, Brendan; Levinson, David M; Owen, Andrew

    2017-09-01

    Assessment of collision risk between pedestrians and automobiles offers a powerful and informative tool in urban planning applications, and can be leveraged to inform proper placement of improvements and treatment projects to improve pedestrian safety. Such assessment can be performed using existing datasets of crashes, pedestrian counts, and automobile traffic flows to identify intersections or corridors characterized by elevated collision risks to pedestrians. The Safety In Numbers phenomenon, which refers to the observable effect that pedestrian safety is positively correlated with increased pedestrian traffic in a given area (i.e. that the individual per-pedestrian risk of a collision decreases with additional pedestrians), is a readily observed phenomenon that has been studied previously, though its directional causality is not yet known. A sample of 488 intersections in Minneapolis were analyzed, and statistically-significant log-linear relationships between pedestrian traffic flows and the per-pedestrian crash risk were found, indicating the Safety In Numbers effect. Potential planning applications of this analysis framework towards improving pedestrian safety in urban environments are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Teams communicating through STEPPS.

    PubMed

    Stead, Karen; Kumar, Saravana; Schultz, Timothy J; Tiver, Sue; Pirone, Christy J; Adams, Robert J; Wareham, Conrad A

    2009-06-01

    To evaluate the effectiveness of the implementation of a TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program at an Australian mental health facility. TeamSTEPPS is an evidence-based teamwork training system developed in the United States. Five health care sites in South Australia implemented TeamSTEPPS using a train-the-trainer model over an 8-month intervention period commencing January 2008 and concluding September 2008. A team of senior clinical staff was formed at each site to drive the improvement process. Independent researchers used direct observation and questionnaire surveys to evaluate the effectiveness of the implementation in three outcome areas: observed team behaviours; staff attitudes and opinions; and clinical performance and outcome. The results reported here focus on one site, an inpatient mental health facility. Team knowledge, skills and attitudes; patient safety culture; incident reporting rates; seclusion rates; observation for the frequency of use of TeamSTEPPS tools. Outcomes included restructuring of multidisciplinary meetings and the introduction of structured communication tools. The evaluation of patient safety culture and of staff knowledge, skills and attitudes (KSA) to teamwork and communication indicated a significant improvement in two dimensions of patient safety culture (frequency of event reporting, and organisational learning) and a 6.8% increase in the total KSA score. Clinical outcomes included reduced rates of seclusion. TeamSTEPPS implementation had a substantial impact on patient safety culture, teamwork and communication at an Australian mental health facility. It encouraged a culture of learning from patient safety incidents and making continuous improvements.

  19. Systems for hybrid cars

    NASA Astrophysics Data System (ADS)

    Bitsche, Otmar; Gutmann, Guenter

    Not only sharp competition but also legislation are pushing development of hybrid drive trains. Based on conventional internal combustion engine (ICE) vehicles, these drive trains offer a wide range of benefits from reduced fuel consumption and emission to multifaceted performance improvements. Hybrid electric drive trains may also facilitate the introduction of fuel cells (FC). The battery is the key component for all hybrid drive trains, as it dominates cost and performance issues. The selection of the right battery technology for the specific automotive application is an important task with an impact on costs of development and use. Safety, power, and high cycle life are a must for all hybrid applications. The greatest pressure to reduce cost is in soft hybrids, where lead-acid embedded in a considerate management presents the cheapest solution, with a considerable improvement in performance needed. From mild to full hybridization, an improvement in specific power makes higher costs more acceptable, provided that the battery's service life is equivalent to the vehicle's lifetime. Today, this is proven for the nickel-metal hydride system. Lithium ion batteries, which make use of a multiple safety concept, and with some development anticipated, provide even better prospects in terms of performance and costs. Also, their scalability permits their application in battery electric vehicles—the basis for better performance and enhanced user acceptance. Development targets for the batteries are discussed with a focus on system aspects such as electrical and thermal management and safety.

  20. Meaningful use and good catches: More appropriate metrics for checklist effectiveness.

    PubMed

    Putnam, Luke R; Anderson, Kathryn T; Diffley, Michael B; Hildebrandt, Aubrey A; Caldwell, Kelly M; Minzenmayer, Andrew N; Covey, Sarah E; Kawaguchi, Akemi L; Lally, Kevin P; Tsao, KuoJen

    2016-12-01

    The benefit of utilizing surgical safety checklists has been recently questioned. We evaluated our checklist performance after implementing a program that includes checklist-related good catches. Multifaceted interventions aimed at the preincision checklist and 5 prospective audits were conducted from 2011-2015. We documented adherence to the checklist (verbalization of each checkpoint), fidelity (meaningful performance of each checkpoint), and good catches (events with the potential to cause the patient harm but that were prevented from occurring). Good catches were divided into quality improvement-based categories (processes, medication, safety, communication, and equipment). A total of 1,346 checklist performances were observed (range, 144-373/yr). Adherence to the preincision checklist improved from 30% to 95% (P < .001), while adherence to the preinduction and debriefing checklists decreased (71% to 56%, P = .002) and remained unchanged (76%), respectively. Preincision fidelity decreased from 86% to 76% (P = .012). Good catches were identified during 16% of preincision checklist performances; process issues were most common (32%) followed by issues of medication administration (30%) and safety (22%). Implementation of a systematic checklist program resulted in significant and sustainable improvement in performance. Meaningful use and associated good catches may be more appropriate metric than actual patient harm for measuring checklist effectiveness. Although not previously described, checklist-related good catches represent an unknown benefit of checklists. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Determinants of safety outcomes and performance: A systematic literature review of research in four high-risk industries.

    PubMed

    Cornelissen, Pieter A; Van Hoof, Joris J; De Jong, Menno D T

    2017-09-01

    In spite of increasing governmental and organizational efforts, organizations still struggle to improve the safety of their employees as evidenced by the yearly 2.3 million work-related deaths worldwide. Occupational safety research is scattered and inaccessible, especially for practitioners. Through systematically reviewing the safety literature, this study aims to provide a comprehensive overview of behavioral and circumstantial factors that endanger or support employee safety. A broad search on occupational safety literature using four online bibliographical databases yielded 27.527 articles. Through a systematic reviewing process 176 online articles were identified that met the inclusion criteria (e.g., original peer-reviewed research; conducted in selected high-risk industries; published between 1980-2016). Variables and the nature of their interrelationships (i.e., positive, negative, or nonsignificant) were extracted, and then grouped and classified through a process of bottom-up coding. The results indicate that safety outcomes and performance prevail as dependent research areas, dependent on variables related to management & colleagues, work(place) characteristics & circumstances, employee demographics, climate & culture, and external factors. Consensus was found for five variables related to safety outcomes and seven variables related to performance, while there is debate about 31 other relationships. Last, 21 variables related to safety outcomes and performance appear understudied. The majority of safety research has focused on addressing negative safety outcomes and performance through variables related to others within the organization, the work(place) itself, employee demographics, and-to a lesser extent-climate & culture and external factors. This systematic literature review provides both scientists and safety practitioners an overview of the (under)studied behavioral and circumstantial factors related to occupational safety behavior. Scientists could use this overview to study gaps, and validate or falsify relationships. Safety practitioners could use the insights to evaluate organizational safety policies, and to further development of safety interventions. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

  2. Aerospace safety advisory panel

    NASA Technical Reports Server (NTRS)

    1983-01-01

    Data acquired on the actual flight experience with the various subsystems are assessed. These subsystems include: flight control and performance, structural integrity, orbiter landing gear, lithium batteries, EVA and prebreathing, and main engines. Improvements for routine operations are recommended. Policy issues for operations and flight safety for aircraft operations are discussed.

  3. Development of a Tool for Documenting, Tracking, Recording, and Analyzing Improvements to Intersection Sites and Roadway Departures in Curve Locations : Research Project Capsule

    DOT National Transportation Integrated Search

    2012-09-01

    Intermodal transportation : system planning, design, : improvement, performance : evaluation, or economic : assessments include safety : improvements because they : lower the overall cost of : transportation. State Departments of Transportation (DOTs...

  4. Taichi-inspired rigid-flexible coupling cellulose-supported solid polymer electrolyte for high-performance lithium batteries

    PubMed Central

    Zhang, Jianjun; Yue, Liping; Hu, Pu; Liu, Zhihong; Qin, Bingsheng; Zhang, Bo; Wang, Qingfu; Ding, Guoliang; Zhang, Chuanjian; Zhou, Xinhong; Yao, Jianhua; Cui, Guanglei; Chen, Liquan

    2014-01-01

    Inspired by Taichi, we proposed rigid-flexible coupling concept and herein developed a highly promising solid polymer electrolyte comprised of poly (ethylene oxide), poly (cyano acrylate), lithium bis(oxalate)borate and robust cellulose nonwoven. Our investigation revealed that this new class solid polymer electrolyte possessed comprehensive properties in high mechanical integrity strength, sufficient ionic conductivity (3 × 10−4 S cm−1) at 60°C and improved dimensional thermostability (up to 160°C). In addition, the lithium iron phosphate (LiFePO4)/lithium (Li) cell using such solid polymer electrolyte displayed superior rate capacity (up to 6 C) and stable cycle performance at 80°C. Furthermore, the LiFePO4/Li battery could also operate very well even at an elevated temperature of 160°C, thus improving enhanced safety performance of lithium batteries. The use of this solid polymer electrolyte mitigates the safety risk and widens the operation temperature range of lithium batteries. Thus, this fascinating study demonstrates a proof of concept of the use of rigid-flexible coupling solid polymer electrolyte toward practical lithium battery applications with improved reliability and safety. PMID:25183416

  5. The Relationships Among Perceived Patients' Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study.

    PubMed

    Ko, YuKyung; Yu, Soyoung

    2017-09-01

    This study was undertaken to explore the correlations among nurses' perceptions of patient safety culture, their intention to report errors, and leader coaching behaviors. The participants (N = 289) were nurses from 5 Korean hospitals with approximately 300 to 500 beds each. Sociodemographic variables, patient safety culture, intention to report errors, and coaching behavior were measured using self-report instruments. Data were analyzed using descriptive statistics, Pearson correlation coefficient, the t test, and the Mann-Whitney U test. Nurses' perceptions of patient safety culture and their intention to report errors showed significant differences between groups of nurses who rated their leaders as high-performing or low-performing coaches. Perceived coaching behavior showed a significant, positive correlation with patient safety culture and intention to report errors, i.e., as nurses' perceptions of coaching behaviors increased, so did their ratings of patient safety culture and error reporting. There is a need in health care settings for coaching by nurse managers to provide quality nursing care and thus improve patient safety. Programs that are systematically developed and implemented to enhance the coaching behaviors of nurse managers are crucial to the improvement of patient safety and nursing care. Moreover, a systematic analysis of the causes of malpractice, as opposed to a focus on the punitive consequences of errors, could increase error reporting and therefore promote a culture in which a higher level of patient safety can thrive.

  6. Changing Safety Culture, One Step at a Time: The Value of the DOE-VPP Program at PNNL

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wright, Patrick A.; Isern, Nancy G.

    2005-02-01

    The primary value of the Pacific Northwest National Laboratory (PNNL) Voluntary Protection Program (VPP) is the ongoing partnership between management and staff committed to change Laboratory safety culture one step at a time. VPP enables PNNL's safety and health program to transcend a top-down, by-the-book approach to safety, and it also raises grassroots safety consciousness by promoting a commitment to safety and health 24 hours a day, 7 days a week. PNNL VPP is a dynamic, evolving program that fosters innovative approaches to continuous improvement in safety and health performance at the Laboratory.

  7. Impact of Safety Training and Interventions on Training-Transfer: Targeting Migrant Construction Workers.

    PubMed

    Hussain, Rahat; Pedro, Akeem; Lee, Do Yeop; Pham, Hai Chien; Park, Chan Sik

    2018-05-01

    Despite substantial efforts to improve construction safety training, the accident rate of migrant workers is still high. One of the primary factors contributing to the inefficacy of training includes information delivery gaps during training sessions (knowledge-transfer). In addition, there is insufficient evidence that these training programs alone are effective enough to enable migrant workers to transfer their skills to jobsite (training-transfer). This research attempts to identify and evaluate additional interventions to improve the transfer of acquired knowledge to workplace. For this purpose, this study presents the first known experimental effort to assess the effect of interventions on migrant work groups in a multinational construction project in Qatar. Data analysis reveals that the adoption of training programs with the inclusion of interventions significantly improves training-transfer. Construction safety experts can leverage the findings of this study to enhance training-transfer by increasing worker's safety performance and hazard identification ability.

  8. Station Blackout: A case study in the interaction of mechanistic and probabilistic safety analysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Curtis Smith; Diego Mandelli; Cristian Rabiti

    2013-11-01

    The ability to better characterize and quantify safety margins is important to improved decision making about nuclear power plant design, operation, and plant life extension. As research and development (R&D) in the light-water reactor (LWR) Sustainability (LWRS) Program and other collaborative efforts yield new data, sensors, and improved scientific understanding of physical processes that govern the aging and degradation of plant SSCs needs and opportunities to better optimize plant safety and performance will become known. The purpose of the Risk Informed Safety Margin Characterization (RISMC) Pathway R&D is to support plant decisions for risk-informed margin management with the aim tomore » improve economics, reliability, and sustain safety of current NPPs. In this paper, we describe the RISMC analysis process illustrating how mechanistic and probabilistic approaches are combined in order to estimate a safety margin. We use the scenario of a “station blackout” wherein offsite power and onsite power is lost, thereby causing a challenge to plant safety systems. We describe the RISMC approach, illustrate the station blackout modeling, and contrast this with traditional risk analysis modeling for this type of accident scenario.« less

  9. A Framework to Guide the Assessment of Human-Machine Systems.

    PubMed

    Stowers, Kimberly; Oglesby, James; Sonesh, Shirley; Leyva, Kevin; Iwig, Chelsea; Salas, Eduardo

    2017-03-01

    We have developed a framework for guiding measurement in human-machine systems. The assessment of safety and performance in human-machine systems often relies on direct measurement, such as tracking reaction time and accidents. However, safety and performance emerge from the combination of several variables. The assessment of precursors to safety and performance are thus an important part of predicting and improving outcomes in human-machine systems. As part of an in-depth literature analysis involving peer-reviewed, empirical articles, we located and classified variables important to human-machine systems, giving a snapshot of the state of science on human-machine system safety and performance. Using this information, we created a framework of safety and performance in human-machine systems. This framework details several inputs and processes that collectively influence safety and performance. Inputs are divided according to human, machine, and environmental inputs. Processes are divided into attitudes, behaviors, and cognitive variables. Each class of inputs influences the processes and, subsequently, outcomes that emerge in human-machine systems. This framework offers a useful starting point for understanding the current state of the science and measuring many of the complex variables relating to safety and performance in human-machine systems. This framework can be applied to the design, development, and implementation of automated machines in spaceflight, military, and health care settings. We present a hypothetical example in our write-up of how it can be used to aid in project success.

  10. Advanced uncertainty modelling for container port risk analysis.

    PubMed

    Alyami, Hani; Yang, Zaili; Riahi, Ramin; Bonsall, Stephen; Wang, Jin

    2016-08-13

    Globalization has led to a rapid increase of container movements in seaports. Risks in seaports need to be appropriately addressed to ensure economic wealth, operational efficiency, and personnel safety. As a result, the safety performance of a Container Terminal Operational System (CTOS) plays a growing role in improving the efficiency of international trade. This paper proposes a novel method to facilitate the application of Failure Mode and Effects Analysis (FMEA) in assessing the safety performance of CTOS. The new approach is developed through incorporating a Fuzzy Rule-Based Bayesian Network (FRBN) with Evidential Reasoning (ER) in a complementary manner. The former provides a realistic and flexible method to describe input failure information for risk estimates of individual hazardous events (HEs) at the bottom level of a risk analysis hierarchy. The latter is used to aggregate HEs safety estimates collectively, allowing dynamic risk-based decision support in CTOS from a systematic perspective. The novel feature of the proposed method, compared to those in traditional port risk analysis lies in a dynamic model capable of dealing with continually changing operational conditions in ports. More importantly, a new sensitivity analysis method is developed and carried out to rank the HEs by taking into account their specific risk estimations (locally) and their Risk Influence (RI) to a port's safety system (globally). Due to its generality, the new approach can be tailored for a wide range of applications in different safety and reliability engineering and management systems, particularly when real time risk ranking is required to measure, predict, and improve the associated system safety performance. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jose Reyes

    In recent years it has been recognized that the application of passive safety systems (i.e., those whose operation takes advantage of natural forces such as convection and gravity), can contribute to simplification and potentially to improved economics of new nuclear power plant designs. In 1991 the IAEA Conference on ''The Safety of Nuclear Power: Strategy for the Future'' noted that for new plants the use of passive safety features is a desirable method of achieving simplification and increasing the reliability of the performance of essential safety functions, and should be used wherever appropriate''.

  12. Are your employees sick of hearing about safety? Ways to improve how safety is communicated at your company

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pollari, Roger A.

    2008-06-02

    Companies that care about their employees care about their employees’ safety and will go to great lengths to communicate the importance of working safely. Monthly safety meetings, creative safety contests, safety websites, sharing lessons learned—safety communicators tend to use a variety of methods to distribute procedures and critical safety information to help employees plan and perform work. However, the safety message falls on deaf ears in some cases, especially when employees feel they’re being overloaded with safety information to the point where they are sick of hearing about it. This poses a conundrum for safety communicators: Should they keep pouringmore » on the safety, or should they lighten up? How much is the right amount?« less

  13. Food safety management systems performance in African food processing companies: a review of deficiencies and possible improvement strategies.

    PubMed

    Kussaga, Jamal B; Jacxsens, Liesbeth; Tiisekwa, Bendantunguka Pm; Luning, Pieternel A

    2014-08-01

    This study seeks to provide insight into current deficiencies in food safety management systems (FSMS) in African food-processing companies and to identify possible strategies for improvement so as to contribute to African countries' efforts to provide safe food to both local and international markets. This study found that most African food products had high microbiological and chemical contamination levels exceeding the set (legal) limits. Relative to industrialized countries, the study identified various deficiencies at government, sector/branch, retail and company levels which affect performance of FSMS in Africa. For instance, very few companies (except exporting and large companies) have implemented HACCP and ISO 22000:2005. Various measures were proposed to be taken at government (e.g. construction of risk-based legislative frameworks, strengthening of food safety authorities, recommend use of ISO 22000:2005, and consumers' food safety training), branch/sector (e.g. sector-specific guidelines and third-party certification), retail (develop stringent certification standards and impose product specifications) and company levels (improving hygiene, strict raw material control, production process efficacy, and enhancing monitoring systems, assurance activities and supportive administrative structures). By working on those four levels, FSMS of African food-processing companies could be better designed and tailored towards their production processes and specific needs to ensure food safety. © 2014 Society of Chemical Industry.

  14. Optimizing efficiency and operations at a California safety-net endoscopy center: a modeling and simulation approach.

    PubMed

    Day, Lukejohn W; Belson, David; Dessouky, Maged; Hawkins, Caitlin; Hogan, Michael

    2014-11-01

    Improvements in endoscopy center efficiency are needed, but scant data are available. To identify opportunities to improve patient throughput while balancing resource use and patient wait times in a safety-net endoscopy center. Safety-net endoscopy center. Outpatients undergoing endoscopy. A time and motion study was performed and a discrete event simulation model constructed to evaluate multiple scenarios aimed at improving endoscopy center efficiency. Procedure volume and patient wait time. Data were collected on 278 patients. Time and motion study revealed that 53.8 procedures were performed per week, with patients spending 2.3 hours at the endoscopy center. By using discrete event simulation modeling, a number of proposed changes to the endoscopy center were assessed. Decreasing scheduled endoscopy appointment times from 60 to 45 minutes led to a 26.4% increase in the number of procedures performed per week, but also increased patient wait time. Increasing the number of endoscopists by 1 each half day resulted in increased procedure volume, but there was a concomitant increase in patient wait time and nurse utilization exceeding capacity. By combining several proposed scenarios together in the simulation model, the greatest improvement in performance metrics was created by moving patient endoscopy appointments from the afternoon to the morning. In this simulation at 45- and 40-minute appointment times, procedure volume increased by 30.5% and 52.0% and patient time spent in the endoscopy center decreased by 17.4% and 13.0%, respectively. The predictions of the simulation model were found to be accurate when compared with actual changes implemented in the endoscopy center. Findings may not be generalizable to non-safety-net endoscopy centers. The combination of minor, cost-effective changes such as reducing appointment times, minimizing and standardizing recovery time, and making small increases in preprocedure ancillary staff maximized endoscopy center efficiency across a number of performance metrics. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  15. Using game technologies to improve the safety of construction plant operations.

    PubMed

    Guo, Hongling; Li, Heng; Chan, Greg; Skitmore, Martin

    2012-09-01

    Many accidents occur world-wide in the use of construction plant and equipment, and safety training is considered by many to be one of the best approaches to their prevention. However, current safety training methods/tools are unable to provide trainees with the hands-on practice needed. Game technology-based safety training platforms have the potential to overcome this problem in a virtual environment. One such platform is described in this paper - its characteristics are analysed and its possible contribution to safety training identified. This is developed and tested by means of a case study involving three major pieces of construction plant, which successfully demonstrates that the platform can improve the process and performance of the safety training involved in their operation. This research not only presents a new and useful solution to the safety training of construction operations, but illustrates the potential use of advanced technologies in solving construction industry problems in general. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.

    PubMed

    Wagar, Elizabeth A; Tamashiro, Lorraine; Yasin, Bushra; Hilborne, Lee; Bruckner, David A

    2006-11-01

    Patient safety is an increasingly visible and important mission for clinical laboratories. Attention to improving processes related to patient identification and specimen labeling is being paid by accreditation and regulatory organizations because errors in these areas that jeopardize patient safety are common and avoidable through improvement in the total testing process. To assess patient identification and specimen labeling improvement after multiple implementation projects using longitudinal statistical tools. Specimen errors were categorized by a multidisciplinary health care team. Patient identification errors were grouped into 3 categories: (1) specimen/requisition mismatch, (2) unlabeled specimens, and (3) mislabeled specimens. Specimens with these types of identification errors were compared preimplementation and postimplementation for 3 patient safety projects: (1) reorganization of phlebotomy (4 months); (2) introduction of an electronic event reporting system (10 months); and (3) activation of an automated processing system (14 months) for a 24-month period, using trend analysis and Student t test statistics. Of 16,632 total specimen errors, mislabeled specimens, requisition mismatches, and unlabeled specimens represented 1.0%, 6.3%, and 4.6% of errors, respectively. Student t test showed a significant decrease in the most serious error, mislabeled specimens (P < .001) when compared to before implementation of the 3 patient safety projects. Trend analysis demonstrated decreases in all 3 error types for 26 months. Applying performance-improvement strategies that focus longitudinally on specimen labeling errors can significantly reduce errors, therefore improving patient safety. This is an important area in which laboratory professionals, working in interdisciplinary teams, can improve safety and outcomes of care.

  17. 76 FR 50315 - Notice of Fiscal Year 2012 Safety Grants and Solicitation for Applications

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-12

    ... grants; MCSAP Incentive grants; New Entrant Safety Audit grants; MCSAP High Priority grants; Commercial...'s License Program Improvement (CDLPI) grants; Performance and Registration Information Systems... Information Systems and Networks (CVISN) grants. It should be noted that FMCSA does not expect the Commercial...

  18. Safety culture assessment in petrochemical industry: a comparative study of two algerian plants.

    PubMed

    Boughaba, Assia; Hassane, Chabane; Roukia, Ouddai

    2014-06-01

    To elucidate the relationship between safety culture maturity and safety performance of a particular company. To identify the factors that contribute to a safety culture, a survey questionnaire was created based mainly on the studies of Fernández-Muñiz et al. The survey was randomly distributed to 1000 employees of two oil companies and realized a rate of valid answer of 51%. Minitab 16 software was used and diverse tests, including the descriptive statistical analysis, factor analysis, reliability analysis, mean analysis, and correlation, were used for the analysis of data. Ten factors were extracted using the analysis of factor to represent safety culture and safety performance. The results of this study showed that the managers' commitment, training, incentives, communication, and employee involvement are the priority domains on which it is necessary to stress the effort of improvement, where they had all the descriptive average values lower than 3.0 at the level of Company B. Furthermore, the results also showed that the safety culture influences the safety performance of the company. Therefore, Company A with a good safety culture (the descriptive average values more than 4.0), is more successful than Company B in terms of accident rates. The comparison between the two petrochemical plants of the group Sonatrach confirms these results in which Company A, the managers of which are English and Norwegian, distinguishes itself by the maturity of their safety culture has significantly higher evaluations than the company B, who is constituted of Algerian staff, in terms of safety management practices and safety performance.

  19. Safety Culture Assessment in Petrochemical Industry: A Comparative Study of Two Algerian Plants

    PubMed Central

    Boughaba, Assia; Hassane, Chabane; Roukia, Ouddai

    2014-01-01

    Background To elucidate the relationship between safety culture maturity and safety performance of a particular company. Methods To identify the factors that contribute to a safety culture, a survey questionnaire was created based mainly on the studies of Fernández-Muñiz et al. The survey was randomly distributed to 1000 employees of two oil companies and realized a rate of valid answer of 51%. Minitab 16 software was used and diverse tests, including the descriptive statistical analysis, factor analysis, reliability analysis, mean analysis, and correlation, were used for the analysis of data. Ten factors were extracted using the analysis of factor to represent safety culture and safety performance. Results The results of this study showed that the managers' commitment, training, incentives, communication, and employee involvement are the priority domains on which it is necessary to stress the effort of improvement, where they had all the descriptive average values lower than 3.0 at the level of Company B. Furthermore, the results also showed that the safety culture influences the safety performance of the company. Therefore, Company A with a good safety culture (the descriptive average values more than 4.0), is more successful than Company B in terms of accident rates. Conclusion The comparison between the two petrochemical plants of the group Sonatrach confirms these results in which Company A, the managers of which are English and Norwegian, distinguishes itself by the maturity of their safety culture has significantly higher evaluations than the company B, who is constituted of Algerian staff, in terms of safety management practices and safety performance. PMID:25180135

  20. Caffeine-based food supplements and beverages: Trends of consumption for performance purposes and safety concerns.

    PubMed

    Bessada, Sílvia M F; Alves, Rita C; Oliveira, M Beatriz P P

    2018-07-01

    Nowadays, daily food supplementation regarding the improvement of physical and mental performance is a growing trend in sport practitioners, young students and active people. Food supplements are foodstuffs, labeled under food law and not obliged to safety assessments before their commercialization. Several products are commercialized claiming ergogenic effects as marketing strategies. Caffeine is often one of their main ingredients, as it increases both physical performance and concentration. This manuscript presents a general overview of the current caffeine-based food supplements and energy drinks available in the Portuguese market, as well as the consuming trends regarding their ergogenic effects, performance purposes, and active ingredients. Product claims, recommended daily intakes, caffeine pharmacology, and safety concerns aspects are also discussed aspects. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Improved safety of retinal photocoagulation with a shaped beam and modulated pulse

    NASA Astrophysics Data System (ADS)

    Sramek, Christopher; Brown, Jefferson; Paulus, Yannis M.; Nomoto, Hiroyuki; Palanker, Daniel

    2010-02-01

    Shorter pulse durations help confine thermal damage during retinal photocoagulation, decrease treatment time and minimize pain. However, safe therapeutic window (the ratio of threshold powers for rupture and mild coagulation) decreases with shorter exposures. A ring-shaped beam enables safer photocoagulation than conventional beams by reducing the maximum temperature in the center of the spot. Similarly, a temporal pulse modulation decreasing its power over time improves safety by maintaining constant temperature for a significant portion of the pulse. Optimization of the beam and pulse shapes was performed using a computational model. In vivo experiments were performed to verify the predicted improvement. With each of these approaches, the pulse duration can be decreased by a factor of two, from 20 ms down to 10 ms while maintaining the same therapeutic window.

  2. Fifty years of driving safety research.

    PubMed

    Lee, John D

    2008-06-01

    This brief review covers the 50 years of driving-related research published in Human Factors, its contribution to driving safety, and emerging challenges. Many factors affect driving safety, making it difficult to assess the impact of specific factors such as driver age, cell phone distractions, or collision warnings. The author considers the research themes associated with the approximately 270 articles on driving published in Human Factors in the past 50 years. To a large extent, current and past research has explored similar themes and concepts. Many articles published in the first 25 years focused on issues such as driver impairment, individual differences, and perceptual limits. Articles published in the past 25 years address similar issues but also point toward vehicle technology that can exacerbate or mitigate the negative effect of these issues. Conceptual and computational models have played an important role in this research. Improved crash-worthiness has contributed to substantial improvements in driving safety over the past 50 years, but future improvements will depend on enhancing driver performance and perhaps, more important, improving driver behavior. Developing models to guide this research will become more challenging as new technology enters the vehicle and shifts the focus from driver performance to driver behavior. Over the past 50 years, Human Factors has accumulated a large base of driving-related research that remains relevant for many of today's design and policy concerns.

  3. Ward round template: enhancing patient safety on ward rounds.

    PubMed

    Gilliland, Niall; Catherwood, Natalie; Chen, Shaouyn; Browne, Peter; Wilson, Jacob; Burden, Helena

    2018-01-01

    Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets. The quality improvement technique of plan-do-study-act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template. Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%. Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.

  4. Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System

    PubMed Central

    Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J

    2013-01-01

    Context “Meaningful use” of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients’ safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). Methods We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. Findings This hospital's approach to quality and safety could be characterized as “technovigilance.” It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients’ safety and quality care, and the correction of organizational or systems defects, technovigilance was—based on the hospital's own evidence—highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. Conclusions The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to ensure proper interpretation and appropriate action. But care is needed to avoid unintended consequences. PMID:24028694

  5. Probabilistic Risk Assessment Procedures Guide for NASA Managers and Practitioners (Second Edition)

    NASA Technical Reports Server (NTRS)

    Stamatelatos,Michael; Dezfuli, Homayoon; Apostolakis, George; Everline, Chester; Guarro, Sergio; Mathias, Donovan; Mosleh, Ali; Paulos, Todd; Riha, David; Smith, Curtis; hide

    2011-01-01

    Probabilistic Risk Assessment (PRA) is a comprehensive, structured, and logical analysis method aimed at identifying and assessing risks in complex technological systems for the purpose of cost-effectively improving their safety and performance. NASA's objective is to better understand and effectively manage risk, and thus more effectively ensure mission and programmatic success, and to achieve and maintain high safety standards at NASA. NASA intends to use risk assessment in its programs and projects to support optimal management decision making for the improvement of safety and program performance. In addition to using quantitative/probabilistic risk assessment to improve safety and enhance the safety decision process, NASA has incorporated quantitative risk assessment into its system safety assessment process, which until now has relied primarily on a qualitative representation of risk. Also, NASA has recently adopted the Risk-Informed Decision Making (RIDM) process [1-1] as a valuable addition to supplement existing deterministic and experience-based engineering methods and tools. Over the years, NASA has been a leader in most of the technologies it has employed in its programs. One would think that PRA should be no exception. In fact, it would be natural for NASA to be a leader in PRA because, as a technology pioneer, NASA uses risk assessment and management implicitly or explicitly on a daily basis. NASA has probabilistic safety requirements (thresholds and goals) for crew transportation system missions to the International Space Station (ISS) [1-2]. NASA intends to have probabilistic requirements for any new human spaceflight transportation system acquisition. Methods to perform risk and reliability assessment in the early 1960s originated in U.S. aerospace and missile programs. Fault tree analysis (FTA) is an example. It would have been a reasonable extrapolation to expect that NASA would also become the world leader in the application of PRA. That was, however, not to happen. Early in the Apollo program, estimates of the probability for a successful roundtrip human mission to the moon yielded disappointingly low (and suspect) values and NASA became discouraged from further performing quantitative risk analyses until some two decades later when the methods were more refined, rigorous, and repeatable. Instead, NASA decided to rely primarily on the Hazard Analysis (HA) and Failure Modes and Effects Analysis (FMEA) methods for system safety assessment.

  6. Improving rural emergency medical services (EMS) through transportation system enhancements.

    DOT National Transportation Integrated Search

    2014-05-01

    Improved emergency medical services (EMS) will impact traffic safety and public health in rural : communities. Better planned, designed, and operated roadway networks that connect hospitals with : communities in need will enhance EMS performance. To ...

  7. Experimental optimization of the FireFly 600 photovoltaic off-grid system.

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Boyson, William Earl; Orozco, Ron; Ralph, Mark E.

    2003-10-01

    A comprehensive evaluation and experimental optimization of the FireFly{trademark} 600 off-grid photovoltaic system manufactured by Energia Total, Ltd. was conducted at Sandia National Laboratories in May and June of 2001. This evaluation was conducted at the request of the manufacturer and addressed performance of individual system components, overall system functionality and performance, safety concerns, and compliance with applicable codes and standards. A primary goal of the effort was to identify areas for improvement in performance, reliability, and safety. New system test procedures were developed during the effort.

  8. Safety and performance enhancement circuit for primary explosive detonators

    DOEpatents

    Davis, Ronald W [Tracy, CA

    2006-04-04

    A safety and performance enhancement arrangement for primary explosive detonators. This arrangement involves a circuit containing an energy storage capacitor and preset self-trigger to protect the primary explosive detonator from electrostatic discharge (ESD). The circuit does not discharge into the detonator until a sufficient level of charge is acquired on the capacitor. The circuit parameters are designed so that normal ESD environments cannot charge the protection circuit to a level to achieve discharge. When functioned, the performance of the detonator is also improved because of the close coupling of the stored energy.

  9. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    PubMed

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  10. Rewarding safe behavior: strategies for change.

    PubMed

    Fell-Carlson, Deborah

    2004-12-01

    Effective, sustainable safety incentives are integrated into a performance management system designed to encourage long term behavior change. Effective incentive program design integrates the fundamental considerations of compensation (i.e., valence, instrumentality, expectancy, equity) with behavior change theory in the context of a strong merit based performance management system. Clear expectations are established and communicated from the time applicants apply for the position. Feedback and social recognition are leveraged and used as rewards, in addition to financial incentives built into the compensation system and offered periodically as short term incentives. Rewards are tied to specific objectives intended to influence specific behaviors. Objectives are designed to challenge employees, providing opportunities to grow and enhance their sense of belonging. Safety contests and other awareness activities are most effective when used to focus safety improvement efforts on specific behaviors or processes, for a predetermined period of time, in the context of a comprehensive safety system. Safety incentive programs designed around injury outcomes can result in unintended, and undesirable, consequences. Safety performance can be leveraged by integrating safety into corporate cultural indicators. Symbols of safety remind employees of corporate safety goals and objectives (e.g., posted safety goals and integrating safety into corporate mission and vision). Rites and ceremonies provide opportunities for social recognition and feedback and demonstrate safety is a corporate value. Feedback opportunities, rewards, and social recognition all provide content for corporate legends, those stories embellished over time, that punctuate the overall system of organizational norms, and provide examples of the organizational safety culture in action.

  11. Memorial Hermann: high reliability from board to bedside.

    PubMed

    Shabot, M Michael; Monroe, Douglas; Inurria, Juan; Garbade, Debbi; France, Anne-Claire

    2013-06-01

    In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.

  12. Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020.

