Online patient feedback as a safety valve: An automated language analysis of unnoticed and unresolved safety incidents

Safety reporting systems are widely used in healthcare to identify risks to patient safety. But, their effectiveness is undermined if staff do not notice or report incidents. Patients, however, might observe and report these overlooked incidents because they experience the consequences, are highly motivated, and independent of the organization. Online patient feedback may be especially valuable because it is a channel of reporting that allows patients to report without fear of consequence (e.g., anonymously). Harnessing this potential is challenging because online feedback is unstructured and lacks demonstrable validity and added value. Accordingly, we developed an automated language analysis method for measuring the likelihood of patient-reported safety incidents in online patient feedback. Feedback from patients and families (n = 146,685, words = 22,191,427, years = 2013–2019) about acute NHS trusts (hospital conglomerates; n = 134) in England were analyzed. The automated measure had good precision (0.69) and excellent recall (0.98) in identifying incidents; was independent of staff-reported incidents (r = −0.04 to 0.19); and was associated with hospital-level mortality rates (z = 3.87; p < 0.001). The identified safety incidents were often reported as unnoticed (89%) or unresolved (21%), suggesting that patients use online platforms to give visibility to safety concerns they believe have been missed or ignored. Online stakeholder feedback is akin to a safety valve; being independent and unconstrained it provides an outlet for reporting safety issues that may have been unnoticed or unresolved within formal channels.     

Application of Human Reliability Analysis to Nursing Errors in Hospitals

Adverse events in hospitals, such as in surgery, anesthesia, radiology, intensive care, internal medicine, and pharmacy, are of worldwide concern and it is important, therefore, to learn from such incidents. There are currently no appropriate tools based on state-of-the art models available for the analysis of large bodies of medical incident reports. In this study, a new model was developed to facilitate medical error analysis in combination with quantitative risk assessment. This model enables detection of the organizational factors that underlie medical errors, and the expedition of decision making in terms of necessary action. Furthermore, it determines medical tasks as module practices and uses a unique coding system to describe incidents. This coding system has seven vectors for error classification: patient category, working shift, module practice, linkage chain (error type, direct threat, and indirect threat), medication, severity, and potential hazard. Such mathematical formulation permitted us to derive two parameters: error rates for module practices and weights for the aforementioned seven elements. The error rate of each module practice was calculated by dividing the annual number of incident reports of each module practice by the annual number of the corresponding module practice. The weight of a given element was calculated by the summation of incident report error rates for an element of interest. This model was applied specifically to nursing practices in six hospitals over a year; 5,339 incident reports with a total of 63,294,144 module practices conducted were analyzed. Quality assurance (QA) of our model was introduced by checking the records of quantities of practices and reproducibility of analysis of medical incident reports. For both items, QA guaranteed legitimacy of our model. Error rates for all module practices were approximately of the order 10(-4) in all hospitals. Three major organizational factors were found to underlie medical errors: "violation of rules" with a weight of 826 x 10(-4), "failure of labor management" with a weight of 661 x 10(-4), and "defects in the standardization of nursing practices" with a weight of 495 x 10(-4).     

Asking a Straightforward Question: Managers' Perceptions and Managers' Emotions

Mezias and Starbuck (2003) raise a number of issues concerning the accuracy of managers' perceptions. In this commentary, I argue that research on managers' perceptions might fruitfully explore further (1) the functional and dysfunctional effects of managers' perceptions and (2) the role of emotion in shaping managers' perceptions and their responses to the environment filtered by these perceptions. Drawing upon research in social and cognitive psychology, I argue that there exist theoretical frameworks from which to frame questions and interpret data in these areas.     

The Violent Incident Form (VIF): A practical instrument for the registration of violent incidents in the health care workplace

The Violent Incident Form (VIF) is a practical instrument that has been developed for the registration of all types of threatening and violent behaviour directed toward staff in health care work environments. The instrument uses a broad definition of violence that encompasses verbal aggression and threats. A 1-page checklist, the VIF, summarizes key aspects of the violent incident, identifying the circumstances, perpetrator, event, and consequences. Results from a 15-week pilot study as well as a follow-up study of the instrument's test-retest reliability are presented. The VIF was then introduced at 47 health care workplaces and used for a period of 12 months. During this period, 684 incidents were recorded by 32 workplaces. Of these, only 147 incidents (21 %) were also filed as official work injury reports. The checklist is based on the principle that all kinds of violent events must be included if an accurate assessment of violence at the workplace is to be made. The VIF is not intended as a replacement for official work injury reports, but as a complement, focusing more specifically on the nature of the violent incident. It is presented here as a research tool for studying violence in today's health care environments. Further work is needed to assess the use of the VIF as a learning tool, and as a possible catalyst for the development of effective violence management programmes.     

