SafetyInsights.org

This draws on Rasmussen’s dynamic safety model to understand how healthcare workers manage competing priorities. Three questions are explored: 1. ID & categorise the types of pressures faced by healthcare workers 2. Understand what risk trade-off decisions are made in response to pressures 3. Analyse the implications of trade-offs for quality & safety of care… Continue reading Capturing challenges and trade-offs in healthcare work using the pressures diagram

Happy to share the first published study in my PhD, with co-authors Drew Rae and Sidney Dekker. (Huge thanks to Drew for his guidance and patience.) This theoretical paper outlines the key concepts and ideas that were used for studies 2 (which looked at major accident reports) and 3 (which explored internal audit reports); both… Continue reading Mini-post: Writing plans instead of eliminating risks: How can written safety artefacts reduce safety?

This explored how the length of the narrative in incident reports is connected to attributions of blame. The authors hypothesised that longer written narratives in reports would lead to higher blame, due to more opportunities for things like opinions, assumptions and accusations [and presumably counterfactual & normative language]. All safety reports related to anaesthesia services… Continue reading Pointing Fingers: Verbosity of Patient Safety Narratives Is Associated With Attribution of Blame

ABSTRACT Decision-making under risk and uncertainty is not straightforward. This paper investigates how people make decisions when they need to choose between prevention and production investments and the decision involves risks and uncertainties that could have major negative consequences. A questionnaire was conducted among 405 students at the University of Antwerp, in Belgium. With regard… Continue reading Major accident prevention decision-making: A large-scale survey-based analysis

How objective are quantitative risk assessments and how subjective are qualitative assessments? This image is another example from a presentation of mine, highlighting a nice quote from Gerd Gigerenzer. He aptly observes the lack of critical evaluation of quantitative risk models, statistics, predictive algorithms etc. Our unwavering support of models is partially reflected by what… Continue reading Mini-post: Fine-tuning the odds until something breaks

This explored the connection between contractor success and project innovation in 31 Australian construction projects from the same company. An innovation framework was developed (client-contractor project innovation, called c2pi), which drew on assessing KPIs and calculations; a completed assessment is shown below. The assessment framework combines efficacy, efficiency and margin. In this framework, innovation is… Continue reading The empirical relationship between contractor success and project innovation

This study compared 22 conventional root cause analysis (RCA) style investigations against 22 Learning Teams (LT). I couldn’t see any additional info on what methodology they used in the RCAs. The investigation reports were compared and interviews conducted with staff familiar with both approaches. LT are defined as a “facilitated conversation between those that do… Continue reading Evaluation of Learning Teams Versus Root Cause Analysis for Incident Investigation in a Large United Kingdom National Health Service Hospital

ABSTRACT The concept of safety culture has become established in safety management applications in all major safety-critical domains. The idea that safety culture somehow represents a “systemic view” on safety is seldom explicitly spoken out, but nevertheless seem to linger behind many safety culture discourses. However, in this paper we argue that the “new” contribution… Continue reading Does the concept of safety culture help or hinder systems thinking in safety?

Risk matrices have many limitations but are they better than nothing? Ron Gantt recently penned an article exploring how injury metrics may not be adequate safety performance measures (link below). This got me thinking about similar arguments I’ve heard justifying other tools or methods, like risk matrices. A recent study highlighted a range of important… Continue reading Mini-post: Are risk matrices “better than nothing?”

This systematic review & meta-analysis evaluated the evidence surrounding the risk of occupational injuries relative to work scheduling. [Note: This study is an update on previous studies the authors published many years ago. Although there’s more recent studies not included in this data-set, I like how Simon Folkard presents the data in his line of… Continue reading Updating the “Risk Index”: A systematic review and meta-analysis of occupational injuries and work schedule characteristics