    PubMed

    Raffo, Veronica; Bliss, Tony; Shotten, Marc; Sleet, David; Blanchard, Claire

    2013-12-01

    This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

  13. Influence Map Methodology for Evaluating Systemic Safety Issues

    NASA Technical Reports Server (NTRS)

    2008-01-01

    "Raising the bar" in safety performance is a critical challenge for many organizations, including Kennedy Space Center. Contributing-factor taxonomies organize information about the reasons accidents occur and therefore are essential elements of accident investigations and safety reporting systems. Organizations must balance efforts to identify causes of specific accidents with efforts to evaluate systemic safety issues in order to become more proactive about improving safety. This project successfully addressed the following two problems: (1) methods and metrics to support the design of effective taxonomies are limited and (2) influence relationships among contributing factors are not explicitly modeled within a taxonomy.

  14. Final Report of the NASA Office of Safety and Mission Assurance Agile Benchmarking Team

    NASA Technical Reports Server (NTRS)

    Wetherholt, Martha

    2016-01-01

    To ensure that the NASA Safety and Mission Assurance (SMA) community remains in a position to perform reliable Software Assurance (SA) on NASAs critical software (SW) systems with the software industry rapidly transitioning from waterfall to Agile processes, Terry Wilcutt, Chief, Safety and Mission Assurance, Office of Safety and Mission Assurance (OSMA) established the Agile Benchmarking Team (ABT). The Team's tasks were: 1. Research background literature on current Agile processes, 2. Perform benchmark activities with other organizations that are involved in software Agile processes to determine best practices, 3. Collect information on Agile-developed systems to enable improvements to the current NASA standards and processes to enhance their ability to perform reliable software assurance on NASA Agile-developed systems, 4. Suggest additional guidance and recommendations for updates to those standards and processes, as needed. The ABT's findings and recommendations for software management, engineering and software assurance are addressed herein.

  15. Economic approaches to measuring the significance of food safety in international trade.

    PubMed

    Caswell, J A

    2000-12-20

    International trade in food products has expanded rapidly in recent years. This paper presents economic approaches for analyzing the effects on trade in food products of the food safety requirements of governments and private buyers. Important economic incentives for companies to provide improved food safety arise from (1) public incentives such as ex ante requirements for sale of a product with sufficient quality and ex post penalties (liability) for sale of products with deficient quality, and (2) private incentives for producing quality such as internal performance goals (self-regulation) and the external (certification) requirements of buyers. The World Trade Organization's Sanitary Phytosanitary Agreement facilitates scrutiny of the benefits and costs of country-level regulatory programs and encourages regulatory rapprochement on food safety issues. Economists can help guide risk management decisions by providing estimates of the benefits and costs of programs to improve food safety and by analyzing their effect on trade in food products.

  16. Emergency and backup power supplies at Department of Energy facilities: Augmented Evaluation Team -- Final report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    This report documents the results of the Defense Programs (DP) Augmented Evaluation Team (AET) review of emergency and backup power supplies (i.e., generator, uninterruptible power supply, and battery systems) at DP facilities. The review was conducted in response to concerns expressed by former Secretary of Energy James D. Watkins over the number of incidents where backup power sources failed to provide electrical power during tests or actual demands. The AET conducted a series of on-site reviews for the purpose of understanding the design, operation, maintenance, and safety significance of emergency and backup power (E&BP) supplies. The AET found that themore » quality of programs related to maintenance of backup power systems varies greatly among the sites visited, and often among facilities at the same site. No major safety issues were identified. However, there are areas where the AET believes the reliability of emergency and backup power systems can and should be improved. Recommendations for improving the performance of E&BP systems are provided in this report. The report also discusses progress made by Management and Operating (M&O) contractors to improve the reliability of backup sources used in safety significant applications. One area that requires further attention is the analysis and understanding of the safety implications of backup power equipment. This understanding is needed for proper graded-approach implementation of Department of Energy (DOE) Orders, and to help ensure that equipment important to the safety of DOE workers, the public, and the environment is identified, classified, recognized, and treated as such by designers, users, and maintainers. Another area considered important for improving E&BP system performance is the assignment of overall ownership responsibility and authority for ensuring that E&BP equipment performs adequately and that reliability and availability are maintained at acceptable levels.« less

  17. Improved tank car design development : ongoing studies on sandwich structures

    DOT National Transportation Integrated Search

    2009-03-02

    The Government and industry have a common interest in : improving the safety performance of railroad tank cars carrying : hazardous materials. Research is ongoing to develop strategies : to maintain the structural integrity of railroad tank cars carr...

  18. Risk Assessment at the Cosmetic Product Manufacturer by Expert Judgment Method

    NASA Astrophysics Data System (ADS)

    Vtorushina, A. N.; Larionova, E. V.; Mezenceva, I. L.; Nikonova, E. D.

    2017-05-01

    A case study was performed in a cosmetic product manufacturer. We have identified the main risk factors of occupational accidents and their causes. Risk of accidents is assessed by the expert judgment method. Event tree for the most probable accident is built and recommendations on improvement of occupational health and safety protection system at the cosmetic product manufacturer are developed. The results of this paper can be used to develop actions to improve the occupational safety and health system in the chemical industry.

  19. Radiation safety and medical education: development and integration of a dedicated educational module into a radiology clerkship, outcomes assessment, and survey of medical students' perceptions.

    PubMed

    Koontz, Nicholas A; Gunderman, Richard B

    2012-04-01

    This study assesses the effect on medical student understanding of a new radiobiology and radiation safety module in a fourth-year radiology clerkship. A dedicated radiobiology and radiation safety module was incorporated into the fourth-year medical school radiology clerkship at our institution. Student understanding of the material was assessed via pretest and posttest. Statistical analysis was performed to assess significance of changes in student performance. In addition, we surveyed student perceptions of the importance of this material in medical education and practice. Monthly pretest mean scores ranged from 47.8% to 55.6%, with an average monthly pretest score of 50.3%. Monthly posttest mean scores ranged from 77.3% to 91.2%, with an average monthly posttest score of 83.9%. The improvement in exam scores after the educational intervention was statistically significant (all P < .01). The introduction of a new educational module can significantly improve medical student understanding of radiobiology and radiation safety. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

  20. Communication and teamwork in patient care: how much can we learn from aviation?

    PubMed

    Lyndon, Audrey

    2006-01-01

    To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.

  1. Light vehicle forward-looking, rear-end collision warning system performance guidelines

    DOT National Transportation Integrated Search

    1998-05-01

    This document presents performance guidelines for forward-looking, rear-end collision warning systems (abbreviated FCW) for improving vehicular safety by preventing or mitigating vehicular rear-end collisions through driver notification or warning. T...

  2. Railway safety climate: a study on organizational development.

    PubMed

    Cheng, Yung-Hsiang

    2017-09-07

    The safety climate of an organization is considered a leading indicator of potential risk for railway organizations. This study adopts the perceptual measurement-individual attribute approach to investigate the safety climate of a railway organization. The railway safety climate attributes are evaluated from the perspective of railway system staff. We identify four safety climate dimensions from exploratory factor analysis, namely safety communication, safety training, safety management and subjectively evaluated safety performance. Analytical results indicate that the safety climate differs at vertical and horizontal organizational levels. This study contributes to the literature by providing empirical evidence of the multilevel safety climate in a railway organization, presents possible causes of the differences under various cultural contexts and differentiates between safety climate scales for diverse workgroups within the railway organization. This information can be used to improve the safety sustainability of railway organizations and to conduct safety supervisions for the government.

  3. The implementation and assessment of a quality and safety culture education program in a large radiation oncology department.

    PubMed

    Woodhouse, Kristina D; Volz, Edna; Bellerive, Marc; Bergendahl, Howard W; Gabriel, Peter E; Maity, Amit; Hahn, Stephen M; Vapiwala, Neha

    2016-01-01

    In 2010, the American Society for Radiation Oncology launched a national campaign to improve patient safety in radiation therapy. One recommendation included the expansion of educational programs dedicated to quality and safety. We subsequently implemented a quality and safety culture education program (Q-SCEP) in our large radiation oncology department. The purpose of this study is to describe the design, implementation, and impact of this Q-SCEP. In 2010, we instituted a comprehensive Q-SCEP, consisting of a longitudinal series of lectures, meetings, and interactive workshops. Participation was mandatory for all department members across all network locations. Electronic surveys were administered to assess employee engagement, knowledge retention, preferred learning styles, and the program's overall impact. The Agency for Healthcare Research and Quality (AHRQ) Survey on Patient Safety Culture was administered. Analysis of variance was used for statistical analysis. Between 2010 and 2015, 100% of targeted staff participated in Q-SCEP. Thirty-three percent (132 of 400) and 30% (136 of 450) responded to surveys in 2012 and 2014, respectively. Mean scores improved from 73% to 89% (P < .001), with the largest improvement seen among therapists (+21.7%). The majority strongly agreed that safety culture education was critical to performing their jobs well. Full course compliance was achieved despite the sizable number of personnel and treatment centers. Periodic assessments demonstrated high knowledge retention, which significantly improved over time in nearly all department divisions. Additionally, our AHRQ patient safety grade remains high and continues to improve. These results will be used to further enhance ongoing internal safety initiatives and to inform future innovative efforts. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  4. Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review.

    PubMed

    Ruggiero, Jeanne S; Redeker, Nancy S

    2014-04-01

    Night-shift workers are prone to sleep deprivation, misalignment of circadian rhythms, and subsequent sleepiness and sleep-related performance deficits. The purpose of this narrative systematic review is to critically review and synthesize the scientific literature regarding improvements in sleepiness and sleep-related performance deficits following planned naps taken during work-shift hours by night workers and to recommend directions for future research and practice. We conducted a literature search using the Medline, PsychInfo, CINAHL, Cochrane Library, and Health and Safety Science Abstracts databases and included English-language quasi-experimental and experimental studies that evaluated the effects of a nighttime nap taken during a simulated or actual night-work shift. We identified 13 relevant studies, which consisted primarily of small samples and mixed designs. Most investigators found that, despite short periods of sleep inertia immediately following naps, night-shift napping led to decreased sleepiness and improved sleep-related performance. None of the studies examined the effects of naps on safety outcomes in the workplace. Larger-scale randomized clinical trials of night-shift napping and direct safety outcomes are needed prior to wider implementation.

  5. The Evaluation of Triphenyl Phosphate as a Flame Retardant Additive to Improve the Safety of Lithium-Ion Battery Electrolytes

    NASA Technical Reports Server (NTRS)

    Smart, M. C.; Krause, F. C.; Hwang, C.; West, W. C.; Soler, J.; Prakash, G. K. S.; Ratnakumar, B. V.

    2011-01-01

    With the intent of improving the safety characteristics of lithium ion cells, electrolytes containing flame retardant additives have been investigated. A number of triphenyl phosphate-containing electrolytes were evaluated in both coin cells and experimental three electrode lithium-ion cells (containing reference electrodes). A number of chemistries were investigated, including MCMB carbon/LiNi(0.8)Co(0.2)O2 (NCO), graphite/LiNi(0.8)Co(0.15)Al(0.05)O2 (NCA), Li/Li(Li(0.17)Ni(0.25)Mn(0.58))O2, Li/LiNiMnCoO2 (NMC) and graphite/LiNiMnCoO2 (NMC), to study the effect that different electrolyte compositions have upon performance. A wide range of TPP-containing electrolytes were demonstrated to have good compatibility with the C/NCO, C/NCA, and Li/NMC systems, however, poor performance was initially observed with the high voltage C/NMC system. This necessitated the development of improved electrolytes with stabilizing additives, leading to formulations containing lithium bis(oxalato)borate (LiBOB) that displayed substantially improved performance.

  6. An integrated approach for improving occupational health and safety management: the voluntary protection program in Taiwan.

    PubMed

    Su, Teh-Sheng; Tsai, Way-Yi; Yu, Yi-Chun

    2005-05-01

    A voluntary compliance program for occupational health and safety management, Voluntary Protection Programs (VPP), was implemented with a strategy of cooperation and encouragement in Taiwan. Due to limitations on increasing the human forces of inspection, a regulatory-based guideline addressing the essence of Occupational Health and Safety Management Systems (OHSMS) was promulgated, which combined the resources of third parties and insurance providers to accredit a self-improving worksite with the benefits of waived general inspection and a merit contributing to insurance premium payment reduction. A designated institute accepts enterprise's applications, performs document review and organizes the onsite inspection. A final review committee of Council of Labor Affairs (CLA) confers a two-year certificate on an approved site. After ten years, the efforts have shown a dramatic reduction of occupational injuries and illness in the total number of 724 worksites granted certification. VPP worksites, in comparison with all industries, had 49% lower frequency rate in the past three years. The severity rate reduction was 80% in the same period. The characteristics of Taiwan VPP program and international occupational safety and health management programs are provided. A Plan-Do-Check-Act management cycle was employed for pursuing continual improvements to the culture fostered. The use of a quantitative measurement for assessing the performance of enterprises' occupational safety and health management showed the efficiency of the rating. The results demonstrate that an employer voluntary protection program is a promising strategy for a developing country.

  7. Impact of broad-specification fuels on future jet aircraft. [engine components and performance

    NASA Technical Reports Server (NTRS)

    Grobman, J. S.

    1978-01-01

    The effects that broad specification fuels have on airframe and engine components were discussed along with the improvements in component technology required to use broad specification fuels without sacrificing performance, reliability, maintainability, or safety.

  8. Performance Testing of Yardney MCMB-LiNiCoAlO2 Lithium-ion Cells Possessing Electrolytes with Improved Safety Characteristics

    NASA Technical Reports Server (NTRS)

    Smart, Marshall C.; Whitcanack, Larry D.; Krause, Frederick C.; Hwang, Constanza; Bugga, Ratnakumar V.; Santee, Stuart; Puglia, Frank J.; Gitzendanner, Rob

    2012-01-01

    Many future NASA missions aimed at exploring the Moon and Mars require high specific energy rechargeable batteries that possess enhanced safety characteristics. There is also a strong desire to develop Li-ion batteries with improved safety characteristics for terrestrial applications, most notably for HEV and PHEV automotive applications. In previous work focused upon evaluating various potential flame retardant additives1, triphenyl phosphate (TPP)2 was observed to have the most desirable attributes, including good life characteristics and resilience to high voltage operation. We have employed a number of approaches in the design of promising TPP-based electrolytes with improved safety, including: (a) varying the flame retardant additive (FRA) content (from 5 to 15%), (b) the use of fluorinated co-solvents, (c) the use of additives to improve compatibility, and (c) the use of ester co-solvents to decrease the viscosity and increase the conductivity. In recent work, we have demonstrated a number of these electrolyte formulations to be compatible with a number of chemistries, including: MCMB carbon-LiNi0.8Co0.2O2, graphite-LiNi0.8Co0.15Al0.05O2, Li-Li(Li0.17Ni 0.25 Mn 0.58 )O2, Li-LiNiCoMnO2 and graphite- LiNiCoMnO2.3,4 In the current study, we have demonstrated the performance of a number of TPP-containing electrolytes in 7 Ah prototype MCMB-LiNiCoO2 cells. We will describe the results of a number of performance tests, including: a) 100% DOD cycle life testing at various temperatures, b) discharge rate characterization as a function of temperature, c) charge rate characterization as a function of temperature, and d) impedance as a function of temperature. In addition to displaying good life characteristics, being comparable to baseline chemistries, a number of cells were observed to provide good performance over a wide temperature range.

  9. Current food safety management systems in fish-exporting companies require further improvements to adequately cope with contextual pressure: case study.

    PubMed

    Onjong, Hillary Adawo; Wangoh, John; Njage, Patrick Murigu Kamau

    2014-10-01

    Fish-processing plants still face food safety (FS) challenges worldwide despite the existence of several quality assurance standards and food safety management systems/s (FSMSs). This study assessed performance of FSMS in fish exporting sector considering pressure from the context in which they operate. A FSMS diagnostic tool with checklist was used to assess the context, FSMS, and FS output in 9 Kenyan fish exporting companies. Majority (67%) companies operated at moderate- to high-risk context but with an average performance in control and assurance activities. This situation could be insufficient to deal with ambiguity, uncertainty, and vulnerability issues in the context characteristics. Contextual risk posed by product characteristics (nature of raw materials) and chain environment characteristics was high. Risk posed by the chain environment characteristics, low power in supplier relationships, and low degree of authority in customer relationships was high. Lack of authority in relationship with suppliers would lead to high raw material risk situation. Even though cooling facilities, a key control activity, was at an advanced level, there was inadequate packaging intervention equipment which coupled with inadequate physical intervention equipment could lead to further weakened FSMS performance. For the fish companies to improve their FSMS to higher level and enhance predictability, they should base their FSMS on scientific information sources, historical results, and own experimental trials in their preventive, intervention, and monitoring systems. Specific suggestions are derived for improvements toward higher FSMS activity levels or lower risk levels in context characteristics. Weak areas in performance of control and assurance activities in export fish-processing sector already implementing current quality assurance guidelines and standards were studied taking into consideration contextual pressure wherein the companies operate. Important mitigation measures toward improved contextual risk, core assurance, and control activities irrespective of applied food safety management systems in fish industries were suggested. © 2014 Institute of Food Technologists®

  10. The European New Car Assessment Programme: A historical review.

    PubMed

    van Ratingen, Michiel; Williams, Aled; Lie, Anders; Seeck, Andre; Castaing, Pierre; Kolke, Reinhard; Adriaenssens, Guido; Miller, Andrew

    2016-04-01

    Established in 1997, the European New Car Assessment Programme (Euro NCAP) provides consumers with a safety performance assessment for the majority of the most popular cars in Europe. Thanks to its rigorous crash tests, Euro NCAP has rapidly become an important driver safety improvement to new cars. After ten years of rating vehicles, Euro NCAP felt that a change was necessary to stay in tune with rapidly emerging driver assistance and crash avoidance systems and to respond to shifting priorities in road safety. A new overall rating system was introduced that combines the most important aspects of vehicle safety under a single star rating. The overall rating system has allowed Euro NCAP to continue to push for better fitment and higher performance for vehicles sold on the European market. In the coming years, the safety rating is expected to play an important role in the support of the roll-out of highly automated vehicles.

  11. Effects on Task Performance and Psychophysiological Measures of Performance During Normobaric Hypoxia Exposure

    NASA Technical Reports Server (NTRS)

    Stephens, Chad; Kennedy, Kellie; Napoli, Nicholas; Demas, Matthew; Barnes, Laura; Crook, Brenda; Williams, Ralph; Last, Mary Carolyn; Schutte, Paul

    2017-01-01

    Human-autonomous systems have the potential to mitigate pilot cognitive impairment and improve aviation safety. A research team at NASA Langley conducted an experiment to study the impact of mild normobaric hypoxia induction on aircraft pilot performance and psychophysiological state. A within-subjects design involved non-hypoxic and hypoxic exposures while performing three 10-minute tasks. Results indicated the effect of 15,000 feet simulated altitude did not induce significant performance decrement but did produce increase in perceived workload. Analyses of psychophysiological responses evince the potential of biomarkers for hypoxia onset. This study represents on-going work at NASA intending to add to the current knowledge of psychophysiologically-based input to automation to increase aviation safety. Analyses involving coupling across physiological systems and wavelet transforms of cortical activity revealed patterns that can discern between the simulated altitude conditions. Specifically, multivariate entropy of ECG/Respiration components were found to be significant predictors (p< 0.02) of hypoxia. Furthermore, in EEG, there was a significant decrease in mid-level beta (15.19-18.37Hz) during the hypoxic condition in thirteen of sixteen sites across the scalp. Task performance was not appreciably impacted by the effect of 15,000 feet simulated altitude. Analyses of psychophysiological responses evince the potential of biomarkers for mild hypoxia onset.The potential for identifying shifts in underlying cortical and physiological systems could serve as a means to identify the onset of deteriorated cognitive state. Enabling such assessment in future flightdecks could permit increasingly autonomous systems-supported operations. Augmenting human operator through assessment of cognitive impairment has the potential to further improve operator performance and mitigate human error in safety critical contexts. This study represents ongoing work at NASA intending to add to the current knowledge of psychophysiologically-based input to automation to increase aviation safety.

  12. Health and safety management systems: liability or asset?

    PubMed

    Bennett, David

    2002-01-01

    Health and safety management systems have a background in theory and in various interests among employers and workplace health and safety professionals. These have resulted in a number of national systems emanating from national standard-writing centres and from employers' organizations. In some cases these systems have been recognized as national standards. The contenders for an international standard have been the International Organization of Standardization (ISO) and the International Labour Organization (ILO). The quality and environmental management systems of ISO indicate what an ISO health and safety management standard would look like. The ILO Guidelines on Safety and Health Management Systems, by contrast, are stringent, specific and potentially effective in improving health and safety performance in the workplace.

  13. Developing the radiation protection safety culture in the UK.

    PubMed

    Cole, P; Hallard, R; Broughton, J; Coates, R; Croft, J; Davies, K; Devine, I; Lewis, C; Marsden, P; Marsh, A; McGeary, R; Riley, P; Rogers, A; Rycraft, H; Shaw, A

    2014-06-01

    In the UK, as elsewhere, there is potential to improve how radiological challenges are addressed through improvement in, or development of, a strong radiation protection (RP) safety culture. In preliminary work in the UK, two areas have been identified as having a strong influence on UK society: the healthcare and nuclear industry sectors. Each has specific challenges, but with many overlapping common factors. Other sectors will benefit from further consideration.In order to make meaningful comparisons between these two principal sectors, this paper is primarily concerned with cultural aspects of RP in the working environment and occupational exposures rather than patient doses.The healthcare sector delivers a large collective dose to patients each year, particularly for diagnostic purposes, which continues to increase. Although patient dose is not the focus, it must be recognised that collective patient dose is inevitably linked to collective occupational exposure, especially in interventional procedures.The nuclear industry faces major challenges as work moves from operations to decommissioning on many sites. This involves restarting work in the plants responsible for the much higher radiation doses of the 1960/70s, but also performing tasks that are considerably more difficult and hazardous than those original performed in these plants.Factors which influence RP safety culture in the workplace are examined, and proposals are considered for a series of actions that may lead to an improvement in RP culture with an associated reduction in dose in many work areas. These actions include methods to improve knowledge and awareness of radiation safety, plus ways to influence management and colleagues in the workplace. The exchange of knowledge about safety culture between the nuclear industry and medical areas may act to develop RP culture in both sectors, and have a wider impact in other sectors where exposures to ionising radiations can occur.

  14. The Role of Leadership in Safety Performance and Results

    NASA Astrophysics Data System (ADS)

    Caravello, Halina E.

    Employee injury rates in U.S. land-based operations in the energy industry are 2 to 3 times higher relative to other regions in the world. Although a rich literature exists on drivers of safety performance, no previous studies investigated factors influencing this elevated rate. Leadership has been identified as a key contributor to safety outcomes and this grounded theory study drew upon the full range leadership model, situational leadership, and leader-member exchange theories for the conceptual framework. Leadership aspects influencing safety performance were investigated through guided interviews of 27 study participants; data analyses included open and axial coding, and constant comparisons identified higher-level categories. Selective coding integrated categories into the theoretical framework that developed the idealized, transformational leader traits motivating safe behaviors of leading by example, expressing care and concern for employees' well-being, celebrating successes, and communicating the importance of safety (other elements included visibility and commitment). Employee and supervisor participants reported similar views on the idealized leader traits, but low levels of these qualities may be driving elevated injury rates. Identifying these key elements provides the foundation to creating strategies and action plans enabling energy sector companies to prevent employee injuries and fatalities in an industry where tens of thousands of employees are subjected to significant hazards and elevated risks. Creating safer workplaces for U.S. employees by enhancing leaders' skills, building knowledge, and improving behaviors will improve the employees' and their families' lives by reducing the pain and suffering resulting from injuries and fatalities.

  15. [Risk management in anesthesia and critical care medicine].

    PubMed

    Eisold, C; Heller, A R

    2017-03-01

    Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.

  16. Defining the performance gap: Conducting a self-assessment

    NASA Technical Reports Server (NTRS)

    Braymer, Susan A.; Stoner, David L.; Powell, William C.

    1992-01-01

    This paper presents two different approaches to performing self-assessments of continuous improvement activities. Case Study 1 describes the activities performed by JSC to assess the implementation of continuous improvement efforts at the NASA Center. The JSC approach included surveys administered to randomly selected NASA personnel and personal interviews with NASA and contractor management personnel. Case Study 2 describes the continuous improvement survey performed by the JSC Safety, Reliability, and Quality Assurance (SR&QA) organization. This survey consisted of a short questionnaire (50 questions) administered to all NASA and contractor SR&QA personnel. The questionnaire is based on the eight categories of the President's Award for Quality and Productivity Improvement. It is designed to objectively determine placement on the TQ benchmark and identify a roadmap for improvement.

  17. Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

    PubMed

    McGrath, Susan P; Blike, George T

    2015-10-01

    A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

  18. Roles of surface chemistry on safety and electrochemistry in lithium ion batteries.

    PubMed

    Lee, Kyu Tae; Jeong, Sookyung; Cho, Jaephil

    2013-05-21

    Motivated by new applications including electric vehicles and the smart grid, interest in advanced lithium ion batteries has increased significantly over the past decade. Therefore, research in this field has intensified to produce safer devices with better electrochemical performance. Most research has focused on the development of new electrode materials through the optimization of bulk properties such as crystal structure, ionic diffusivity, and electric conductivity. More recently, researchers have also considered the surface properties of electrodes as critical factors for optimizing performance. In particular, the electrolyte decomposition at the electrode surface relates to both a lithium ion battery's electrochemical performance and safety. In this Account, we give an overview of the major developments in the area of surface chemistry for lithium ion batteries. These ideas will provide the basis for the design of advanced electrode materials. Initially, we present a brief background to lithium ion batteries such as major chemical components and reactions that occur in lithium ion batteries. Then, we highlight the role of surface chemistry in the safety of lithium ion batteries. We examine the thermal stability of cathode materials: For example, we discuss the oxygen generation from cathode materials and describe how cells can swell and heat up in response to specific conditions. We also demonstrate how coating the surfaces of electrodes can improve safety. The surface chemistry can also affect the electrochemistry of lithium ion batteries. The surface coating strategy improved the energy density and cycle performance for layered LiCoO2, xLi2MnO3·(1 - x)LiMO2 (M = Mn, Ni, Co, and their combinations), and LiMn2O4 spinel materials, and we describe a working mechanism for these enhancements. Although coating the surfaces of cathodes with inorganic materials such as metal oxides and phosphates improves the electrochemical performance and safety properties of batteries, the microstructure of the coating layers and the mechanism of action are not fully understood. Therefore, researchers will need to further investigate the surface coating strategy during the development of new lithium ion batteries.

  19. The relationship of chronobiology to sleep schedules and performance demands

    NASA Technical Reports Server (NTRS)

    Monk, T. H.

    1990-01-01

    This review is concerned with how chronobiological results concerning the human circadian timekeeping system ( biological clock'), its response to changes in schedule, and its influence on performance ability can be used to improve shift worker wellbeing, safety and productivity.

  20. Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.

    PubMed

    Bordeianou, Liliana; Cauley, Christy E; Antonelli, Donna; Bird, Sarah; Rattner, David; Hutter, Matthew; Mahmood, Sadiqa; Schnipper, Deborah; Rubin, Marc; Bleday, Ronald; Kenney, Pardon; Berger, David

    2017-01-01

    Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. This study aimed to compare database concordance. This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated. This study was conducted at Boston-area hospitals. National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included. Standardized surgical site infection rates were the primary outcomes of interest. Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient between standardized infection rates was 0.03 (p = 0.88). During 25 site-time period observations, National Surgical Quality Improvement Program and National Healthcare Safety Network data matched for 52% of observations (13/25). κ = 0.10 (95% CI, -0.1366 to 0.3402; p = 0.403), indicating poor agreement. This study investigated hospitals located in the Northeastern United States only. Variation in Centers for Medicare & Medicaid Services-mandated National Healthcare Safety Network infection surveillance methodology leads to unreliable results, which is apparent when these results are compared with standardized data. High-quality data would improve care quality and compare outcomes among institutions.

  1. Self-Sustaining Thorium Boiling Water Reactors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Greenspan, Ehud; Gorman, Phillip M.; Bogetic, Sandra

    The primary objectives of this project are to: Perform a pre-conceptual design of a core for an alternative to the Hitachi proposed fuel-self- sustaining RBWR-AC, to be referred to as a RBWR-Th. The use of thorium fuel is expected to assure negative void coefficient of reactivity (versus positive of the RBWR-AC) and improve reactor safety; Perform a pre-conceptual design of an alternative core to the Hitachi proposed LWR TRU transmuting RBWR-TB2, to be referred to as the RBWR-TR. In addition to improved safety, use of thorium for the fertile fuel is expected to improve the TRU transmutation effectiveness; Compare themore » RBWR-Th and RBWR-TR performance against that of the Hitachi RBWR core designs and sodium cooled fast reactor counterparts - the ARR and ABR; and, Perform a viability assessment of the thorium-based RBWR design concepts to be identified along with their associated fuel cycle, a technology gap analysis, and a technology development roadmap. A description of the work performed and of the results obtained is provided in this Overview Report and, in more detail, in the Attachments. The major findings of the study are summarized.« less

  2. The Ecology of Defensive Medicine and Malpractice Litigation

    PubMed Central

    2016-01-01

    Using an evolutionary game, we show that patients and physicians can interact with predator-prey relationships. Litigious patients who seek compensation are the ‘predators’ and physicians are their ‘prey’. Physicians can adapt to the risk of being sued by performing defensive medicine. We find that improvements in clinical safety can increase the share of litigious patients and leave unchanged the share of physicians who perform defensive medicine. This paradoxical result is consistent with increasing trends in malpractice claims in spite of safety improvements, observed for example in empirical studies on anesthesiologists. Perfect cooperation with neither defensive nor litigious behaviors can be the Pareto-optimal solution when it is not a Nash equilibrium, so maximizing social welfare may require government intervention. PMID:26982056

  3. Projecting effects of improvements in passive safety of the New Zealand light vehicle fleet.

    PubMed

    Keall, Michael; Newstead, Stuart; Jones, Wayne

    2007-09-01

    In the year 2000, as part of the process for setting New Zealand road safety targets, a projection was made for a reduction in social cost of 15.5 percent associated with improvements in crashworthiness, which is a measure of the occupant protection of the light passenger vehicle fleet. Since that document was produced, new estimates of crashworthiness have become available, allowing for a more accurate projection. The objective of this paper is to describe a methodology for projecting changes in casualty rates associated with passive safety features and to apply this methodology to produce a new prediction. The shape of the age distribution of the New Zealand light passenger vehicle fleet was projected to 2010. Projected improvements in crashworthiness and associated reductions in social cost were also modeled based on historical trends. These projections of changes in the vehicle fleet age distribution and of improvements in crashworthiness together provided a basis for estimating the future performance of the fleet in terms of secondary safety. A large social cost reduction of about 22 percent for 2010 compared to the year 2000 was predicted due to the expected huge impact of improvements in passive vehicle features on road trauma in New Zealand. Countries experiencing improvements in their vehicle fleets can also expect significant reductions in road injury compared to a less crashworthy passenger fleet. Such road safety gains can be analyzed using some of the methodology described here.

  4. Threats to safety during sedation outside of the operating room and the death of Michael Jackson.

    PubMed

    Webster, Craig S; Mason, Keira P; Shafer, Steven L

    2016-03-01

    From an understanding of human psychology and the reliability of high-technology systems, this review considers critical threats to the safety of patients undergoing sedation outside of the operating room, and will stratify these threats along what we define as the 'Patient Risk Continuum'. We then consider interventions suitable for addressing identified risks. The technology, organization and delivery of healthcare continue to become more complex, highlighting the importance of maintaining the safety of patients. Sedation outside of the operating room is known to be associated with higher rates of adverse events. However, a number of recent safety initiatives have shown benefit in improving patient safety. The following threats to patients undergoing sedation, in increasing order of risk, are discussed: equipment and environmental factors, known patient risks, poor team performance, combinatorial problems and egregious violations. To address these threats, we discuss a number of approaches consistent with the systems approach to safety, namely: encouraging functions, forcing functions, cognitive safety nets, information sharing, recovery strategies and regulatory change. Demonstrating improvement with any safety initiative relies critically on quality data collected on the problem area in question.

  5. Does correcting astigmatism with toric lenses improve driving performance?

    PubMed

    Cox, Daniel J; Banton, Thomas; Record, Steven; Grabman, Jesse H; Hawkins, Ronald J

    2015-04-01

    Driving is a vision-based activity of daily living that impacts safety. Because visual disruption can compromise driving safety, contact lens wearers with astigmatism may pose a driving safety risk if they experience residual blur from spherical lenses that do not correct their astigmatism or if they experience blur from toric lenses that rotate excessively. Given that toric lens stabilization systems are continually improving, this preliminary study tested the hypothesis that astigmats wearing toric contact lenses, compared with spherical lenses, would exhibit better overall driving performance and driving-specific visual abilities. A within-subject, single-blind, crossover, randomized design was used to evaluate driving performance in 11 young adults with astigmatism (-0.75 to -1.75 diopters cylinder). Each participant drove a highly immersive, virtual reality driving simulator (210 degrees field of view) with (1) no correction, (2) spherical contact lens correction (ACUVUE MOIST), and (3) toric contact lens correction (ACUVUE MOIST for Astigmatism). Tactical driving skills such as steering, speed management, and braking, as well as operational driving abilities such as visual acuity, contrast sensitivity, and foot and arm reaction time, were quantified. There was a main effect for type of correction on driving performance (p = 0.05). Correction with toric lenses resulted in significantly safer tactical driving performance than no correction (p < 0.05), whereas correction with spherical lenses did not differ in driving safety from no correction (p = 0.118). Operational tests differentiated corrected from uncorrected performance for both spherical (p = 0.008) and toric (p = 0.011) lenses, but they were not sensitive enough to differentiate toric from spherical lens conditions. Given previous research showing that deficits in these tactical skills are predictive of future real-world collisions, these preliminary data suggest that correcting low to moderate astigmatism with toric lenses may be important to driving safety. Their merits relative to spherical lens correction require further investigation.

  6. Predictors of Payer Mix and Financial Performance Among Safety Net Hospitals Prior to the Affordable Care Act.

    PubMed

    Sommers, Benjamin D; Stone, Juliana; Kane, Nancy

    2016-01-01

    The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. We analyzed the 2010 financial statements of 98 large, urban safety net hospital systems in 34 states, supplemented with data on population demographics, hospital features, and state policies. We used multivariate regression to identify independent predictors of three outcomes: 1) Medicaid-reliant payer mix (hospitals for which at least 25% of hospital days are paid for by Medicaid); 2) safety net revenue-to-cost ratio (Medicaid and Medicare Disproportionate Share Hospital payments and local government transfers, divided by charity care costs and Medicaid payment shortfall); and 3) operating margin. Medicaid-reliant payer mix was positively associated with more inclusive state Medicaid eligibility criteria and more minority patients. More inclusive Medicaid eligibility and higher Medicaid reimbursement rates positively predicted safety net revenue-to-cost ratio. University governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs. Institutional and state policies may outweigh patient demographics in the financial health of safety net hospitals. © The Author(s) 2015.

