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Medical errors in obstetric departments are commonly reported and may involve both mother and neonate. The complexity of obstetric care, the interactions between various disciplines, and the inherent limitations of human performance make it critically important for these departments to provide patient-safe and friendly working environments that are open to learning and participative safety. Obstetric care involves stressful work, and health care professionals are prone to develop burnout, this being associated with unsafe practices and lower probability for reporting safety concerns. This study aims to test the mediating role of burnout in the relationship of patient-safe and friendly working environment with unsafe performance. The full population of professionals working in an obstetrics department in Malta was invited to participate in a cross-sectional study, with 73.6% (n = 184) of its members responding. The research tool was adapted from the Sexton et al.’s Safety Attitudes Questionnaire – Labor and Delivery version and surveyed participants on their working environment, burnout, and perceived unsafe performance. Analysis was done using Structural Equation Modeling. Results supported the relationship between the lack of a perceived patient-safe and friendly working environment and unsafe performance that is mediated by burnout. Creating a working environment that ensures patient safety practices, that allows communication, and is open to learning may protect employees from burnout. In so doing, they are more likely to perceive that they are practicing safely. This study contributes to patient safety literature by relating working environment, burnout, and perceived unsafe practice with the intention of raising awareness of health managers’ roles in ensuring optimal clinical working environment for health care employees.

Under which conditions do social movements receive extensive attention from the mainstream news media? We develop an institutional mediation model that argues that combinations of the news-heightening characteristics of movements, including their disruptive capacities, organizational resources, and political orientation, and political contexts, including partisan regimes and benefiting from national policies, bring extensive attention to movements. It also holds that investigations will draw extensive media attention to movements, and those that have achieved prominence in the news will remain prominent under specific conditions. We appraise these combinational arguments by examining 29 social movements across 100 years in four national newspapers using qualitative comparative analysis (QCA). Researchers typically use QCA to study the consequences of movements when they hypothesize outcomes to result from multiple combinations of conditions. This raises our second main question: How should scholars best address combinational hypotheses using QCA? Here we employ Venn diagrams to identify and illustrate key analytical issues and anomalies, including constrained diversity in observational data, empirical instances when combinations of conditions do not produce the expected outcome, and instances when unexpected combinations of conditions produce a consistent result. We also demonstrate the value of broad comparisons across movements and over time in these analyses.