Andreeva Bay in northwest Russia hosts one of the former coastal technical bases of the Northern Fleet. Currently, this base is designated as the Andreeva Bay branch of Northwest Center for Radioactive Waste Management (SevRAO) and is a site of temporary storage (STS) for spent nuclear fuel (SNF) and other radiological waste generated during the operation and decommissioning of nuclear submarines and ships. According to an integrated expert evaluation, this site is the most dangerous nuclear facility in northwest Russia. Environmental rehabilitation of the site is currently in progress and is supported by strong international collaboration. This paper describes how the optimization principle (ALARA) has been adopted during the planning of remediation work at the Andreeva Bay STS and how Russian-Norwegian collaboration greatly contributed to ensuring the development and maintenance of a high level safety culture during this process. More specifically, this paper describes how integration of a system, specifically designed for improving the radiological safety of workers during the remediation work at Andreeva Bay, was developed in Russia. It also outlines the 3D radiological simulation and virtual reality based systems developed in Norway that have greatly facilitated effective implementation of the ALARA principle, through supporting radiological characterisation, work planning and optimization, decision making, communication between teams and with the authorities and training of field operators.
In a longitudinal cohort study, organizational climate and long-term effects of exposure to nasty teasing (aggression) at work were investigated. The baseline consisted of a representative sample of Danish employees in 1995 with a response rate of 80% (N = 5,652). Of these, 4,647 participated in the follow-up in 2000 (response rate 84%). In 1995, 6.3% were subjected to nasty teasing with no significant gender difference. At baseline, we found significant associations among nasty teasing, a negative organizational climate, and psychological health effects. In the follow-up analyses, associations were found between exposure to nasty teasing at baseline and psychological health problems at follow-up, even when controlled for organizational climate and psychological health at baseline and nasty teasing at follow-up. Stratified for gender, the follow-up associations were significant for women but not for men. Low coworker support and conflicts at baseline and teasing at follow-up mediated the effects on men.
The purpose of this paper is to describe and understand the effects of the accreditation process on organizational control and quality management practices in two Quebec primary-care health organizations.
A multiple-case longitudinal study was conducted taking a mixed qualitative/quantitative approach. An analytical model was developed of the effects of the accreditation process on the type of organizational control exercised and the quality management practices implemented. The data were collected through group interviews, semi-directed interviews of key informers, non-participant observations, a review of the literature, and structured questionnaires distributed to all the employees working in both institutions.
The accreditation process has fostered the implementation of consultation mechanisms in self-assessment teams. Improving assessments of client satisfaction was identified as a prime objective but, in terms of the values promoted in organizations, accreditation has little effect on the perceptions of employees not directly involved in the process. As long as not all staff members have integrated the basis for accreditation and its outcomes, the accreditation process appears to remain an external, bureaucratic control instrument.
This study provides a theoretical model for understanding organizational changes brought about by accreditation of primary services. Through self-assessment of professional values and standards, accreditation may foster better quality management practices.
Ecosystems are complex adaptive systems that require flexible governance with the ability to respond to environmental feedback. We present, through examples from Sweden and Canada, the development of adaptive comanagement systems, showing how local groups self-organize, learn, and actively adapt to and shape change with social networks that connect institutions and organizations across levels and scales and that facilitate information flows. The development took place through a sequence of responses to environmental events that widened the scope of local management from a particular issue or resource to a broad set of issues related to ecosystem processes across scales and from individual actors, to group of actors to multiple-actor processes. The results suggest that the institutional and organizational landscapes should be approached as carefully as the ecological in order to clarify features that contribute to the resilience of social-ecological systems. These include the following: vision, leadership, and trust; enabling legislation that creates social space for ecosystem management; funds for responding to environmental change and for remedial action; capacity for monitoring and responding to environmental feedback; information flow through social networks; the combination of various sources of information and knowledge; and sense-making and arenas of collaborative learning for ecosystem management. We propose that the self-organizing process of adaptive comanagement development, facilitated by rules and incentives of higher levels, has the potential to expand desirable stability domains of a region and make social-ecological systems more robust to change.
In recent years, there has been increased focus on improving the quality of the working lives of staff in health care organizations. Research shows that improvements can be achieved through a comprehensive organizational approach to workplace health. Improved worker engagement is a realizable outcome of such an approach, provided that it is based on reliable and relevant data and is tailored to the specific environment in which it is being implemented.
An intervention project was designed to develop an organization-wide approach to employee workplace health. A comprehensive health risk assessment was undertaken, along with a staff survey on workplace culture, individual health practice and environmental effects on physical health.
In general, the findings present a positive picture of the culture and factors that influence psychological wellbeing. However, improvement is needed in some areas: satisfaction is only marginally outweighing stress, and musculoskeletal disorders account for much absenteeism. Employee health needs include weight management, improving fitness and nutrition, and decreasing coronary risk.
Results have prompted this organization to pursue the development of a Healthy Workplace Policy that will be used as a filter for all other policies relating to workplace culture, environment and practice, and have provided the impetus and focus to review the organization of employee health services.
Three major administrative activities are necessary to move from planning to sustained action: ensure adherence of all staff to any policy derived from a health risk assessment; ensure staff feel proposed changes are relevant and important; and create a road map to guide the development of a strategic and an implementation plan. The findings outlined in this report can be addressed by organizations that are willing to commit to a comprehensive approach to workplace health.
To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement.
Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents.
A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement.
The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions.
The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.
Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.
A culture of safety in healthcare will not be achieved until the fragmentation that currently characterizes the delivery system is replaced by an alignment of the many component parts, including providers, patients and their families and front-line workers on the "sharp end'--physicians, nurses and pharmacists. A systemic approach should be introduced that would recognize the interacting nature of the delivery system's component parts, and that a change in one component of the system will provoke a change in another part. Consumers and their families can be empowered through programs that raise awareness, prevent error and mitigate its effect when error does happen. Within the system, the "safety sciences' can provide guides to effective work processes. Finally, it is critical to capture knowledge of what type of error occurs in what place and to elucidate strategies to prevent the error.
There is a growing body of evidence suggesting that an unhealthy work environment has an adverse impact not only on patients and families but on employees and organizations. The purpose of this article is to introduce the American Association of Critical-Care Nurses standards for establishing and sustaining a healthy work environment and to discuss ways to implement the standards in the acute and critical care workplace.