  7. Performance Analysis of the IEEE 802.11p Multichannel MAC Protocol in Vehicular Ad Hoc Networks

    PubMed Central

    2017-01-01

    Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. The safety applications require timely and reliable transmissions, while the non-safety applications require efficient and high throughput. In the IEEE 1609.4 protocol, operating interval is divided into alternating Control Channel (CCH) interval and Service Channel (SCH) interval with an identical length. During the CCH interval, nodes transmit safety-related messages and control messages, and Enhanced Distributed Channel Access (EDCA) mechanism is employed to allow four Access Categories (ACs) within a station with different priorities according to their criticality for the vehicle’s safety. During the SCH interval, the non-safety massages are transmitted. An analytical model is proposed in this paper to evaluate performance, reliability and efficiency of the IEEE 802.11p and IEEE 1609.4 protocols. The proposed model improves the existing work by taking serval aspects and the character of multichannel switching into design consideration. Extensive performance evaluations based on analysis and simulation help to validate the accuracy of the proposed model and analyze the capabilities and limitations of the IEEE 802.11p and IEEE 1609.4 protocols, and enhancement suggestions are given. PMID:29231882

  8. Performance Analysis of the IEEE 802.11p Multichannel MAC Protocol in Vehicular Ad Hoc Networks.

    PubMed

    Song, Caixia

    2017-12-12

    Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. The safety applications require timely and reliable transmissions, while the non-safety applications require efficient and high throughput. In the IEEE 1609.4 protocol, operating interval is divided into alternating Control Channel (CCH) interval and Service Channel (SCH) interval with an identical length. During the CCH interval, nodes transmit safety-related messages and control messages, and Enhanced Distributed Channel Access (EDCA) mechanism is employed to allow four Access Categories (ACs) within a station with different priorities according to their criticality for the vehicle's safety. During the SCH interval, the non-safety massages are transmitted. An analytical model is proposed in this paper to evaluate performance, reliability and efficiency of the IEEE 802.11p and IEEE 1609.4 protocols. The proposed model improves the existing work by taking serval aspects and the character of multichannel switching into design consideration. Extensive performance evaluations based on analysis and simulation help to validate the accuracy of the proposed model and analyze the capabilities and limitations of the IEEE 802.11p and IEEE 1609.4 protocols, and enhancement suggestions are given.

  9. Idaho National Laboratory Integrated Safety Management System FY 2016 Effectiveness Review and Declaration Report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hunt, Farren J.

    Idaho National Laboratory’s (INL’s) Integrated Safety Management System (ISMS) effectiveness review of fiscal year (FY) 2016 shows that INL has integrated management programs and safety elements throughout the oversight and operational activities performed at INL. The significant maturity of Contractor Assurance System (CAS) processes, as demonstrated across INL’s management systems and periodic reporting through the Management Review Meeting process, over the past two years has provided INL with current real-time understanding and knowledge pertaining to the health of the institution. INL’s sustained excellence of the Integrated Safety and effective implementation of the Worker Safety and Health Program is also evidencedmore » by other external validations and key indicators. In particular, external validations include VPP, ISO 14001, DOELAP accreditation, and key Laboratory level indicators such as ORPS (number, event frequency and severity); injury/illness indicators such as Days Away, Restricted and Transfer (DART) case rate, back & shoulder metric and open reporting indicators, demonstrate a continuous positive trend and therefore improved operational performance over the last few years. These indicators are also reflective of the Laboratory’s overall organizational and safety culture improvement. Notably, there has also been a step change in ESH&Q Leadership actions that have been recognized both locally and complex-wide. Notwithstanding, Laboratory management continues to monitor and take action on lower level negative trends in numerous areas including: Conduct of Operations, Work Control, Work Site Analysis, Risk Assessment, LO/TO, Fire Protection, and Life Safety Systems, to mention a few. While the number of severe injury cases has decreased, as evidenced by the reduction in the DART case rate, the two hand injuries and the fire truck/ambulance accident were of particular concern. Aggressive actions continue in order to understand the causes and define actions needed to prevent similar injuries and accidents in the future. While our injury rate is not where we want it to be, it is not the only indicator that defines our ISMS program, safety culture, and efforts to be a continuous learning organization. When reviewing the entire year’s performance, and all areas that integrate ISMS principles and core functions, INL has an “effective” ISMS program that is continually improving.« less

  10. Strengthening leadership as a catalyst for enhanced patient safety culture: a repeated cross-sectional experimental study.

    PubMed

    Kristensen, Solvejg; Christensen, Karl Bang; Jaquet, Annette; Møller Beck, Carsten; Sabroe, Svend; Bartels, Paul; Mainz, Jan

    2016-05-13

    Current literature emphasises that clinical leaders are in a position to enable a culture of safety, and that the safety culture is a performance mediator with the potential to influence patient outcomes. This paper aims to investigate staff's perceptions of patient safety culture in a Danish psychiatric department before and after a leadership intervention. A repeated cross-sectional experimental study by design was applied. In 2 surveys, healthcare staff were asked about their perceptions of the patient safety culture using the 7 patient safety culture dimensions in the Safety Attitudes Questionnaire. To broaden knowledge and strengthen leadership skills, a multicomponent programme consisting of academic input, exercises, reflections and discussions, networking, and action learning was implemented among the clinical area level leaders. In total, 358 and 325 staff members participated before and after the intervention, respectively. 19 of the staff members were clinical area level leaders. In both surveys, the response rate was >75%. The proportion of frontline staff with positive attitudes improved by ≥5% for 5 of the 7 patient safety culture dimensions over time. 6 patient safety culture dimensions became more positive (increase in mean) (p<0.05). Frontline staff became more positive on all dimensions except stress recognition (p<0.05). For the leaders, the opposite was the case (p<0.05). Staff leaving the department after the first measurement had rated job satisfaction lower than the staff staying on (p<0.05). The improvements documented in the patient safety culture are remarkable, and imply that strengthening the leadership can act as a significant catalyst for patient safety culture improvement. Further studies using a longitudinal study design are recommended to investigate the mechanism behind leadership's influence on patient safety culture, sustainability of improvements over time, and the association of change in the patient safety culture measures with change in psychiatric patient safety outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Software IV and V Research Priorities and Applied Program Accomplishments Within NASA

    NASA Technical Reports Server (NTRS)

    Blazy, Louis J.

    2000-01-01

    The mission of this research is to be world-class creators and facilitators of innovative, intelligent, high performance, reliable information technologies that enable NASA missions to (1) increase software safety and quality through error avoidance, early detection and resolution of errors, by utilizing and applying empirically based software engineering best practices; (2) ensure customer software risks are identified and/or that requirements are met and/or exceeded; (3) research, develop, apply, verify, and publish software technologies for competitive advantage and the advancement of science; and (4) facilitate the transfer of science and engineering data, methods, and practices to NASA, educational institutions, state agencies, and commercial organizations. The goals are to become a national Center Of Excellence (COE) in software and system independent verification and validation, and to become an international leading force in the field of software engineering for improving the safety, quality, reliability, and cost performance of software systems. This project addresses the following problems: Ensure safety of NASA missions, ensure requirements are met, minimize programmatic and technological risks of software development and operations, improve software quality, reduce costs and time to delivery, and improve the science of software engineering

  12. The quest to standardize hemodialysis care.

    PubMed

    Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

    2011-01-01

    A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

  13. A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial

    PubMed Central

    Jacobsohn, Gwen C.; Rajamanickam, Victoria P.; Carayon, Pascale; Kelly, Michelle M.; Wetterneck, Tosha B.; Rathouz, Paul J.; Brown, Roger L.

    2017-01-01

    BACKGROUND AND OBJECTIVES: Family-centered rounds (FCRs) have become standard of care, despite the limited evaluation of FCRs’ benefits or interventions to support high-quality FCR delivery. This work examines the impact of the FCR checklist intervention, a checklist and associated provider training, on performance of FCR elements, family engagement, and patient safety. METHODS: This cluster randomized trial involved 298 families. Two hospital services were randomized to use the checklist; 2 others delivered usual care. We evaluated the performance of 8 FCR checklist elements and family engagement from 673 pre- and postintervention FCR videos and assessed the safety climate with the Children’s Hospital Safety Climate Questionnaire. Random effects regression models were used to assess intervention impact. RESULTS: The intervention significantly increased the number of FCR checklist elements performed (β = 1.2, P < .001). Intervention rounds were significantly more likely to include asking the family (odds ratio [OR] = 2.43, P < .05) or health care team (OR = 4.28, P = .002) for questions and reading back orders (OR = 12.43, P < .001). Intervention families’ engagement and reports of safety climate were no different from usual care. However, performance of specific checklist elements was associated with changes in these outcomes. For example, order read-back was associated with significantly more family engagement. Asking families for questions was associated with significantly better ratings of staff’s communication openness and safety of handoffs and transitions. CONCLUSIONS: The performance of FCR checklist elements was enhanced by checklist implementation and associated with changes in family engagement and more positive perceptions of safety climate. Implementing the checklist improves delivery of FCRs, impacting quality and safety of care. PMID:28557720

  14. The role of health and safety experts in the management of hazardous and toxic wastes in Indonesia

    NASA Astrophysics Data System (ADS)

    Supriyadi; Hadiyanto

    2018-02-01

    Occupational Safety and Health Experts in Indonesia have an important role in integrating environmental health and safety factors, including in this regard as human resources assigned to undertake hazardous waste management. Comprehensive knowledge and competence skills need to be carried out responsibly, as an inherent professional occupational safety and health profession. Management leaders should continue to provide training in external agencies responsible for science in the management of toxic waste to enable occupational safety and health experts to improve their performance in the hierarchy of control over the presence of hazardous materials. This paper provides an overview of what strategies and competencies the Occupational Safety and Health expert needs to have in embracing hazardous waste management practices.

  15. An airport occupational health and safety management system from the OHSAS 18001 perspective.

    PubMed

    Dejanović, Dejana; Heleta, Milenko

    2016-09-01

    Occupational health and safety represents a set of technical, medical, legal, psychological, pedagogical and other measures with the aim to detect and eliminate hazards that threaten the lives and health of employees. These measures should be applied in a systematic way. Therefore, the aim of this study is to review occupational health and safety legislation in Serbia and the requirements that airports should fulfill for Occupational Health and Safety Assessment Series certification. Analyzing the specificity of airport activities and injuries as their outcomes, the article also proposes preventive measures for the health and safety of employees. Furthermore, the airport activities which are the most important from the standpoint of risks are defined, as the goals for occupational health and safety performance improvement.

  16. Performance measurement evaluation framework and co-benefit / tradeoff analysis for connected and automated vehicles (CAV) applications : a survey : a research report from the National Center for Sustainable Transportation.

    DOT National Transportation Integrated Search

    2017-09-01

    A number of Connected and/or Automated Vehicle (CAV) applications have recently been designed to improve the performance of our transportation system. Safety, mobility and environmental sustainability are three cornerstone performance metrics when ev...

  17. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study.

    PubMed

    Erestam, Sofia; Haglind, Eva; Bock, David; Andersson, Annette Erichsen; Angenete, Eva

    2017-01-01

    Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. NCT02329691.

  18. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    PubMed Central

    Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

  19. Efficiency improvement by navigated safety inspection involving visual clutter based on the random search model.

    PubMed

    Sun, Xinlu; Chong, Heap-Yih; Liao, Pin-Chao

    2018-06-25

    Navigated inspection seeks to improve hazard identification (HI) accuracy. With tight inspection schedule, HI also requires efficiency. However, lacking quantification of HI efficiency, navigated inspection strategies cannot be comprehensively assessed. This work aims to determine inspection efficiency in navigated safety inspection, controlling for the HI accuracy. Based on a cognitive method of the random search model (RSM), an experiment was conducted to observe the HI efficiency in navigation, for a variety of visual clutter (VC) scenarios, while using eye-tracking devices to record the search process and analyze the search performance. The results show that the RSM is an appropriate instrument, and VC serves as a hazard classifier for navigation inspection in improving inspection efficiency. This suggests a new and effective solution for addressing the low accuracy and efficiency of manual inspection through navigated inspection involving VC and the RSM. It also provides insights into the inspectors' safety inspection ability.

  20. An evaluation of NASA's program in human factors research: Aircrew-vehicle system interaction

    NASA Technical Reports Server (NTRS)

    1982-01-01

    Research in human factors in the aircraft cockpit and a proposed program augmentation were reviewed. The dramatic growth of microprocessor technology makes it entirely feasible to automate increasingly more functions in the aircraft cockpit; the promise of improved vehicle performance, efficiency, and safety through automation makes highly automated flight inevitable. An organized data base and validated methodology for predicting the effects of automation on human performance and thus on safety are lacking and without such a data base and validated methodology for analyzing human performance, increased automation may introduce new risks. Efforts should be concentrated on developing methods and techniques for analyzing man machine interactions, including human workload and prediction of performance.

  1. The influence of economic incentives linked to road safety indicators on accidents: the case of toll concessions in Spain.

    PubMed

    Rangel, Thais; Vassallo, José Manuel; Herraiz, Israel

    2013-10-01

    The goal of this paper is to evaluate whether the incentives incorporated in toll highway concession contracts in order to encourage private operators to adopt measures to reduce accidents are actually effective at improving safety. To this end, we implemented negative binomial regression models using information about highway characteristics and accident data from toll highway concessions in Spain from 2007 to 2009. Our results show that even though road safety is highly influenced by variables that are not managed by the contractor, such as the annual average daily traffic (AADT), the percentage of heavy vehicles on the highway, number of lanes, number of intersections and average speed; the implementation of these incentives has a positive influence on the reduction of accidents and injuries. Consequently, this measure seems to be an effective way of improving safety performance in road networks. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Safety and compliance-related hazards in the medical practice: Part one.

    PubMed

    Calway, R C

    2001-01-01

    Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

  3. Improving patient safety by instructional systems design

    PubMed Central

    Battles, J B

    2006-01-01

    Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm. PMID:17142604

  4. A national study of nurse leadership and supports for quality improvement in rural hospitals.

    PubMed

    Paez, Kathryn; Schur, Claudia; Zhao, Lan; Lucado, Jennifer

    2013-01-01

    This study assessed the perceptions and actions of rural hospital nurse executives with regard to patient safety and quality improvement (QI). A national sample of rural hospital nurse executives (n = 300) completed a survey measuring 4 domains related to patient safety and QI: (a) patient "Safety Culture," (b) adequacy of QI "Resources," (c) "Barriers" related to QI, and (d) "Nurse Leader Engagement" in activities supporting QI. Perceptions of Safety Culture were strong but 47% of the Resources needed to carry out QI were inadequate, 29% of Barriers were moderate to major, and 25% of Nurse Leader Engagement activities were performed infrequently. Nurse Leader Engagement in quality-related activities was less frequent among nurses in isolated and small rural town hospitals compared with large rural city hospitals. To further QI, rural nurse executives may need to use their communications and actions to raise the visibility of QI.

  5. Self-employed individuals performing different types of work have different occupational safety and health problems.

    PubMed

    Park, Jungsun; Han, Boyoung; Kim, Yangho

    2018-05-22

    We assessed the occupational safety and health (OSH) issues of self-employed individuals in Korea. The working conditions and OSH issues in three groups were analyzed using the Korean Working Conditions Survey of 2014. Among self-employed individuals, "Physical work" was more common among males, whereas "Emotional work" was more common among females. Self-employed individuals performing "Mental work" had more education, higher incomes, and the lowest exposure to physical/chemical and ergonomic hazards in the workplace. In contrast, those performing "Physical work" were older, had less education, lower incomes, greater exposure to physical/chemical and ergonomic hazards in the workplace, and more health problems. Individuals performing "Physical work" were most vulnerable to OSH problems. The self-employed are a heterogeneous group of individuals. We suggest development of specific strategies that focus on workers performing "Physical work" to improve the health and safety of self-employed workers in Korea. © 2018 Wiley Periodicals, Inc.

  6. Impact of technological innovation on a nursing home performance and on the medication-use process safety.

    PubMed

    Baril, Chantal; Gascon, Viviane; Brouillette, Christel

    2014-03-01

    Despite the fact that since 1985 the government of Québec increased by 5.75 % on average the amount of money spent on healthcare per year, little improvement was noted. It is obvious that an optimal use of resources is essential to reduce waiting times and provide safer and faster services to patients. The use of new technology can contribute to improve the healthcare system efficiency. Our study aims to assess the impact of a medication distribution technology on 1) the performance of a health and social services center's pharmacy, 2) the performance of one care unit in a nursing home and on 3) the medication-use process safety. To measure performance we were inspired by the Lean approach. The results show that medication distribution technology is considered as an effective way to significantly detect medication errors, to allow nurses to focus more on patients and pharmacy to react more rapidly to changes in patient medications.

  7. [Process management in the hospital pharmacy for the improvement of the patient safety].

    PubMed

    Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D

    2013-01-01

    To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

  8. An interprofessional training course in crises and human factors for perioperative teams.

    PubMed

    Stephens, Tim; Hunningher, Annie; Mills, Helen; Freeth, Della

    2016-09-01

    Improving patient safety and the culture of care are health service priorities that coexist with financial pressures on organisations. Research suggests team training and better team processes can improve team culture, safety, performance, and clinical outcomes, yet opportunities for interprofessional learning remain scarce. Perioperative practitioners work in a high pressure, high-risk environment without the benefits of stable team membership: this limits opportunities and momentum for team-initiated collaborative improvements. This article describes an interprofessional course focused on crises and human factors which comprised a 1-day event and a multifaceted sustainment programme for perioperative practitioners, grouped by surgical specialty. Participants reported increased understanding and confidence to enact processes and behaviours that support patient safety, including: team behaviours (communication, coordination, cooperation and back-up, leadership, situational awareness); recognising different perspectives and expectations within the team; briefing and debriefing; after action review; and using specialty-specific incident reports to generate specialty-specific interprofessional improvement plans. Participants valued working with specialty colleagues away from normal work pressures. In the high-pressure arena of front-line healthcare delivery, improving patient safety and theatre efficiency can often be erroneously considered conflicting agendas. Interprofessional collaboration amongst staff participating in this initiative enabled general and specialty-specific interprofessional learning that transcended this conflict.

  9. A multidisciplinary three-phase approach to improve the clinical utility of patient safety indicators.

    PubMed

    Najjar, Peter; Kachalia, Allen; Sutherland, Tori; Beloff, Jennifer; David-Kasdan, Jo Ann; Bates, David W; Urman, Richard D

    2015-01-01

    The AHRQ Patient Safety Indicators (PSIs) are used for calculation of risk-adjusted postoperative rates for adverse events. The payers and quality consortiums are increasingly requiring public reporting of hospital performance on these metrics. We discuss processes designed to improve the accuracy and clinical utility of PSI reporting in practice. The study was conducted at a 793-bed tertiary care academic medical center where PSI processes have been aggressively implemented to track patient safety events at discharge. A three-phased approach to improving administrative data quality was implemented. The initiative consisted of clinical review of all PSIs, documentation improvement, and provider outreach including active querying for patient safety events. This multidisciplinary effort to develop a streamlined process for PSI calculation reduced the reporting of miscoded PSIs and increased the clinical utility of PSI monitoring. Over 4 quarters, 4 of 41 (10%) PSI-11 and 9 of 138 (7%) PSI-15 errors were identified on review of clinical documentation and appropriate adjustments were made. A multidisciplinary, phased approach leveraging existing billing infrastructure for robust metric coding, ongoing clinical review, and frontline provider outreach is a novel and effective way to reduce the reporting of false-positive outcomes and improve the clinical utility of PSIs.

  10. A multicenter trial of aviation-style training for surgical teams.

    PubMed

    Catchpole, Ken R; Dale, Trevor J; Hirst, D Guy; Smith, J Phillip; Giddings, Tony A E B

    2010-09-01

    This study measured the effect of aviation-style team training on 3 surgical teams from different specialties. It focused on team working and communication, particularly briefing, time-out, and debriefing, and sought to understand how improvements in team skills could be implemented in a broad range of naturalistic surgical environments to improve safety, quality, and efficiency. Surgical teams performing maxillofacial, vascular, and neurosurgery were studied during 112 operations: 51 before and 61 after intervention. Human factors experts delivered the training of up to 2 days in the classroom followed by 6 days of coaching in theater for each team. Trained observers measured teamwork using the Oxford NOTECHS and the frequency of preoperative briefings, pre-incision time-outs, and postoperative debriefings. The Safety Attitudes Questionnaire and ethnographic observations were used to provide contextual details. There were significantly more time-outs (chi = 18.17, P < 0.001), briefings (chi = 8.62, P = 0.004), and debriefings (chi = 8.58, P = 0.004) after the intervention. The NOTECHS scores showed an interaction between site and intervention (F2,106 = 7.57, P = 0.001). The Safety Attitudes Questionnaire and ethnographic observations helped understand these differences. Aviation-style teamwork training can increase compliance and team performance, but this was influenced by the attitude and collaboration of key individuals, and the effect was reduced by significant latent failures. This study demonstrates the need to improve organizational and personal management factors in the National Health Service if training in patient safety is to be effective and sustained. It also shows the influence of working conditions on clinical studies of quality improvement.

  11. A cross-sectional study to assess the patient safety culture in the Palestinian hospitals: a baseline assessment for quality improvement.

    PubMed

    Elsous, Aymen; Akbari Sari, Ali; Rashidian, Arash; Aljeesh, Yousef; Radwan, Mahmoud; AbuZaydeh, Hatem

    2016-12-01

    To measure and establish a baseline assessment of the patient safety culture in the Palestinian hospitals. A cross-sectional descriptive study using the Arabic version of the Safety Attitude Questionnaire (Short Form 2006). A total of 339 nurses and physicians returned the questionnaire out of 370 achieving a response rate of 91.6%. Four public general hospitals in the Gaza Strip, Palestine. Nurses and physicians were randomly selected using a proportionate random sampling. Data analysis performed using Statistical Package for the Social Sciences software version 20, and p value less than 0.05 was statistically significant. Current status of patient safety culture among healthcare providers and percentage of positive attitudes. Male to female ratio was 2.16:1, and mean age was 36.5 ± 9.4 years. The mean score of Arabic Safety Attitude Questionnaire across the six dimensions on 100-point scale ranged between 68.5 for Job Satisfaction and 48.5 for Working Condition. The percentage of respondents holding a positive attitude was 34.5% for Teamwork Climate, 28.4% for Safety Climate, 40.7% for Stress Recognition, 48.8% for Job Satisfaction, 11.3% for Working Conditions and 42.8% for Perception of Management. Healthcare workers holding positive attitudes had better collaboration with co-workers than those without positive attitudes. Findings are useful to formulate a policy on patient safety culture and targeted a specific safety culture dimension to improve the safety of patients and improve the clinical outcomes within healthcare organisations.

  12. Safety and Efficacy of Rivastigmine in Adolescents with Down Syndrome: Long-Term Follow-Up

    PubMed Central

    Spiridigliozzi, Gail A.; Crissman, Blythe G.; McKillop, Jane Anne; Yamamoto, Haru; Kishnani, Priya S.

    2010-01-01

    Abstract Following the completion of a 20-week, open-label study of the safety and efficacy of liquid rivastigmine for adolescents with Down syndrome, 5 of the 10 adolescents in the clinical trial continued long-term rivastigmine therapy and 5 did not. After an average period of 38 months, all 10 subjects returned for a follow-up assessment to determine the safety and efficacy of long-term rivastigmine use. Rivastigmine was well tolerated and overall health appeared to be unaffected by long-term rivastigmine use. Performance change on cognitive and language measures administered at the termination of the open-label clinical trial was compared between the two groups. No between-group difference in median performance change across the long-term period was found, suggesting that the long-term use of rivastigmine does not improve cognitive and language performance. However, two subjects demonstrated remarkable improvement in adaptive function over the long-term period. Both subjects had received long-term rivastigmine therapy. The discussion addresses the challenge of assessing cognitive change in clinical trials using adolescents with Down syndrome as subjects and the use of group versus individual data to evaluate the relevance of medication effects. PMID:21186971

  13. Road safety issues for bus transport management.

    PubMed

    Cafiso, Salvatore; Di Graziano, Alessandro; Pappalardo, Giuseppina

    2013-11-01

    Because of the low percentage of crashes involving buses and the assumption that public transport improves road safety by reducing vehicular traffic, public interest in bus safety is not as great as that in the safety of other types of vehicles. It is possible that less attention is paid to the significance of crashes involving buses because the safety level of bus systems is considered to be adequate. The purpose of this study was to evaluate the knowledge and perceptions of bus managers with respect to safety issues and the potential effectiveness of various technologies in achieving higher safety standards. Bus managers were asked to give their opinions on safety issues related to drivers (training, skills, performance evaluation and behaviour), vehicles (maintenance and advanced devices) and roads (road and traffic safety issues) in response to a research survey. Kendall's algorithm was used to evaluate the level of concordance. The results showed that the majority of the proposed items were considered to have great potential for improving bus safety. The data indicated that in the experience of the participants, passenger unloading and pedestrians crossing near bus stops are the most dangerous actions with respect to vulnerable users. The final results of the investigation showed that start inhibition, automatic door opening, and the materials and internal architecture of buses were considered the items most strongly related to bus passenger safety. Brake assistance and vehicle monitoring systems were also considered to be very effective. With the exception of driver assistance systems for passenger and pedestrian safety, the perceptions of the importance of other driver assistance systems for vehicle monitoring and bus safety were not unanimous among the bus company managers who participated in this survey. The study results showed that the introduction of new technologies is perceived as an important factor in improving bus safety, but a better understanding of their actual effectiveness and related risk factor avoidance must be developed to permit their useful implementation in bus fleets. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial.

    PubMed

    Troche, M S; Okun, M S; Rosenbek, J C; Musson, N; Fernandez, H H; Rodriguez, R; Romrell, J; Pitts, T; Wheeler-Hegland, K M; Sapienza, C M

    2010-11-23

    Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement. This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images. No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group. EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement. This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

  15. Physical performance of biodegradable films intended for antimicrobial food packaging.

    PubMed

    Marcos, Begonya; Aymerich, Teresa; Monfort, Josep M; Garriga, Margarita

    2010-10-01

    Antimicrobial films were prepared by including enterocins to alginate, polyvinyl alcohol (PVOH), and zein films. The physical performance of the films was assessed by measuring color, microstructure (SEM), water vapor permeability (WVP), and tensile properties. All studied biopolymers showed poor WVP and limited tensile properties. PVOH showed the best performance exhibiting the lowest WVP values, higher tensile properties, and flexibility among studied biopolymers. SEM of antimicrobial films showed increased presence of voids and pores as a consequence of enterocin addition. However, changes in microstructure did not disturb WVP of films. Moreover, enterocin-containing films showed slight improvement compared to control films. Addition of enterocins to PVOH films had a plasticizing effect, by reducing its tensile strength and increasing the strain at break. The presence of enterocins had an important effect on tensile properties of zein films by significantly reducing its brittleness. Addition of enterocins, thus, proved not to disturb the physical performance of studied biopolymers. Development of new antimicrobial biodegradable packaging materials may contribute to improving food safety while reducing environmental impact derived from packaging waste. Practical Application: Development of new antimicrobial biodegradable packaging materials may contribute to improving food safety while reducing environmental impact derived from packaging waste.

  16. Tracking Progress in Improving Diagnosis: A Framework for Defining Undesirable Diagnostic Events.

    PubMed

    Olson, Andrew P J; Graber, Mark L; Singh, Hardeep

    2018-01-29

    Diagnostic error is a prevalent, harmful, and costly phenomenon. Multiple national health care and governmental organizations have recently identified the need to improve diagnostic safety as a high priority. A major barrier, however, is the lack of standardized, reliable methods for measuring diagnostic safety. Given the absence of reliable and valid measures for diagnostic errors, we need methods to help establish some type of baseline diagnostic performance across health systems, as well as to enable researchers and health systems to determine the impact of interventions for improving the diagnostic process. Multiple approaches have been suggested but none widely adopted. We propose a new framework for identifying "undesirable diagnostic events" (UDEs) that health systems, professional organizations, and researchers could further define and develop to enable standardized measurement and reporting related to diagnostic safety. We propose an outline for UDEs that identifies both conditions prone to diagnostic error and the contexts of care in which these errors are likely to occur. Refinement and adoption of this framework across health systems can facilitate standardized measurement and reporting of diagnostic safety.

  17. Safety compliance and safety climate: A repeated cross-sectional study in the oil and gas industry.

    PubMed

    Kvalheim, Sverre A; Dahl, Øyvind

    2016-12-01

    Violations of safety rules and procedures are commonly identified as a causal factor in accidents in the oil and gas industry. Extensive knowledge on effective management practices related to improved compliance with safety procedures is therefore needed. Previous studies of the causal relationship between safety climate and safety compliance demonstrate that the propensity to act in accordance with prevailing rules and procedures is influenced to a large degree by workers' safety climate. Commonly, the climate measures employed differ from one study to another and identical measures of safety climate are seldom tested repeatedly over extended periods of time. This research gap is addressed in the present study. The study is based on a survey conducted four times among sharp-end workers of the Norwegian oil and gas industry (N=31,350). This is done by performing multiple tests (regression analysis) over a period of 7years of the causal relationship between safety climate and safety compliance. The safety climate measure employed is identical across the 7-year period. Taking all periods together, the employed safety climate model explained roughly 27% of the variance in safety compliance. The causal relationship was found to be stable across the period, thereby increasing the reliability and the predictive validity of the factor structure. The safety climate factor that had the most powerful effect on safety compliance was work pressure. The factor structure employed shows high predictive validity and should therefore be relevant to organizations seeking to improve safety in the petroleum sector. The findings should also be relevant to other high-hazard industries where safety rules and procedures constitute a central part of the approach to managing safety. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

  18. Underlying influence of perception of management leadership on patient safety climate in healthcare organizations - A mediation analysis approach.

    PubMed

    Weng, Shao-Jen; Kim, Seung-Hwan; Wu, Chieh-Liang

    2017-02-01

    We aim to draw insights on how medical staff's perception of management leadership affects safety climate with key safety related dimensions-teamwork climate, job satisfaction and working conditions. A cross-sectional survey using Safety Attitude Questionnaire (SAQ) was performed in a medical center in Taichung City, Taiwan. The relationships among the dimensions in SAQ were then analyzed by structural equation modeling with a mediation analysis. 2205 physicians and nurses of the medical center participated in the survey. Because not all questions in the survey are suitable for entire hospital staff, only the valid responses (n = 1596, response rate of 72%) were extracted for analysis. Key measures are the direct and indirect effects of teamwork climate, job satisfaction, perception of management leadership, and working conditions on safety climate. Outcomes show that effect of perception of management leadership on safety climate is significant (standardized indirect effect of 0.892 with P-value 0.002) and fully mediated by other dimensions, where 66.9% is mediated through teamwork climate, 24.1% through working conditions and 9.0% through job satisfaction. Our findings point to the importance of management leadership and the mechanism of its influence on safety climate. To improve safety climate, the implication is that commitment by management on leading safety improvement needs to be demonstrated when it implements daily supportive actions for other safety dimensions. For future improvement, development of a management system that can facilitate two-way trust between management and staff over the long term is recommended. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. Testing the effects of safety climate and disruptive children behavior on school bus drivers performance: A multilevel model.

    PubMed

    Zohar, Dov; Lee, Jin

    2016-10-01

    The study was designed to test a multilevel path model whose variables exert opposing effects on school bus drivers' performance. Whereas departmental safety climate was expected to improve driving safety, the opposite was true for in-vehicle disruptive children behavior. The driving safety path in this model consists of increasing risk-taking practices starting with safety shortcuts leading to rule violations and to near-miss events. The study used a sample of 474 school bus drivers in rural areas, driving children to school and school-related activities. Newly developed scales for measuring predictor, mediator and outcome variables were validated with video data taken from inner and outer cameras, which were installed in 29 buses. Results partially supported the model by indicating that group-level safety climate and individual-level children distraction exerted opposite effects on the driving safety path. Furthermore, as hypothesized, children disruption moderated the strength of the safety rule violation-near miss relationship, resulting in greater strength under high disruptiveness. At the same time, the hypothesized interaction between the two predictor variables was not supported. Theoretical and practical implications for studying safety climate in general and distracted driving in particular for professional drivers are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Technology Overview for Advanced Aircraft Armament System Program.

    DTIC Science & Technology

    1981-05-01

    availability of methods or systems for improving stores and armament safety. Of particular importance are aspects of safety involving hazards analysis ...flutter virtually insensitive to inertia and center-of- gravity location of store - Simplifies and reduces analysis and testing required to flutter- clear...status. Nearly every existing reliability analysis and discipline that prom- ised a positive return on reliability performance was drawn out, dusted

  1. New research opportunities for roadside safety barriers improvement

    NASA Astrophysics Data System (ADS)

    Cantisani, Giuseppe; Di Mascio, Paola; Polidori, Carlo

    2017-09-01

    Among the major topics regarding the protection of roads, restraint systems still represent a big opportunity in order to increase safety performances. When accidents happen, in fact, the infrastructure can substantially contribute to the reduction of consequences if its marginal spaces are well designed and/or effective restraint systems are installed there. Nevertheless, basic concepts and technology of road safety barriers have not significantly changed for the last two decades. The paper proposes a new approach to the study aimed to define possible enhancements of restraint safety systems performances, by using new materials and defining innovative design principles. In particular, roadside systems can be developed with regard to vehicle-barrier interaction, vehicle-oriented design (included low-mass and extremely low-mass vehicles), traffic suitability, user protection, working width reduction. In addition, thanks to sensors embedded into the barriers, it is also expected to deal with new challenges related to the guidance of automatic vehicles and I2V communication.

  2. Structural equation model to investigate the dimensions influencing safety culture improvement in construction sector: A case in Indonesia

    NASA Astrophysics Data System (ADS)

    Machfudiyanto, Rossy Armyn; Latief, Yusuf; Yogiswara, Yoko; Setiawan, R. Mahendra Fitra

    2017-06-01

    In facing the ASEAN Economic Community, the level of prevailing working accidents becomes one of the competitiveness factors among the companies. A construction industry is one of the industries prone to high level of accidents. Improving the safety record will not be completely effective unless the occupational safety and healthy culture is enhanced. The aim of this research was to develop a model and to conduct empirical investigation on the relationships among the dimensions of construction occupational safety culture. This research used the structural equation model as a means to examine the hypothesis of positive relationships between dimensions and objectives. The method used in this research was questionnaire survey which was distributed to the respondents from construction companies in a state-owned enterprise in Indonesia. Moreover, there were dimensions of occupational safety culture that was established, such as leadership, behavior, value, strategy, policy, process, employee, safety cost, and contract system. The results of this study indicated that all dimensions were significant and inter-related in forming the safety culture. The result of R2 yielded the safety performance was 54%, which means it was in low category and evaluation of policies on construction companies was required in addressing the issue of working accidents.

