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Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures to align delivery system processes with the workforce requirements to improve patient outcomes. Until health systems can provide safer care environments, patients remain at risk for suboptimal care and adverse outcomes. Health science researchers have begun to explore how safety cultures might act as an essential system feature to improve organizational outcomes. Since safety cultures are established through modification in employee safety perspective and work behavior, human resource (HR) professionals need to contribute to this developing organizational domain. The IOM indicates individual employee behaviors cumulatively provide the primary antecedent for organizational safety and quality outcomes. Yet, many safety culture scholars indicate the concept is neither theoretically defined nor consistently applied and researched as the terms safety culture, safety climate, and safety attitude are interchangeably used to represent the same concept. As such, this paper examines the intersection of organizational culture and healthcare safety by analyzing the theoretical underpinnings of safety culture, exploring the constructs for measurement, and assessing the current state of safety culture research. Safety culture draws from the theoretical perspectives of sociology (represented by normal accident theory), organizational psychology (represented by high reliability theory), and human factors (represented by the aviation framework). By understanding not only the origins but also the empirical safety culture research and the associated intervention initiatives, healthcare professionals can design appropriate HR strategies to address the system characteristics that adversely affect patient outcomes. Increased emphasis on human resource management research is particularly important to the development of safety cultures. This paper contributes to the existing healthcare literature by providing the first comprehensive critical analysis of the theory, research, and practice that comprise contemporary safety culture science.

This chapter defines what road safety advertising campaigns are and the objectives that they typically seek to achieve. The argument put forward in this chapter is that when theoretically informed in their design and sensitive to the array of potential personal, social, and cultural influences which may be at play, road safety advertising can contribute to both reinforcing and transforming contemporary traffic safety culture. This chapter offers guidance to researchers and practitioners in the field regarding relevant theory which may be applied to inform message design and evaluation.

Drawing upon the Traffic Safety Culture (TSC) perspective, this chapter outlines the reinforcing and transforming functions of advertising and illustrates such approaches by drawing upon examples from Australian road safety advertising campaigns. The argument put forth is that road safety advertising can be a robust tool; it can reinforce other countermeasures (enforcement) as well as transform community expectations and values and thus ultimately contribute to social as well as behavioral change.

Driving for work has been identified as potentially one of the riskiest activities performed by workers within the course of their working day. Jurisdictions around the world have passed legislation and adopted policy and procedures to improve the safety of workers. However, particularly within the work driving setting, complying with legislation and the minimum safety standards and procedures is not sufficient to improve work driving safety. This chapter outlines the manner in which safety citizenship behavior can offer further improvement to work-related driving safety by acting as a complementary paradigm to improve risk management and current models and applications of safety culture.

Research on concepts associated with risk management and theoretical frameworks associated with safety culture and safety citizenship behavior are reviewed, along with their practical application within the work driving safety setting. A model incorporating safety citizenship behavior as a complementary paradigm to safety culture is proposed. It is suggested that this model provides a theoretical framework to inform future research directions aimed at improving safety within the work driving setting.

While research on workplace safety spans across disciplines in medicine, public health, engineering, psychology, and business, research to date has not adopted a multilevel theoretical perspective that integrates theoretical issues and findings from various disciplines. In this chapter, we integrate research on workplace safety from a variety of disciplines and fields to develop a multilevel model of the processes that affect individual safety performance and safety and health outcomes. In doing so, we focus on cross-level linkages among national, organizational, and individual-level variables in relation to the exhibition of safe work behavior and occurrence of individual-level accidents, injuries, illnesses, and diseases. Our modeling of workplace safety is intended to fill a theoretical gap in our understanding of how the multitude of individual differences and situational factors interrelate across time to influence individual level safety behaviors and the consequences of these actions, and to encourage research to expand the limits of our knowledge.

Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major “change management” initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

In this chapter we interpret traffic safety culture (TSC) in terms of data on beliefs, attitudes, and behaviors from the fourth wave of the SARTRE study to find out whether they can be interpreted in a perspective. The SARTRE study is a European-wide survey that started in 1991 and collects information on mobility, risk perceptions, attitudes, behaviors, and experiences on the road (Cauzard, 1998, 2004; Cestac & Delhomme, 2012). The chapter focuses on the group of car drivers.

A principal component factor analysis was conducted to explore the underlying structure of the data set. Results suggest an underlying structure of five components which explain more than 55% of the variance. These dimensions were labeled (1) acceptance of technology and enforcement, (2) risk attitudes, (3) experienced and self-exerted behavioral control, (4) personal concern, (5) perception of other road users’ safety performance.

The influence of these five factors on safety performance (fatality rates) was estimated by regression analysis. Results show that only the second factor (risk attitudes) has a significant effect on fatality rates. As a consequence, expressive and instrumental attitudes about risk-taking should be addressed in driver training as well as information campaigns in order to improve safety culture at the level of individual car drivers.

The present chapter puts one perspective center stage and looks at the relationship between TSC and its manifestation in individuals. More specifically, we are concerned with the relationship between processes of attitude formation and attitude change. The concept of attitudes is one out of several psychological constructs which are known to have mediating influence on actual behavior. Thus, it is a possible starting point to positively influence behavior in road traffic toward higher levels of (commitment to) safety. Understanding how safety culture is internalized by individuals and how it shapes safe conduct shall be theoretically described and practically exemplified to show how this approach can become useful and relevant for practitioners in the field of road safety.

The argument is developed in three parts. In the first part, Herbert Kelman’s (1958) conceptual scheme of three stages of attitude change is presented in which the levels of compliance, identification, and internalization of values are distinguished. In the second part, it is argued that these different levels of value integration correspond with three different kinds of psychological theories which address the relationship between attitudes and deliberately conducted behavior (action). It is a well-known fact in the science of human action that there is no direct relationship between attitudes, decision making, and action. Using Kelman’s three levels of value internalization as a scheme of reference, the conditions under which persons act in line with their attitudes can be conceptualized more precisely. From a normative point of view, it is argued that persons who align their actions and attitudes with reference to socially appreciated values are said to be elaborated. They orient their conduct by an ethos of safety to which they feel committed and they are able to interact in mindful ways. We discuss some of the basic constructs at each level and underpin their importance with reference to behavioral change toward higher levels of safety with empirical findings that have been published. In a third part, we present our findings in a summarizing table and suggest a list of factors and themes which mainly correspond to one of the three stages of attitudinal change and value internalization. Finally, we outline some examples of how traffic safety interventions can be conceptualized at these different levels.