The Influence of Weather Conditions on the Relative Incident Rate of Fishing Vessels

There is a long history of studying the relationship between weather and maritime activities. This article analyzes the link between relative incident rate (RIR) and general weather factors within certain gridded areas and time periods. The study area, which encompasses a broad extent of Atlantic Canadian waters, includes fishing incidents recorded by the Canadian Coast Guard from 1997 to 1999. Methodologies used for traffic track generation in a geographical information system and aggregation of all relevant weather data needed for the statistical analyses are presented. Ultimately, a regression tree was built to illustrate the relationship between incident rate and the following six weather factors: wave height; sea surface temperature; air temperature; ice concentration; fog presence; and precipitation. Results from the regression tree reveal that the RIR defined as (incident number per area-day)/(traffic amount per area-day) across grid cells with incidents, increases as the weather conditions deteriorate in a general way, and the concentration of ice has the biggest influence on the magnitude of incident rates for a given level of traffic exposure. The results from this analysis may assist administrators of maritime traffic, especially those associated with fishing activities, through a better understanding of the influence on RIR of certain weather conditions within given areas in specific time periods.     

Work-related violence—is national reporting good enough?

Throughout Europe there are relatively few statistics, gathered a national level, which deal specifically with the problem of violence at work. In the UK, the revised Reporting of Injuries. Discases and Dangerous Occurrences Regulations (RIDDOR) 1995 now require that certain violent incidents are reported on a national basis. The criteria for reporting, which are entirely dependent on the physical outcome of incidents. are discussed. It is recommended that employing organizations should establish their own internal systems for reporting and recording a wider range of violent, and potentially violent. incidents. These should then be used to inform risk assessment and risk management.     

Should I Text or Call Here? A Situation‐Based Analysis of Drivers’ Perceived Likelihood of Engaging in Mobile Phone Multitasking

This study investigated how situational characteristics typically encountered in the transport system influence drivers’ perceived likelihood of engaging in mobile phone multitasking. The impacts of mobile phone tasks, perceived environmental complexity/risk, and drivers' individual differences were evaluated as relevant individual predictors within the behavioral adaptation framework. An innovative questionnaire, which includes randomized textual and visual scenarios, was administered to collect data from a sample of 447 drivers in South East Queensland‐Australia (66% females; n = 296). The likelihood of engaging in a mobile phone task across various scenarios was modeled by a random parameters ordered probit model. Results indicated that drivers who are female, are frequent users of phones for texting/answering calls, have less favorable attitudes towards safety, and are highly disinhibited were more likely to report stronger intentions of engaging in mobile phone multitasking. However, more years with a valid driving license, self‐efficacy toward self‐regulation in demanding traffic conditions and police enforcement, texting tasks, and demanding traffic conditions were negatively related to self‐reported likelihood of mobile phone multitasking. The unobserved heterogeneity warned of riskier groups among female drivers and participants who need a lot of convincing to believe that multitasking while driving is dangerous. This research concludes that behavioral adaptation theory is a robust framework explaining self‐regulation of distracted drivers.     

Behavioural criteria of managerial and leadership effectiveness within Egyptian and British public sector hospitals: an empirical case study and multi-case/cross-nation comparative analysis

This paper reports the results of a study of managerial and leadership effectiveness carried out within an Egyptian public sector hospital in which concrete examples of ‘effective’ and ‘least effective/ineffective’ manager and managerial leader behaviour, as observed by superiors, peers and subordinates, were collected using the critical incident technique. These critical incidents were then content analyzed to identify a smaller number of discrete behavioural statements and criteria of effectiveness. The paper also reports the results of a subsequent comparative analysis of these Egyptian findings against equivalent behavioural criteria that emerged from studies in two different British NHS Trust hospitals. This latter multi-case/cross-nation study revealed high degrees of overlap, commonality, and relative generalization across all three organizations. The results lend strong empirical support to those who believe in ‘generic’ and ‘universalistic’ explanations of the nature of managerial and leadership effectiveness.     