  3. TU-EF-BRD-03: Mental Workload and Performance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mazur, L.

    Research related to quality and safety has been a staple of medical physics academic activities for a long time. From very early on, medical physicists have developed new radiation measurement equipment and analysis techniques, created ever increasingly accurate dose calculation models, and have vastly improved imaging, planning, and delivery techniques. These and other areas of interest have improved the quality and safety of radiotherapy for our patients. With the advent of TG-100, quality and safety is an area that will garner even more research interest in the future. As medical physicists pursue quality and safety research in greater numbers, itmore » is worthwhile to consider what actually constitutes research on quality and safety. For example, should the development of algorithms for real-time EPID-based in-vivo dosimetry be defined as “quality and safety” research? How about the clinical implementation of such as system? Surely the application of failure modes and effects analysis to a clinical process would be considered quality and safety research, but is this type of research that should be included in the medical physics peer-reviewed literature? The answers to such questions are of critical importance to set researchers in a direction that will provide the greatest benefit to our field and the patients we serve. The purpose of this symposium is to consider what constitutes research in the arena of quality and safety and differentiate it from other research directions. The key distinction here is developing the tool itself (e.g. algorithms for EPID dosimetry) vs. studying the impact of the tool with some quantitative metric. Only the latter would I call quality and safety research. Issues of ‘basic’ versus ‘applied’ quality and safety research will be covered as well as how the research results should be structured to provide increasing levels of support that a quality and safety intervention is effective and sustainable. Examples from existing peer-reviewed research will be used to highlight the main points. Historical, medical physicists have leveraged many areas of applied physics, engineering and biology to improve radiotherapy. Research on quality and safety is another area where physicists can have an impact. The key to further progress is to clearly define what constitutes quality and safety research for those interested in doing such research and the reviewers of that research. Learning Objectives: List several tools of quality and safety with references to peer-reviewed literature. Describe effects of mental workload on performance. Outline research in quality and safety indicators and technique analysis. Understand what quality and safety research needs to be going forward. Understand the links between cooperative group trials and quality and safety research.« less

  4. Making time for learning-oriented leadership in multidisciplinary hospital management groups.

    PubMed

    Singer, Sara J; Hayes, Jennifer E; Gray, Garry C; Kiang, Mathew V

    2015-01-01

    Although the clinical requirements of health care delivery imply the need for interdisciplinary management teams to work together to promote frontline learning, such interdisciplinary, learning-oriented leadership is atypical. We designed this study to identify behaviors enabling groups of diverse managers to perform as learning-oriented leadership teams on behalf of quality and safety. We randomly selected 12 of 24 intact groups of hospital managers from one hospital to participate in a Safety Leadership Team Training program. We collected primary data from March 2008 to February 2010 including pre- and post-staff surveys, multiple interviews, observations, and archival data from management groups. We examined the level and trend in frontline perceptions of managers' learning-oriented leadership following the intervention and ability of management groups to achieve objectives on targeted improvement projects. Among the 12 intervention groups, we identified higher- and lower-performing intervention groups and behaviors that enabled higher performers to work together more successfully. Management groups that achieved more of their performance goals and whose staff perceived more and greater improvement in their learning-oriented leadership after participation in Safety Leadership Team Training invested in structures that created learning capacity and conscientiously practiced prescribed learning-oriented management and problem-solving behaviors. They made the time to do these things because they envisioned the benefits of learning, valued the opportunity to learn, and maintained an environment of mutual respect and psychological safety within their group. Learning in management groups requires vision of what learning can accomplish; will to explore, practice, and build learning capacity; and mutual respect that sustains a learning environment.

  5. Professional conceptualisation and accomplishment of patient safety in mental healthcare: an ethnographic approach

    PubMed Central

    2011-01-01

    Background This study seeks to broaden current understandings of what patient safety means in mental healthcare and how it is accomplished. We propose a qualitative observational study of how safety is produced or not produced in the complex context of everyday professional mental health practice. Such an approach intentionally contrasts with much patient safety research which assumes that safety is achieved and improved through top-down policy directives. We seek instead to understand and articulate the connections and dynamic interactions between people, materials, and organisational, legal, moral, professional and historical safety imperatives as they come together at particular times and places to perform safe or unsafe practice. As such we advocate an understanding of patient safety 'from the ground up'. Methods/Design The proposed project employs a six-phase data collection framework in two mental health settings: an inpatient unit and a community team. The first four phases comprise multiple modes of focussed, unobtrusive observation of professionals at work, to enable us to trace the conceptualisation and enactment of safety as revealed in dialogue and narrative, use of artefacts and space, bodily activity and patterns of movement, and in the accomplishment of specific work tasks. An interview phase and a social network analysis phase will subsequently be conducted to offer comparative perspectives on the observational data. This multi-modal and holistic approach to studying patient safety will complement existing research, which is dominated by instrumentalist approaches to discovering factors contributing to error, or developing interventions to prevent or manage adverse events. Discussion This ethnographic research framework, informed by the principles of practice theories and in particular actor-network ideas, provides a tool to aid the understanding of patient safety in mental healthcare. The approach is novel in that it seeks to articulate an 'anatomy of patient safety' as it actually occurs, in terms of the networks of elements coalescing to enable the conceptual and material performance of safety in mental health settings. By looking at how patient safety happens or does not happen, this study will enable us to better understand how we might in future productively tackle its improvement. PMID:21569572

  6. A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign.

    PubMed

    Doron, Shira I; Kifuji, Kayoko; Hynes, Brooke Tyson; Dunlop, Dan; Lemon, Tricia; Hansjosten, Karen; Cheung, Teresa; Curley, Barbara; Snydman, David R; Fairchild, David G

    2011-01-01

    Prevention of health care-associated infections starts with scrupulous hand hygiene (HH). Improving HH compliance is a major target for the World Health Organization Patient Safety Challenge and is one of The Joint Commission's National Patient Safety Goals. Yet, adherence to HH protocols is generally poor for health care professionals, despite interventions designed to improve compliance. At Tufts Medical Center (Boston), HH compliance rates were consistently low despite the presence of a traditional HH campaign that used communication and education. A comprehensive program incorporated strong commitment by hospital leadership-who were actively involved in responsibilities previously only performed by infection preventionists and quality and patient safety staff-dedication of financial resources, including securing a grant; collaborating with a private advertising firm in a marketing campaign; and employing a multifaceted approach to education, observation, and feedback. This campaign resulted in a rapid and sustained improvement in HH compliance: Compared with the mean HH compliance rate for the six months before the campaign (72%), postcampaign HH compliance (mean = 94%) was significantly greater (p < .0001). Factors contributing to the success of the campaign included the development of the marketing campaign to fit this academic medical center's particular culture, strong support from the medical center leadership, a multifaceted educational approach, and monthly feedback on HH compliance. A comprehensive campaign resulted in rapid and sustained improvement in HH compliance at an academic medical center after traditional communication and education strategies failed to improve HH performance.

  7. Modeling the factors affecting unsafe behavior in the construction industry from safety supervisors' perspective.

    PubMed

    Khosravi, Yahya; Asilian-Mahabadi, Hassan; Hajizadeh, Ebrahim; Hassanzadeh-Rangi, Narmin; Bastani, Hamid; Khavanin, Ali; Mortazavi, Seyed Bagher

    2014-01-01

    There can be little doubt that the construction is the most hazardous industry in the worldwide. This study was designed to modeling the factors affecting unsafe behavior from the perspective of safety supervisors. The qualitative research was conducted to extract a conceptual model. A structural model was then developed based on a questionnaire survey (n=266) by two stage Structural Equation Model (SEM) approach. An excellent confirmed 12-factors structure explained about 62% of variances unsafe behavior in the construction industry. A good fit structural model indicated that safety climate factors were positively correlated with safety individual factors (P<0.001) and workplace safety condition (P<0.001). The workplace safety condition was found to play a strong mediating role in linking the safety climate and construction workers' engagement in safe or unsafe behavior. In order to improve construction safety performance, more focus on the workplace condition is required.

  8. Safety evaluation of joint and conventional lane merge configurations for freeway work zones.

    PubMed

    Ishak, Sherif; Qi, Yan; Rayaprolu, Pradeep

    2012-01-01

    Inefficient operation of traffic in work zone areas not only leads to an increase in travel time delays, queue length, and fuel consumption but also increases the number of forced merges and roadway accidents. This study evaluated the safety performance of work zones with a conventional lane merge (CLM) configuration in Louisiana. Analysis of variance (ANOVA) was used to compare the crash rates for accidents involving fatalities, injuries, and property damage only (PDO) in each of the following 4 areas: (1) advance warning area, (2) transition area, (3) work area, and (4) termination area. The analysis showed that the advance warning area had higher fatality, injury, and PDO crash rates when compared to the transition area, work area, and termination area. This finding confirmed the need to make improvements in the advance warning area where merging maneuvers take place. Therefore, a new lane merge configuration, called joint lane merge (JLM), was proposed and its safety performance was examined and compared to the conventional lane merge configuration using a microscopic simulation model (VISSIM), which was calibrated with real-world data from an existing work zone on I-55 and used to simulate a total of 25 different scenarios with different levels of demand and traffic composition. Safety performance was evaluated using 2 surrogate measures: uncomfortable decelerations and speed variance. Statistical analysis was conducted to determine whether the differences in safety performance between both configurations were significant. The safety analysis indicated that JLM outperformed CLM in most cases with low to moderate flow rates and that the percentage of trucks did not have a significant impact on the safety performance of either configuration. Though the safety analysis did not clearly indicate which lane merge configuration is safer for the overall work zone area, it was able to identify the possibly associated safety changes within the work zone area under different traffic conditions. Copyright © 2012 Taylor & Francis Group, LLC

  9. State-of-the-art and emerging technologies for atrial fibrillation ablation.

    PubMed

    Dewire, Jane; Calkins, Hugh

    2010-03-01

    Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups-particularly those with long-standing persistent AF-has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.

  10. Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance.

    PubMed

    Jinnett, Kimberly; Schwatka, Natalie; Tenney, Liliana; Brockbank, Claire V S; Newman, Lee S

    2017-02-01

    An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Energy Storage Technology Development for Space Exploration

    NASA Technical Reports Server (NTRS)

    Mercer, Carolyn R.; Jankovsky, Amy L.; Reid, Concha M.; Miller, Thomas B.; Hoberecht, Mark A.

    2011-01-01

    The National Aeronautics and Space Administration is developing battery and fuel cell technology to meet the expected energy storage needs of human exploration systems. Improving battery performance and safety for human missions enhances a number of exploration systems, including un-tethered extravehicular activity suits and transportation systems including landers and rovers. Similarly, improved fuel cell and electrolyzer systems can reduce mass and increase the reliability of electrical power, oxygen, and water generation for crewed vehicles, depots and outposts. To achieve this, NASA is developing non-flow-through proton-exchange-membrane fuel cell stacks, and electrolyzers coupled with low permeability membranes for high pressure operation. The primary advantage of this technology set is the reduction of ancillary parts in the balance-of-plant fewer pumps, separators and related components should result in fewer failure modes and hence a higher probability of achieving very reliable operation, and reduced parasitic power losses enable smaller reactant tanks and therefore systems with lower mass and volume. Key accomplishments over the past year include the fabrication and testing of several robust, small-scale non-flow-through fuel cell stacks that have demonstrated proof-of-concept. NASA is also developing advanced lithium-ion battery cells, targeting cell-level safety and very high specific energy and energy density. Key accomplishments include the development of silicon composite anodes, lithiatedmixed- metal-oxide cathodes, low-flammability electrolytes, and cell-incorporated safety devices that promise to substantially improve battery performance while providing a high level of safety.

  12. The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities.

    PubMed

    Paxton, Elizabeth W; Inacio, Maria Cs; Kiley, Mary-Lou

    2012-01-01

    Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research.

  13. Three Reflections on Assessing Safety Training Needs: A Case Study

    ERIC Educational Resources Information Center

    Sleezer, Catherine M.; Kelsey, Kathleen D.; Wood, Thomas E.

    2008-01-01

    Needs assessment plays an important role in training and human performance improvement efforts, but the literature contains little research on this topic. This study extended previous research on the Performance Analysis for Training (PAT) model of needs assessment by examining its implementation to determine environmental and occupational health…

  14. [Nursing professionals and health care assistants' perception of patient safety culture in the operating room].

    PubMed

    Bernalte-Martí, Vicente; Orts-Cortés, María Isabel; Maciá-Soler, Loreto

    2015-01-01

    To assess nursing professionals and health care assistants' perceptions, opinions and behaviours on patient safety culture in the operating room of a public hospital of the Spanish National Health Service. To describe strengths and weaknesses or opportunities for improvement according to the Agency for Healthcare Research and Quality criteria, as well as to determine the number of events reported. A descriptive, cross-sectional study was conducted using the Spanish version of the questionnaire Hospital Survey on Patient Safety Culture. The sample consisted of nursing professionals, who agreed to participate voluntarily in this study and met the selection criteria. A descriptive and inferential analysis was performed depending on the nature of the variables and the application conditions of statistical tests. Significance if p < .05. In total, 74 nursing professionals responded (63.2%). No strengths were found in the operating theatre, and improvements are needed concerning staffing (64.0%), and hospital management support for patient safety (52.9%). A total of 52.3% (n = 65) gave patient safety a score from 7 to 8.99 (on a 10 point scale); 79.7% (n = 72) reported no events last year. The total variance explained by the regression model was 0.56 for "Frequency of incident reporting" and 0.26 for "Overall perception of safety". There was a more positive perception of patient safety culture at unit level. Weaknesses have been identified, and they can be used to design specific intervention activities to improve patient safety culture in other nearby operating theatres. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  15. Open wide: looking into the safety culture of dental school clinics.

    PubMed

    Ramoni, Rachel; Walji, Muhammad F; Tavares, Anamaria; White, Joel; Tokede, Oluwabunmi; Vaderhobli, Ram; Kalenderian, Elsbeth

    2014-05-01

    Although dentists perform highly technical procedures in complex environments, patient safety has not received the same focus in dentistry as in medicine. Cultivating a robust patient safety culture is foundational to minimizing patient harm, but little is known about how dental teams view patient safety or the patient safety culture within their practice. As a step toward rectifying that omission, the goals of this study were to benchmark the patient safety culture in three U.S. dental schools, identifying areas for improvement. The extensively validated Medical Office Survey on Patient Safety Culture (MOSOPS), developed by the Agency for Healthcare Research and Quality, was administered to dental faculty, dental hygienists, dental students, and staff at the three schools. Forty-seven percent of the 328 invited individuals completed the survey. The "Teamwork" category received the highest marks and "Patient Care Tracking and Follow-Up" and "Leadership Support for Patient Safety" the lowest. Only 48 percent of the respondents rated systems and processes in place to prevent/catch patient problems as good/excellent. All patient safety dimensions received lower marks than in medical practices. These findings and the inherent risk associated with dental procedures lead to the conclusion that dentistry in general, and academic dental clinics in particular, stands to benefit from an increased focus on patient safety. This first published use of the MOSOPS in a dental clinic setting highlights both clinical and educational priorities for improving the safety of care in dental school clinics.

  16. Effects of turning and through lane sharing on traffic performance at intersections

    NASA Astrophysics Data System (ADS)

    Li, Xiang; Sun, Jian-Qiao

    2016-02-01

    Turning vehicles strongly influence traffic flows at intersections. Effective regulation of turning vehicles is important to achieve better traffic performance. This paper studies the impact of lane sharing and turning signals on traffic performance at intersections by using cellular automata. Both right-turn and left-turn lane sharing are studied. Interactions between vehicles and pedestrians are considered. The transportation efficiency, road safety and energy economy are the traffic performance metrics. Extensive simulations are carried out to study the traffic performance indices. It is observed that shared turning lanes and permissive left-turn signal improve the transportation efficiency and reduce the fuel consumption in most cases, but the safety is usually sacrificed. It is not always beneficial for the through vehicles when they are allowed to be in the turning lanes.

  17. Mentoring Human Performance - 12480

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Geis, John A.; Haugen, Christian N.

    2012-07-01

    Although the positive effects of implementing a human performance approach to operations can be hard to quantify, many organizations and industry areas are finding tangible benefits to such a program. Recently, a unique mentoring program was established and implemented focusing on improving the performance of managers, supervisors, and work crews, using the principles of Human Performance Improvement (HPI). The goal of this mentoring was to affect behaviors and habits that reliably implement the principles of HPI to ensure continuous improvement in implementation of an Integrated Safety Management System (ISMS) within a Conduct of Operations framework. Mentors engaged with personnel inmore » a one-on-one, or one-on-many dialogue, which focused on what behaviors were observed, what factors underlie the behaviors, and what changes in behavior could prevent errors or events, and improve performance. A senior management sponsor was essential to gain broad management support. A clear charter and management plan describing the goals, objectives, methodology, and expected outcomes was established. Mentors were carefully selected with senior management endorsement. Mentors were assigned to projects and work teams based on the following three criteria: 1) knowledge of the work scope; 2) experience in similar project areas; and 3) perceived level of trust they would have with project management, supervision, and work teams. This program was restructured significantly when the American Reinvestment and Recovery Act (ARRA) and the associated funding came to an end. The program was restructured based on an understanding of the observations, attributed successes and identified shortfalls, and the consolidation of those lessons. Mentoring the application of proven methods for improving human performance was shown effective at increasing success in day-to-day activities and increasing confidence and level of skill of supervisors. While mentoring program effectiveness is difficult to measure, and return on investment is difficult to quantify, especially in complex and large organizations where the ability to directly correlate causal factors can be challenging, the evidence presented by Sydney Dekker, James Reason, and others who study the field of human factors does assert managing and reducing error is possible. Employment of key behaviors-HPI techniques and skills-can be shown to have a significant impact on error rates. Our mentoring program demonstrated reduced error rates and corresponding improvements in safety and production. Improved behaviors are the result, of providing a culture with consistent, clear expectations from leadership, and processes and methods applied consistently to error prevention. Mentoring, as envisioned and executed in this program, was effective in helping shift organizational culture and effectively improving safety and production. (authors)« less

  18. Serotonin 2C receptor antagonist improves fear discrimination and subsequent safety signal recall

    PubMed Central

    Foilb, Allison R.; Christianson, John P.

    2015-01-01

    The capacity to discriminate between safety and danger is fundamental for survival, but is disrupted in individuals with posttraumatic stress disorder (PTSD). Acute stressors cause a release of serotonin (5-HT) in the forebrain, which is one mechanism for enhanced fear and anxiety; these effects are mediated by the 5-HT2C receptor. Using a fear discrimination paradigm where a danger signal conditioned stimulus (CS+) coterminates with a mild footshock and a safety signal (CS-) indicates the absence of shock, we demonstrate that danger/safety discrimination and fear inhibition develops over the course of 4 daily conditioning sessions. Systemic administration of the 5-HT2C receptor antagonist SB 242084 (0.25 or 1.0 mg/kg) prior to conditioning reduced behavioral freezing during conditioning, improved learning and subsequent inhibition of fear by the safety signal. Discrimination was apparent in the first recall test, and discrimination during training was evident after 3 days of conditioning versus 5 days in the vehicle treated controls. These results suggest a novel therapeutic use for 5-HT2C receptor antagonists to improve learning under stressful circumstances. Potential anatomical loci for 5-HT2C receptor modulation of fear discrimination learning and cognitive performance enhancement are discussed. PMID:26344640

  19. 76 FR 3211 - Federal Motor Vehicle Safety Standards, Ejection Mitigation; Phase-In Reporting Requirements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-19

    ... be tethered near the base of the vehicle's pillars or otherwise designed to keep the impactor within... performance and occupant behavior, and with the FHWA taking the lead, improving roadway designs. Vehicle... remaining in the vehicle during a rollover included improved roof crush resistance and research on whether...

  20. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients.

    PubMed

    Belcaro, Gianni; Cesarone, Maria Rosaria; Dugall, Mark; Pellegrini, Luciano; Ledda, Andrea; Grossi, Maria Giovanna; Togni, Stefano; Appendino, Giovanni

    2010-12-01

    In a previous three-month study of Meriva, a proprietary curcumin-phosphatidylcholine phytosome complex, decreased joint pain and improvement in joint function were observed in 50 osteoarthritis (OA) patients. Since OA is a chronic condition requiring prolonged treatment, the long-term efficacy and safety of Meriva were investigated in a longer (eight months) study involving 100 OA patients. The clinical end points (Western Ontario and McMaster Universities [WOMAC] score, Karnofsky Performance Scale Index, and treadmill walking performance) were complemented by the evaluation of a series of inflammatory markers (interleukin [IL]-1beta, IL-6, soluble CD40 ligand [sCD40L], soluble vascular cell adhesion molecule (sVCAM)-1, and erythrocyte sedimentation rate [ESR]). This represents the most ambitious attempt, to date, to evaluate the clinical efficacy and safety of curcumin as an anti-inflammatory agent. Significant improvements of both the clinical and biochemical end points were observed for Meriva compared to the control group. This, coupled with an excellent tolerability, suggests that Meriva is worth considering for the long-term complementary management of osteoarthritis.

  1. Importance of awareness in improving performance of emergency medical services (EMS) systems in enhancing traffic safety: A lesson from India.

    PubMed

    Vasudevan, Vinod; Singh, Preeti; Basu, Samyajit

    2016-10-02

    India has been slow in implementing a central emergency medical services (EMS) system across the country. "108 services" is one of the most popular services that is functional under the public-private partnership model. Limited available literature shows that despite access to services, many traffic crash victims are transported using private vehicles. The objective of this study is to understand the effectiveness of 108 services from a traffic safety perspective. A questionnaire survey is conducted to understand the awareness of EMS and their function. Using traffic-related fatalities as the dependent variable, a fixed effect panel data model is developed to analyze the effectiveness of the 108 services in improving the traffic safety. The results from the survey show that, in general, people are not aware of the 108 services. A majority of the population prefers taking victims to the hospital using their personal vehicles or any other vehicles available compared to calling an ambulance. Results from panel data analysis show that despite having an efficient system, these services failed to make significant improvement in the safety of road users in the states in which their services were subscribed. The lack of awareness of an important safety service is alarming. This could be a major reason for lower utilization of 108 services for transporting victims of traffic crashes. This article shows the importance of having efficient awareness campaigns to improve the efficiency of any similar programs that are aimed to enhance the safety of a region.

  2. Preliminary Evaluation of an Aviation Safety Thesaurus' Utility for Enhancing Automated Processing of Incident Reports

    NASA Technical Reports Server (NTRS)

    Barrientos, Francesca; Castle, Joseph; McIntosh, Dawn; Srivastava, Ashok

    2007-01-01

    This document presents a preliminary evaluation the utility of the FAA Safety Analytics Thesaurus (SAT) utility in enhancing automated document processing applications under development at NASA Ames Research Center (ARC). Current development efforts at ARC are described, including overviews of the statistical machine learning techniques that have been investigated. An analysis of opportunities for applying thesaurus knowledge to improving algorithm performance is then presented.

  3. Patient safety culture assessment in oman.

    PubMed

    Al-Mandhari, Ahmed; Al-Zakwani, Ibrahim; Al-Kindi, Moosa; Tawilah, Jihane; Dorvlo, Atsu S S; Al-Adawi, Samir

    2014-07-01

    To illustrate the patient safety culture in Oman as gleaned via 12 indices of patient safety culture derived from the Hospital Survey on Patient Safety Culture (HSPSC) and to compare the average positive response rates in patient safety culture between Oman and the USA, Taiwan, and Lebanon. This was a cross-sectional research study employed to gauge the performance of HSPSC safety indices among health workers representing five secondary and tertiary care hospitals in the northern region of Oman. The participants (n=398) represented different professional designations of hospital staff. Analyses were performed using univariate statistics. The overall average positive response rate for the 12 patient safety culture dimensions of the HSPSC survey in Oman was 58%. The indices from HSPSC that were endorsed the highest included 'organizational learning and continuous improvement' while conversely, 'non-punitive response to errors' was ranked the least. There were no significant differences in average positive response rates between Oman and the United States (58% vs. 61%; p=0.666), Taiwan (58% vs. 64%; p=0.386), and Lebanon (58% vs. 61%; p=0.666). This study provides the first empirical study on patient safety culture in Oman which is similar to those rates reported elsewhere. It highlights the specific strengths and weaknesses which may stem from the specific milieu prevailing in Oman.

  4. Improving safety in pavement field testing.

    DOT National Transportation Integrated Search

    2017-09-15

    The Florida Department of Transportation (FDOT) collects pavement condition and performance data each year, using both site-specific equipment that requires temporary traffic control (TTC) operations (either moving or closed operations) and full-size...

  5. Ontology-Based Architecture for Intelligent Transportation Systems Using a Traffic Sensor Network.

    PubMed

    Fernandez, Susel; Hadfi, Rafik; Ito, Takayuki; Marsa-Maestre, Ivan; Velasco, Juan R

    2016-08-15

    Intelligent transportation systems are a set of technological solutions used to improve the performance and safety of road transportation. A crucial element for the success of these systems is the exchange of information, not only between vehicles, but also among other components in the road infrastructure through different applications. One of the most important information sources in this kind of systems is sensors. Sensors can be within vehicles or as part of the infrastructure, such as bridges, roads or traffic signs. Sensors can provide information related to weather conditions and traffic situation, which is useful to improve the driving process. To facilitate the exchange of information between the different applications that use sensor data, a common framework of knowledge is needed to allow interoperability. In this paper an ontology-driven architecture to improve the driving environment through a traffic sensor network is proposed. The system performs different tasks automatically to increase driver safety and comfort using the information provided by the sensors.

  6. Ontology-Based Architecture for Intelligent Transportation Systems Using a Traffic Sensor Network

    PubMed Central

    Fernandez, Susel; Hadfi, Rafik; Ito, Takayuki; Marsa-Maestre, Ivan; Velasco, Juan R.

    2016-01-01

    Intelligent transportation systems are a set of technological solutions used to improve the performance and safety of road transportation. A crucial element for the success of these systems is the exchange of information, not only between vehicles, but also among other components in the road infrastructure through different applications. One of the most important information sources in this kind of systems is sensors. Sensors can be within vehicles or as part of the infrastructure, such as bridges, roads or traffic signs. Sensors can provide information related to weather conditions and traffic situation, which is useful to improve the driving process. To facilitate the exchange of information between the different applications that use sensor data, a common framework of knowledge is needed to allow interoperability. In this paper an ontology-driven architecture to improve the driving environment through a traffic sensor network is proposed. The system performs different tasks automatically to increase driver safety and comfort using the information provided by the sensors. PMID:27537878

  7. Demonstration of emulator-based Bayesian calibration of safety analysis codes: Theory and formulation

    DOE PAGES

    Yurko, Joseph P.; Buongiorno, Jacopo; Youngblood, Robert

    2015-05-28

    System codes for simulation of safety performance of nuclear plants may contain parameters whose values are not known very accurately. New information from tests or operating experience is incorporated into safety codes by a process known as calibration, which reduces uncertainty in the output of the code and thereby improves its support for decision-making. The work reported here implements several improvements on classic calibration techniques afforded by modern analysis techniques. The key innovation has come from development of code surrogate model (or code emulator) construction and prediction algorithms. Use of a fast emulator makes the calibration processes used here withmore » Markov Chain Monte Carlo (MCMC) sampling feasible. This study uses Gaussian Process (GP) based emulators, which have been used previously to emulate computer codes in the nuclear field. The present work describes the formulation of an emulator that incorporates GPs into a factor analysis-type or pattern recognition-type model. This “function factorization” Gaussian Process (FFGP) model allows overcoming limitations present in standard GP emulators, thereby improving both accuracy and speed of the emulator-based calibration process. Calibration of a friction-factor example using a Method of Manufactured Solution is performed to illustrate key properties of the FFGP based process.« less

  8. Sustaining Teamwork Behaviors Through Reinforcement of TeamSTEPPS Principles.

    PubMed

    Lee, Soo-Hoon; Khanuja, Harpal S; Blanding, Renee J; Sedgwick, Jeanne; Pressimone, Kathleen; Ficke, James R; Jones, Lynne C

    2017-10-30

    Teamwork training improves short-term teamwork behaviors. However, improvements are often not sustained. The purpose of this study was to explore the extent to which teamwork reinforcement activities for orthopedic surgery teams lead to sustained teamwork behaviors. Seven months after 104 staff from an orthopedic surgical unit were trained in Team Strategies and Tools to Enhance Performance and Patient Safety principles, 4 reinforcement activities were implemented regarding leadership and communication: lectures with videos on leadership skills for nursing staff; an online self-paced learning program on communication skills for nursing staff; a 1-page summary on leadership skills e-mailed to surgical staff; and a 1-hour perioperative grand rounds on Team Strategies and Tools to Enhance Performance and Patient Safety principles for anesthesia staff and new staff. Twenty-four orthopedic surgical teams were evaluated on teamwork behaviors during surgery by 2 observers before and after the reinforcement period using the Observational Teamwork Assessment for Surgery tool. After reinforcement, leadership (P = 0.022) and communication (P = 0.044) behaviors improved compared with prereinforcement levels. Specifically, nursing staff improved in leadership (P = 0.016) and communication (P = 0.028) behaviors, surgical staff improved in leadership behaviors (P = 0.009), but anesthesia staff did not improve in any teamwork behaviors. Sustained improvement in teamwork behaviors requires reinforcement. Level III, prospective pre-post cohort study.

  9. Effects of the Sunny Days, Healthy Ways Curriculum on Students in Grades 6–8

    PubMed Central

    Buller, David B.; Reynolds, Kim D.; Yaroch, Amy; Cutter, Gary R.; Hines, Joan M.; Geno, Cristy R.; Maloy, Julie A.; Brown, Melissa; Woodall, W. Gill; Grandpre, Joseph

    2006-01-01

    Background There are few effective sun safety education programs for use in secondary schools. The project aims were to create a sun safety curriculum for grades 6–9 and to test whether exposure to the curriculum would increase children’s sun protection behavior. Design A pair-matched group-randomized pretest-posttest controlled trial, with middle schools as the unit of randomization, was performed. Teachers implemented the six-unit sun safety curriculum in 2001–03 and analyses were performed in 2003–04. Setting/participants 2038 children from 30 middle schools in Colorado, New Mexico, and Arizona. Main outcome measures Self-reported sun protection behavior using frequency ratings and diary. Results Compared to control schools, children receiving the curriculum reported more frequent sun protection (p=0.0035), and a greater proportion wore long-sleeved shirts in during recess (p<0.0001) and applied sunscreen (p<0.0001). Exposure to the curriculum improved knowledge (p<0.0001), decreased perceived barriers to using sunscreen (p=0.0046), and enhanced self-efficacy expectations (p=0.0577) about sun safety, and reduced favorable attitudes toward sun tanning (p=0.0026 to <0.0001). In intent-to-treat analyses, the treatment effect was eliminated only under the most conservative assumptions about dropouts. Conclusions Educational approaches to sun safety in middle school may be effective for improving children’s sun safety. Potential trial limitations include measuring short-term outcomes, focusing on young adolescents, using active parental consent, and testing in the American southwest. PMID:16414419

  10. Stories from the Sharp End: Case Studies in Safety Improvement

    PubMed Central

    McCarthy, Douglas; Blumenthal, David

    2006-01-01

    Motivated by pressure and a wish to improve, health care organizations are implementing programs to improve patient safety. This article describes six natural experiments in health care safety that show where the safety field is heading and opportunities for and barriers to improvement. All these programs identified organizational culture change as critical to making patients safer, differing chiefly in their methods of creating a patient safety culture. Their goal is a safety culture that promotes continuing innovation and improvement, transcending whatever particular safety methodology is used. Policymakers could help stimulate a culture of safety by linking regulatory goals to safety culture expectations, sponsoring voluntary learning collaborations, rewarding safety improvements, better using publicly reported data, encouraging consumer involvement, and supporting research and education. PMID:16529572

  11. Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement

    PubMed Central

    Sites, Brian D.; Barrington, Michael J.; Davis, Matthew

    2014-01-01

    Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. Conclusions To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies. PMID:25275578

  12. Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

    PubMed

    Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

    2010-07-01

    To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

  13. Improving patient safety incident reporting systems by focusing upon feedback - lessons from English and Welsh trusts.

    PubMed

    Wallace, Louise M; Spurgeon, Peter; Benn, Jonathan; Koutantji, Maria; Vincent, Charles

    2009-08-01

    This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide.

  14. Patient safety culture: finding meaning in patient experiences.

    PubMed

    Bishop, Andrea C; Cregan, Brianna R

    2015-01-01

    The purpose of this paper is to determine what patient and family stories can tell us about patient safety culture within health care organizations and how patients experience patient safety culture. A total of 11 patient and family stories of adverse event experiences were examined in September 2013 using publicly available videos on the Canadian Patient Safety Insitute web site. Videos were transcribed verbatim and collated as one complete data set. Thematic analysis was used to perform qualitative inquiry. All qualitative analysis was done using NVivo 10 software. A total of three themes were identified: first, Being Passed Around; second, Not Having the Conversation; and third, the Person Behind the Patient. Results from this research also suggest that while health care organizations and providers might expect patients to play a larger role in managing their health, there may be underlying reasons as to why patients are not doing so. The findings indicate that patient experiences and narratives are useful sources of information to better understand organizational safety culture and patient experiences of safety while hospitalized. Greater inclusion and analysis of patient safety narratives is important in understanding the needs of patients and how patient safety culture interventions can be improved to ensure translation of patient safety strategies at the frontlines of care. Greater acknowledgement of the patient and family experience provides organizations with an integral perspective to assist in defining and addressing deficiencies within their patient safety culture and to identify opportunities for improvement.

  15. A predictive control framework for torque-based steering assistance to improve safety in highway driving

    NASA Astrophysics Data System (ADS)

    Ercan, Ziya; Carvalho, Ashwin; Tseng, H. Eric; Gökaşan, Metin; Borrelli, Francesco

    2018-05-01

    Haptic shared control framework opens up new perspectives on the design and implementation of the driver steering assistance systems which provide torque feedback to the driver in order to improve safety. While designing such a system, it is important to account for the human-machine interactions since the driver feels the feedback torque through the hand wheel. The controller should consider the driver's impact on the steering dynamics to achieve a better performance in terms of driver's acceptance and comfort. In this paper we present a predictive control framework which uses a model of driver-in-the-loop steering dynamics to optimise the torque intervention with respect to the driver's neuromuscular response. We first validate the system in simulations to compare the performance of the controller in nominal and model mismatch cases. Then we implement the controller in a test vehicle and perform experiments with a human driver. The results show the effectiveness of the proposed system in avoiding hazardous situations under different driver behaviours.

  16. Validation of tungsten cross sections in the neutron energy region up to 100 keV

    NASA Astrophysics Data System (ADS)

    Pigni, Marco T.; Žerovnik, Gašper; Leal, Luiz. C.; Trkov, Andrej

    2017-09-01

    Following a series of recent cross section evaluations on tungsten isotopes performed at Oak Ridge National Laboratory (ORNL), this paper presents the validation work carried out to test the performance of the evaluated cross sections based on lead-slowing-down (LSD) benchmarks conducted in Grenoble. ORNL completed the resonance parameter evaluation of four tungsten isotopes - 182,183,184,186W - in August 2014 and submitted it as an ENDF-compatible file to be part of the next release of the ENDF/B-VIII.0 nuclear data library. The evaluations were performed with support from the US Nuclear Criticality Safety Program in an effort to provide improved tungsten cross section and covariance data for criticality safety sensitivity analyses. The validation analysis based on the LSD benchmarks showed an improved agreement with the experimental response when the ORNL tungsten evaluations were included in the ENDF/B-VII.1 library. Comparison with the results obtained with the JEFF-3.2 nuclear data library are also discussed.

  17. Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses.

    PubMed

    Baldwin, Abigail; Rodriguez, Elizabeth S

    2016-02-01

    The prevalence of medication errors associated with chemotherapy administration is not precisely known. Little evidence exists concerning the extent or nature of errors; however, some evidence demonstrates that errors are related to prescribing. This article demonstrates how the review of chemotherapy orders by a designated nurse known as a verification nurse (VN) at a National Cancer Institute-designated comprehensive cancer center helps to identify prescribing errors that may prevent chemotherapy administration mistakes and improve patient safety in outpatient infusion units. This article will describe the role of the VN and details of the verification process. To identify benefits of the VN role, a retrospective review and analysis of chemotherapy near-miss events from 2009-2014 was performed. A total of 4,282 events related to chemotherapy were entered into the Reporting to Improve Safety and Quality system. A majority of the events were categorized as near-miss events, or those that, because of chance, did not result in patient injury, and were identified at the point of prescribing.

  18. [Changing of the patient safety culture in the pilot institutes of the Hungarian accreditation program].

    PubMed

    Lám, Judit; Merész, Gergő; Bakacsi, Gyula; Belicza, Éva; Surján, Cecília; Takács, Erika

    2016-10-01

    The accreditation system for health care providers was developed in Hungary aiming to increase safety, efficiency, and efficacy of care and optimise its organisational operation. The aim of this study was to assess changes of organisational culture in pilot institutes of the accreditation program. 7 volunteer pilot institutes using an internationally validated questionnaire were included. The impact study was performed in 2 rounds: the first before the introduction of the accreditation program, and the second a year later, when the standards were already known. Data were analysed using descriptive statistics and logistic regression models. Statistically significant (p<0.05) positive changes were detected in hospitals in three dimensions: organisational learning - continuous improvement, communication openness, teamwork within the unit while in outpatient clinics: overall perceptions of patient safety, and patient safety within the unit. Organisational culture in the observed institutes needs improvement, but positive changes already point to a safer care. Orv. Hetil., 2016, 157(42), 1667-1673.

