Background
Healthcare workers (HCWs) voicing their views (speaking up) is crucial for patient safety and care quality. Yet, this is underused, especially during multidisciplinary team meetings (MDTMs), where diverse professionals collaborate to optimise patient treatment plans. Despite the benefits of open communication, HCWs face barriers such as hierarchical dynamics, time constraints and psychological risks.

Aim
This study examines factors influencing HCWs’ speaking-up behaviours in MDTMs, focusing on motivators, barriers and dynamics across disciplines.

Method
We conducted 21 semistructured interviews with MDTM participants of a gastrointestinal surgery ward, including surgeons, residents, nurses, nursing students, dieticians, ostomy nurses and physical therapists. Data were analysed collaboratively using thematic analysis.

Results
Participants are highly motivated to advocate for patients and provide optimal care. However, barriers impact speaking up during MDTMs. Three major themes were identified: (1) time pressure, (2) perception of goals and roles and (3) familiarity among team members. Structural, relational and contextual factors affect HCWs’ ability to speak up, with nurses and paramedics experiencing more hesitancy than physicians. Lack of preparation time, ambiguous objectives, no formal agenda and unfamiliarity among team members hinder contributions, leading to unbalanced input.

Conclusion
Findings support a systems-based approach to addressing barriers. Interventions should focus on clear goals, reduced time pressures and enhanced team cohesion, rather than placing the responsibility solely on individuals. For instance, adjusting meeting schedules to accommodate diverse availability improves participation across disciplines. Strengthening familiarity among team members fosters trust and lowers the perceived risks of speaking up, ensuring more balanced contributions during MDTMs. ... Read more

Background
Speaking up among healthcare professionals plays an essential role in improving patient safety and quality of care, yet it remains complex and multifaceted behaviour. Despite awareness of potential risks and adverse outcomes for patients, professionals often hesitate to voice concerns due to various influencing factors. This complexity has encouraged research into the determinants of speaking-up behaviour in hospital settings. This review synthesises these factors into a multi-layered framework. It aims to provide a more comprehensive perspective on the influencing factors, which provides guidance for interventions aimed at fostering environments contributing to speaking up in hospitals.

Methods
A systematic review was conducted in November 2024, searching databases: PubMed, Scopus and Web of Science. Following PRISMA guidelines and the three stages for thematic synthesis, we developed the classification of influencing factors. Out of 1,735 articles identified articles, 413 duplicates were removed, 1,322 titles and abstracts were screened, and 152 full texts (plus six additional articles) were assessed. Ultimately, 45 articles met the inclusion criteria.

Results
The review categorised influencing factors into four categories: individual (29 articles, 64%), relational (21 articles, 47%), contextual (19 articles, 42%), and organisational (26 articles, 58%). These categories encompass motivating, hindering and trade-off factors affecting speaking up among healthcare professionals in hospitals.

Conclusions
The multi-layered framework highlights the dynamic interplay of factors influencing speaking up among healthcare professionals. A systems approach is essential for identifying barriers and enablers and designing effective speaking up interventions. This framework serves as a foundation for more focused research and practical guidance, enabling healthcare leaders to address barriers across all categories. By fostering environments that support open communication, organisations can enhance patient safety and quality of care. ... Read more

In the Netherlands, approximately 2.300 workers have a serious reportable accident at work every year, of which around 60 are fatal (Inspectie SZW, 2020; Bellamy et al., 2014). Safety practitioners employ many methods to improve occupational safety for workers within their companies. Interventions might, for example, be aimed at improving companies’ overall ‘safety culture’, at the introduction of a safety management system (e.g. Robson et al., 2007), or at improving the compliance of workers to specific safety rules (e.g. Peuscher and Groeneweg 2012; Bryden et al., 2016). However, the effectiveness of many of those interventions remains largely unclear (Dyreborg et al, 2015). The Dutch National Institute for Public Health and the Environment (RIVM) has started a project with the ultimate goal of developing a database filled with effective safety interventions. Developers can submit their interventions using a fixed protocol. To support this project, we developed a survey, which was sent to all members of the Dutch Society for Safety Science (NVVK). In the survey, we used a list of 48 predefined descriptions of common interventions. Respondents could indicate whether they made use of these common interventions and the extent to which they considered these effective. The survey thus provided an extensive overview of the use and perceived effectiveness of 48 specific safety interventions. In the future, these insights can support the development and testing of more effective safety interventions. ... Read more

De bal is rond. Dat geldt in de sport maar zeker ook voor veilig werken. Je kunt winnen en je kunt verliezen. Als je wint, ben je blij, als je verliest heb je gewoon… pech. Game over. Of niet? Wij vinden van niet en daarom schreven wij de handreiking arbeidsveiligheid. Zodat je kunt winnen in arbeidsveiligheid. Maar hoe zorg je dat je wint in veiligheid en hoe voorkom je dat je verliest? ... Read more

