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A training intervention to improve frontline construction leaders' safety leadership practices and overall jobsite safety climate.

ABSTRACT: INTRODUCTION:The 2.5?h Foundations for Safety Leadership (FSL) training program teaches construction supervisors the leadership skills they need to strengthen jobsite safety climate and reduce adverse safety-related outcomes. METHODS:Using a quasi-experimental prospective switching replications study design, we examined (1) if FSL-trained jobsite safety leaders would report improved understanding and practice of the FSL leadership skills, safety practices and crew reporting of safety related conditions, and (2) if their crew perceived a change in (a) their supervisors' practices, (b) their own safety practices and reporting of safety-related conditions, and (c) overall jobsite safety climate. Twenty construction sub-contracting companies were recruited and randomly assigned to either an early or lagged-control training group. Participating supervisors and workers completed surveys at multiple time points before and after the FSL training. We used linear mixed modeling to test changes over time. RESULTS:Only supervisors in the early group reported a statistically significant improvement in their understanding and practice of the leadership skills as well as safety practices from before to 2- and 4-weeks post-training. Overall, no significant change was detected in crew-reported outcomes from before to after their supervisors' participated in the FSL training. CONCLUSIONS:These results provide evidence that the FSL training can, at least in the short-term, improve construction frontline leaders' jobsite leadership skills. Future research could include an evaluation of FSL refresher activities and a longer-term follow-up. Practical applications: The Foundations for Safety Leadership (FSL) program fills an identified need for construction frontline supervisors to learn and practice critical safety leadership skills on the jobsite. It has already reached over 60,000 leaders and has the potential to reach over 100,000 each year during either an OSHA 30-h or a stand-alone course.

SUBMITTER: Schwatka NV

PROVIDER: S-EPMC7076738 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Project description:IntroductionEffective team leadership is linked to better teamwork, which in turn is believed to improve patient care. Simulation-based training provides a mechanism to develop effective leadership behaviors. Traditionally, healthcare curricula have included leadership as a small component of broader teamwork training, with very few examples of leadership-focused curricula. The objective of this work is to describe a novel simulation-based team leadership curriculum that easily adapts to individual learners.MethodsWe created a simulation-based team leadership training for trauma team leaders in graduate medical education. Participants included second- and third-year emergency medicine and surgery residents. Training consisted of a single, four-hour session and included facilitated discussion of trauma leadership skills, a brief didactic session integrating leadership behaviors into Advanced Trauma Life Support®, and a series of simulations and debriefing sessions. The simulations contained adaptable components that facilitated individualized learning while delivering set curricular content. A survey evaluation was administered 7-24 months following the training to assess self-reported implementation of trained material.ResultsA total of 36 residents participated in the training and 23 (64%) responded to the survey. The majority of respondents (n = 22, 96%) felt the training was a valuable component of their residency education and all respondents reported ongoing use of at least one behavior learned during the training. The most commonly cited skills for ongoing use included the pre-arrival brief (n = 21, 91%) and prioritization (n = 21, 91%).ConclusionWe delivered a leadership-focused, simulation-based training that 1) adapted to learners' individual needs, and 2) was perceived to impact practice up to 24 months post-training. More work is needed to understand the impact of this training on learner knowledge and behavior, as well as patient outcomes.

Project description:For the purpose of providing excellent patient care, residents need to be strong, effective leaders. The lack of clinical leadership is alarming given the detrimental effects on patient safety. The objective of the study was to assess whether a leadership training addressing transactional and transformational leadership enhances leadership skills in residents.A volunteer sample of 57 residents from postgraduate year one to four was recruited across a range of medical specialties. The residents took part in an interventional controlled trial. The four-week IMPACT leadership training provided specific strategies for leadership in the clinical environment, addressing transactional (e.g. active control, contingent reward) and transformational leadership skills (e.g. appreciation, inspirational motivation). Transactional and transformational leadership skill performance was rated (1) on the Performance Scale by an external evaluator blinded to the study design and (2) self-assessed transformational and transactional leadership skills. Both measures contained items of the Multifactor Leadership Questionnaire, with higher scores indicating greater leadership skills.Both scores were significantly different between the IMPACT group and the control group. In the IMPACT group, the Performance Scale increased 15% in transactional leadership skill performance (2.10 to 2.86) (intervention effect, 0.76; 95% CI, 0.40 to 1.13; p < .001, eta2 = 0.31) and 14% in transformational leadership skill performance (2.26 to 2.94) (intervention effect, 0.68; 95% CI, 0.27 to 1.09; p < .001, eta2 = 0.22). The self-assessed transactional skills revealed a 4% increase (3.83 to 4.03) (intervention effect, 0.20; 95% CI, 0.08 to 0.33; p < .001, eta2 = 0.18) and a 6% increase in transformational leadership skills (3.54 to 3.86) (intervention effect, 0.31; 95% CI, 0.02 to 0.40; p< .001, eta2 = 0.53).These findings support the use of the transactional and transformational leadership framework for graduate leadership training. Future studies should incorporate time-latent post-tests, evaluating the stability of the behavioral performance increase.