  19. [In silico, in vitro, in omic experimental models and drug safety evaluation].

    PubMed

    Claude, Nancy; Goldfain-Blanc, Françoise; Guillouzo, André

    2009-01-01

    Over the last few decades, toxicology has benefited from scientific, technical, and bioinformatic developments relating to patient safety assessment during clinical and drug marketing studies. Based on this knowledge, new in silico, in vitro, and "omic" experimental models are emerging. Although these models cannot currently replace classic safety evaluations performed on laboratory animals, they allow compounds with unacceptable toxicity to be rejected in the early stages of drug development, thereby reducing the number of laboratory animals needed. In addition, because these models are particularly adapted to mechanistic studies, they can help to improve the relevance of the data obtained, thus enabling better prevention and screening of the adverse effects that may occur in humans. Much progress remains to be done, especially in the field of validation. Nevertheless, current efforts by industrial, academic laboratories, and regulatory agencies should, in coming years, significantly improve preclinical drug safety evaluation thanks to the integration of these new methods into the drug research and development process.

  20. Plan for Quality to Improve Patient Safety at the Point of Care

    PubMed Central

    Ehrmeyer, Sharon S.

    2011-01-01

    The U.S. Institute of Medicine (IOM) much publicized report in “To Err is Human” (2000, National Academy Press) stated that as many as 98 000 hospitalized patients in the U.S. die each year due to preventable medical errors. This revelation about medical error and patient safety focused the public and the medical community's attention on errors in healthcare delivery including laboratory and point-of-care-testing (POCT). Errors introduced anywhere in the POCT process clearly can impact quality and place patient's safety at risk. While POCT performed by or near the patient reduces the potential of some errors, the process presents many challenges to quality with its multiple tests sites, test menus, testing devices and non-laboratory analysts, who often have little understanding of quality testing. Incoherent or no regulations and the rapid availability of test results for immediate clinical intervention can further amplify errors. System planning and management of the entire POCT process are essential to reduce errors and improve quality and patient safety. PMID:21808107

  1. Fall Protection Characteristics of Safety Belts and Human Impact Tolerance.

    PubMed

    Hino, Yasumichi; Ohdo, Katsutoshi; Takahashi, Hiroki

    2014-08-23

    Many fatal accidents due to falls from heights have occurred at construction sites not only in Japan but also in other countries. This study aims to determine the fall prevention performance of two types of safety belts: a body belt 1) , which has been used for more than 40 yr in the Japanese construction industry as a general type of safety equipment for fall accident prevention, and a full harness 2, 3) , which has been used in many other countries. To determine human tolerance for impact trauma, this study discusses features of safety belts with reference 4-9) to relevant studies in the medical science, automobile crash safety, and aircrew safety. For this purpose, simple drop tests were carried out in a virtual workplace to measure impact load, head acceleration, and posture in the experiments, the Hybrid-III pedestrian model 10) was used as a human dummy. Hybrid-III is typically employed in official automobile crash tests (New Car Assessment Program: NCAP) and is currently recognized as a model that faithfully reproduces dynamic responses. Experimental results shows that safety performance strongly depends on both the variety of safety belts used and the shock absorbers attached onto lanyards. These findings indicate that fall prevention equipment, such as safety belts, lanyards, and shock absorbers, must be improved to reduce impact injuries to the human head and body during falls.

  2. Fall protection characteristics of safety belts and human impact tolerance.

    PubMed

    Hino, Yasumichi; Ohdo, Katsutoshi; Takahashi, Hiroki

    2014-01-01

    Many fatal accidents due to falls from heights have occurred at construction sites not only in Japan but also in other countries. This study aims to determine the fall prevention performance of two types of safety belts: a body belt, which has been used for more than 40 yr in the Japanese construction industry as a general type of safety equipment for fall accident prevention, and a full harness, which has been used in many other countries. To determine human tolerance for impact trauma, this study discusses features of safety belts with reference to relevant studies in the medical science, automobile crash safety, and aircrew safety. For this purpose, simple drop tests were carried out in a virtual workplace to measure impact load, head acceleration, and posture in the experiments, the Hybrid-III pedestrian model was used as a human dummy. Hybrid-III is typically employed in official automobile crash tests (New Car Assessment Program: NCAP) and is currently recognized as a model that faithfully reproduces dynamic responses. Experimental results shows that safety performance strongly depends on both the variety of safety belts used and the shock absorbers attached onto lanyards. These findings indicate that fall prevention equipment, such as safety belts, lanyards, and shock absorbers, must be improved to reduce impact injuries to the human head and body during falls.

  3. Fall Protection Characteristics of Safety Belts and Human Impact Tolerance

    PubMed Central

    HINO, Yasumichi; OHDO, Katsutoshi; TAKAHASHI, Hiroki

    2014-01-01

    Abstract: Many fatal accidents due to falls from heights have occurred at construction sites not only in Japan but also in other countries. This study aims to determine the fall prevention performance of two types of safety belts: a body belt1), which has been used for more than 40 yr in the Japanese construction industry as a general type of safety equipment for fall accident prevention, and a full harness2, 3), which has been used in many other countries. To determine human tolerance for impact trauma, this study discusses features of safety belts with reference4,5,6,7,8,9) to relevant studies in the medical science, automobile crash safety, and aircrew safety. For this purpose, simple drop tests were carried out in a virtual workplace to measure impact load, head acceleration, and posture in the experiments, the Hybrid-III pedestrian model10) was used as a human dummy. Hybrid-III is typically employed in official automobile crash tests (New Car Assessment Program: NCAP) and is currently recognized as a model that faithfully reproduces dynamic responses. Experimental results shows that safety performance strongly depends on both the variety of safety belts used and the shock absorbers attached onto lanyards. These findings indicate that fall prevention equipment, such as safety belts, lanyards, and shock absorbers, must be improved to reduce impact injuries to the human head and body during falls. PMID:25345426

  4. Development and Validation of Performance Assessment Tools for Interprofessional Communication and Teamwork (PACT)

    ERIC Educational Resources Information Center

    Chiu, Chia-Ju

    2014-01-01

    Background: Medical errors caused by breakdowns in teamwork and interprofessional communication contribute to many deaths in the United States each year. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) is an evidence-based teamwork system developed to improve communication and teamwork skills among health care…

  5. 42 CFR 460.134 - Minimum requirements for quality assessment and performance improvement program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Quality of life of participants. (4) Effectiveness and safety of staff-provided and contracted services... 42 Public Health 4 2012-10-01 2012-10-01 false Minimum requirements for quality assessment and... ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance...

  6. 42 CFR 460.134 - Minimum requirements for quality assessment and performance improvement program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Quality of life of participants. (4) Effectiveness and safety of staff-provided and contracted services... 42 Public Health 4 2011-10-01 2011-10-01 false Minimum requirements for quality assessment and... ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance...

  7. 42 CFR 460.134 - Minimum requirements for quality assessment and performance improvement program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Quality of life of participants. (4) Effectiveness and safety of staff-provided and contracted services... 42 Public Health 4 2010-10-01 2010-10-01 false Minimum requirements for quality assessment and... ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance...

  8. 42 CFR 460.134 - Minimum requirements for quality assessment and performance improvement program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Quality of life of participants. (4) Effectiveness and safety of staff-provided and contracted services... 42 Public Health 4 2013-10-01 2013-10-01 false Minimum requirements for quality assessment and... ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance...

  9. 42 CFR 460.134 - Minimum requirements for quality assessment and performance improvement program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Quality of life of participants. (4) Effectiveness and safety of staff-provided and contracted services... 42 Public Health 4 2014-10-01 2014-10-01 false Minimum requirements for quality assessment and... ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance...

  10. Environment, Safety, and Health Self-Assessment Report, Fiscal Year 2008

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Chernowski, John

    2009-02-27

    Lawrence Berkeley National Laboratory's Environment, Safety, and Health (ES&H) Self-Assessment Program ensures that Integrated Safety Management (ISM) is implemented institutionally and by all divisions. The Self-Assessment Program, managed by the Office of Contract Assurance (OCA), provides for an internal evaluation of all ES&H programs and systems at LBNL. The functions of the program are to ensure that work is conducted safely, and with minimal negative impact to workers, the public, and the environment. The Self-Assessment Program is also the mechanism used to institute continuous improvements to the Laboratory's ES&H programs. The program is described in LBNL/PUB 5344, Environment, Safety, andmore » Health Self-Assessment Program and is composed of four distinct assessments: the Division Self-Assessment, the Management of Environment, Safety, and Health (MESH) review, ES&H Technical Assurance, and the Appendix B Self-Assessment. The Division Self-Assessment uses the five core functions and seven guiding principles of ISM as the basis of evaluation. Metrics are created to measure performance in fulfilling ISM core functions and guiding principles, as well as promoting compliance with applicable regulations. The five core functions of ISM are as follows: (1) Define the Scope of Work; (2) Identify and Analyze Hazards; (3) Control the Hazards; (4) Perform the Work; and (5) Feedback and Improvement. The seven guiding principles of ISM are as follows: (1) Line Management Responsibility for ES&H; (2) Clear Roles and Responsibilities; (3) Competence Commensurate with Responsibilities; (4) Balanced Priorities; (5) Identification of ES&H Standards and Requirements; (6) Hazard Controls Tailored to the Work Performed; and (7) Operations Authorization. Performance indicators are developed by consensus with OCA, representatives from each division, and Environment, Health, and Safety (EH&S) Division program managers. Line management of each division performs the Division Self-Assessment annually. The primary focus of the review is workplace safety. The MESH review is an evaluation of division management of ES&H in its research and operations, focusing on implementation and effectiveness of the division's ISM plan. It is a peer review performed by members of the LBNL Safety Review Committee (SRC), with staff support from OCA. Each division receives a MESH review every two to four years, depending on the results of the previous review. The ES&H Technical Assurance Program (TAP) provides the framework for systematic reviews of ES&H programs and processes. The intent of ES&H Technical Assurance assessments is to provide assurance that ES&H programs and processes comply with their guiding regulations, are effective, and are properly implemented by LBNL divisions. The Appendix B Performance Evaluation and Measurement Plan (PEMP) requires that LBNL sustain and enhance the effectiveness of integrated safety, health, and environmental protection through a strong and well-deployed system. Information required for Appendix B is provided by EH&S Division functional managers. The annual Appendix B report is submitted at the close of the fiscal year. This assessment is the Department of Energy's (DOE) primary mechanism for evaluating LBNL's contract performance in ISM.« less

  11. Use of directional median openings on urban roadways.

    DOT National Transportation Integrated Search

    2014-05-01

    Over the past decades, many states and local transportation agencies have installed directional median openings on : divided roadways to improve arterial safety and operational performance. A directional opening is normally used to : restrict crossin...

  12. Work zone performance monitoring application development.

    DOT National Transportation Integrated Search

    2016-10-01

    The Federal Highway Administration (FHWA) requires state transportation agencies to (a) collect and analyze safety and mobility data to manage the work zone impacts of individual projects during construction and (b) improve overall agency processes a...

  13. Engineering Analysis of Stresses in Railroad Rails.

    DOT National Transportation Integrated Search

    1981-10-01

    One portion of the Federal Railroad Administration's (FRA) Track Performance Improvement Program is the development of engineering and analytic techniques required for the design and maintenance of railroad track of increased integrity and safety. Un...

  14. Preliminary Description of Stresses in Railroad Rail

    DOT National Transportation Integrated Search

    1976-11-01

    One portion of the Federal Railroad Administration's (FRA) Track Performance Improvement Program is the development of engineering and analytic techniques required for the design and maintenance of railroad track of increased integrity and safety. Un...

  15. Measures to Improve Diagnostic Safety in Clinical Practice.

    PubMed

    Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

    2016-10-20

    Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health-care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  16. [Experience feedback committee: a method for patient safety improvement].

    PubMed

    François, P; Sellier, E; Imburchia, F; Mallaret, M-R

    2013-04-01

    An experience feedback committee (CREX, Comité de Retour d'EXpérience) is a method which contributes to the management of safety of care in a medical unit. Originally used for security systems of civil aviation, the method has been adapted to health care facilities and successfully implemented in radiotherapy units and in other specialties. We performed a brief review of the literature for studies reporting data on CREX established in hospitals. The review was performed using the main bibliographic databases and Google search results. The CREX is designed to analyse incidents reported by professionals. The method includes monthly meetings of a multi-professional committee that reviews the reported incidents, chooses a priority incident and designates a "pilot" responsible for investigating the incident. The investigation of the incident involves a systemic analysis method and a written synthesis presented at the next meeting of the committee. The committee agrees on actions for improvement that are suggested by the analysis and follows their implementation. Systems for the management of health care, including reporting systems, are organized into three levels: the medical unit, the hospital and the country as a triple loop learning process. The CREX is located in the base level, short loop of risk management and allows direct involvement of care professionals in patient safety. Safety of care has become a priority of health systems. In this context, the CREX can be a useful vehicle for the implementation of a safety culture in medical units. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Preoperative Safety Briefing Project

    PubMed Central

    DeFontes, James; Surbida, Stephanie

    2004-01-01

    Context: Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors. Objective: To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure. Methods: A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data. Results: Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from “good” to “outstanding.” Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially. Conclusions: Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center. PMID:26704913

  18. Status of patient safety culture in Arab countries: a systematic review

    PubMed Central

    Almashrafi, Ahmed; Banarsee, Ricky

    2017-01-01

    Objectives To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC). Design Systematic review. Methods We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies. Results 18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a ‘culture of blame’ still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries. Conclusions There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ. PMID:28237956

  19. Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran

    PubMed Central

    Raeissi, Pouran; Sharifi, Marziye; Khosravizadeh, Omid; Heidari, Mohammad

    2017-01-01

    Background: Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care. Objective: This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences. Materials and Methods: This descriptive-analytical cross-sectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software. Results: The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05). Conclusion: Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication. PMID:29072411

  20. Integrating Safety Assessment Methods using the Risk Informed Safety Margins Characterization (RISMC) Approach

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Curtis Smith; Diego Mandelli

    Safety is central to the design, licensing, operation, and economics of nuclear power plants (NPPs). As the current light water reactor (LWR) NPPs age beyond 60 years, there are possibilities for increased frequency of systems, structures, and components (SSC) degradations or failures that initiate safety significant events, reduce existing accident mitigation capabilities, or create new failure modes. Plant designers commonly “over-design” portions of NPPs and provide robustness in the form of redundant and diverse engineered safety features to ensure that, even in the case of well-beyond design basis scenarios, public health and safety will be protected with a very highmore » degree of assurance. This form of defense-in-depth is a reasoned response to uncertainties and is often referred to generically as “safety margin.” Historically, specific safety margin provisions have been formulated primarily based on engineering judgment backed by a set of conservative engineering calculations. The ability to better characterize and quantify safety margin is important to improved decision making about LWR design, operation, and plant life extension. A systematic approach to characterization of safety margins and the subsequent margin management options represents a vital input to the licensee and regulatory analysis and decision making that will be involved. In addition, as research and development (R&D) in the LWR Sustainability (LWRS) Program and other collaborative efforts yield new data, sensors, and improved scientific understanding of physical processes that govern the aging and degradation of plant SSCs needs and opportunities to better optimize plant safety and performance will become known. To support decision making related to economics, readability, and safety, the RISMC Pathway provides methods and tools that enable mitigation options known as margins management strategies. The purpose of the RISMC Pathway R&D is to support plant decisions for risk-informed margin management with the aim to improve economics, reliability, and sustain safety of current NPPs. As the lead Department of Energy (DOE) Laboratory for this Pathway, the Idaho National Laboratory (INL) is tasked with developing and deploying methods and tools that support the quantification and management of safety margin and uncertainty.« less

  1. Researchers' Roles in Patient Safety Improvement.

    PubMed

    Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

    2016-03-01

    In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

  2. QUEST®: A Data-Driven Collaboration to Improve Quality, Efficiency, Safety, and Transparency in Acute Care.

    PubMed

    Crimmins, Mary M; Lowe, Timothy J; Barrington, Monica; Kaylor, Courtney; Phipps, Terri; Le-Roy, Charlene; Brooks, Tammy; Jones, Mashekia; Martin, John

    2016-06-01

    In 2008 Premier (Premier, Inc., Charlotte, North Carolina) began its Quality, Efficiency, and Safety with Transparency (QUEST®) collaborative, which is an acute health care organization program focused on improving quality and reducing patient harm. Retrospective performance data for QUEST hospitals were used to establish trends from the third quarter (Q3; July–September) of 2006 through Q3 2015. The study population included past and present members of the QUEST collaborative (N = 356), with each participating hospital considered a member. The QUEST program engages with member hospitals through a routine-coaching structure, sprints, minicollaboratives, and face-to-face meetings. Cost and efficiency data showed reductions in adjusted cost per discharge for hospitals between Q3 2013 (mean, $8,296; median, $8,459) and Q3 2015 (mean, $8,217; median, $7,895). Evidence-based care (EBC) measures showed improvement from baseline (Q3 2006; mean, 77%; median, 79%) to Q3 2015 (mean, 95%; median, 96%). Observed-to-expected (O/E) mortality improved from 1% to 22% better-than-expected outcomes on average. The QUEST safety harm composite score showed moderate reduction from Q1 2009 to Q3 2015, as did the O/E readmission rates--from Q1 2010 to Q3 2015--with improvement from a 5% to an 8% better-than-expected score. Quantitative and qualitative evaluation of QUEST collaborative hospitals indicated that for the 2006-2015 period, QUEST facilities reduced cost per discharge, improved adherence with evidence-based practice, reduced safety harm composite score, improved patient experience, and reduced unplanned readmissions.

  3. Advances in Liposuction: Five Key Principles with Emphasis on Patient Safety and Outcomes

    PubMed Central

    Tabbal, Geo N.; Ahmad, Jamil; Lista, Frank

    2013-01-01

    Summary: Since Illouz’s presentation of a technique for lipoplasty at the 1982 Annual Meeting of the American Society of Plastic and Reconstructive Surgeons, liposuction has become one of the most commonly performed aesthetic surgery procedures. The evolution of liposuction has seen refinements in technique and improvement of patient safety-related standards of care. Based on long-term experience with body contouring surgery, 5 principles of advanced liposuction are presented: preoperative evaluation and planning, intraoperative monitoring—safety measures, the role of wetting solutions and fluid resuscitation, circumferential contouring and complication prevention, and outcomes measurement. PMID:25289270

  4. Safety Assurances at Space Test Centres: Lessons Learned

    NASA Astrophysics Data System (ADS)

    Alarcon Ruiz, Raul; O'Neil, Sean; Valls, Rafel Prades

    2010-09-01

    The European Space Agency’s(ESA) experts in quality, cleanliness and contamination control, safety, test facilities and test methods have accumulated valuable experience during the performance of dedicated audits of space test centres in Europe over a period of 10 years. This paper is limited to a summary of the safety findings and provides a valuable reference to the lessons learned, identifying opportunities for improvement in the areas of risk prevention measures associated to the safety of all test centre personnel, the test specimen, the test facilities and associated infrastructure. Through the analysis of the audit results the authors present what are the main lessons learned, and conclude how an effective safety management system will contribute to successful test campaigns and have a positive impact on the cost and schedule of space projects.

  5. Aviation's Normal Operations Safety Audit: a safety management and educational tool for health care? Results of a small-scale trial.

    PubMed

    Bennett, Simon A

    2017-01-01

    A National Health Service (NHS) contingent liability for medical error claims of over £26 billion. To evaluate the safety management and educational benefits of adapting aviation's Normal Operations Safety Audit (NOSA) to health care. In vivo research, a NOSA was performed by medical students at an English NHS Trust. After receiving training from the author, the students spent 6 days gathering data under his supervision. The data revealed a threat-rich environment, where errors - some consequential - were made (359 threats and 86 errors were recorded over 2 weeks). The students claimed that the exercise improved their observational, investigative, communication, teamworking and other nontechnical skills. NOSA is potentially an effective safety management and educational tool for health care. It is suggested that 1) the UK General Medical Council mandates that all medical students perform a NOSA in fulfillment of their degree; 2) the participating NHS Trusts be encouraged to act on students' findings; and 3) the UK Department of Health adopts NOSA as a cornerstone risk assessment and management tool.

  6. A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

    PubMed Central

    Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

    2017-01-01

    Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

  7. Using escaped prescribed fire reviews to improve organizational learning

    Treesearch

    Anne E. Black; James Saveland; Dave Thomas; Jennifer Ziegler

    2012-01-01

    The US wildland fire community has been interested in cultivating organizational learning to improve safety and overall performance for a number of years. A key focus has been on understanding the difference between culpability (to be guilty) and accountability (to explain) and on re-orienting review processes towards building a collective account of (as opposed to...

  8. Patient safety and health policy: a history and review.

    PubMed

    Small, Stephen D; Barach, Paul

    2002-12-01

    Policy initiatives on many fronts have converged to improve patient safety. A major tension that characterizes this process is the attempt to achieve a balance between learning and control in complex systems with technical, social, and organizational components. Efforts to improve learning are marked by better information flow, discovery, flexibility in thinking, embracing of failures as learning opportunities, and core incentives to promote voluntary participation of all stakeholders in the process. Efforts to improve accountability are traditionally marked by public disclosure, meeting of certain widely disseminated standards, availability of performance measures, exposure to legal liability, and compliance with mandated directives (statutes, regulations, accreditation requirements). In some sense, these directions are mutually exclusive. Although a more collaborative regulatory-improvement model would be helpful in creating an industrywide safety culture, it is likely that learning and accountability functions will follow separate tracks. An exception would be policy that stimulates organizations to comply with regulation by showing how well and by what methods they are learning and how others can profit from these experiences. Any approach to improving patient safety should, at a minimum, include a nonpunitive in-depth mechanism for reporting incidents, postincident evaluations for identification of system changes to prevent subsequent occurrences, and state-guaranteed legislative protection from discovery for all aspects of information gathered to improve patient safety. Nonpunitive approaches have yielded useful results in other industries [43]. State and federal courts, state licensing boards, and accrediting bodies such as JCAHO all function to maintain accountability and standards; however, the very fear of existing legal liability or its misapplication are the greatest hurdles to pioneering patient-safety efforts. The health care system needs to transform the existing culture of blame and punishment that suppresses information about errors and adverse events into a culture of safety that focuses on openness and information sharing to improve health care and prevent adverse outcomes. Education and leadership will be most important to creating and sustaining a strong safety culture and arguably the most important defense against preventable harms. Safety culture cannot be legislated, just as the old adage states that it is easier to pull rather than push a piece of spaghetti. Given the imbalances and inefficiencies of market forces in health care, perverse incentives that have strengthened resistance to change, and secrecy when it comes to adverse event information, however, it is likely that policy initiatives will continue to play an important role in the transformation of the industry to more highly reliable, safer levels of care.

  9. Patient and family involvement in contemporary health care.

    PubMed

    Angood, Peter; Dingman, Jennifer; Foley, Mary E; Ford, Dan; Martins, Becky; O'Regan, Patti; Salamendra, Arlene; Sheridan, Sue; Denham, Charles R

    2010-03-01

    The objective of this article was to provide a guide to health care providers on patient and family involvement in health care. This article evaluated the latest published studies for patient and family involvement and reexamined the objectives, the requirements for achieving these objectives, and the evidence of how to involve patients and families. Critical components for patient safety include changing the organizational culture; including patients and families on teams; listening to patients and families; incorporating their input into leadership structures and systems; providing full detail about treatment, procedures, and medication adverse effects; involving them on patient safety and performance improvement committees; and disclosing medical errors. The conclusion of this article is that, for the future, patient and family involvement starts with educating patients and families and ends with listening to them and taking them seriously. If patient and family input is emphatically built into systems of performance improvement, and if patients and families are taken seriously and are respected for their valuable perspectives about how care can be improved, then organizations can improve at improving. Resources in health care are in short supply, yet the resources of patient and family help and time are almost limitless, are ready to be tapped, and can have a huge impact on improving the reliability and overall success for any health care organization.

  10. Continuous quality improvement using intelligent infusion pump data analysis.

    PubMed

    Breland, Burnis D

    2010-09-01

    The use of continuous quality-improvement (CQI) processes in the implementation of intelligent infusion pumps in a community teaching hospital is described. After the decision was made to implement intelligent i.v. infusion pumps in a 413-bed, community teaching hospital, drug libraries for use in the safety software had to be created. Before drug libraries could be created, it was necessary to determine the epidemiology of medication use in various clinical care areas. Standardization of medication administration was performed through the CQI process, using practical knowledge of clinicians at the bedside and evidence-based drug safety parameters in the scientific literature. Post-implementation, CQI allowed refinement of clinically important safety limits while minimizing inappropriate, meaningless soft limit alerts on a few select agents. Assigning individual clinical care areas (CCAs) to individual patient care units facilitated customization of drug libraries and identification of specific CCA compliance concerns. Between June 2007 and June 2008, there were seven library updates. These involved drug additions and deletions, customization of individual CCAs, and alterations of limits. Overall compliance with safety software use rose over time, from 33% in November 2006 to over 98% in December 2009. Many potentially clinically significant dosing errors were intercepted by the safety software, prompting edits by end users. Only 4-6% of soft limit alerts resulted in edits. Compliance rates for use of infusion pump safety software varied among CCAs over time. Education, auditing, and refinement of drug libraries led to improved compliance in most CCAs.

  11. Safety Oversight of Decommissioning Activities at DOE Nuclear Sites

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zull, Lawrence M.; Yeniscavich, William

    2008-01-15

    The Defense Nuclear Facilities Safety Board (Board) is an independent federal agency established by Congress in 1988 to provide nuclear safety oversight of activities at U.S. Department of Energy (DOE) defense nuclear facilities. The activities under the Board's jurisdiction include the design, construction, startup, operation, and decommissioning of defense nuclear facilities at DOE sites. This paper reviews the Board's safety oversight of decommissioning activities at DOE sites, identifies the safety problems observed, and discusses Board initiatives to improve the safety of decommissioning activities at DOE sites. The decommissioning of former defense nuclear facilities has reduced the risk of radioactive materialmore » contamination and exposure to the public and site workers. In general, efforts to perform decommissioning work at DOE defense nuclear sites have been successful, and contractors performing decommissioning work have a good safety record. Decommissioning activities have recently been completed at sites identified for closure, including the Rocky Flats Environmental Technology Site, the Fernald Closure Project, and the Miamisburg Closure Project (the Mound site). The Rocky Flats and Fernald sites, which produced plutonium parts and uranium materials for defense needs (respectively), have been turned into wildlife refuges. The Mound site, which performed R and D activities on nuclear materials, has been converted into an industrial and technology park called the Mound Advanced Technology Center. The DOE Office of Legacy Management is responsible for the long term stewardship of these former EM sites. The Board has reviewed many decommissioning activities, and noted that there are valuable lessons learned that can benefit both DOE and the contractor. As part of its ongoing safety oversight responsibilities, the Board and its staff will continue to review the safety of DOE and contractor decommissioning activities at DOE defense nuclear sites.« less

  12. Challenges in performance of food safety management systems: a case of fish processing companies in Tanzania.

    PubMed

    Kussaga, Jamal B; Luning, Pieternel A; Tiisekwa, Bendantunguka P M; Jacxsens, Liesbeth

    2014-04-01

    This study provides insight for food safety (FS) performance in light of the current performance of core FS management system (FSMS) activities and context riskiness of these systems to identify the opportunities for improvement of the FSMS. A FSMS diagnostic instrument was applied to assess the performance levels of FSMS activities regarding context riskiness and FS performance in 14 fish processing companies in Tanzania. Two clusters (cluster I and II) with average FSMS (level 2) operating under moderate-risk context (score 2) were identified. Overall, cluster I had better (score 3) FS performance than cluster II (score 2 to 3). However, a majority of the fish companies need further improvement of their FSMS and reduction of context riskiness to assure good FS performance. The FSMS activity levels could be improved through hygienic design of equipment and facilities, strict raw material control, proper follow-up of critical control point analysis, developing specific sanitation procedures and company-specific sampling design and measuring plans, independent validation of preventive measures, and establishing comprehensive documentation and record-keeping systems. The risk level of the context could be reduced through automation of production processes (such as filleting, packaging, and sanitation) to restrict people's interference, recruitment of permanent high-skilled technological staff, and setting requirements on product use (storage and distribution conditions) on customers. However, such intervention measures for improvement could be taken in phases, starting with less expensive ones (such as sanitation procedures) that can be implemented in the short term to more expensive interventions (setting up assurance activities) to be adopted in the long term. These measures are essential for fish processing companies to move toward FSMS that are more effective.

  13. Assessment of Primary Production of Horticultural Safety Management Systems of Mushroom Farms in South Africa.

    PubMed

    Dzingirayi, Garikayi; Korsten, Lise

    2016-07-01

    Growing global consumer concern over food safety in the fresh produce industry requires producers to implement necessary quality assurance systems. Varying effectiveness has been noted in how countries and food companies interpret and implement food safety standards. A diagnostic instrument (DI) for global fresh produce industries was developed to measure the compliancy of companies with implemented food safety standards. The DI is made up of indicators and descriptive grids for context factors and control and assurance activities to measure food safety output. The instrument can be used in primary production to assess food safety performance. This study applied the DI to measure food safety standard compliancy of mushroom farming in South Africa. Ten farms representing almost half of the industry farms and more than 80% of production were independently assessed for their horticultural safety management system (HSMS) compliance via in-depth interviews with each farm's quality assurance personnel. The data were processed using Microsoft Office Excel 2010 and are represented in frequency tables. The diagnosis revealed that the mushroom farming industry had an average food safety output. The farms were implementing an average-toadvanced HSMS and operating in a medium-risk context. Insufficient performance areas in HSMSs included inadequate hazard analysis and analysis of control points, low specificity of pesticide assessment, and inadequate control of suppliers and incoming materials. Recommendations to the industry and current shortcomings are suggested for realization of an improved industry-wide food safety assurance system.

  14. Testing of Anesthesia Machines and Defibrillators in Healthcare Institutions.

    PubMed

    Gurbeta, Lejla; Dzemic, Zijad; Bego, Tamer; Sejdic, Ervin; Badnjevic, Almir

    2017-09-01

    To improve the quality of patient treatment by improving the functionality of medical devices in healthcare institutions. To present the results of the safety and performance inspection of patient-relevant output parameters of anesthesia machines and defibrillators defined by legal metrology. This study covered 130 anesthesia machines and 161 defibrillators used in public and private healthcare institutions, during a period of two years. Testing procedures were carried out according to international standards and legal metrology legislative procedures in Bosnia and Herzegovina. The results show that in 13.84% of tested anesthesia machine and 14.91% of defibrillators device performance is not in accordance with requirements and should either have its results be verified, or the device removed from use or scheduled for corrective maintenance. Research emphasizes importance of independent safety and performance inspections, and gives recommendations for the frequency of inspection based on measurements. Results offer implications for adequacy of preventive and corrective maintenance performed in healthcare institutions. Based on collected data, the first digital electronical database of anesthesia machines and defibrillators used in healthcare institutions in Bosnia and Herzegovina is created. This database is a useful tool for tracking each device's performance over time.

  15. Accuracy and safety of ward based pleural ultrasound in the Australian healthcare system.

    PubMed

    Hammerschlag, Gary; Denton, Matthew; Wallbridge, Peter; Irving, Louis; Hew, Mark; Steinfort, Daniel

    2017-04-01

    Ultrasound has been shown to improve the accuracy and safety of pleural procedures. Studies to date have been performed in large, specialized units, where pleural procedures are performed by a small number of highly specialized physicians. There are no studies examining the safety and accuracy of ultrasound in the Australian healthcare system where procedures are performed by junior doctors with a high staff turnover. We performed a retrospective review of the ultrasound database in the Respiratory Department at the Royal Melbourne Hospital to determine accuracy and complications associated pleural procedures. A total of 357 ultrasounds were performed between October 2010 and June 2013. Accuracy of pleural procedures was 350 of 356 (98.3%). Aspiration of pleural fluid was successful in 121 of 126 (96%) of patients. Two (0.9%) patients required chest tube insertion for management of pneumothorax. There were no recorded pleural infections, haemorrhage or viscera puncture. Ward-based ultrasound for pleural procedures is safe and accurate when performed by appropriately trained and supported junior medical officers. Our findings support this model of pleural service care in the Australian healthcare system. © 2016 Asian Pacific Society of Respirology.

  16. Safety performance evaluation of the steel-backed log rail

    DOT National Transportation Integrated Search

    1992-12-01

    The Coordinated Federal Lands Highways Technology Improvement Program (CTIP) was developed with the purpose of serving the immediate needs of those who design and construct Federal Lands Highways, including Indian Reservation roads, National Park roa...

  17. Road weather management program performance metrics : implementation and assessment.

    DOT National Transportation Integrated Search

    2009-08-31

    Since the late 1990s, the U.S. Department of Transportation (USDOT), Federal Highway Administration (FHWA) has managed a program dedicated to improving the safety, mobility and productivity of the nations surface transportation modes by integra...

  18. Line pilot perspectives on complexity of terminal instrument flight procedures

    DOT National Transportation Integrated Search

    2016-09-01

    Many new Performance Based Navigation (PBN) Instrument Flight Procedures (IFPs) are being developed as the United States transforms its airspace to improve safety and efficiency. Despite significant efforts to prepare for operational implementation o...

  19. Improving the Acoustical Performance of Porous Asphalt Pavements

    DOT National Transportation Integrated Search

    1999-09-01

    Selection of pavement for noise reduction considerations is becoming a major concern for those involved in highway construction within densely populated areas. However, the pavements available are designed for durability and safety reasons and not fo...

  20. Foam composite structures. [for fire retardant airframe materials

    NASA Technical Reports Server (NTRS)

    Delano, C. B.; Milligan, R. J.

    1976-01-01

    The need to include fire resistant foams into state of the art aircraft interior paneling to increase passenger safety in aircraft fires was studied. Present efforts were directed toward mechanical and fire testing of panels with foam inclusions. Skinned foam filled honeycomb and PBI structural foams were the two constructions investigated with attention being directed toward weight/performance/cost trade-off. All of the new panels demonstrated improved performance in fire and some were lighter weight but not as strong as the presently used paneling. Continued efforts should result in improved paneling for passenger safety. In particular the simple partial filling (fire side) of state-of-the-art honeycomb with fire resistant foams with little sacrifice in weight would result in panels with increased fire resistance. More important may be the retarded rate of toxic gas evolution in the fire due to the protection of the honeycomb by the foam.

  1. Multi-method laboratory user evaluation of an actionable clinical performance information system: Implications for usability and patient safety.