Online Corporate Environmental Reporting: Improvements and Innovation to Enhance Stakeholder Value

Corporate environmental/sustainability reporting is a growing trend among top global companies. In many cases, these reports have been made available online. Although the internet has provided reporting companies with a new channel to convey environmental information to the public, effective use of this media requires careful thought.Usability is a primary consideration that is not being addressed in many online corporate environmental/sustainability reports (CER). Often, these reports are difficult for users to locate from the corporate homepage, the search option does not render the correct page, some are only available in PDF format, and navigation within the report can be difficult. Current online reporting can also be ineffective if the technology is not oriented towards a framework of maximizing stakeholder value.If approached properly, internet technology allows for interactivity between a company and its stakeholders, provision of real-time updates of information and specialized information retrieval depending on the needs of users. This paper focuses on the current state of online CER reporting and suggests methods and practices for enhancing stakeholder value.     

Financial Reporting,Private Disclosure and the Corporate Governance Role of Financial Institutions

This paper explores how large UK financial institutions (FIs) pursued a private corporate governance agenda with their portfolio companies. It also investigates the role of financial reporting in private and public corporate governance. The case financial institutions argued that the limited quality of public information, especially in financial reports, was a major constraint on their ability to act in fund management and corporate governance roles. However, the financial reporting cycle determined a private institutional and company meeting cycle and this created opportunities for private information collection and for governance influence by FIs. In addition, the perceived limitations of public governance mechanisms such as voting encouraged private governance approaches. As a result, the case financial institutions had the incentive and the means to improve the quality of their sources of corporate information and to obtain a competitive edge over other financial institutions and the market through their direct contact with companies. Despite the limitations of public information, the paper reveals how public disclosure in financial statements and the financial reporting cycle played a central role in corporate governance. Public sources of information were combined with private sources to create a financial institutional knowledge advantage. The institutions used this knowledge to diagnose problem areas in strategy, management quality, and the effectiveness of the board, and their impact on financial performance. The financial reporting cycle meant that the quasi insider financial institution had the access opportunity and the joint public/private insight to influence companies across a wide corporate governance agenda and in a range of corporate circumstances. The case institutions exploited these private access and knowledge advantages for investment purposes and for Cadbury style corporate governance purposes. Thus, the private governance process was critically dependent on the FI knowledge advantage, which in turn relied on both financial reports and private disclosure. This wide ranging governance behaviour by institutions corresponds to recommendations subsequently made by the Hampel report in 1998 concerning UK corporate governance. The paper ends by exploring how the private institutional and company meeting agenda can suggest new directions for financial reporting and public disclosure and how this can further improve public and private corporate governance.     

The tone of business model disclosure: an impression management analysis of the integrated reports

The rising emphasis on the business model (BM) as a reportable element reflects the view that it constitutes one of the key starting points for investors’ analysis. In spite of this, recent academic and professional studies describe current reporting on BMs as uninformative: too optimistic, generic and incomplete. The International Integrated Reporting Council (IIRC) claims that these limitations may be overcome by means of an “Integrated Report”, an innovative report which is expected to offer a complete and balanced representation of how organizations create value by mean of their BMs. The paper investigates the informativeness of BM disclosure questioning whether companies adopt impression management (IM) strategies by manipulating the tone of the BM disclosures provided in their reports. We perform a manual content analysis of all the reports identified in the IIRC website and a multivariate statistical analysis to assess if a positive tone of BM disclosure is significantly associated with weak corporate governance, bad performance and low verifiability of the disclosure itself. Our findings support the idea that managers use BM disclosure as an IM strategy. This evidence has relevant implications for both accounting scholars and practitioners, since it questions the role of integrated reporting in improving corporate reporting on BMs.     

Conflict and cooperation: A revised model

The authors report one aspect of their study in which they observed and analysed the activities of 21 middle managers at work in five different manufacturing firms. Although originally incidental to the main purpose of their study, they soon observed patterns of conflict and cooperation between colleagues which were not consistent with previous reports. Incidences of cooperation were more frequent than had been expected. The paper analyses the cooperative incidents particularly within lateral contracts and proposes a revised model and calls for more balance in future research between conflict and cooperation.     

Do you think that your health or safety are at risk because of your work? A large European study on psychological and physical work demands

Throughout Europe there are relatively few statistics, gathered a national level, which deal specifically with the problem of violence at work. In the UK, the revised Reporting of Injuries. Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995 now require that certain violent incidents are reported on a national basis. The criteria for reporting, which are entirely dependent on the physical outcome of incidents, are discussed. It is recommended that employing organizations should establish their own internal systems for reportmg and recording a wider range of violent, and potentially violent, incidents. These should then be used to inform risk assessment and risk management.     