In de SER-handreiking Arbeidsveiligheid. Aanpak voor betere veiligheidsprestaties wordt haarfijn uitgelegd hoe je maximaal kunt presteren in veilig werken. Tijdens het schrijven van de handreiking hebben Jos Bus en Frank Guldenmund zich vaak afgevraagd hoe een topcoach tegen de handreiking en de sportmetaforen aankijkt. Wat zou bijvoorbeeld Louis van Gaal ervan vinden? Ze beelden zich in dat een gesprek met Dé Bondscoach zo zou kunnen gaan… ... Read more

Background: Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision-making by policy makers, public health practitioners, workplace, and worker advocates. Objectives: The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context. Date Sources: Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS-DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched. Study Eligibility Criteria, Participants, and Interventions: Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi-experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of:. Attitudes (through information and persuasive campaign messaging). Behaviors (through training, incentives, goal setting, feedback/coaching). Physiological condition (by physical training). Climate/norms/culture (by coaching, feedback, modification of safety management/leadership). Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial-level norms). When combined approaches were used, interventions were termed “multifaceted,” and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed “across levels.”. Study Appraisal and Synthesis Methods: Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random-effects inverse variance weighted meta-analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings. Results: In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring “decision-to-use” by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow-up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium-term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent. Limitations: Acute musculoskeletal injuries and injuries from more long-time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta-analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non-English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors. Conclusions and Implications of Key Findings: Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker “decision-to-use” at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population-based effects. ... Read more

De NVVK bestaat dit jaar 75 jaar, dit mag u niet ontgaan zijn. Een mooi moment om stil te staan bij het vakgebied veiligheidskunde en de veiligheidsprofessional, die hier de scepter zwaait. Wat bezielt die veiligheidsprofessional toch? En is dat in de loop van de tijd veranderd? Waar komt dit door? ... Read more

No other concept in safety science is as studied, yet poorly understood (or measured) as safety culture. In this chapter, we aim to bring conceptual and methodological clarity to this field. Our proposition is that to effectively measure safety culture, one must firstly clearly define it, and align the research design and method with the definition. Drawing on recent theoretical development in organizational culture and safety science, we critically review safety culture research published in the past two decades. We then present an argument to encourage researchers to adopt closer definitional-methodological alignment. A safety culture ‘manifesto’ is also shown, which we hope will guide future research on safety culture by advancing commitments that researchers can uphold. Finally, we look towards the future and summarize emerging measurement methods from the organizational culture literature to explore how technology and innovative tools and techniques can be used to take the safety culture field forward. ... Read more

Niet zo heel lang geleden stormde een veiligheidsprofessional na afloop van een praatje op mij af om mij te bezweren dat het vasthouden van de leuning een voortreffelijke maatregel is. In mijn ogen is het eerder betuttelend. Negatieve veiligheid, we moeten er nu écht vanaf. ... Read more

In deze rubriek kiest de auteur per letter één thema en licht dit kort toe aan de hand van zijn of haar ervaring hiermee. Dit geeft een unieke kijk op welzijn en preventie. In dit artikel komt het Welzijnsalfabet van Frank Guldenmund aan bod. Guldenmund is psycholoog en bijna 30 jaar werkzaam bij de sectie Veiligheidskunde van de Technische Universiteit Delft. Bij de Nederlandse Vereniging voor Veiligheidskunde (NVVK) is hij actief als bestuurslid. ... Read more

Safety culture remains an elusive concept, not only for scholars and practitioners but for the workers who actually have to deal with safety on a daily basis as well. The metaphor of football provides particular working groups a medium to explore the meaning of safety culture by drawing parallels with team roles, changing working conditions, the importance of production vs. safety and the creation of safety therein. Being a familiar team sport in many countries, the football metaphor can also function as a communication device within work teams to facilitate and promote a shared understanding of work and safety. ... Read more

Het Bestuur van de NVVK heeft afgelopen oktober en november door een extern bureau een onderzoek onder haar leden laten uitvoeren. Dit onderzoek bestond uit een kwalitatief deel en een kwantitatief deel. De eerste resultaten daarvan zijn tijdens de Algemene Ledenvergadering van november 2019 gepresenteerd. Voor wie er toen niet bij was, volgt hier een bondige samenvatting. ... Read more