    PubMed

    Brown, Benjamin; Balatsoukas, Panos; Williams, Richard; Sperrin, Matthew; Buchan, Iain

    2018-01-01

    Electronic audit and feedback (e-A&F) systems are used worldwide for care quality improvement. They measure health professionals' performance against clinical guidelines, and some systems suggest improvement actions. However, little is known about optimal interface designs for e-A&F, in particular how to present suggested actions for improvement. We developed a novel theory-informed system for primary care (the Performance Improvement plaN GeneratoR; PINGR) that covers the four principal interface components: clinical performance summaries; patient lists; detailed patient-level information; and suggested actions. As far as we are aware, this is the first report of an e-A&F system with all four interface components. (1) Use a combination of quantitative and qualitative methods to evaluate the usability of PINGR with target end-users; (2) refine existing design recommendations for e-A&F systems; (3) determine the implications of these recommendations for patient safety. We recruited seven primary care physicians to perform seven tasks with PINGR, during which we measured on-screen behaviour and eye movements. Participants subsequently completed usability questionnaires, and were interviewed in-depth. Data were integrated to: gain a more complete understanding of usability issues; enhance and explain each other's findings; and triangulate results to increase validity. Participants committed a median of 10 errors (range 8-21) when using PINGR's interface, and completed a median of five out of seven tasks (range 4-7). Errors violated six usability heuristics: clear response options; perceptual grouping and data relationships; representational formats; unambiguous description; visually distinct screens for confusable items; and workflow integration. Eye movement analysis revealed the integration of components largely supported effective user workflow, although the modular design of clinical performance summaries unnecessarily increased cognitive load. Interviews and questionnaires revealed PINGR is user-friendly, and that improved information prioritisation could further promote useful user action. Comparing our results with the wider usability literature we refine a previously published set of interface design recommendations for e-A&F. The implications for patient safety are significant regarding: user engagement; actionability; and information prioritisation. Our results also support adopting multi-method approaches in usability studies to maximise issue discovery and the credibility of findings. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  2. [The road to patient safety: facts and desire].

    PubMed

    Aibar-Remón, Carlos; Barrasa-Villar, Ignacio; Moliner-Lahoz, Javier; Gutiérrez-Cía, Isabel; Aibar-Villán, Laura; Obón-Azuara, Blanca; Mareca-Doñate, Rosa; Ríos-Faure, David

    2018-01-27

    To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Practical Approaches to Quality Improvement for Radiologists.

    PubMed

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

  4. Safety and function of a prototype microprocessor-controlled knee prosthesis for low active transfemoral amputees switching from a mechanic knee prosthesis: a pilot study.

    PubMed

    Hasenoehrl, Timothy; Schmalz, Thomas; Windhager, Reinhard; Domayer, Stephan; Dana, Sara; Ambrozy, Clemens; Palma, Stefano; Crevenna, Richard

    2018-02-01

    Aim of this pilot study was to assess safety and functioning of a microprocessor-controlled knee prosthesis (MPK) after a short familiarization time and no structured physical therapy. Five elderly, low-active transfemoral amputees who were fitted with a standard non-microprocessor controlled knee prosthesis (NMPK) performed a baseline measurement consisting of a 3 D gait analysis, functional tests and questionnaires. The first follow-up consisted of the same test procedure and was performed with the MPK after 4 to 6 weeks of familiarization. After being refitted to their standard NMPK again, the subjects undertook the second follow-up which consisted of solely questionnaires 4 weeks later. Questionnaires and functional tests showed an increase in the perception of safety. Moreover, gait analysis revealed more physiologic knee and hip extension/flexion patterns when using the MPK. Our results showed that although the Genium with Cenior-Leg ruleset-MPK (GCL-MPK) might help to improve several safety-related outcomes as well as gait biomechanics the functional potential of the GCL-MPK may have been limited without specific training and a sufficient acclimation period. Implications for Rehabilitation Elderly transfemoral amputees are often limited in their activity by safety issues as well as insufficient functioning regarding the non microprocessor-controlled knee prostheses (NMPK), thing that could be eliminated with the use of suitable microprocessor-controlled prostheses (MPK). The safety and functioning of a prototype MPK (GCL-MPK) specifically designed for the needs of older and low-active transfemoral amputees was assessed in this pilot study. The GCL-MPK showed indicators of increased safety and more natural walking patterns in older and low-active transfemoral amputees in comparison to the standard NMPK already after a short acclimatisation time and no structured physical therapy. Regarding functional performance it seems as if providing older and low-active transfemoral amputees with the GCL-MPK alone without prescribing structured prosthesis training might be insufficient to achieve improvements over the standard NMPKs.

  5. Integrating Safety with Science,Technology and Innovation at Los Alamos National Laboratory

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rich, Bethany M

    2012-04-02

    The mission of Los Alamos National Laboratory (LANL) is to develop and apply science, technology and engineering solutions to ensure the safety, security, and reliability of the U.S. nuclear deterrent; reduce global threats; and solve emerging national security challenges. The most important responsibility is to direct and conduct efforts to meet the mission with an emphasis on safety, security, and quality. In this article, LANL Environmental, Safety, and Health (ESH) trainers discuss how their application and use of a kinetic learning module (learn by doing) with a unique fall arrest system is helping to address one the most common industrialmore » safety challenges: slips and falls. A unique integration of Human Performance Improvement (HPI), Behavior Based Safety (BBS) and elements of the Voluntary Protection Program (VPP) combined with an interactive simulator experience is being used to address slip and fall events at Los Alamos.« less

  6. When systems fail: improving care through technology can create risk.

    PubMed

    Bagalio, Sharon A

    2007-01-01

    Emerging medical technology is transforming the care of the modern-day patient. Hospital performance and patient safety is improving, lowering professional liability and medical malpractice costs. This advanced technology affects not only diagnosis and treatment but also hospital productivity and revenue. However, it also exposes hospitals and medical personnel to a number of unforeseeable risks. This article examines ongoing efforts to improve patient safety through the use of technology, automation and complex systems operations. It discusses the importance of skilled negotiation when vying for technology contracts and the value of maintaining a reliable data center to support it. Technology risk exposure is now a reality. A hospital needs to know how to protect itself from cyber liability, business interruption, and data loss and theft by ensuring that there is adequate coverage.

  7. Lithium-Ion Electrolytes with Improved Safety Tolerance to High Voltage Systems

    NASA Technical Reports Server (NTRS)

    Smart, Marshall C. (Inventor); Prakash, Surya G. (Inventor); Bugga, Ratnakumar V. (Inventor); Krause, Frederick C. (Inventor)

    2015-01-01

    The invention discloses various embodiments of electrolytes for use in lithium-ion batteries, the electrolytes having improved safety and the ability to operate with high capacity anodes and high voltage cathodes. In one embodiment there is provided an electrolyte for use in a lithium-ion battery comprising an anode and a high voltage cathode. The electrolyte has a mixture of a cyclic carbonate of ethylene carbonate (EC) or mono-fluoroethylene carbonate (FEC) co-solvent, ethyl methyl carbonate (EMC), a flame retardant additive, a lithium salt, and an electrolyte additive that improves compatibility and performance of the lithium-ion battery with a high voltage cathode. The lithium-ion battery is charged to a voltage in a range of from about 2.0 V (Volts) to about 5.0 V (Volts).

  8. ThedaCare's business performance system: sustaining continuous daily improvement through hospital management in a lean environment.

    PubMed

    Barnas, Kim

    2011-09-01

    For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.

  9. Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents.

    PubMed

    Hicks, Christopher M; Kiss, Alex; Bandiera, Glen W; Denny, Christopher J

    2012-11-01

    Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation-based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved team-based attitudes as assessed by the HFAS (p  =  0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p  =  0.16). EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

  10. Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).

    PubMed

    Schleyer, Anneliese M; Best, Jennifer A; McIntyre, Lisa K; Ehrmantraut, Ross; Calver, Patty; Goss, J Richard

    2013-01-01

    Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

  11. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Knee Arthroplasty.

    PubMed

    Soffin, Ellen M; Gibbons, Melinda M; Ko, Clifford Y; Kates, Stephen L; Wick, Elizabeth; Cannesson, Maxime; Scott, Michael J; Wu, Christopher L

    2018-06-08

    Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute (AI) for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. The program comprises a national effort to incorporate best practice in perioperative care and improve patient safety, for over 750 hospitals and multiple procedures over the next 5 years, including orthopedic surgery. We have conducted a full evidence review of anesthetic interventions to derive anesthesiology-related components of an evidence-based ERAS pathway for TKA. A PubMed search was performed for each protocol component, focusing on the highest levels of evidence in the literature. Search findings are summarized in narrative format. Anesthesiology components of care were identified and evaluated across the pre-, intra-, and postoperative phases. A summary of the best available evidence, together with recommendations for inclusion in ERAS protocols for TKA, is provided. There is extensive evidence in the literature, and from society guidelines to support the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery goals for TKA.

  12. Lessons learned from measuring safety culture: an Australian case study.

    PubMed

    Allen, Suellen; Chiarella, Mary; Homer, Caroline S E

    2010-10-01

    adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understand the safety culture of an organisation to make improvements to patient safety. this paper reports a case study examining the safety culture in one maternity service in Australia and considers the benefits of using surveys and interviews to understand safety culture as an approach to identify possible strategies to improve patient safety in this setting. the study took place in one maternity service in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure which was part of a major health reform agenda. The priorities of the reform included improving the quality of care and patient safety; and, creating a more efficient health system by reducing administration inefficiencies and duplication. a descriptive case study using three approaches: the safety culture was identified to warrant improvement across all six safety culture domains. There was reduced infrastructure and capacity to support incident management activities required to improve safety, which was influenced by instability from the organisational restructure. There was a perceived lack of leadership at all levels to drive safety and quality and improving the safety culture was neither a key priority nor was it valued by the organisation. the safety culture was complex as was undertaking this study. We were unable to achieve a desired 60% response rate highlighting the limitations of using safety culture surveys in isolation as a strategy to improve safety culture. Qualitative interviews provided greater insight into the factors influencing the safety culture. The findings of this study provide evidence of the benefits of including qualitative methods with quantitative surveys when examining safety culture. Undertaking research in this way requires local engagement, commitment and capacity from the study site. The absence of these factors is likely to limit the practicality of this approach in the clinical setting. the use of safety culture surveys as the only method of assessing safety culture is of limited value in identifying strategies to potentially improve the safety culture. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. Risk-Informed External Hazards Analysis for Seismic and Flooding Phenomena for a Generic PWR

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Parisi, Carlo; Prescott, Steve; Ma, Zhegang

    This report describes the activities performed during the FY2017 for the US-DOE Light Water Reactor Sustainability Risk-Informed Safety Margin Characterization (LWRS-RISMC), Industry Application #2. The scope of Industry Application #2 is to deliver a risk-informed external hazards safety analysis for a representative nuclear power plant. Following the advancements occurred during the previous FYs (toolkits identification, models development), FY2017 focused on: increasing the level of realism of the analysis; improving the tools and the coupling methodologies. In particular the following objectives were achieved: calculation of buildings pounding and their effects on components seismic fragility; development of a SAPHIRE code PRA modelsmore » for 3-loops Westinghouse PWR; set-up of a methodology for performing static-dynamic PRA coupling between SAPHIRE and EMRALD codes; coupling RELAP5-3D/RAVEN for performing Best-Estimate Plus Uncertainty analysis and automatic limit surface search; and execute sample calculations for demonstrating the capabilities of the toolkit in performing a risk-informed external hazards safety analyses.« less

  14. Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies.

    PubMed

    Balka, Ellen; Tolar, Marianne; Coates, Shannon; Whitehouse, Sandra

    2013-12-01

    Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools. Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed. We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge.

    PubMed

    Mort, Elizabeth A; Demehin, Akinluwa A; Marple, Keith B; McCullough, Kathryn Y; Meyer, Gregg S

    2013-08-01

    Hospitals are continually challenged to provide safer and higher-quality patient care despite resource constraints. With an ever-increasing range of quality and safety targets at the national, state, and local levels, prioritization is crucial in effective institutional quality goal setting and resource allocation.Organizational goal-setting theory is a performance improvement methodology with strong results across many industries. The authors describe a structured goal-setting process they have established at Massachusetts General Hospital for setting annual institutional quality and safety goals. Begun in 2008, this process has been conducted on an annual basis. Quality and safety data are gathered from many sources, both internal and external to the hospital. These data are collated and classified, and multiple approaches are used to identify the most pressing quality issues facing the institution. The conclusions are subject to stringent internal review, and then the top quality goals of the institution are chosen. Specific tactical initiatives and executive owners are assigned to each goal, and metrics are selected to track performance. A reporting tool based on these tactics and metrics is used to deliver progress updates to senior hospital leadership.The hospital has experienced excellent results and strong organizational buy-in using this effective, low-cost, and replicable goal-setting process. It has led to improvements in structural, process, and outcomes aspects of quality.

  16. Efficacy, Safety, and Tolerability of Armodafinil Therapy for Hypersomnia Associated With Dementia With Lewy Bodies: A Pilot Study

    PubMed Central

    Lapid, Maria I.; Kuntz, Karen M.; Mason, Sara S.; Aakre, Jeremiah A.; Lundt, Emily S.; Kremers, Walter; Allen, Laura A.; Drubach, Daniel A.; Boeve, Bradley F.

    2017-01-01

    Background/Aims Hypersomnia is common in dementia with Lewy bodies (DLB). We assessed the efficacy, safety, and tolerability of armodafinil for hypersomnia associated with DLB. Methods We performed a 12-week pilot trial of armodafinil therapy (125–250 mg orally daily) in DLB outpatients with hypersomnia. Patients underwent neurologic examinations, neuropsychological battery, laboratory testing, electrocardiography, and polysomnography. Efficacy was assessed at 2, 4, 8, and 12 weeks. Safety assessment included laboratory examinations, QTc interval, and heart rate. Tolerability was assessed by analysis of adverse events. Data were analyzed using the last-observation-carried-forward method. Results Of 20 participants, 17 completed the protocol. Median age was 72 years, most were men (80%), and most had spouses as caregivers. Epworth Sleepiness Scale (P<.001), Maintenance of Wakefulness Test (P=.003), and Clinical Global Impression of Change (P<.001) scores improved at week 12. Neuropsychiatric Inventory total score (P=.003), visual hallucinations (P=.003), and agitation (P=.02) improved at week 4. Caregiver overall quality of life improved at week 12 (P=.004). No adverse events occurred. Conclusion These pilot data suggest improvements in hypersomnia and wakefulness and reasonable safety and tolerability of armodafinil therapy in hypersomnolent patients with DLB. Our findings inform the use of pharmacologic strategies to manage hypersomnolence in these patients. PMID:28448998

  17. Improving patient safety through quality assurance.

    PubMed

    Raab, Stephen S

    2006-05-01

    Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

  18. A Qualitative Study on Organizational Factors Affecting Occupational Accidents

    PubMed Central

    ESKANDARI, Davood; JAFARI, Mohammad Javad; MEHRABI, Yadollah; KIAN, Mostafa Pouya; CHARKHAND, Hossein; MIRGHOTBI, Mostafa

    2017-01-01

    Background: Technical, human, operational and organizational factors have been influencing the sequence of occupational accidents. Among them, organizational factors play a major role in causing occupational accidents. The aim of this research was to understand the Iranian safety experts’ experiences and perception of organizational factors. Methods: This qualitative study was conducted in 2015 by using the content analysis technique. Data were collected through semi-structured interviews with 17 safety experts working in Iranian universities and industries and analyzed with a conventional qualitative content analysis method using the MAXQDA software. Results: Eleven organizational factors’ sub-themes were identified: management commitment, management participation, employee involvement, communication, blame culture, education and training, job satisfaction, interpersonal relationship, supervision, continuous improvement, and reward system. The participants considered these factors as effective on occupational accidents. Conclusion: The mentioned 11 organizational factors are probably involved in occupational accidents in Iran. Naturally, improving organizational factors can increase the safety performance and reduce occupational accidents. PMID:28435824

  19. Massive parallelization of serial inference algorithms for a complex generalized linear model

    PubMed Central

    Suchard, Marc A.; Simpson, Shawn E.; Zorych, Ivan; Ryan, Patrick; Madigan, David

    2014-01-01

    Following a series of high-profile drug safety disasters in recent years, many countries are redoubling their efforts to ensure the safety of licensed medical products. Large-scale observational databases such as claims databases or electronic health record systems are attracting particular attention in this regard, but present significant methodological and computational concerns. In this paper we show how high-performance statistical computation, including graphics processing units, relatively inexpensive highly parallel computing devices, can enable complex methods in large databases. We focus on optimization and massive parallelization of cyclic coordinate descent approaches to fit a conditioned generalized linear model involving tens of millions of observations and thousands of predictors in a Bayesian context. We find orders-of-magnitude improvement in overall run-time. Coordinate descent approaches are ubiquitous in high-dimensional statistics and the algorithms we propose open up exciting new methodological possibilities with the potential to significantly improve drug safety. PMID:25328363

  20. The nuts and bolts of pills and portions: the functions of a drug safety working group.

    PubMed

    Nath, Noleen S; Jones, Ellen H; Stride, Peter; Premaratne, Manuja; Thaker, Darshit; Lim, Ivan

    2011-11-01

    Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital.

  1. A Qualitative Study on Organizational Factors Affecting Occupational Accidents.

    PubMed

    Eskandari, Davood; Jafari, Mohammad Javad; Mehrabi, Yadollah; Kian, Mostafa Pouya; Charkhand, Hossein; Mirghotbi, Mostafa

    2017-03-01

    Technical, human, operational and organizational factors have been influencing the sequence of occupational accidents. Among them, organizational factors play a major role in causing occupational accidents. The aim of this research was to understand the Iranian safety experts' experiences and perception of organizational factors. This qualitative study was conducted in 2015 by using the content analysis technique. Data were collected through semi-structured interviews with 17 safety experts working in Iranian universities and industries and analyzed with a conventional qualitative content analysis method using the MAXQDA software. Eleven organizational factors' sub-themes were identified: management commitment, management participation, employee involvement, communication, blame culture, education and training, job satisfaction, interpersonal relationship, supervision, continuous improvement, and reward system. The participants considered these factors as effective on occupational accidents. The mentioned 11 organizational factors are probably involved in occupational accidents in Iran. Naturally, improving organizational factors can increase the safety performance and reduce occupational accidents.

  2. Lithium ion battery with improved safety

    DOEpatents

    Chen, Chun-hua; Hyung, Yoo Eup; Vissers, Donald R.; Amine, Khalil

    2006-04-11

    A lithium battery with improved safety that utilizes one or more additives in the battery electrolyte solution wherein a lithium salt is dissolved in an organic solvent, which may contain propylene, carbonate. For example, a blend of 2 wt % triphenyl phosphate (TPP), 1 wt % diphenyl monobutyl phosphate (DMP) and 2 wt % vinyl ethylene carbonate additives has been found to significantly enhance the safety and performance of Li-ion batteries using a LiPF6 salt in EC/DEC electrolyte solvent. The invention relates to both the use of individual additives and to blends of additives such as that shown in the above example at concentrations of 1 to 4-wt % in the lithium battery electrolyte. This invention relates to additives that suppress gas evolution in the cell, passivate graphite electrode and protect it from exfoliating in the presence of propylene carbonate solvents in the electrolyte, and retard flames in the lithium batteries.

  3. Tactile display landing safety and precision improvements for the Space Shuttle

    NASA Astrophysics Data System (ADS)

    Olson, John M.

    A tactile display belt using 24 electro-mechanical tactile transducers (tactors) was used to determine if a modified tactile display system, known as the Tactile Situation Awareness System (TSAS) improved the safety and precision of a complex spacecraft (i.e. the Space Shuttle Orbiter) in guided precision approaches and landings. The goal was to determine if tactile cues enhance safety and mission performance through reduced workload, increased situational awareness (SA), and an improved operational capability by increasing secondary cognitive workload capacity and human-machine interface efficiency and effectiveness. Using both qualitative and quantitative measures such as NASA's Justiz Numerical Measure and Synwork1 scores, an Overall Workload (OW) measure, the Cooper-Harper rating scale, and the China Lake Situational Awareness scale, plus Pre- and Post-Flight Surveys, the data show that tactile displays decrease OW, improve SA, counteract fatigue, and provide superior warning and monitoring capacity for dynamic, off-nominal, high concurrent workload scenarios involving complex, cognitive, and multi-sensory critical scenarios. Use of TSAS for maintaining guided precision approaches and landings was generally intuitive, reduced training times, and improved task learning effects. Ultimately, the use of a homogeneous, experienced, and statistically robust population of test pilots demonstrated that the use of tactile displays for Space Shuttle approaches and landings with degraded vehicle systems, weather, and environmental conditions produced substantial improvements in safety, consistency, reliability, and ease of operations under demanding conditions. Recommendations for further analysis and study are provided in order to leverage the results from this research and further explore the potential to reduce the risk of spaceflight and aerospace operations in general.

  4. "No-Go Considerations" for In Situ Simulation Safety.

    PubMed

    Bajaj, Komal; Minors, Anjoinette; Walker, Katie; Meguerdichian, Michael; Patterson, Mary

    2018-06-01

    In situ simulation is the practice of simulation in the actual clinical environment and has demonstrated utility in the assessment of system processes, identification of latent safety threats, and improvement in teamwork and communication. Nonetheless, performing simulated events in a real patient care setting poses potential risks to patient and staff safety. One integral aspect of a comprehensive approach to ensure the safety of in situ simulation includes the identification and establishment of "no-go considerations," that is, key decision-making considerations under which in situ simulations should be canceled, postponed, moved to another area, or rescheduled. These considerations should be modified and adjusted to specific clinical units. This article provides a framework of key essentials in developing no-go considerations.

  5. Cooperative Vehicle–Highway Automation (CVHA) Technology : Simulation of Benefits and Operational Issues

    DOT National Transportation Integrated Search

    2017-03-01

    The past few years have witnessed a rapidly growing market in assistive driving technologies, designed to improve safety and operations by supporting driver performance. Often referred to as cooperative vehiclehighway automation (CVHA) systems, th...

  6. Studies to determine the effectiveness of longitudinal channelizing devices in work zones.

    DOT National Transportation Integrated Search

    2011-01-01

    This report describes the methodology and results of analyses performed to determine whether the following longitudinal : channelizing device (LCD) applications improve the traffic safety and operations of work zones relative to the use of standard :...

  7. Evaluation of the effectiveness of converging chevron pavement markings.

    DOT National Transportation Integrated Search

    2011-10-01

    Converging chevron pavement markings have recently seen rising interest in the United States as a : means to reduce speeds at high-speed locations in a desire to improve safety performance. This report : presents an investigation into the effectivene...

  8. Evaluating the effectiveness of converging chevron pavement markings.

    DOT National Transportation Integrated Search

    2010-10-01

    Converging chevron pavement markings have recently seen rising interest in the United States as a : means to reduce speeds at high-speed locations in a desire to improve safety performance. This report : presents an investigation into the effectivene...

  9. Identification of High Performance, Low Environmental Impact Materials and Processes Using Systematic Substitution (SyS)

    NASA Technical Reports Server (NTRS)

    Dhooge, P. M.; Nimitz, J. S.

    2001-01-01

    Process analysis can identify opportunities for efficiency improvement including cost reduction, increased safety, improved quality, and decreased environmental impact. A thorough, systematic approach to materials and process selection is valuable in any analysis. New operations and facilities design offer the best opportunities for proactive cost reduction and environmental improvement, but existing operations and facilities can also benefit greatly. Materials and processes that have been used for many years may be sources of excessive resource use, waste generation, pollution, and cost burden that should be replaced. Operational and purchasing personnel may not recognize some materials and processes as problems. Reasons for materials or process replacement may include quality and efficiency improvements, excessive resource use and waste generation, materials and operational costs, safety (flammability or toxicity), pollution prevention, compatibility with new processes or materials, and new or anticipated regulations.

  10. Management of local economic and ecological system of coal processing company

    NASA Astrophysics Data System (ADS)

    Kiseleva, T. V.; Mikhailov, V. G.; Karasev, V. A.

    2016-10-01

    The management issues of local ecological and economic system of coal processing company - coal processing plant - are considered in the article. The objectives of the research are the identification and the analysis of local ecological and economic system (coal processing company) performance and the proposals for improving the mechanism to support the management decision aimed at improving its environmental safety. The data on the structure of run-of-mine coal processing products are shown. The analysis of main ecological and economic indicators of coal processing enterprises, characterizing the state of its environmental safety, is done. The main result of the study is the development of proposals to improve the efficiency of local enterprise ecological and economic system management, including technical, technological and business measures. The results of the study can be recommended to industrial enterprises to improve their ecological and economic efficiency.

  11. Merits of using color and shape differentiation to improve the speed and accuracy of drug strength identification on over-the-counter medicines by laypeople.

    PubMed

    Hellier, Elizabeth; Tucker, Mike; Kenny, Natalie; Rowntree, Anna; Edworthy, Judy

    2010-09-01

    This study aimed to examine the utility of using color and shape to differentiate drug strength information on over-the-counter medicine packages. Medication errors are an important threat to patient safety, and confusions between drug strengths are a significant source of medication error. A visual search paradigm required laypeople to search for medicine packages of a particular strength from among distracter packages of different strengths, and measures of reaction time and error were recorded. Using color to differentiate drug strength information conferred an advantage on search times and accuracy. Shape differentiation did not improve search times and had only a weak effect on search accuracy. Using color to differentiate drug strength information improves drug strength identification performance. Color differentiation of drug strength information may be a useful way of reducing medication errors and improving patient safety.

  12. Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care.

    PubMed

    Mohr, David C; Eaton, Jennifer Lipkowitz; McPhaul, Kathleen M; Hodgson, Michael J

    2015-04-22

    We examined relationships between employee safety climate and patient safety culture. Because employee safety may be a precondition for the development of patient safety, we hypothesized that employee safety culture would be strongly and positively related to patient safety culture. An employee safety climate survey was administered in 2010 and assessed employees' views and experiences of safety for employees. The patient safety survey administered in 2011 assessed the safety culture for patients. We performed Pearson correlations and multiple regression analysis to examine the relationships between a composite measure of employee safety with subdimensions of patient safety culture. The regression models controlled for size, geographic characteristics, and teaching affiliation. Analyses were conducted at the group level using data from 132 medical centers. Higher employee safety climate composite scores were positively associated with all 9 patient safety culture measures examined. Standardized multivariate regression coefficients ranged from 0.44 to 0.64. Medical facilities where staff have more positive perceptions of health care workplace safety climate tended to have more positive assessments of patient safety culture. This suggests that patient safety culture and employee safety climate could be mutually reinforcing, such that investments and improvements in one domain positively impacts the other. Further research is needed to better understand the nexus between health care employee and patient safety to generalize and act upon findings.

  13. Investigation of criticality safety control infraction data at a nuclear facility

    DOE PAGES

    Cournoyer, Michael E.; Merhege, James F.; Costa, David A.; ...

    2014-10-27

    Chemical and metallurgical operations involving plutonium and other nuclear materials account for most activities performed at the LANL's Plutonium Facility (PF-4). The presence of large quantities of fissile materials in numerous forms at PF-4 makes it necessary to maintain an active criticality safety program. The LANL Nuclear Criticality Safety (NCS) Program provides guidance to enable efficient operations while ensuring prevention of criticality accidents in the handling, storing, processing and transportation of fissionable material at PF-4. In order to achieve and sustain lower criticality safety control infraction (CSCI) rates, PF-4 operations are continuously improved, through the use of Lean Manufacturing andmore » Six Sigma (LSS) business practices. Employing LSS, statistically significant variations (trends) can be identified in PF-4 CSCI reports. In this study, trends have been identified in the NCS Program using the NCS Database. An output metric has been developed that measures ADPSM Management progress toward meeting its NCS objectives and goals. Using a Pareto Chart, the primary CSCI attributes have been determined in order of those requiring the most management support. Data generated from analysis of CSCI data help identify and reduce number of corresponding attributes. In-field monitoring of CSCI's contribute to an organization's scientific and technological excellence by providing information that can be used to improve criticality safety operation safety. This increases technical knowledge and augments operational safety.« less

  14. Validation of the French version of the Hospital Survey on Patient Safety Culture questionnaire.

    PubMed

    Occelli, P; Quenon, J-L; Kret, M; Domecq, S; Delaperche, F; Claverie, O; Castets-Fontaine, B; Amalberti, R; Auroy, Y; Parneix, P; Michel, P

    2013-09-01

    To assess the psychometric properties of the French version of the Hospital Survey on Patient Safety Culture questionnaire (HSOPSC) and study the hierarchical structure of the measured dimensions. Cross-sectional survey of the safety culture. 18 acute care units of seven hospitals in South-western France. Full- and part-time healthcare providers who worked in the units. None. Item responses measured with 5-point agreement or frequency scales. Data analyses A principal component analysis was used to identify the emerging components. Two structural equation modeling methods [LInear Structural RELations (LISREL) and Partial Least Square (PLS)] were used to verify the model and to study the relative importance of the dimensions. Internal consistency of the retained dimensions was studied. A test-retest was performed to assess reproducibility of the items. Overall response rate was 77% (n = 401). A structure in 40 items grouped in 10 dimensions was proposed. The LISREL approach showed acceptable data fit of the proposed structure. The PLS approach indicated that three dimensions had the most impact on the safety culture: 'Supervisor/manager expectations & actions promoting safety' 'Organizational learning-continuous improvement' and 'Overall perceptions of safety'. Internal consistency was above 0.70 for six dimensions. Reproducibility was considered good for four items. The French HSOPSC questionnaire showed acceptable psychometric properties. Classification of the dimensions should guide future development of safety culture improving action plans.

  15. HSE training and competence assessment in the geophysical industry

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Covil, M.W.; Soethout, J.A.; Reynolds, G.

    1996-11-01

    This paper looks at the efforts of the seismic geophysical industry to continually improve it`s health, safety and environmental performance, and in particular to improve the HSE behavior and understanding of individuals within the industry. Specifically it deals with the HSE training and assessment of competence of individuals in relation to their job responsibilities, based on best industry practice.

  16. Improving clinical handover in a paediatric ward: implications for nursing management.

    PubMed

    Mannix, Trudi; Parry, Yvonne; Roderick, Allison

    2017-04-01

    To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise. © 2017 John Wiley & Sons Ltd.

  17. A review on lithium-ion power battery thermal management technologies and thermal safety

    NASA Astrophysics Data System (ADS)

    An, Zhoujian; Jia, Li; Ding, Yong; Dang, Chao; Li, Xuejiao

    2017-10-01

    Lithium-ion power battery has become one of the main power sources for electric vehicles and hybrid electric vehicles because of superior performance compared with other power sources. In order to ensure the safety and improve the performance, the maximum operating temperature and local temperature difference of batteries must be maintained in an appropriate range. The effect of temperature on the capacity fade and aging are simply investigated. The electrode structure, including electrode thickness, particle size and porosity, are analyzed. It is found that all of them have significant influences on the heat generation of battery. Details of various thermal management technologies, namely air based, phase change material based, heat pipe based and liquid based, are discussed and compared from the perspective of improving the external heat dissipation. The selection of different battery thermal management (BTM) technologies should be based on the cooling demand and applications, and liquid cooling is suggested being the most suitable method for large-scale battery pack charged/discharged at higher C-rate and in high-temperature environment. The thermal safety in the respect of propagation and suppression of thermal runaway is analyzed.

  18. Priming patient safety: A middle-range theory of safety goal priming via safety culture communication.

    PubMed

    Groves, Patricia S; Bunch, Jacinda L

    2018-05-18

    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 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. © 2018 John Wiley & Sons Ltd.

  19. Deep Needle Procedures: Improving Safety With Ultrasound Visualization

    PubMed Central

    Peabody, Christopher R.; Mandavia, Diku

    2017-01-01

    Abstract Promoting patient safety and increasing health care quality have dominated the health care landscape during the last 15 years. Health care regulators and payers are now tying patient safety outcomes and best practices to hospital reimbursement. Many health care leaders are searching for new technologies that not only make health care for patients safer but also reduce overall health care costs. New advances in ultrasonography have made this technology available to health care providers at the patient’s bedside. Point-of-care ultrasound assistance now aids providers with real-time diagnosis and with visualization for procedural guidance. This is especially true for common deep needle procedures such as central venous catheter insertion, thoracentesis, and paracentesis. There is now mounting evidence that clinician-performed point-of-care ultrasound improves patient safety, enhances health care quality, and reduces health care cost for deep needle procedures. Furthermore, the miniaturization, ease of use, and the evolving affordability of ultrasound have now made this technology widely available. The adoption of point-of-care ultrasonography has reached a tipping point and should be seriously considered the safety standard for all hospital-based deep needle procedures. PMID:24786918

  20. Crew Factors in Flight Operations XIV: Alertness Management in Regional Flight Operations Education Module

    NASA Technical Reports Server (NTRS)

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.

    2002-01-01

    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  1. Crew Factors in Flight Operations XV: Alertness Management in General Aviation Education Module

    NASA Technical Reports Server (NTRS)

    Rosekind, Mark R.; Co, Elizabeth L.; Neri, David F.; Oyung, Raymond L.; Mallis, Melissa M.; Cannon, Mary M. (Technical Monitor)

    2002-01-01

    Regional operations encompass a broad range of pilots and equipment. This module is intended to help all those involved in regional aviation, including pilots, schedulers, dispatchers, maintenance technicians, policy makers, and others, to understand the physiological factors underlying fatigue, how flight operations affect fatigue, and what can be done to counteract fatigue and maximize alertness and performance in their operations. The overall purpose of this module is to promote aviation safety, performance, and productivity. It is intended to meet three specific objectives: (1) to explain the current state of knowledge about the physiological mechanisms underlying fatigue; (2) to demonstrate how this knowledge can be applied to improving flight crew sleep, performance, and alertness; and (3) to offer strategies for alertness management. Aviation Safety Reporting System (ASRS) and National Transportation Safety Board (NISH) reports are used throughout this module to demonstrate that fatigue is a safety issue in the regional operations community. The appendices at the end of this module include the ASRS reports used for the examples contained in this publication, brief introductions to sleep disorders and relaxation techniques, summaries of relevant NASA publications, and a list of general readings on sleep, sleep disorders, and circadian rhythms.

  2. A statistical model for predicting muscle performance

    NASA Astrophysics Data System (ADS)

    Byerly, Diane Leslie De Caix

    The objective of these studies was to develop a capability for predicting muscle performance and fatigue to be utilized for both space- and ground-based applications. To develop this predictive model, healthy test subjects performed a defined, repetitive dynamic exercise to failure using a Lordex spinal machine. Throughout the exercise, surface electromyography (SEMG) data were collected from the erector spinae using a Mega Electronics ME3000 muscle tester and surface electrodes placed on both sides of the back muscle. These data were analyzed using a 5th order Autoregressive (AR) model and statistical regression analysis. It was determined that an AR derived parameter, the mean average magnitude of AR poles, significantly correlated with the maximum number of repetitions (designated Rmax) that a test subject was able to perform. Using the mean average magnitude of AR poles, a test subject's performance to failure could be predicted as early as the sixth repetition of the exercise. This predictive model has the potential to provide a basis for improving post-space flight recovery, monitoring muscle atrophy in astronauts and assessing the effectiveness of countermeasures, monitoring astronaut performance and fatigue during Extravehicular Activity (EVA) operations, providing pre-flight assessment of the ability of an EVA crewmember to perform a given task, improving the design of training protocols and simulations for strenuous International Space Station assembly EVA, and enabling EVA work task sequences to be planned enhancing astronaut performance and safety. Potential ground-based, medical applications of the predictive model include monitoring muscle deterioration and performance resulting from illness, establishing safety guidelines in the industry for repetitive tasks, monitoring the stages of rehabilitation for muscle-related injuries sustained in sports and accidents, and enhancing athletic performance through improved training protocols while reducing injury.