Trait Predictors of Aggression and Crash‐Related Behaviors Across Drivers from the United Kingdom and the Irish Republic

Aggressive driving is acknowledged as a contributor to motor vehicle crashes. This study explored a theoretical model of aggressive expression and crash‐related outcomes using self‐report data collected, using an online questionnaire, from drivers in the United Kingdom and the Republic of Ireland. The proposed model tested whether the personality traits of boredom proneness, sensation seeking, and impulsivity, coupled with trait driving anger, predicted aggressive driving; and whether aggressive driving predicted crash‐related outcomes (loss of concentration and control, near misses, and moving violations). The structural model was confirmed, with aggressive expressions of anger being found to mediate the relationships driving anger and impulsivity had with the crash‐related outcomes. Multigroup invariance analysis showed that the model remained invariant across drivers from the United Kingdom and Ireland, suggesting that the contributing factors for aggressive expression and crash involvement are similar across both countries. When self‐reported crash‐related conditions were compared between drivers in the United Kingdom and Ireland, drivers in the United Kingdom reported more aggressive driving, more minor crashes, more incidents of road rage, and more frequent losses of concentration and vehicle control.     

Evaluation of error across natural gas pipeline incidents

This paper demonstrates how qualitative analysis can be a novel means of investigating theories of error and causation in natural gas pipeline incidents. Qualitative analysis offers unique opportunities to understand process, interactions, and the role of context in identifying active error and latent conditions in incident causation. Through the coding of text from 24 onshore natural gas pipeline incident reports on leaks and explosions in the United States and Canada, our findings reveal a proportion of active and latent errors consistent with other hazardous infrastructure contexts (roughly 3:1 latent-active ratio across 817 coded errors). These findings underscore the robustness of extant error theory and support the argument for documenting multiple, connected causes of disaster in aggregate. Conclusions highlight the utility of in-depth case analyses and critique present pipeline incident database aggregation. Our interpretation provides a means to convey complex causation in aggregate form thus enabling more nuanced future qualitative and qualitative analyses.     

基于社会资本的突发事件理论分析

近年来,在全球频发的各种突发事件与社会资本运作空间的失当密不可分。在突发事件的前期,存在着社会资本原状与突发事件前期因子之间的不良互动和媾和,这种状态持续到质变的程度时,又在某种诱发因素的作用下,以积累爆发或扩散爆发等形式表现为突发事件,并产生一系列消极性的社会影响。突发事件发生和扩散的过程同时也是各种社会资本被动性应急调整、资本组织治理的过程。鉴于社会资本在突发事件中的动因作用,积极地改善社会资本的运作状况,消化突发事件的消极影响,改变社会资本误运作和优化社会资本结构的过程,对于减少突发事件的发生和积极的应对,具有十分重要的现实意义。     

Do you think that your health or safety are at risk because of your work? A large European study on psychological and physical work demands

Abstract

Throughout Europe there are relatively few statistics, gathered a national level, which deal specifically with the problem of violence at work. In the UK, the revised Reporting of Injuries. Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995 now require that certain violent incidents are reported on a national basis. The criteria for reporting, which are entirely dependent on the physical outcome of incidents, are discussed. It is recommended that employing organizations should establish their own internal systems for reportmg and recording a wider range of violent, and potentially violent, incidents. These should then be used to inform risk assessment and risk management.     

Voluntary disclosure of sustainability reports by Canadian universities

In contrast to corporate firms, voluntary sustainability reporting by universities is still in its infancy. Against this background, we have investigated which Canadian universities report their sustainability performance and what specifically is reported. Our study applies content analyses as a methodological approach to determine the relative importance of disclosure topics by using a university-specific catalogue of indicators. This unique study completely covers all sustainability reports published between 2011 and 2015 by Canadian universities and as such provides evidence and analyses of voluntary sustainability reporting by universities, which has been the subject of very little research to date. The findings show that sustainability reporting by Canadian universities diverges considerably and the range of aspects included is relatively narrow. Overall, the results show a clear focus on the environmental dimension and very weak coverage of the social dimension. The environmental orientation of many Canadian universities seems to be a result of their participation in the STARS program.     

Strategies,management values,and outcomes in manufacturing companies

Popular literature on corporate cultures presents stories about the importance of management's values. This article reports statistical analyses based on data obtained from middle and top managers employed by manufacturing companies. Results show that companies pursuing a strategy of cost leadership possess cultures emphasizing pragmatic values and strong performance norms. Moreover, these values and norms relate significantly with managers' career satisfaction and their organizational commitment.