Objective: What is the influence of general management trends and safety research on managing safety? Method: A literature study which is limited to original English and Dutch books, documents, and articles in relevant scientific journals, for the period 1988–2010. Results and conclusions: Safety science does not yet have a unifying theory, which betrays its young age as a scientific discipline. In the period concerned, well-known theories, models and metaphors are established or re-issued, including the High Reliability Theory, the Man-Made Disasters and the corresponding Disaster Incubation Theory, and the Normal Accident Theory. The Swiss cheese metaphor takes its final form, the bowtie metaphor and the Drift into Danger model are published. All these theories, models and metaphors emphasize organisational aspects of major accidents in high-tech-high-hazard sectors. General management trends highlight the importance of external stakeholders, which are only reflected in the Drift into Danger metaphor. These developments must be considered in the context of a dynamic influence of external factors, like a decrease in government influence coinciding with strong market and technology developments, which can conflict with safety requirements for high-tech-high-hazard companies. Organisational/safety culture and risk/safety management systems take off during this period, both in terms of academic research and consultancy activities for companies. Whether these concepts will have a lasting influence on safety levels in companies is yet to be seen, given the unclear relationship with major accident processes. Research findings show that many companies suffer from sloppy management, having only a limited insight into possible disaster scenarios. ... Read more

Research question: What is the influence of general management trends and research into causes of accidents on safety management? Method: The literature study is limited to English and Dutch books, documents and articles in the scientific, professional, and technical literature from the period 1988–2010. Results and conclusions: Quite some developments occurred in the occupational safety domain. During the period concerned three models are developed, the Dutch Tripod Model, the Swedish Occupational Risk Unit Model (QARU), and the Dutch Occupational Risk Model (QRM), a barrier based model founded on the bowtie metaphor. These models address occupational accidents from different perspectives, and surprisingly similar factors. While terminology differs, these factors are called basic risk factors, situational, or management factors. Self-regulation of companies has been a strong stimulus for research on safety management systems and audits. Traditionally research in management related topics has not been part of safety research, and thus it has to be developed. While the quality of this type of research is rather low, a general structure of safety management systems is related to the Rhineland management concept. Such evidence is found in new management models such as the EFQM/INK and, to a lesser extent, Corporate Social Responsibility (CSR). While organisational learning, its quality and effectiveness on occupational safety is not researched in this period, research interests are focussing on other organisational aspects like safety culture and climate, including a renewed interest in human behaviour. ... Read more

The waste management sector is dominated by micro and small-sized enterprises. Although it is possible to anticipate that they may face the same problems as other small firms, information about activities related to the prevention of occupational risks in this sector and how this influences Occupational Health & Safety (OHS) performance is still limited. This study aims to address the issue, contributing to current literature about the protection of employees and the prevention of occupational risks in the waste management sector. The study was conducted at 66 enterprises in Portugal. Data about OHS management practices was collected through different sources, such as questionnaires applied to employers and analysis of documents and records available at the enterprise. A summative index that assesses seven OHS performance aspects was used to characterize the enterprises regarding their OHS performance level. The results showed that micro and small-sized waste management firms display several constraints with regard to OHS management. Several enterprises still do not have organized preventive services. Additionally, OSH policies or objectives, risk assessment, training and accident recording mechanisms were found to be non-existent in several cases. The time dedicated by employers to OHS issues and the support of external advisory services was also low for some firms. A positive and statistically significant association was found between these variables and the enterprises’ OHS performance level. Future research will focus on designing an intervention to improve OHS in the waste management sector as a whole. ... Read more

Een aantal jaar geleden zag ik in Peking een schilderij van de Grote Roerganger, Mao Zedong. Mao staat alleen op een berg, met zijn handen op zijn rug, de flappen van zijn jas aan weerszijden opengewaaid door de wind. Achter hem zijn besneeuwde bergtoppen zichtbaar. Het is koud daarboven, en eenzaam. Hij kijkt aandachtig
naar links (waar anders?), maar wij zien niet naar wat. ... Read more

Het overkomt iedereen: dagdromen of even met je gedachten afdwalen. Het is onvermijdelijk. Het is menselijk. Maar wat is het nog meer? Is het gevaarlijk? Misschien. Is het leuk? Soms niet. Is het te voorkomen? Waarschijnlijk niet. ... Read more

U loopt naar een andere kamer om een boek te pakken. Terwijl u daar bent, valt uw oog op een rekening die nog niet is betaald. U pakt die op en wilt weer naar de andere kamer teruggaan. Op dat moment realiseert u zich dat u voor iets anders naar deze kamer was gekomen. Maar voor wat ook alweer? ... Read more

Op 13 en 14 maart was weer het 2-jaarlijkse NVVK-congres op de inmiddels vertrouwde locatie van Papendal. Met 588 gasten was het andermaal ‘volle bak’. Achteraf hebben 314 van hen de moeite genomen om de evaluatie in te vullen (een respons van maar liefst 53 procent). Als vereniging en als congrescommissie mogen wij beslist tevreden zijn. Waarom? Dat leest u hieronder. ... Read more