  3. Serious injuries: an additional indicator to fatalities for road safety benchmarking.

    PubMed

    Shen, Yongjun; Hermans, Elke; Bao, Qiong; Brijs, Tom; Wets, Geert

    2015-01-01

    Almost all of the current road safety benchmarking studies focus entirely on fatalities, which, however, represent only one measure of the magnitude of the road safety problem. The main objective of this article was to investigate the possibility of including the number of serious injuries in addition to the number of fatalities for road safety benchmarking and to further illuminate its impact on the countries' rankings. We introduced the technique of data envelopment analysis (DEA) to the road safety domain and developed a DEA-based road safety model (DEA-RS) in this study. Moreover, we outlined different types of possible weight restrictions and adopted 2 of them to indicate the relationship between road fatalities and serious injuries for the sake of rational benchmarking. One was a relative weight restriction based on the information of their shadow price, and the other was a virtual weight restriction using a priori knowledge about the importance level of these 2 aspects. By computing the most optimal road safety risk scores of 10 European countries based on the different models, we found that United Kingdom was the only best-performing country no matter which model was utilized. However, countries such as The Netherlands, Sweden, and Switzerland were no longer best-performing when the serious injuries were integrated. On the contrary, Spain, which ranked almost at the bottom among all of the countries when only the number of road fatalities was considered, became a relatively well-performing country when integrating its number of serious injuries in the evaluation. In general, no matter whether the country's road safety ranking was improved or deteriorated, most of the countries achieved a higher risk score when the number of serious injuries was included, which implied that compared to the road fatalities, more policy attention has to be paid to improve the situation of serious injuries in most countries. Given the importance of considering the serious injuries in addition to the fatalities for international benchmarking of road safety, the proposed model (i.e., the DEA-RS model with weight restrictions) turned out to be effective in deriving reasonable results. We are thereby also inspired to apply this kind of model to a more complete road safety benchmarking practice in the future when the data on, for example, the number of slight injuries, the degree of property damage, and the number of crashes are ready (i.e., comparable) to use.

  4. A job safety program for construction workers designed to reduce the potential for occupational injury using tool box training sessions and computer-assisted biofeedback stress management techniques.

    PubMed

    Johnson, Kenneth A; Ruppe, Joan

    2002-01-01

    This project was conducted with a multicultural construction company in Hawaii, USA. The job duties performed included drywall and carpentry work. The following objectives were selected for this project: (a) fire prevention training and inspection of first aid equipment; (b) blood-borne pathogen training and risk evaluation; (c) ergonomic and risk evaluation intervention program; (d) electrical safety training and inspection program; (e) slips, trips, and falls safety training; (f) stress assessment and Personal Profile System; (g) safety and health program survey; (h) improving employee relations and morale by emphasizing spirituality; and (i) computer-assisted biofeedback stress management training. Results of the project indicated that observed safety hazards, reported injuries, and levels of perceived stress. were reduced for the majority of the population.

  5. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload.

    PubMed

    Stefanidis, Dimitrios; Wang, Fikre; Korndorffer, James R; Dunne, J Bruce; Scott, Daniel J

    2010-02-01

    Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room. Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant. Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001). Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing performance and safety of novices in the operating room while decreasing their workload. Moreover, the robot significantly shortened the learning curve of this difficult task. Further study is needed to assess the value of robotic assistance for experienced surgeons, and validated robotic training curricula need to be developed.

  6. Semiquantitative analysis of gaps in microbiological performance of fish processing sector implementing current food safety management systems: a case study.

    PubMed

    Onjong, Hillary Adawo; Wangoh, John; Njage, Patrick Murigu Kamau

    2014-08-01

    Fish processing plants still face microbial food safety-related product rejections and the associated economic losses, although they implement legislation, with well-established quality assurance guidelines and standards. We assessed the microbial performance of core control and assurance activities of fish exporting processors to offer suggestions for improvement using a case study. A microbiological assessment scheme was used to systematically analyze microbial counts in six selected critical sampling locations (CSLs). Nine small-, medium- and large-sized companies implementing current food safety management systems (FSMS) were studied. Samples were collected three times on each occasion (n = 324). Microbial indicators representing food safety, plant and personnel hygiene, and overall microbiological performance were analyzed. Microbiological distribution and safety profile levels for the CSLs were calculated. Performance of core control and assurance activities of the FSMS was also diagnosed using an FSMS diagnostic instrument. Final fish products from 67% of the companies were within the legally accepted microbiological limits. Salmonella was absent in all CSLs. Hands or gloves of workers from the majority of companies were highly contaminated with Staphylococcus aureus at levels above the recommended limits. Large-sized companies performed better in Enterobacteriaceae, Escherichia coli, and S. aureus than medium- and small-sized ones in a majority of the CSLs, including receipt of raw fish material, heading and gutting, and the condition of the fish processing tables and facilities before cleaning and sanitation. Fish products of 33% (3 of 9) of the companies and handling surfaces of 22% (2 of 9) of the companies showed high variability in Enterobacteriaceae counts. High variability in total viable counts and Enterobacteriaceae was noted on fish products and handling surfaces. Specific recommendations were made in core control and assurance activities associated with sampling locations showing poor performance.

  7. Implementation of a "No Fly" safety culture in a multicenter radiation medicine department.

    PubMed

    Potters, Louis; Kapur, Ajay

    2012-01-01

    The safe delivery of radiation therapy requires multiple disciplines and interactions to perform flawlessly for each patient. Because treatment is individualized and every aspect of the patient's care is unique, it is difficult to regiment a delivery process that works flawlessly. The purpose of this study is to describe one safety-directed component of our quality program called the "No Fly Policy" (NFP). Our quality assurance program for radiation therapy reviewed the entire process of care prior, during, and after a patient's treatment course. Each component of care was broken down and rebuilt within a matrix of multidisciplinary safety quality checklists (QCL). The QCL process map was subsequently streamlined with revised task due dates and stopping rules. The NFP was introduced to place a holding pattern on treatment initiation pending reconciliation of associated stopping events. The NFP was introduced in a pilot phase using a Six-Sigma process improvement approach. Quantitative analysis on the performance of the new QCLs was performed using crystal reports in the Oncology Information Systems. Root cause analysis was conducted. Notable improvements in QCL performance were observed. The variances among staff in completing tasks reduced by a factor of at least 3, suggesting better process control. Steady improvements over time indicated an increasingly compliant and controlled adoption of the new safety-oriented process map. Stopping events led to rescheduling treatments with average and maximum delays of 2 and 4 days, respectively, with no reported adverse effects. The majority of stopping events were due to incomplete plan approvals stemming from treatment planning delays. Whereas these may have previously solicited last-minute interventions, including intensity modulated radiation therapy quality assurance, the NFP enabled nonpunitive, reasonable schedule adjustments to mitigate compromises in safe delivery. Implementation of the NFP has helped to mitigate risk from expedited care, convert reactive to proactive delays, and created a checklist, process driven, and variance-reducing culture in a large, multicenter department. Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  8. Organizational safety culture and medical error reporting by Israeli nurses.

    PubMed

    Kagan, Ilya; Barnoy, Sivia

    2013-09-01

    To investigate the association between patient safety culture (PSC) and the incidence and reporting rate of medical errors by Israeli nurses. Self-administered structured questionnaires were distributed to a convenience sample of 247 registered nurses enrolled in training programs at Tel Aviv University (response rate = 91%). The questionnaire's three sections examined the incidence of medication mistakes in clinical practice, the reporting rate for these errors, and the participants' views and perceptions of the safety culture in their workplace at three levels (organizational, departmental, and individual performance). Pearson correlation coefficients, t tests, and multiple regression analysis were used to analyze the data. Most nurses encountered medical errors from a daily to a weekly basis. Six percent of the sample never reported their own errors, while half reported their own errors "rarely or sometimes." The level of PSC was positively and significantly correlated with the error reporting rate. PSC, place of birth, error incidence, and not having an academic nursing degree were significant predictors of error reporting, together explaining 28% of variance. This study confirms the influence of an organizational safety climate on readiness to report errors. Senior healthcare executives and managers can make a major impact on safety culture development by creating and promoting a vision and strategy for quality and safety and fostering their employees' motivation to implement improvement programs at the departmental and individual level. A positive, carefully designed organizational safety culture can encourage error reporting by staff and so improve patient safety. © 2013 Sigma Theta Tau International.

  9. Recent Development of Augmented Reality in Surgery: A Review.

    PubMed

    Vávra, P; Roman, J; Zonča, P; Ihnát, P; Němec, M; Kumar, J; Habib, N; El-Gendi, A

    2017-01-01

    The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms "augmented reality" and "surgery." Results . The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

  10. STORC safety initiative: a multicentre survey on preparedness & confidence in obstetric emergencies.

    PubMed

    Guise, Jeanne-Marie; Segel, Sally Y; Larison, Kristine; M Jump, Sarah; Constable, Marion; Li, Hong; Osterweil, Patricia; Dieter Zimmer

    2010-12-01

    Patient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated with confidence in responding to obstetric emergencies and to evaluate perceptions about the value of team training to improve preparedness. An anonymous survey was administered to all clinical staff members who respond to obstetric emergencies in seven Oregon hospitals from June 2006 to August 2006. 614 clinical staff (74.5%) responded. While over 90% felt confident that the appropriate clinical staff would respond to emergencies, more than half reported that other clinical staff members were confused about their role during emergencies. Over 84% were confident that emergency drills or simulation-based team training would improve performance. Clinical staff who respond to obstetric emergencies in their practice reported feeling confident that the qualified personnel would respond to an emergency; however, they were less confident that the responders would perform well as a team. They reported that simulation and team training may improve their preparedness and confidence in responding to emergencies.

  11. Measures to Improve Diagnostic Safety in Clinical Practice

    PubMed Central

    Singh, Hardeep; Graber, Mark L; Hofer, Timothy P

    2016-01-01

    Timely and accurate diagnosis is foundational to good clinical practice and an essential first step to achieving optimal patient outcomes. However, a recent Institute of Medicine report concluded that most of us will experience at least one diagnostic error in our lifetime. The report argues for efforts to improve the reliability of the diagnostic process through better measurement of diagnostic performance. The diagnostic process is a dynamic team-based activity that involves uncertainty, plays out over time, and requires effective communication and collaboration among multiple clinicians, diagnostic services, and the patient. Thus, it poses special challenges for measurement. In this paper, we discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. We highlight challenges and opportunities for developing potential measures of “diagnostic safety” related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, we propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety, and call for these to be studied and further refined. This would enable safe diagnosis to become an organizational priority and facilitate quality improvement. Health care systems should consider measurement and evaluation of diagnostic performance as essential to timely and accurate diagnosis and to the reduction of preventable diagnostic harm. PMID:27768655

  12. Safety of clinical and non-clinical decision makers in telephone triage: a narrative review.

    PubMed

    Wheeler, Sheila Q; Greenberg, Mary E; Mahlmeister, Laura; Wolfe, Nicole

    2015-09-01

    Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard. © The Author(s) 2015.

  13. Barriers to the implementation of checklists in the office-based procedural setting.

    PubMed

    Shapiro, Fred E; Fernando, Rohesh J; Urman, Richard D

    2014-01-01

    Patient safety is critical for the patients, providers, and risk managers in the office-based procedural setting, and the same standard of care should be maintained regardless of the healthcare environment. Checklists may improve patient safety and potentially decrease risk. This study explored utilization of checklists in the office-based setting and the potential barriers to their implementation. A cross-sectional prospective study was performed by using a 19-question anonymous survey designed with REDCap®. Medical providers including physicians and nurses from 25 different offices that performed procedures participated, and 38 individual responses were included in the study. Only 50% of offices surveyed use safety checklists in their practice. Only 34% had checklists or equivalent protocol for emergencies such as anaphylaxis or failed airway. As many as 23.7% of respondents indicated that they encountered barriers to implementing checklists. The top barriers identified in the study were no incentive to use a checklist (77.8%), no mandate from a local or federal regulatory agency (44.4%), being too time consuming (33.3%), and lack of training (33.3%). Reasons identified that would encourage providers to use checklists included a clear mandate (36.8%) and evidence-based research (26.3%). Checklists are not being universally utilized in the office-based setting. There are barriers preventing their successful implementation. Risk managers may be able to improve patient safety and decrease risk by encouraging practitioners, possibly through incentives, to use customizable safety checklists. © 2014 American Society for Healthcare Risk Management of the American Hospital Association.

  14. Safety I-II, resilience and antifragility engineering: a debate explained through an accident occurring on a mobile elevating work platform.

    PubMed

    Martinetti, Alberto; Chatzimichailidou, Maria Mikela; Maida, Luisa; van Dongen, Leo

    2018-04-24

    Occupational health and safety (OHS) represents an important field of exploration for the research community: in spite of the growth of technological innovations, the increasing complexity of systems involves critical issues in terms of degradation of the safety levels. In such a situation, new safety management approaches are now mandatory in order to face the safety implications of the current technological evolutions. Along these lines, performing risk-based analysis alone seems not to be enough anymore. The evaluation of robustness, antifragility and resilience of a socio-technical system is now indispensable in order to face unforeseen events. This article will briefly introduce the topics of Safety I and Safety II, resilience engineering and antifragility engineering, explaining correlations, overlapping aspects and synergies. Secondly, the article will discuss the applications of those paradigms to a real accident, highlighting how they can challenge, stimulate and inspire research for improving OHS conditions.

  15. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

    PubMed Central

    Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

    2015-01-01

    Background A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. Method The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. Results The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Conclusion Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. PMID:25918337

  16. Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.

    PubMed

    Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

    2015-05-01

    A constructive safety culture is essential for the successful implementation of patient safety improvements. To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. © British Journal of General Practice 2015.

  17. A Risk Assessment Model for Reduced Aircraft Separation: A Quantitative Method to Evaluate the Safety of Free Flight

    NASA Technical Reports Server (NTRS)

    Cassell, Rick; Smith, Alex; Connors, Mary; Wojciech, Jack; Rosekind, Mark R. (Technical Monitor)

    1996-01-01

    As new technologies and procedures are introduced into the National Airspace System, whether they are intended to improve efficiency, capacity, or safety level, the quantification of potential changes in safety levels is of vital concern. Applications of technology can improve safety levels and allow the reduction of separation standards. An excellent example is the Precision Runway Monitor (PRM). By taking advantage of the surveillance and display advances of PRM, airports can run instrument parallel approaches to runways separated by 3400 feet with the same level of safety as parallel approaches to runways separated by 4300 feet using the standard technology. Despite a wealth of information from flight operations and testing programs, there is no readily quantifiable relationship between numerical safety levels and the separation standards that apply to aircraft on final approach. This paper presents a modeling approach to quantify the risk associated with reducing separation on final approach. Reducing aircraft separation, both laterally and longitudinally, has been the goal of several aviation R&D programs over the past several years. Many of these programs have focused on technological solutions to improve navigation accuracy, surveillance accuracy, aircraft situational awareness, controller situational awareness, and other technical and operational factors that are vital to maintaining flight safety. The risk assessment model relates different types of potential aircraft accidents and incidents and their contribution to overall accident risk. The framework links accident risks to a hierarchy of failsafe mechanisms characterized by procedures and interventions. The model will be used to assess the overall level of safety associated with reducing separation standards and the introduction of new technology and procedures, as envisaged under the Free Flight concept. The model framework can be applied to various aircraft scenarios, including parallel and in-trail approaches. This research was performed under contract to NASA and in cooperation with the FAA's Safety Division (ASY).

  18. Research on regularized mean-variance portfolio selection strategy with modified Roy safety-first principle.

    PubMed

    Atta Mills, Ebenezer Fiifi Emire; Yan, Dawen; Yu, Bo; Wei, Xinyuan

    2016-01-01

    We propose a consolidated risk measure based on variance and the safety-first principle in a mean-risk portfolio optimization framework. The safety-first principle to financial portfolio selection strategy is modified and improved. Our proposed models are subjected to norm regularization to seek near-optimal stable and sparse portfolios. We compare the cumulative wealth of our preferred proposed model to a benchmark, S&P 500 index for the same period. Our proposed portfolio strategies have better out-of-sample performance than the selected alternative portfolio rules in literature and control the downside risk of the portfolio returns.

  19. The CCLM contribution to improvements in quality and patient safety.

    PubMed

    Plebani, Mario

    2013-01-01

    Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

  20. Quality improvement for patient safety: project-level versus program-level learning.

    PubMed

    Rivard, Peter E; Parker, Victoria A; Rosen, Amy K

    2013-01-01

    Improving quality and patient safety is of increasing strategic importance to health care organizations. However, simply increasing the volume of quality improvement (QI) activity does not necessarily improve patient outcomes. There is a need for greater understanding of QI success factors. This study looked for differences in QI implementation across hospitals with a range of performance on Patient Safety Indicators. We conducted an exploratory comparative case study of 4 Veterans Health Administration hospitals including site visits and interviews with leaders and staff. Two themes emerged. Project-level QI learning is assessing and modifying specific QI projects relative to expectations. Program-level QI learning is assessing and modifying the overall QI endeavor. The nature of project-level QI learning was similar across sites, whereas we identified qualitative differences across organizations in program-level QI learning. The highest performing organization was evaluating and refining its overall approach to QI, whereas the others were learning how to build and control QI programs. Program-level QI learning may be key if a QI program is to succeed in improving patient outcomes. This type of organizational learning entails a big-picture, organization-wide view of QI. It also entails second-order organizational learning based on assessment not only of whether QI is being done correctly but also whether the right QI activities are being done, for the right reasons. The organization is "learning to learn." In addition to gaining mastery and control of QI, leaders regularly engage with staff in rethinking QI and experimenting with new approaches. Leaders also assess how QI activity fits in the organization's developmental journey and how it supports realization of strategy.

  1. Air traffic management as principled negotiation between intelligent agents

    NASA Technical Reports Server (NTRS)

    Wangermann, J. P.

    1994-01-01

    The major challenge facing the world's aircraft/airspace system (AAS) today is the need to provide increased capacity, while reducing delays, increasing the efficiency of flight operations, and improving safety. Technologies are emerging that should improve the performance of the system, but which could also introduce uncertainty, disputes, and inefficiency if not properly implemented. The aim of our research is to apply techniques from intelligent control theory and decision-making theory to define an Intelligent Aircraft/Airspace System (IAAS) for the year 2025. The IAAS would make effective use of the technical capabilities of all parts of the system to meet the demand for increased capacity with improved performance.

  2. Evaluation of j-turn intersection design performance in Missouri.

    DOT National Transportation Integrated Search

    2013-12-01

    Research shows that a high percentage of crashes that take place on high-speed rural expressways occur at intersections with : minor roads. One low-cost alternative design for improving the safety of at-grade intersections on such expressways is the ...

  3. Performance of advance warning systems in a coordinated system : final report.

    DOT National Transportation Integrated Search

    2016-09-01

    The Advance Warning System (AWS), developed by the Nebraska Department of Roads (NDOR) has proven to be effective at improving traffic safety at isolated signalized intersections. However, the effectiveness of the system has not been analyzed at sign...

  4. Improving safety in pavement field testing [project summary].

    DOT National Transportation Integrated Search

    2017-09-01

    As part of its pavement evaluation program, the Florida Department of Transportation drives over 500,000 miles annually in its mission to collect pavement condition and performance data. Some of this work is conducted by vehicles that often travel at...

  5. Effect of Cycling Skills on Bicycle Safety and Comfort Associated with Bicycle Infrastructure and Environment

    DOT National Transportation Integrated Search

    2017-08-31

    This study seeks to improve the methodology for determining the relationship between cycling dynamic performance and roadway environment characteristics across different bicyclists' skill levels. To achieve the goal of this study, an Instrumented Pro...

  6. Asphalt surface treatment practice in southeastern United States : [tech summary].

    DOT National Transportation Integrated Search

    2014-09-01

    Pavement preservation is an approach in enhancing pavement performance using a set of practices that extends the life : of the pavement and improves safety and ride quality. According to the World Banks Pavement Deterioration Model, the : cost of ...

  7. Modeling level-of-safety for bus stops in China.

    PubMed

    Ye, Zhirui; Wang, Chao; Yu, Yongbo; Shi, Xiaomeng; Wang, Wei

    2016-08-17

    Safety performance at bus stops is generally evaluated by using historical traffic crash data or traffic conflict data. However, in China, it is quite difficult to obtain such data mainly due to the lack of traffic data management and organizational issues. In light of this, the primary objective of this study is to develop a quantitative approach to evaluate bus stop safety performance. The concept of level-of-safety for bus stops is introduced and corresponding models are proposed to quantify safety levels, which consider conflict points, traffic factors, geometric characteristics, traffic signs and markings, pavement conditions, and lighting conditions. Principal component analysis and k-means clustering methods were used to model and quantify safety levels for bus stops. A case study was conducted to show the applicability of the proposed model with data collected from 46 samples for the 7 most common types of bus stops in China, using 32 of the samples for modeling and 14 samples for illustration. Based on the case study, 6 levels of safety for bus stops were defined. Finally, a linear regression analysis between safety levels and the number of traffic conflicts showed that they had a strong relationship (R(2) value of 0.908). The results indicated that the method was well validated and could be practically used for the analysis and evaluation of bus stop safety in China. The proposed model was relatively easy to implement without the requirement of traffic crash data and/or traffic conflict data. In addition, with the proposed method, it was feasible to evaluate countermeasures to improve bus stop safety (e.g., exclusive bus lanes).

  8. Comparative efficacy and safety of mavacoxib and carprofen in the treatment of canine osteoarthritis.

    PubMed

    Payne-Johnson, M; Becskei, C; Chaudhry, Y; Stegemann, M R

    2015-03-14

    A multi-site, masked, randomised parallel group study employing a double dummy treatment design was performed in canine veterinary patients to determine the comparative efficacy and safety of mavacoxib and carprofen in the treatment of pain and inflammation associated with osteoarthritis for a period of 134 days. Treatments were administered according to their respective summaries of product characteristics. Of 139 dogs screened, 124 were suitable for study participation: 62 of which were dosed with mavacoxib and 62 with carprofen. Both treatments resulted in a very similar pattern of considerable improvement as indicated in all parameters assessed by both owner and veterinarian. The primary efficacy endpoint 'overall improvement' was a composite score of owner assessments after approximately six weeks of treatment. Both drugs were remarkably effective, with 57/61 (93.4 per cent) of mavacoxib-treated dogs and 49/55 (89.1 per cent) of carprofen-treated dogs demonstrating overall improvement and with mavacoxib's efficacy being non-inferior to carprofen. The treatments had a similar safety profile as evidenced by documented adverse events and summaries of clinical pathology parameters. The positive clinical response to treatment along with the safety and dosing regimen of mavacoxib makes it an attractive therapy for canine osteoarthritis. British Veterinary Association.

  9. Analysis of the medication-use process in North American hospital systems: underlining key points for adoption to improve patient safety in French hospitals.

    PubMed

    Brouard, Agnes; Fagon, Jean Yves; Daniels, Charles E

    2011-01-01

    This project was designed to underline any actions relative to medication error prevention and patient safety improvement setting up in North American hospitals which could be implemented in French Parisian hospitals. A literature research and analysis of medication-use process in the North American hospitals and a validation survey of hospital pharmacist managers in the San Diego area was performed to assess main points of hospital medication-use process. Literature analysis, survey analysis of respondents highlighted main differences between the two countries at three levels: nationwide, hospital level and pharmaceutical service level. According to this, proposal development to optimize medication-use process in the French system includes the following topics: implementation of an expanded use of information technology and robotics; increase pharmaceutical human resources allowing expansion of clinical pharmacy activities; focus on high-risk medications and high-risk patient populations; develop a collective sense of responsibility for medication error prevention in hospital settings, involving medical, pharmaceutical and administrative teams. Along with a strong emphasis that should be put on the identified topics to improve the quality and safety of hospital care in France, consideration of patient safety as a priority at a nationwide level needs to be reinforced.

  10. Prediction of Driver’s Intention of Lane Change by Augmenting Sensor Information Using Machine Learning Techniques

    PubMed Central

    Kim, Il-Hwan; Bong, Jae-Hwan; Park, Jooyoung; Park, Shinsuk

    2017-01-01

    Driver assistance systems have become a major safety feature of modern passenger vehicles. The advanced driver assistance system (ADAS) is one of the active safety systems to improve the vehicle control performance and, thus, the safety of the driver and the passengers. To use the ADAS for lane change control, rapid and correct detection of the driver’s intention is essential. This study proposes a novel preprocessing algorithm for the ADAS to improve the accuracy in classifying the driver’s intention for lane change by augmenting basic measurements from conventional on-board sensors. The information on the vehicle states and the road surface condition is augmented by using an artificial neural network (ANN) models, and the augmented information is fed to a support vector machine (SVM) to detect the driver’s intention with high accuracy. The feasibility of the developed algorithm was tested through driving simulator experiments. The results show that the classification accuracy for the driver’s intention can be improved by providing an SVM model with sufficient driving information augmented by using ANN models of vehicle dynamics. PMID:28604582

  11. Less is (sometimes) more in cognitive engineering: the role of automation technology in improving patient safety

    PubMed Central

    Vicente, K

    2003-01-01

    

 There is a tendency to assume that medical error can be stamped out by automation. Technology may improve patient safety, but cognitive engineering research findings in several complex safety critical systems, including both aviation and health care, show that more is not always better. Less sophisticated technological systems can sometimes lead to better performance than more sophisticated systems. This "less is more" effect arises because safety critical systems are open systems where unanticipated events are bound to occur. In these contexts, decision support provided by a technological aid will be less than perfect because there will always be situations that the technology cannot accommodate. Designing sophisticated automation that suggests an uncertain course of action seems to encourage people to accept the imperfect advice, even though information to decide independently on a better course of action is available. It may be preferable to create more modest designs that merely provide feedback about the current state of affairs or that critique human generated solutions than to rush to automate by creating sophisticated technological systems that recommend (fallible) courses of action. PMID:12897363

  12. Efficacy and safety of tolvaptan in heart failure patients with volume overload despite the standard treatment with conventional diuretics: a phase III, randomized, double-blind, placebo-controlled study (QUEST study).

    PubMed

    Matsuzaki, Masunori; Hori, Masatsugu; Izumi, Tohru; Fukunami, Masatake

    2011-12-01

    Diuretics are recommended to treat volume overload with heart failure (HF), however, they may cause serum electrolyte imbalance, limiting their use. Moreover, patients with advanced HF could poorly respond to these diuretics. In this study, we evaluated the efficacy and safety of Tolvaptan, a competitive vasopressin V2-receptor antagonist developed as a new drug to treat volume overload in HF patients. A phase III, multicenter, randomized, double-blind, placebo-controlled parallel study was performed to assess the efficacy and safety of tolvaptan in treating HF patients with volume overload despite the use of conventional diuretics. One hundred and ten patients were randomly assigned to receive either placebo or 15 mg/day tolvaptan for 7 consecutive days. Compared with placebo, tolvaptan administered for 7 days significantly reduced body weight and improved symptoms associated with volume overload. The safety profile of tolvaptan was considered acceptable for clinical use with minimal adverse effects. Tolvaptan reduced volume overload and improved congestive symptoms associated with HF by a potent water diuresis (aquaresis).

  13. Safety analysis, 200 Area, Savannah River Plant: Separations area operations

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Perkins, W.C.; Lee, R.; Allen, P.M.

    1991-07-01

    The nev HB-Line, located on the fifth and sixth levels of Building 221-H, is designed to replace the aging existing HB-Line production facility. The nev HB-Line consists of three separate facilities: the Scrap Recovery Facility, the Neptunium Oxide Facility, and the Plutonium Oxide Facility. There are three separate safety analyses for the nev HB-Line, one for each of the three facilities. These are issued as supplements to the 200-Area Safety Analysis (DPSTSA-200-10). These supplements are numbered as Sup 2A, Scrap Recovery Facility, Sup 2B, Neptunium Oxide Facility, Sup 2C, Plutonium Oxide Facility. The subject of this safety analysis, the, Plutoniummore » Oxide Facility, will convert nitrate solutions of {sup 238}Pu to plutonium oxide (PuO{sub 2}) powder. All these new facilities incorporate improvements in: (1) engineered barriers to contain contamination, (2) barriers to minimize personnel exposure to airborne contamination, (3) shielding and remote operations to decrease radiation exposure, and (4) equipment and ventilation design to provide flexibility and improved process performance.« less

  14. FY2017 Updates to the SAS4A/SASSYS-1 Safety Analysis Code

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fanning, T. H.

    The SAS4A/SASSYS-1 safety analysis software is used to perform deterministic analysis of anticipated events as well as design-basis and beyond-design-basis accidents for advanced fast reactors. It plays a central role in the analysis of U.S. DOE conceptual designs, proposed test and demonstration reactors, and in domestic and international collaborations. This report summarizes the code development activities that have taken place during FY2017. Extensions to the void and cladding reactivity feedback models have been implemented, and Control System capabilities have been improved through a new virtual data acquisition system for plant state variables and an additional Block Signal for a variablemore » lag compensator to represent reactivity feedback for novel shutdown devices. Current code development and maintenance needs are also summarized in three key areas: software quality assurance, modeling improvements, and maintenance of related tools. With ongoing support, SAS4A/SASSYS-1 can continue to fulfill its growing role in fast reactor safety analysis and help solidify DOE’s leadership role in fast reactor safety both domestically and in international collaborations.« less

  15. Closed-loop control of anesthesia: a primer for anesthesiologists.

    PubMed

    Dumont, Guy A; Ansermino, J Mark

    2013-11-01

    Feedback control is ubiquitous in nature and engineering and has revolutionized safety in fields from space travel to the automobile. In anesthesia, automated feedback control holds the promise of limiting the effects on performance of individual patient variability, optimizing the workload of the anesthesiologist, increasing the time spent in a more desirable clinical state, and ultimately improving the safety and quality of anesthesia care. The benefits of control systems will not be realized without widespread support from the health care team in close collaboration with industrial partners. In this review, we provide an introduction to the established field of control systems research for the everyday anesthesiologist. We introduce important concepts such as feedback and modeling specific to control problems and provide insight into design requirements for guaranteeing the safety and performance of feedback control systems. We focus our discussion on the optimization of anesthetic drug administration.

  16. Ergonomics contributions to company strategies.

    PubMed

    Dul, Jan; Neumann, W Patrick

    2009-07-01

    Managers usually associate ergonomics with occupational health and safety and related legislation, not with business performance. In many companies, these decision makers seem not to be positively motivated to apply ergonomics for reasons of improving health and safety. In order to strengthen the position of ergonomics and ergonomists in the business and management world, we discuss company strategies and business goals to which ergonomics could contribute. Conceptual models are presented and examples are given to illustrate: (1) the present situation in which ergonomics is not part of regular planning and control cycles in organizations to ensure business performance; and (2) the desired situation in which ergonomics is an integrated part of strategy formulation and implementation. In order to realize the desired situation, considerable changes must take place within the ergonomics research, education and practice community by moving from a health ergonomics paradigm to a business ergonomics paradigm, without losing the health and safety goals.

  17. Technology Infusion of CodeSonar into the Space Network Ground Segment (RII07)

    NASA Technical Reports Server (NTRS)

    Benson, Markland

    2008-01-01

    The NASA Software Assurance Research Program (in part) performs studies as to the feasibility of technologies for improving the safety, quality, reliability, cost, and performance of NASA software. This study considers the application of commercial automated source code analysis tools to mission critical ground software that is in the operations and sustainment portion of the product lifecycle.

  18. Values Education: The Power2Achieve Approach for Building Sustainability and Enduring Impact

    ERIC Educational Resources Information Center

    Davidson, Matthew; Khmelkov, Vladimir; Baker, Kyle; Lickona, Thomas

    2011-01-01

    Schools today struggle to prepare students for the moral and performance character challenges they will face in the 21st Century. Whether it is bolstering academic performance, reducing dropout, or improving integrity and safety, developing the character and culture of excellence and ethics is a critical need of schools--and yet they must do so…

  19. Context-aware system for pre-triggering irreversible vehicle safety actuators.

    PubMed

    Böhmländer, Dennis; Dirndorfer, Tobias; Al-Bayatti, Ali H; Brandmeier, Thomas

    2017-06-01

    New vehicle safety systems have led to a steady improvement of road safety and a reduction in the risk of suffering a major injury in vehicle accidents. A huge leap forward in the development of new vehicle safety systems are actuators that have to be activated irreversibly shortly before a collision in order to mitigate accident consequences. The triggering decision has to be based on measurements of exteroceptive sensors currently used in driver assistance systems. This paper focuses on developing a novel context-aware system designed to detect potential collisions and to trigger safety actuators even before an accident occurs. In this context, the analysis examines the information that can be collected from exteroceptive sensors (pre-crash data) to predict a certain collision and its severity to decide whether a triggering is entitled or not. A five-layer context-aware architecture is presented, that is able to collect contextual information about the vehicle environment and the actual driving state using different sensors, to perform reasoning about potential collisions, and to trigger safety functions upon that information. Accident analysis is used in a data model to represent uncertain knowledge and to perform reasoning. A simulation concept based on real accident data is introduced to evaluate the presented system concept. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Dual Liquid Flyback Booster for the Space Shuttle

    NASA Technical Reports Server (NTRS)

    Blum, C.; Jones, P.; Meinders, B.

    1998-01-01

    Liquid Flyback Boosters provide an opportunity to improve shuttle safety, increase performance, and reduce operating costs. The objective of the LFBB study is to establish the viability of a LFBB configuration to integrate into the shuffle vehicle and meet the goals of the Space Shuttle upgrades program. The design of a technically viable LFBB must integrate into the shuffle vehicle with acceptable impacts to the vehicle elements, i.e. orbiter and external tank and the shuttle operations infrastructure. The LFBB must also be capable of autonomous return to the launch site. The smooth integration of the LFBB into the space shuttle vehicle and the ability of the LFBB to fly back to the launch site are not mutually compatible capabilities. LFBB wing configurations optimized for ascent must also provide flight quality during the powered return back to the launch site. This paper will focus on the core booster design and ascent performance. A companion paper 'Conceptual Design for a Space Shuttle Liquid Flyback Booster' will focus on the flyback system design and performance. The LFBB study developed design and aerodynamic data to demonstrate the viability of a dual booster configuration to meet the shuttle upgrade goals, i.e. enhanced safety, improved performance and reduced operations costs.

  1. Dual Liquid Flyback Booster for the Space Shuttle

    NASA Technical Reports Server (NTRS)

    Blum, C.; Jones, Patti; Meinders, B.

    1998-01-01

    Liquid Flyback Boosters provide an opportunity to improve shuttle safety, increase performance, and reduce operating costs. The objective of the LFBB study is to establish the viability of a LFBB configuration to integrate into the shuttle vehicle and meet the goals of the Space Shuttle upgrades program. The design of a technically viable LFBB must integrate into the shuttle vehicle with acceptable impacts to the vehicle elements, i.e. orbiter and external tank and the shuttle operations infrastructure. The LFBB must also be capable of autonomous return to the launch site. The smooth integration of the LFBB into the space shuttle vehicle and the ability of the LFBB to fly back to the launch site are not mutually compatible capabilities. LFBB wing configurations optimized for ascent must also provide flight quality during the powered return back to the launch site. This paper will focus on the core booster design and ascent performance. A companion paper, "Conceptual Design for a Space Shuttle Liquid Flyback Booster" will focus on the flyback system design and performance. The LFBB study developed design and aerodynamic data to demonstrate the viability of a dual booster configuration to meet the shuttle upgrade goals, i.e. enhanced safety, improved performance and reduced operations costs.

  2. Practical use of high-speed cameras for research and development within the automotive industry: yesterday and today

    NASA Astrophysics Data System (ADS)

    Steinmetz, Klaus

    1995-05-01

    Within the automotive industry, especially for the development and improvement of safety systems, we find a lot of high accelerated motions, that can not be followed and consequently not be analyzed by human eye. For the vehicle safety tests at AUDI, which are performed as 'Crash Tests', 'Sled Tests' and 'Static Component Tests', 'Stalex', 'Hycam', and 'Locam' cameras are in use. Nowadays the automobile production is inconceivable without the use of high speed cameras.