Project description:OBJECTIVE:To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. DATA SOURCES/STUDY SETTING:Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. STUDY DESIGN:Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas. RESULTS:Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]). CONCLUSIONS:WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.

Project description:Importance:Although leadership behavior of physician supervisors is associated with the occupational well-being of the physicians they supervise, the factors associated with leadership behaviors are poorly understood. Objective:To evaluate the associations between burnout, professional fulfillment, and self-care practices of physician leaders and their independently assessed leadership behavior scores. Design, Setting, and Participants:This survey study of physicians and physician leaders at Stanford University School of Medicine (n?=?1924) was conducted from April 1 to May 13, 2019. The survey included assessments of professional fulfillment, self-valuation, sleep-related impairment, and burnout. Physicians also rated the leadership behaviors of their immediate physician supervisors using a standardized assessment. Leaders' personal well-being metrics were paired with their leadership behavior scores as rated by the physicians they supervised. All assessment scores were converted to a standardized scale (range, 0-10). Data were analyzed from October 20, 2019, to March 10, 2020. Main Outcomes and Measures:Association between leaders' own well-being scores and their independently assessed leadership behavior. Results:Of 1924 physicians invited to participate, 1285 (66.8%) returned surveys, including 67 of 117 physician leaders (57.3%). Among these respondents, 651 (50.7%) were women and 729 (56.7%) were 40 years or older. Among the 67 leaders, 57 (85.1%) had their leadership behaviors evaluated by at least 5 physicians (median,?11 [interquartile range, 9-15]) they supervised. Overall, 9.8% of the variation in leaders' aggregate leadership behavior scores was associated with their own degree of burnout. In models adjusted for age and sex, each 1-point increase in burnout score of the leaders was associated with a 0.19-point decrement in leadership behavior score (??=?-0.19; 95% CI, -0.35 to -0.03; P?=?.02), whereas each 1-point increase in their professional fulfillment and self-valuation scores was associated with a 0.13-point (??=?0.13; 95% CI, 0.01-0.26; P?=?.03) and 0.15-point (??=?0.15; 95% CI, 0.02-0.29; P?=?.03) increase in leadership behavior score, respectively. Each 1-point increase in leaders' sleep-related impairment was associated with a 0.15-point increment in sleep-related impairment among those they supervised (??=?0.15; 95% CI, 0.02-0.29; P?=?.03). The associations between leaders' well-being scores in other dimensions and the corresponding well-being measures of those they supervised were not significant. Conclusions and Relevance:In this survey study, burnout, professional fulfillment, and self-care practices of physician leaders were associated with their independently assessed leadership effectiveness. Training, skill building, and support to improve leader well-being should be considered a dimension of leadership development rather than simply a dimension of self-care.

