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Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

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.

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.

Road trauma remains a significant concern internationally. Traffic crashes rank within the top three leading causes of death for individuals aged between 15–44 years old, with nonfatal casualties occurring at around 30 times the rate of fatal incidents. Historically, road safety research has not captured factors relating to driving purpose. However, more recently, researchers have focused on the importance of driving for work. Over a third of traffic volume represents commuting or driving in the line of employment; improving workplace road safety practices represents a tangible way of reducing road trauma. This chapter considers the link between safety culture and best practice in workplace road safety. It is argued that best practice is not a term to define individual safety practices, but a system of practices that create a culture of safety. This research uses data collected on organizations workplace road safety practices within the Australian context. This data has been collected by the National Road Safety Partnership Program (NRSPP); an initiative that constitutes a network of organizations and academics working together to develop a positive road safety culture. Twenty-four case studies are presented of organizations that have implemented workplace road safety programs to improve their safe driving culture. Qualitative analysis was conducted to systematically categorize the safety initiatives and their indicators of success. Almost all case studies expressed the importance of developing a safety-first culture in the workplace. Third-party regulation, internal policy and corporate social responsibility form the foundation of workplace safety. However, it was the culture and attitude towards the safety initiatives that achieved effectiveness in the long-term. The findings of this research support the argument that best practice is best achieved when integrated within a culture that values and prioritizes safety, rather than implemented in isolation to other elements in the workplace system.

This chapter uses symbolic interactionism as a theoretical framework for considering data produced during two in-depth ethnographic investigations: one at Orco, a minerals processing facility; the other at RTE, the Rail Transport Executive of an urban region in Australia. It discusses the value of symbolic interactionism in revealing the detailed importance of interaction between managers and workers and, particularly, within specific workgroups. It argues that regular, repeated and intense interaction such as characterizes daily work in high-pressure occupations helps establish subcultures. It is then comparatively easy for a subculture group to develop its own values and meanings in opposition to those promulgated by management. The two case studies differ significantly around the organizational value placed on investigating injuries and accidents. In the Orco workplace, injury statistics are clearly communicated and workers believe that the “zero injury workplace” is a management priority. In the RTE, transit officer injuries are kept confidential and workers believe that a major purpose of investigations is to show how individual workers are at fault. In both cases, however, the work group has developed an informal safety culture at odds with that promoted by managers.The conclusion drawn by the end of the chapter is that managers seeking to influence the safety cultures of workers in dangerous and fraught occupations should pay close attention to the ways in which those workers operate at a symbolic distance from management. They should engage with the workers to understand the symbolic value placed by frontline staff upon the meanings attributed to safe work practices, and should collaborate together to develop a shared safety culture in which workers are protected by active management engagement in their symbolic reality. Where this occurs, workers’ perspectives are appreciated at the same time as their practices become more regulated and aligned with managerial wishes. Symbolic interactionism offers a rich perspective that takes into account the dynamism of changing circumstances and that works outwards from the thought processes of individuals through to interactions across entire organizations.

Building a culture of safety in transportation is not dissimilar from building a culture of safety in health. Public health is widely known for protecting the public from diseases through milk pasteurization and chlorination of drinking water, and from injuries by implementing environmental and occupational safeguards and fostering behavioral change. Lifestyle and environmental changes that have contributed to the reductions in smoking and heart disease can also help change driving, walking and cycling behaviors, and environments. Stimulating a culture of safety on the road means providing safe and accessible transportation for all. The vision for a culture of traffic safety is to change the public’s attitude about the unacceptable toll from traffic injuries and to implement a systems approach to traffic injury prevention as a means for improving public health and public safety. Framing the motor vehicle injury problem in this way provides an opportunity for partnerships between highway safety and public health to improve the culture of safety.

Our commitment to the goal of zero traffic fatalities and serious injuries requires consideration of innovative traffic safety thinking. There is growing recognition that this goal requires a change in our culture as it relates to traffic safety (traffic safety culture). And yet, there is no consensus about a definition for traffic safety culture, no explicit theory-based model to predict the effect of traffic safety culture, and no practical guidance for applying these models to develop effective culture-based strategies. This chapter seeks to address these omissions from both an academic and practitioner perspective.