  3. Nuclear Data Uncertainty Propagation to Reactivity Coefficients of a Sodium Fast Reactor

    NASA Astrophysics Data System (ADS)

    Herrero, J. J.; Ochoa, R.; Martínez, J. S.; Díez, C. J.; García-Herranz, N.; Cabellos, O.

    2014-04-01

    The assessment of the uncertainty levels on the design and safety parameters for the innovative European Sodium Fast Reactor (ESFR) is mandatory. Some of these relevant safety quantities are the Doppler and void reactivity coefficients, whose uncertainties are quantified. Besides, the nuclear reaction data where an improvement will certainly benefit the design accuracy are identified. This work has been performed with the SCALE 6.1 codes suite and its multigroups cross sections library based on ENDF/B-VII.0 evaluation.

  4. Adverse outcomes in maternity care for women with a low risk profile in The Netherlands: a case series analysis

    PubMed Central

    2013-01-01

    Background This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety. Methods We included 71 critical incidents in primary midwifery care and subsequent hospital care in case of referral after 36 weeks of pregnancy that were related to substandard care and for that reason were reported to the Health Care Inspectorate in The Netherlands in 36 months (n = 357). We performed a case-by-case analysis, using a previously validated instrument which covered five broad domains: healthcare organization, communication between healthcare providers, patient risk factors, clinical management, and clinical outcomes. Results Determinants that were associated with risk concerned healthcare organization (n = 20 incidents), communication about treatment procedures (n = 39), referral processes (n = 19), risk assessment by telephone triage (n = 10), and clinical management in an out of hours setting (n = 19). The 71 critical incidents included three cases of maternal death, eight cases of severe maternal morbidity, 42 perinatal deaths and 12 critical incidents with severe morbidity for the child. Suboptimal prenatal risk assessment, a delay in availability of health care providers in urgent situations, miscommunication about treatment between care providers, and miscommunication with patients in situations with a language barrier were associated with safety risks. Conclusions Systematic analysis of critical incidents improves insight in determinants of safety risk. The wide variety of determinants of risk of critical incidents implies that there is no single intervention to improve patient safety in the care for pregnant women with initially a low risk profile. PMID:24286376

  5. Design and implementation of an identification system in construction site safety for proactive accident prevention.

    PubMed

    Yang, Huanjia; Chew, David A S; Wu, Weiwei; Zhou, Zhipeng; Li, Qiming

    2012-09-01

    Identifying accident precursors using real-time identity information has great potential to improve safety performance in construction industry, which is still suffering from day to day records of accident fatality and injury. Based on the requirements analysis for identifying precursor and the discussion of enabling technology solutions for acquiring and sharing real-time automatic identification information on construction site, this paper proposes an identification system design for proactive accident prevention to improve construction site safety. Firstly, a case study is conducted to analyze the automatic identification requirements for identifying accident precursors in construction site. Results show that it mainly consists of three aspects, namely access control, training and inspection information and operation authority. The system is then designed to fulfill these requirements based on ZigBee enabled wireless sensor network (WSN), radio frequency identification (RFID) technology and an integrated ZigBee RFID sensor network structure. At the same time, an information database is also designed and implemented, which includes 15 tables, 54 queries and several reports and forms. In the end, a demonstration system based on the proposed system design is developed as a proof of concept prototype. The contributions of this study include the requirement analysis and technical design of a real-time identity information tracking solution for proactive accident prevention on construction sites. The technical solution proposed in this paper has a significant importance in improving safety performance on construction sites. Moreover, this study can serve as a reference design for future system integrations where more functions, such as environment monitoring and location tracking, can be added. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Six sigma tools for a patient safety-oriented, quality-checklist driven radiation medicine department.

    PubMed

    Kapur, Ajay; Potters, Louis

    2012-01-01

    The purpose of this work was to develop and implement six sigma practices toward the enhancement of patient safety in an electronic, quality checklist-driven, multicenter, paperless radiation medicine department. A quality checklist process map (QPM), stratified into consultation through treatment-completion stages was incorporated into an oncology information systems platform. A cross-functional quality management team conducted quality-function-deployment and define-measure-analyze-improve-control (DMAIC) six sigma exercises with a focus on patient safety. QPM procedures were Pareto-sorted in order of decreasing patient safety risk with failure mode and effects analysis (FMEA). Quantitative metrics for a grouped set of highest risk procedures were established. These included procedural delays, associated standard deviations and six sigma Z scores. Baseline performance of the QPM was established over the previous year of usage. Data-driven analysis led to simplification, standardization, and refinement of the QPM with standard deviation, slip-day reduction, and Z-score enhancement goals. A no-fly policy (NFP) for patient safety was introduced at the improve-control DMAIC phase, with a process map interlock imposed on treatment initiation in the event of FMEA-identified high-risk tasks being delayed or not completed. The NFP was introduced in a pilot phase with specific stopping rules and the same metrics used for performance assessments. A custom root-cause analysis database was deployed to monitor patient safety events. Relative to the baseline period, average slip days and standard deviations for the risk-enhanced QPM procedures improved by over threefold factors in the NFP period. The Z scores improved by approximately 20%. A trend for proactive delays instead of reactive hard stops was observed with no adverse effects of the NFP. The number of computed potential no-fly delays per month dropped from 60 to 20 over a total of 520 cases. The fraction of computed potential no-fly cases that were delayed in NFP compliance rose from 28% to 45%. Proactive delays rose to 80% of all delayed cases. For potential no-fly cases, event reporting rose from 18% to 50%, while for actually delayed cases, event reporting rose from 65% to 100%. With complex technologies, resource-compromised staff, and pressures to hasten treatment initiation, the use of the six sigma driven process interlocks may mitigate potential patient safety risks as demonstrated in this study. Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  7. SafetyAnalyst : software tools for safety management of specific highway sites

    DOT National Transportation Integrated Search

    2010-07-01

    SafetyAnalyst provides a set of software tools for use by state and local highway agencies for highway safety management. SafetyAnalyst can be used by highway agencies to improve their programming of site-specific highway safety improvements. SafetyA...

  8. Aviation’s Normal Operations Safety Audit: a safety management and educational tool for health care? Results of a small-scale trial

    PubMed Central

    Bennett, Simon A

    2017-01-01

    Background A National Health Service (NHS) contingent liability for medical error claims of over £26 billion. Objectives To evaluate the safety management and educational benefits of adapting aviation’s Normal Operations Safety Audit (NOSA) to health care. Methods In vivo research, a NOSA was performed by medical students at an English NHS Trust. After receiving training from the author, the students spent 6 days gathering data under his supervision. Results The data revealed a threat-rich environment, where errors – some consequential – were made (359 threats and 86 errors were recorded over 2 weeks). The students claimed that the exercise improved their observational, investigative, communication, teamworking and other nontechnical skills. Conclusion NOSA is potentially an effective safety management and educational tool for health care. It is suggested that 1) the UK General Medical Council mandates that all medical students perform a NOSA in fulfillment of their degree; 2) the participating NHS Trusts be encouraged to act on students’ findings; and 3) the UK Department of Health adopts NOSA as a cornerstone risk assessment and management tool. PMID:28860881

  9. Resilient health care: turning patient safety on its head.

    PubMed

    Braithwaite, Jeffrey; Wears, Robert L; Hollnagel, Erik

    2015-10-01

    The current approach to patient safety, labelled Safety I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  10. IEC 61511 and the capital project process--a protective management system approach.

    PubMed

    Summers, Angela E

    2006-03-17

    This year, the process industry has reached an important milestone in process safety-the acceptance of an internationally recognized standard for safety instrumented systems (SIS). This standard, IEC 61511, documents good engineering practice for the assessment, design, operation, maintenance, and management of SISs. The foundation of the standard is established by several requirements in Part 1, Clauses 5-7, which cover the development of a management system aimed at ensuring that functional safety is achieved. The management system includes a quality assurance process for the entire SIS lifecycle, requiring the development of procedures, identification of resources and acquisition of tools. For maximum benefit, the deliverables and quality control checks required by the standard should be integrated into the capital project process, addressing safety, environmental, plant productivity, and asset protection. Industry has become inundated with a multitude of programs focusing on safety, quality, and cost performance. This paper introduces a protective management system, which builds upon the work process identified in IEC 61511. Typical capital project phases are integrated with the management system to yield one comprehensive program to efficiently manage process risk. Finally, the paper highlights areas where internal practices or guidelines should be developed to improve program performance and cost effectiveness.

  11. [Nanomaterials in cosmetics--present situation and future].

    PubMed

    Masunaga, Takuji

    2014-01-01

    Cosmetics are consumer products intended to contribute to increasing quality of life and designed for long-term daily use. Due to such features of cosmetics, they are required to ensure quality and safety at a high level, as well as to perform well, in response to consumers' demands. Recently, the technology associated with nanomaterials has progressed rapidly and has been applied to various products, including cosmetics. For example, nano-sized titanium dioxide has been formulated in sunscreen products in pursuit of improving its performance. As some researchers and media have expressed concerns about the safety of nanomaterials, a vague feeling of anxiety has been raised in society. In response to this concern, the Japan Cosmetic Industry Association (JCIA) has begun original research related to the safety assurance of nanomaterials formulated in cosmetics, to allow consumers to use cosmetics without such concerns. This paper describes the activities of the JCIA regarding safety research on nanomaterials, including a survey of the actual usage of nanomaterials in cosmetics, analysis of the existence of nanomaterials on the skin, and assessment of skin carcinogenicity of nano-sized titanium dioxide. It also describes the international status of safety assurance and regulation regarding nanomaterials in cosmetics.

  12. Improving the DoD’s Tooth-to-Tail Ratio. Revision

    DTIC Science & Technology

    2014-02-01

    same time improving working conditions and safety for employees. Companies have invested in these technologies not only to reduce costs but to improve...NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION...or personnel by some arbitrary percentage may not suffice. Schwartz and Mosler (2013) wrote that across-the-board cuts simply do not work ; rather

  13. Intelligent single switch wheelchair navigation.

    PubMed

    Ka, Hyun W; Simpson, Richard; Chung, Younghyun

    2012-11-01

    We have developed an intelligent single switch scanning interface and wheelchair navigation assistance system, called intelligent single switch wheelchair navigation (ISSWN), to improve driving safety, comfort and efficiency for individuals who rely on single switch scanning as a control method. ISSWN combines a standard powered wheelchair with a laser rangefinder, a single switch scanning interface and a computer. It provides the user with context sensitive and task specific scanning options that reduce driving effort based on an interpretation of sensor data together with user input. Trials performed by 9 able-bodied participants showed that the system significantly improved driving safety and efficiency in a navigation task by significantly reducing the number of switch presses to 43.5% of traditional single switch wheelchair navigation (p < 0.001). All participants made a significant improvement (39.1%; p < 0.001) in completion time after only two trials.

  14. Current and anticipated uses of thermalhydraulic and neutronic codes at PSI

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Aksan, S.N.; Zimmermann, M.A.; Yadigaroglu, G.

    1997-07-01

    The thermalhydraulic and/or neutronic codes in use at PSI mainly provide the capability to perform deterministic safety analysis for Swiss NPPs and also serve as analysis tools for experimental facilities for LWR and ALWR simulations. In relation to these applications, physical model development and improvements, and assessment of the codes are also essential components of the activities. In this paper, a brief overview is provided on the thermalhydraulic and/or neutronic codes used for safety analysis of LWRs, at PSI, and also of some experiences and applications with these codes. Based on these experiences, additional assessment needs are indicated, together withmore » some model improvement needs. The future needs that could be used to specify both the development of a new code and also improvement of available codes are summarized.« less

  15. An integrated evaluation for the performance of clinical engineering department.

    PubMed

    Yousry, Ahmed M; Ouda, Bassem K; Eldeib, Ayman M

    2014-01-01

    Performance benchmarking have become a very important component in all successful organizations nowadays that must be used by Clinical Engineering Department (CED) in hospitals. Many researchers identified essential mainstream performance indicators needed to improve the CED's performance. These studies revealed mainstream performance indicators that use the database of a CED to evaluate its performance. In this work, we believe that those indicators are insufficient for hospitals. Additional important indicators should be included to improve the evaluation accuracy. Therefore, we added new indicators: technical/maintenance indicators, economic indicators, intrinsic criticality indicators, basic hospital indicators, equipment acquisition, and safety indicators. Data is collected from 10 hospitals that cover different types of healthcare organizations. We developed a software tool that analyses collected data to provide a score for each CED under evaluation. Our results indicate that there is an average gap of 67% between the CEDs' performance and the ideal target. The reasons for the noncompliance are discussed in order to improve performance of CEDs under evaluation.

  16. Motivation for documentation.

    PubMed

    Graham, Denise H

    2004-11-01

    The quality improvement plan relies on controlling quality of care through improving the process or system as a whole. Your ongoing data collection is paramount to the process of system-wide improvement and performance, enhancement of financial performance, operational performance and overall service performance and satisfaction. The threat of litigation and having to defend yourself from a claim of wrongdoing still looms every time your wheels turn. Your runsheet must serve and protect you. Look at the NFPA 1710 standard, which was enacted to serve and protect firefighters. This standard was enacted with their personal safety and well-being as the principle behind staffing requirements. At what stage of draft do you suppose the NFPA 1710 standard would be today if the relative data were collected sporadically or were not tracked for each service-related death? It may have taken many more service-related deaths to effect change for a system-wide improvement in operational performance. Every call merits documentation and data collection. Your data are catalysts for change.

  17. Improving efficiency and safety in external beam radiation therapy treatment delivery using a Kaizen approach.

    PubMed

    Kapur, Ajay; Adair, Nilda; O'Brien, Mildred; Naparstek, Nikoleta; Cangelosi, Thomas; Zuvic, Petrina; Joseph, Sherin; Meier, Jason; Bloom, Beatrice; Potters, Louis

    Modern external beam radiation therapy treatment delivery processes potentially increase the number of tasks to be performed by therapists and thus opportunities for errors, yet the need to treat a large number of patients daily requires a balanced allocation of time per treatment slot. The goal of this work was to streamline the underlying workflow in such time-interval constrained processes to enhance both execution efficiency and active safety surveillance using a Kaizen approach. A Kaizen project was initiated by mapping the workflow within each treatment slot for 3 Varian TrueBeam linear accelerators. More than 90 steps were identified, and average execution times for each were measured. The time-consuming steps were stratified into a 2 × 2 matrix arranged by potential workflow improvement versus the level of corrective effort required. A work plan was created to launch initiatives with high potential for workflow improvement but modest effort to implement. Time spent on safety surveillance and average durations of treatment slots were used to assess corresponding workflow improvements. Three initiatives were implemented to mitigate unnecessary therapist motion, overprocessing of data, and wait time for data transfer defects, respectively. A fourth initiative was implemented to make the division of labor by treating therapists as well as peer review more explicit. The average duration of treatment slots reduced by 6.7% in the 9 months following implementation of the initiatives (P = .001). A reduction of 21% in duration of treatment slots was observed on 1 of the machines (P < .001). Time spent on safety reviews remained the same (20% of the allocated interval), but the peer review component increased. The Kaizen approach has the potential to improve operational efficiency and safety with quick turnaround in radiation therapy practice by addressing non-value-adding steps characteristic of individual department workflows. Higher effort opportunities are identified to guide continual downstream quality improvements. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. Highway construction work zone safety performance and improvement in Louisiana : research project capsule.

    DOT National Transportation Integrated Search

    2016-08-01

    While the number of : crashes in Louisiana : construction work zones : has decreased in recent : years, the total count of : work zone crashes is still : significant, warranting : research into how to reduce : crashes. An assessment : of risk factors...

  19. Energy Performance Techniques and Technologies: Preserving Historic Homes – Volume 13

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Pacific Northwest National Laboratory

    2011-02-01

    Following Building America-sponsored research, this guide focuses on planning energy-efficient improvements for historic houses while preserving the home’s historic features, being aware of and adhering to regulations related to historic designations, and addressing health and safety issues.

  20. Evaluation of j-turn intersection design performance in Missouri, final report.

    DOT National Transportation Integrated Search

    2013-12-01

    Research shows that a high percentage of crashes that take place on high-speed rural expressways occur at intersections : with minor roads. One low-cost alternative design for improving the safety of at-grade intersections on such expressways is : th...

  1. Stress Testing of an Artificial Pancreas System With Pizza and Exercise Leads to Improvements in the System's Fuzzy Logic Controller.

    PubMed

    Mauseth, Richard; Lord, Sandra M; Hirsch, Irl B; Kircher, Robert C; Matheson, Don P; Greenbaum, Carla J

    2015-09-14

    Under controlled conditions, the Dose Safety artificial pancreas (AP) system controller, which utilizes "fuzzy logic" (FL) methodology to calculate and deliver appropriate insulin dosages based on changes in blood glucose, successfully managed glycemic excursions. The aim of this study was to show whether stressing the system with pizza (high carbohydrate/high fat) meals and exercise would reveal deficits in the performance of the Dose Safety FL controller (FLC) and lead to improvements in the dosing matrix. Ten subjects with type 1 diabetes (T1D) were enrolled and participated in 30 studies (17 meal, 13 exercise) using 2 versions of the FLC. After conducting 13 studies with the first version (FLC v2.0), interim results were evaluated and the FLC insulin-dosing matrix was modified to create a new controller version (FLC v2.1) that was validated through regression testing using v2.0 CGM datasets prior to its use in clinical studies. The subsequent 17 studies were performed using FLC v2.1. Use of FLC v2.1 vs FLC v2.0 in the pizza meal tests showed improvements in mean blood glucose (205 mg/dL vs 232 mg/dL, P = .04). FLC v2.1 versus FLC v2.0 in exercise tests showed improvements in mean blood glucose (146 mg/dL vs 201 mg/dL, P = .004), percentage time spent >180 mg/dL (19.3% vs 46.7%, P = .001), and percentage time spent 70-180 mg/dL (80.0% vs 53.3%, P = .002). Stress testing the AP system revealed deficits in the FLC performance, which led to adjustments to the dosing matrix followed by improved FLC performance when retested. © 2015 Diabetes Technology Society.

  2. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Napper, P.R.; Carpenter, W.R.; Garner, R.W.

    By DOE-ID Order 5481.1A, a five year currency review is required of the Safety Analysis Reports of all ID or ID contractor operations having hazards of a type and magnitude not routinely encountered and/or accepted by the public. In keeping with this order, a currency review has been performed of the Advanced Test Reactor Critical Facility (ADTRC) Safety Analysis Report (SAR), Issue 003, 1990. The objectives of this currency review were to: evaluate the content, completeness, clarity of presentation and compliance with NRC Regulatory Guides and DOE Orders, etc., and evaluate the technical content of the SAR, particularly the Technicalmore » Specifications, and to evaluate the safety of continued operation of the ATRC. The reviewers concluded that although improvements may be needed in the overall content, clarity, and demonstration of compliance with current orders and regulations, the safety of the ATRC is in no way compromised and no unreviewed safety questions were identified. 6 figs., 3 tabs.« less

  3. National plan to enhance aviation safety through human factors improvements

    NASA Technical Reports Server (NTRS)

    Foushee, Clay

    1990-01-01

    The purpose of this section of the plan is to establish a development and implementation strategy plan for improving safety and efficiency in the Air Traffic Control (ATC) system. These improvements will be achieved through the proper applications of human factors considerations to the present and future systems. The program will have four basic goals: (1) prepare for the future system through proper hiring and training; (2) develop a controller work station team concept (managing human errors); (3) understand and address the human factors implications of negative system results; and (4) define the proper division of responsibilities and interactions between the human and the machine in ATC systems. This plan addresses six program elements which together address the overall purpose. The six program elements are: (1) determine principles of human-centered automation that will enhance aviation safety and the efficiency of the air traffic controller; (2) provide new and/or enhanced methods and techniques to measure, assess, and improve human performance in the ATC environment; (3) determine system needs and methods for information transfer between and within controller teams and between controller teams and the cockpit; (4) determine how new controller work station technology can optimally be applied and integrated to enhance safety and efficiency; (5) assess training needs and develop improved techniques and strategies for selection, training, and evaluation of controllers; and (6) develop standards, methods, and procedures for the certification and validation of human engineering in the design, testing, and implementation of any hardware or software system element which affects information flow to or from the human.

  4. Analysis of the car body stability performance after coupler jack-knifing during braking

    NASA Astrophysics Data System (ADS)

    Guo, Lirong; Wang, Kaiyun; Chen, Zaigang; Shi, Zhiyong; Lv, Kaikai; Ji, Tiancheng

    2018-06-01

    This paper aims to improve car body stability performance by optimising locomotive parameters when coupler jack-knifing occurs during braking. In order to prevent car body instability behaviour caused by coupler jack-knifing, a multi-locomotive simulation model and a series of field braking tests are developed to analyse the influence of the secondary suspension and the secondary lateral stopper on the car body stability performance during braking. According to simulation and test results, increasing secondary lateral stiffness contributes to limit car body yaw angle during braking. However, it seriously affects the dynamic performance of the locomotive. For the secondary lateral stopper, its lateral stiffness and free clearance have a significant influence on improving the car body stability capacity, and have less effect on the dynamic performance of the locomotive. An optimised measure was proposed and adopted on the test locomotive. For the optimised locomotive, the lateral stiffness of secondary lateral stopper is increased to 7875 kN/m, while its free clearance is decreased to 10 mm. The optimised locomotive has excellent dynamic and safety performance. Comparing with the original locomotive, the maximum car body yaw angle and coupler rotation angle of the optimised locomotive were reduced by 59.25% and 53.19%, respectively, according to the practical application. The maximum derailment coefficient was 0.32, and the maximum wheelset lateral force was 39.5 kN. Hence, reasonable parameters of secondary lateral stopper can improve the car body stability capacity and the running safety of the heavy haul locomotive.

  5. Improvements to rural intersections to improve motorist compliance.

    DOT National Transportation Integrated Search

    2014-10-01

    The Texas Department of Transportation (TxDOT) has placed improving safety as one of its top objectives. : Improving safety in rural intersections is a means to improve roadway safety especially in rural districts such : as the districts in West Texa...

  6. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    PubMed

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2014-10-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  7. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    PubMed

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2015-01-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  8. Preoperative surgical rehearsal using cadaveric fresh tissue surgical simulation increases resident operative confidence.

    PubMed

    Weber, Erin L; Leland, Hyuma A; Azadgoli, Beina; Minneti, Michael; Carey, Joseph N

    2017-08-01

    Rehearsal is an essential part of mastering any technical skill. The efficacy of surgical rehearsal is currently limited by low fidelity simulation models. Fresh cadaver models, however, offer maximal surgical simulation. We hypothesize that preoperative surgical rehearsal using fresh tissue surgical simulation will improve resident confidence and serve as an important adjunct to current training methods. Preoperative rehearsal of surgical procedures was performed by plastic surgery residents using fresh cadavers in a simulated operative environment. Rehearsal was designed to mimic the clinical operation, complete with a surgical technician to assist. A retrospective, web-based survey was used to assess resident perception of pre- and post-procedure confidence, preparation, technique, speed, safety, and anatomical knowledge on a 5-point scale (1= not confident, 5= very confident). Twenty-six rehearsals were performed by 9 residents (PGY 1-7) an average of 4.7±2.1 days prior to performance of the scheduled operation. Surveys demonstrated a median pre-simulation confidence score of 2 and a post-rehearsal score of 4 (P<0.01). The perceived improvement in confidence and performance was greatest when simulation was performed within 3 days of the scheduled case. All residents felt that cadaveric simulation was better than standard preparation methods of self-directed reading or discussion with other surgeons. All residents believed that their technique, speed, safety, and anatomical knowledge improved as a result of simulation. Fresh tissue-based preoperative surgical rehearsal was effectively implemented in the residency program. Resident confidence and perception of technique improved. Survey results suggest that cadaveric simulation is beneficial for all levels of residents. We believe that implementation of preoperative surgical rehearsal is an effective adjunct to surgical training at all skill levels in the current environment of decreased work hours.

  9. Effects of organizational safety on employees' proactivity safety behaviors and occupational health and safety management systems in Chinese high-risk small-scale enterprises.

    PubMed

    Mei, Qiang; Wang, Qiwei; Liu, Suxia; Zhou, Qiaomei; Zhang, Jingjing

    2018-06-07

    Based on the characteristics of small-scale enterprises, the improvement of occupational health and safety management systems (OHS MS) needs an effective intervention. This study proposed a structural equation model and examined the relationships of perceived organization support for safety (POSS), person-organization safety fit (POSF) and proactivity safety behaviors with safety management, safety procedures and safety hazards identification. Data were collected from 503 employees of 105 Chinese high-risk small-scale enterprises over 6 months. The results showed that both POSS and POSF were positively related to improvement in safety management, safety procedures and safety hazards identification through proactivity safety behaviors. Our findings provide a new perspective on organizational safety for improving OHS MS for small-scale enterprises and extend the application of proactivity safety behaviors.

  10. Using lagging and leading indicators for the evaluation of occupational safety and health performance in industry.

    PubMed

    Pawłowska, Zofia

    2015-01-01

    Improvement of occupational safety and health (OSH) management is closely related to the development of OSH performance measurement, which should include OSH outcomes (e.g., occupational accidents), OSH inputs (including working conditions) and OSH-related activities. The indicators used to measure the OSH outcomes are often called lagging indicators, and the indicators of inputs and OSH activities are leading indicators. A study was conducted in 60 companies in order to determine what kinds of indicators were used for OSH performance measurement by companies with different levels of OSH performance. The results reveal that the indicators most commonly used in all of the companies are those related to ensuring compliance with the statutory requirements. At the same time, the leading indicators are much more often adopted in companies with a higher performance level. These companies also much more often monitor on a regular basis the indicators adopted for the evaluation of their OSH performance.

  11. Using lagging and leading indicators for the evaluation of occupational safety and health performance in industry

    PubMed Central

    Pawłowska, Zofia

    2015-01-01

    Improvement of occupational safety and health (OSH) management is closely related to the development of OSH performance measurement, which should include OSH outcomes (e.g., occupational accidents), OSH inputs (including working conditions) and OSH-related activities. The indicators used to measure the OSH outcomes are often called lagging indicators, and the indicators of inputs and OSH activities are leading indicators. A study was conducted in 60 companies in order to determine what kinds of indicators were used for OSH performance measurement by companies with different levels of OSH performance. The results reveal that the indicators most commonly used in all of the companies are those related to ensuring compliance with the statutory requirements. At the same time, the leading indicators are much more often adopted in companies with a higher performance level. These companies also much more often monitor on a regular basis the indicators adopted for the evaluation of their OSH performance. PMID:26647949

  12. Public reporting and pay-for-performance: safety-net hospital executives' concerns and policy suggestions.

    PubMed

    Goldman, L Elizabeth; Henderson, Stuart; Dohan, Daniel P; Talavera, Jason A; Dudley, R Adams

    2007-01-01

    Safety-net hospitals (SNHs) may gain little financial benefit from the rapidly spreading adoption of public reporting and pay-for-performance, but may feel compelled to participate (and bear the costs of data collection) to meet public expectations of transparency and accountability. To better understand the concerns that SNH administrators have regarding public reporting and pay-for-performance, we interviewed 37 executives at randomly selected California SNHs. The main concerns noted by SNH executives were that human and financial resource constraints made it difficult for SNHs to accurately measure their performance. Additionally, some executives felt that market-driven public reporting and pay-for-performance may focus on clinical areas and incentive structures that may not be high-priority clinical areas for SNHs. Executives at SNHs suggested several policy responses to these concerns-such as offering training programs for SNH data collectors-that could be relatively inexpensive and might improve the cost-benefit ratio of public reporting and pay-for-performance programs.

  13. Quantitative evaluation of a thrust vector controlled transport at the conceptual design phase

    NASA Astrophysics Data System (ADS)

    Ricketts, Vincent Patrick

    The impetus to innovate, to push the bounds and break the molds of evolutionary design trends, often comes from competition but sometimes requires catalytic political legislature. For this research endeavor, the 'catalyzing legislation' comes in response to the rise in cost of fossil fuels and the request put forth by NASA on aircraft manufacturers to show reduced aircraft fuel consumption of +60% within 30 years. This necessitates that novel technologies be considered to achieve these values of improved performance. One such technology is thrust vector control (TVC). The beneficial characteristic of thrust vector control technology applied to the traditional tail-aft configuration (TAC) commercial transport is its ability to retain the operational advantage of this highly evolved aircraft type like cabin evacuation, ground operation, safety, and certification. This study explores if the TVC transport concept offers improved flight performance due to synergistically reducing the traditional empennage size, overall resulting in reduced weight and drag, and therefore reduced aircraft fuel consumption. In particular, this study explores if the TVC technology in combination with the reduced empennage methodology enables the TAC aircraft to synergistically evolve while complying with current safety and certification regulation. This research utilizes the multi-disciplinary parametric sizing software, AVD Sizing, developed by the Aerospace Vehicle Design (AVD) Laboratory. The sizing software is responsible for visualizing the total system solution space via parametric trades and is capable of determining if the TVC technology can enable the TAC aircraft to synergistically evolve, showing marked improvements in performance and cost. This study indicates that the TVC plus reduced empennage methodology shows marked improvements in performance and cost.

  14. Ergonomics, safety, and resilience in the helicopter offshore transportation system of Campos Basin.

    PubMed

    Gomes, José Orlando; Huber, Gilbert J; Borges, Marcos R S; de Carvalho, Paulo Victor R

    2015-01-01

    Air transportation of personnel to offshore oil platforms is one of the major hazards of this kind of endeavor. Pilot performance is a key factor in the safety of the transportation system. This study seeks to identify the ergonomic factors present in pilots' activities that may in some way compromise or enhance their performance, the constraints and affordances which they are subject to; and where possible to link these to their associated risk factors. Methodology adopted in this project studies work in its context. It is a merging of Activity Analysis (Guerin et al. 2001) of European tradition with Cognitive Task Analysis (CTA - www.ctaresource.com) articulated with the recent approaches to cognitive systems engineering developed by Professors David Woods and Erik Hollnagel. Fifty-five hours of field interviews provided the input for analysis. Sixteen ergonomic constraints were identified, some cognitive, some physical, all considered relevant by the research subjects and expert advisers. Although the safety record of the personnel transportation system studied is considered acceptable, there is low hanging fruit to be picked which can help improve the system's safety.

  15. Road accident rates: strategies and programmes for improving road traffic safety.

    PubMed

    Goniewicz, K; Goniewicz, M; Pawłowski, W; Fiedor, P

    2016-08-01

    Nowadays, the problem of road accident rates is one of the most important health and social policy issues concerning the countries in all continents. Each year, nearly 1.3 million people worldwide lose their life on roads, and 20-50 million sustain severe injuries, the majority of which require long-term treatment. The objective of the study was to identify the most frequent, constantly occurring causes of road accidents, as well as outline actions constituting a basis for the strategies and programmes aiming at improving traffic safety on local and global levels. Comparative analysis of literature concerning road safety was performed, confirming that although road accidents had a varied and frequently complex background, their causes have changed only to a small degree over the years. The causes include: lack of control and enforcement concerning implementation of traffic regulation (primarily driving at excessive speed, driving under the influence of alcohol, and not respecting the rights of other road users (mainly pedestrians and cyclists), lack of appropriate infrastructure and unroadworthy vehicles. The number of fatal accidents and severe injuries, resulting from road accidents, may be reduced through applying an integrated approach to safety on roads. The strategies and programmes for improving road traffic should include the following measures: reducing the risk of exposure to an accident, prevention of accidents, reduction in bodily injuries sustained in accidents, and reduction of the effects of injuries by improvement of post-accident medical care.

  16. Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation.

    PubMed

    Fuenzalida Squella, Sara Agueda; Kannenberg, Andreas; Brandão Benetti, Ângelo

    2018-04-01

    Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes. To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees. Comparative within-subject clinical study. A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor-enhanced knee. Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions. The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects' satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees. Clinical relevance This study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

  17. 16 CFR 1500.88 - Exemptions from lead limits under section 101 of the Consumer Product Safety Improvement Act for...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 101 of the Consumer Product Safety Improvement Act for certain electronic devices. 1500.88 Section... from lead limits under section 101 of the Consumer Product Safety Improvement Act for certain electronic devices. (a) The Consumer Product Safety Improvement Act (CPSIA) provides for specific lead limits...

  18. Assessment of patient safety culture in clinical laboratories in the Spanish National Health System.

    PubMed

    Giménez-Marín, Angeles; Rivas-Ruiz, Francisco; García-Raja, Ana M; Venta-Obaya, Rafael; Fusté-Ventosa, Margarita; Caballé-Martín, Inmaculada; Benítez-Estevez, Alfonso; Quinteiro-García, Ana I; Bedini, José Luis; León-Justel, Antonio; Torra-Puig, Montserrat

    2015-01-01

    There is increasing awareness of the importance of transforming organisational culture in order to raise safety standards. This paper describes the results obtained from an evaluation of patient safety culture in a sample of clinical laboratories in public hospitals in the Spanish National Health System. A descriptive cross-sectional study was conducted among health workers employed in the clinical laboratories of 27 public hospitals in 2012. The participants were recruited by the heads of service at each of the participating centers. Stratified analyses were performed to assess the mean score, standardized to a base of 100, of the six survey factors, together with the overall patient safety score. 740 completed questionnaires were received (88% of the 840 issued). The highest standardized scores were obtained in Area 1 (individual, social and cultural) with a mean value of 77 (95%CI: 76-78), and the lowest ones, in Area 3 (equipment and resources), with a mean value of 58 (95%CI: 57-59). In all areas, a greater perception of patient safety was reported by the heads of service than by other staff. We present the first multicentre study to evaluate the culture of clinical safety in public hospital laboratories in Spain. The results obtained evidence a culture in which high regard is paid to safety, probably due to the pattern of continuous quality improvement. Nevertheless, much remains to be done, as reflected by the weaknesses detected, which identify areas and strategies for improvement.

  19. Sharing adverse drug event data using business intelligence technology.

    PubMed

    Horvath, Monica M; Cozart, Heidi; Ahmad, Asif; Langman, Matthew K; Ferranti, Jeffrey

    2009-03-01

    Duke University Health System uses computerized adverse drug event surveillance as an integral part of medication safety at 2 community hospitals and an academic medical center. This information must be swiftly communicated to organizational patient safety stakeholders to find opportunities to improve patient care; however, this process is encumbered by highly manual methods of preparing the data. Following the examples of other industries, we deployed a business intelligence tool to provide dynamic safety reports on adverse drug events. Once data were migrated into the health system data warehouse, we developed census-adjusted reports with user-driven prompts. Drill down functionality enables navigation from aggregate trends to event details by clicking report graphics. Reports can be accessed by patient safety leadership either through an existing safety reporting portal or the health system performance improvement Web site. Elaborate prompt screens allow many varieties of reports to be created quickly by patient safety personnel without consultation with the research analyst. The reduction in research analyst workload because of business intelligence implementation made this individual available to additional patient safety projects thereby leveraging their talents more effectively. Dedicated liaisons are essential to ensure clear communication between clinical and technical staff throughout the development life cycle. Design and development of the business intelligence model for adverse drug event data must reflect the eccentricities of the operational system, especially as new areas of emphasis evolve. Future usability studies examining the data presentation and access model are needed.

  20. Research notes : are safety corridors really safe? Evaluation of the corridor safety improvement program.

    DOT National Transportation Integrated Search

    1998-08-26

    High accident frequencies on Oregons highway corridors are of concern to the Oregon Department of Transportation (ODOT). : ODOT adopted the Corridor Safety Improvement Program as part of an overall program of safety improvements using federal and ...

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