Project description:BackgroundNationally over 50% of physicians report symptoms of burnout.ObjectiveTo understand the perspectives of health system leaders and frontline physicians on contributors to physician burnout and strategies to improve well-being.DesignWe conducted in-depth interviews with health system leaders and frontline physicians at a large, predominantly fee-for-service, multispecialty group practice with approximately 1300 physicians.ParticipantsThe 17 participants included 15 physicians, (12 Internal Medicine and Family Medicine physicians and 3 from other specialties), 11 individuals in leadership roles, and 11 women.ApproachInterviews included a review of factors associated with burnout at the organization, asking participants which factors they believed contributed to burnout, questions about experiences of burnout, and what specific changes would improve well-being.Key resultsAll 17 participants agreed that organizational factors were key contributors to burnout, while only 9 mentioned the salience of individual factors: "It does not matter how resilient or positive you are, the work environment, especially in primary care will eventually be a problem." An increasing workload associated with the electronic health record (EHR) and a culture focused on productivity were cited as contributing to burnout, especially among physicians in Internal Medicine and Family Medicine (primary care) departments. Physicians in primary care, women, and leaders described multiple barriers to well-being. Participants described responding to increased workloads by reducing clinical work hours. Participants suggested reducing and compensating EHR work, expanding care teams/support staff, reducing use of metrics, providing more support to leaders, changing the business model, and increasing positivity and collegiality, as essential to improving well-being.ConclusionInterviews reveal a variety of interacting factors contributing to physician burnout. Reducing clinical work hours has become a coping strategy. Changes recommended to improve physician well-being include increasing support staff, reducing EHR workload, changing revenue generation and compensation approaches, and shifting organizational culture to place more value on physician wellness.

Project description:BACKGROUND:Logging is recognized as one of the most dangerous industries in the United States (US), ranking among those with the highest occupational injury and fatality rates. Although logging operations in the Southeastern US have lower rates of injuries and fatalities compared to other regions of the US, due in part to the use of large machinery to fell timber as opposed to chainsaw felling, safety hazards continue to persist. The hazards present in the logging cut sites in which loggers operate may result in worker injury, illness, or fatality. Our objective was to develop, deliver, and evaluate a safety management and leadership training among logging contractors and supervisors using mobile tablets as a personal learning environment. METHODS:A safety leadership and management training vignette was developed based on previously collected focus group needs assessment data. A non-random sample of 31 male logging supervisors received the safety leadership and management training on a mobile tablet. Kirkpatrick Levels 1, 2, and 3 training effectiveness evaluations were performed. RESULTS:A statistically significant large effect size suggests safety knowledge was gained among training participants when comparing post-test scores to pre-test scores (Level-2). Participants rated their training experience favorably (Level-1), and applied knowledge gained from the training throughout their weekly work activities three months after training (Level-3). CONCLUSION:Our findings suggest the utilization of mobile learning techniques can be an effective means to deliver safety management and leadership training content to logging contractors and supervisors. Future trainings should be linguistically and literacy-level appropriate, as well as comprehensive in nature, including meaningful and relevant content. Our observations support the use of mobile devices as just one component of a more comprehensive health and safety management program for workers in the logging industry.

Project description:BackgroundPromoting patient and occupational safety are two key challenges for hospitals. When aiming to improve these two outcomes synergistically, psychosocial working conditions, leadership by hospital management and supervisors, and perceptions of patient and occupational safety climate have to be considered. Recent studies have shown that these key topics are interrelated and form a critical foundation for promoting patient and occupational safety in hospitals. So far, these topics have mainly been studied independently from each other. The present study investigated hospital staffs' perceptions of four different topics: (1) psychosocial working conditions, (2) leadership, (3) patient safety climate, and (4) occupational safety climate. We present results from a survey in two German university hospitals aiming to detect differences between nurses and physicians.MethodsWe performed a cross-sectional study using a standardized paper-based questionnaire. The survey was conducted with nurses and physicians to assess the four topics. The instruments mainly consisted of scales of the German version of the COPSOQ (Copenhagen Psychosocial Questionnaire), one scale of the Copenhagen Burnout Inventory (CBI), scales to assess leadership and transformational leadership, scales to assess patient safety climate using the Hospital Survey on Patient Safety Culture (HSPSC), and analogous items to assess occupational safety climate.ResultsA total of 995 completed questionnaires out of 2512 distributed questionnaires were returned anonymously. The overall response rate was 39.6%. The sample consisted of 381 physicians and 567 nurses. We found various differences with regard to the four topics. In most of the COPSOQ and the HSPSC-scales, physicians rated psychosocial working conditions and patient safety climate more positively than nurses. With regard to occupational safety, nurses indicated higher occupational risks than physicians.ConclusionsThe WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results, improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals - especially for nurses.

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A training intervention to improve frontline construction leaders' safety leadership practices and overall jobsite safety climate.

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