This chapter proposes a standard definition of traffic safety culture based on a model that integrates relevant theories of willful and intentional behavior. Importantly, a set of 10 principles are identified that provide the context and foundation from which the definition and model are derived. An understanding of these principles provides the logic and purpose for developing strategies that can transform traffic safety culture:

• (1)

  Traffic crashes are a significant public health concern.

• (2)

  Most traffic crashes are caused by human behavior, not the roadway, vehicle, or environment (e.g., weather).

• (3)

  Human behavior is influenced by beliefs.

• (4)

  Beliefs develop based on experience (actual and vicarious) and socialization.

• (5)

  Socialization is the process whereby an individual develops beliefs which align with the culture of a group with which the individual identifies (social identity).

• (6)

  Individuals can form an identity with many different groups in their social environment, each with a different degree of bonding.

• (7)

  A stronger bond results in greater conformity and motivation to abide with the group culture.

• (8)

  The shared beliefs of a group that affect behaviors related to traffic safety are called traffic safety culture.

• (9)

  The traffic safety culture of a group emerges from actions taken by stakeholders across the social ecology.

• (10)

  Traffic safety culture strategies increase actions by stakeholders across the social ecology to improve traffic safety culture among various groups.

Traffic crashes are a significant public health concern.

Most traffic crashes are caused by human behavior, not the roadway, vehicle, or environment (e.g., weather).

Human behavior is influenced by beliefs.

Beliefs develop based on experience (actual and vicarious) and socialization.

Socialization is the process whereby an individual develops beliefs which align with the culture of a group with which the individual identifies (social identity).

Individuals can form an identity with many different groups in their social environment, each with a different degree of bonding.

A stronger bond results in greater conformity and motivation to abide with the group culture.

The shared beliefs of a group that affect behaviors related to traffic safety are called traffic safety culture.

The traffic safety culture of a group emerges from actions taken by stakeholders across the social ecology.

Traffic safety culture strategies increase actions by stakeholders across the social ecology to improve traffic safety culture among various groups.

For the academic, these principles can also serve as hypotheses that can be explored to expand our knowledge about traffic safety culture. For the practitioner, these principles represent the basic logic and impetus for transforming traffic safety culture. By effectively communicating these principles and their connecting logic, we can express the importance of traffic safety culture and the need for supporting resources with other stakeholders.

The purpose of this chapter is to describe the rationale for and structure of organizational networks in support of traffic safety programming. It outlines the operational considerations and approaches important to both understanding network-based partnerships and improving their functionality. The chapter draws on conceptual and empirical studies of organizational networks in order to enhance the effectiveness of networks and integrate network-based approaches with the cultural orientation already present in traffic safety research and practice.

This chapter proceeds from the premise that, increasingly, efforts to impact traffic safety behaviors will be interconnected with other concerns, and that traffic safety initiatives will require engagement with organizations focused on concerns other than traffic safety. The implication of the ideas examined in this chapter is that traffic safety agencies will need to focus not just on traffic-related behaviors, but also on the strategic and operational coordination with other organizations. Doing so has the potential to create synergies that would be unachievable if agencies operation in isolation.

Occupational injury in the health care sector in the United States rates among the highest of all industries. Specific to hospital support service workers (e.g., Food & Nutrition, Environmental Services), studies have shown that injury rates for support service workers tend to be among the highest of hospital personnel, and yet there is a shortage of research investigating the safety climate of these workers. Therefore, the purpose of this study is to examine safety perceptions of support service workers. Surveys were used to measure safety climate leadership factors (per the AHRQ's Survey of Patient Safety Culture) to determine if they are related to individual safety perceptions, as well as ratings of work unit safety. Following established safety climate research, we examined the role of the work environment (e.g., supervisor support and work unit culture) on safety perceptions. We found that both supervisor and organizational safety leadership are positively related to individual safety perceptions and supervisor support. Organizational safety leadership and work unit culture were positively related to work unit safety rating. Our findings demonstrate that the antecedent factors and pathways that promote a positive safety climate among health care providers functions in a similar manner for support service workers. These findings contribute to a better understanding of occupational safety of this understudied work group and provide evidence to hospital administration that developing a strong safety climate among support service workers is not entirely different from what is required to promote a robust safety climate across an organization.