A new framework to identify and assess hidden assumptions in the background knowledge of a risk assessment

A risk assessment has a more or less subjective nature, as the analyst needs to make assumptions, analyse data, use models, and so on, to produce risk-related knowledge of the phenomena of interest. This background knowledge that forms the foundation of a risk assessment can be more or less strong, implying that it needs to be taken into consideration when describing and communicating risks. To meet this challenge, different methods have been developed to evaluate and inform the decision-maker about the strength of the background knowledge. For all these methods to be fully informative, the content of the background knowledge needs to be of good quality, covering, for example, all the relevant assumptions. To identify all the relevant assumptions, however, is not a trivial task, and the risk of missing assumptions increases with the complexity of the situation of interest. Hidden assumptions, which are not considered or identified, may induce false confidence in the risk assessment, its results and recommendations. This paper suggests a framework, using a systems approach, to identify and assess the background knowledge, as a means to reduce the risk of missing critical knowledge and obtain a more complete background knowledge, on which risk can be assessed.publishedVersio

Utilizing students' feedback to ensure quality in teaching and learning: A lesson from covid-19

In this article we investigate the impact of COVID-19 on teaching quality and student active teaching. The data used for the analysis is from more than 4,000 students at the University of Stavanger, collected for the Study Barometer, one of the most important metrics for assessing student satisfaction in higher education, in the period 2018-2020. Special attention is given to the teaching quality index and the active student participation in teaching index. Comparisons of the data from 2020 with the data given in the period 2018-2019 show few significant differences. For the Faculty of Health Sciences, however, there are strong significant differences for both the teaching quality index and the student active participation in teaching index. We reflect upon and discuss factors that may have contributed to these differences and show how a large-scale survey can identify drawbacks in teaching and learning in higher education.publishedVersio

On the use of the ‘Return Of Safety Investments’ (ROSI) measure for decision-making in the chemical processing industry

Due to the high potential of chemical and process industry to damage people, as well as to cause environmental contamination, there is a need of objective criteria and methods supporting plant operators to make decisions and optimise investments in safety measures. Currently, the use of risk-based approaches is popular in order to prioritize criticalities, based on the results of risk assessments; this approach is usually combined with cost-benefit analyses that provide criterions in the decision-making process. A commonly used framework to prioritise safety measures is based on the calculation of the return of safety investments (ROSI), which quantifies the expected return of the investment in safety with respect to the invested resources. In this paper the usefulness of such a framework is discussed and the need for an extension is shown using a case-study from the chemical processing industry. The study concluded that the ROSI should be used with caution, because it does not give a sufficient weight to uncertainties as it is based on the use of expected values. Some improvements to the framework are suggested, i.e. the assessment of ROSI given an accidental event and to highlight the importance of reflecting the strength of knowledge on which the ROSI metric is based.publishedVersio

Assessing safety climate in prehospital settings: Testing psychometric properties of a common structural model in a cross-sectional and prospective study

Background Little research exists on patient safety climate in the prehospital context. The purpose of this article is to test and validate a safety climate measurement model for the prehospital environment, and to explore and develop a theoretical model measuring associations between safety climate factors and the outcome variable transitions and handoffs. Methods A web-based survey design was utilized. An adjusted short version of the instrument Hospital Survey on Patient Safety Culture (HSOPSC) was developed into a hypothetical structural model. Three samples were obtained. Two from air ambulance workers in 2012 and 2016, with respectively 83 and 55% response rate, and the third from the ground ambulance workers in 2016, with 26% response rate. Confirmatory factor analysis (CFA) was applied to test validity and psychometric properties. Internal consistency was estimated and descriptive data analysis was performed. Structural equation modelling (SEM) was applied to assess the theoretical model developed for the prehospital setting. Results A post-hoc modified instrument consisting of six dimensions and 17 items provided overall acceptable psychometric properties for all samples, i.e. acceptable Chronbach’s alphas (.68–.86) and construct validity (model fit values: SRMR; .026–.056, TLI; .95–.98, RMSEA; .031–.052, CFI; .96–.98). A common structural model could also be established. Conclusions The results provided a validated instrument, the Prehospital Survey on Patient Safety Culture short version (PreHSOPSC-S), for measuring patient safety climate in a prehospital context. We also demonstrated a positive relation between safety climate dimensions from leadership to unit level, from unit to individual level, and from individual level on the outcome dimension related to transitions and handoffs. Safe patient transitions and handoffs are considered an important outcome of prehospital deliveries; hence, new theory and a validated model will constitute an important contribution to the prehospital safety climate research.publishedVersio

Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study

Background Deficient non-technical skills (NTS) among providers of critical care in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. A previous study indicated that physicians underwent less frequent training compared to pilots and HEMS crew members (HCM) and that all professional groups in Norwegian HEMS received limited training in how to cope with fatigue. Since then, training initiatives and a fatigue risk management project has been initiated. Our study aimed to explore if the frequency of simulation-based training and assessment of NTS in Norwegian HEMS has changed since 2011 following these measures. Methods A cross-sectional web-based survey from October through December 2016, of physicians, HCM and pilots from all civilian Norwegian HEMS-bases reporting the overall extent of simulation-based training and assessment of NTS. Results Of 214 invited, 109 responses were eligible for analysis. The frequency of simulation-based training and assessment of NTS has increased significantly for all professional groups in Norwegian HEMS, most prominently for the physicians. For all groups, the frequency of assessment is generally lower than the frequency of training. Conclusions Physicians in Norwegian HEMS seem to have adjusted to the NTS training culture of the other crew member groups. This might be a consequence of improved NTS training programs. The use of behavioural marker systems systematically in HEMS should be emphasized.publishedVersio

Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians

Objective Personnel working in helicopter emergency medical services (HEMS) and search and rescue (SAR) are exposed to environmental stressors, which may impair performance. The aim of this survey was to study the extent HEMS and SAR physicians report the influence of specific danger-based and non–danger-based stressors. Methods The study was performed as a cross-sectional, anonymous, Web-based (Questback AS, Bogstadveien 54, 0366 Oslo, Norway) survey of Norwegian HEMS and SAR physicians between December 2, 2019, and February 25, 2020. Results Of the recipients, 119 (79.3%) responded. In helicopter operations, 33.6% (n = 40) reported involvement in a minor accident and 44.5% (n = 53) a near accident. In the rapid response car, 26.1% (n = 31) reported near accidents, whereas 26.9% (32) reported this in an ambulance. Of physicians, 20.2% (n = 24) received verbal abuse or threats during the last 12 months. When on call, 50.4% (n = 60) of physicians reported sometimes or often being influenced by fatigue. Conclusion This study shows that Norwegian HEMS and SAR physicians are exposed to several stressors of both a danger-based and non–danger-based nature, especially regarding accidents, threatening patient behavior, and fatigue. Very serious incidents appear to be seldom, and job satisfaction is high.publishedVersio

How to improve situation assessment and decision-making in a simulated mass casualty incident by using an Unmanned Aerial Vehicle

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Use of an Unmanned Aerial Vehicle to support situation assessment and decision-making in search and rescue operations in the mountains

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A socio-economic analysis of increased staffing in the Norwegian helicopter emergency medical service

Background: The European Aviation Safety Agency (EASA) is preparing a new set of regulations that will cover working and resting periods for crew members engaged in emergency medical services with helicopters (HEMS) and aeroplanes (AEMS). Such a shared European regulatory framework has already been introduced for the majority of commercial operations with aeroplanes, whereas national regulations are still in place for helicopter operations. A possible consequence of changing the regulations on working and resting periods for helicopter operations is that current abilities to provide 24-h, continuous emergency readiness with the same helicopter crew will be changed to a daily shift pattern with two, and even up to three, different crews to cover one 24-h period. Methods: A cost-benefit study is used to analyse whether changed working and resting periods, through the introduction of a shared European framework are socio-economically profitable for Norwegian helicopter emergency medical service (HEMS). For the study, relevant data is available for the total of nine HEMS helicopters of the three regions in Norway, for the period 2006–2013. The aim of the study is to document whether changed working and resting periods will be socio-economically beneficial for the Norwegian HEMS. Results: The expected present value of changing the current regulations on working and resting periods is estimated at negative 181 million NOK over a 40-year period. This includes the assumption that all missions that are not completed today due to limitation in crew availability will be completed upon introducing new working and resting periods. In the current regulatory regime for the Norwegian HEMS, there are on average seven missions per HEMS base annually that are not completed due to the limitations in crew availability with the current working and resting periods. Changing the regulations on working and resting periods is estimated to be cost-effective when a minimum of 14 missions per year are prevented from being cancelled due to crew availability. Discussion: The benefit and cost elements used in the socio-economic analysis contain an estimated benefit of the measure, based on the valuation of life years gained for a limited number of patients. The prerequisites for life years gained, with the associated monetary value for quality-adjusted life years, are important for the outcome of the cost-benefit analysis. In this study 6.95 life years gained is used as basis for the benefit of the measure. This number is based on the conclusion of two studies, which have studied the benefits of HEMS helicopters staffed with a doctor in Norway. In a cost-benefit analyses, a quantification shall as far as possible be made in monetary values of all the positive and negative effects the measure entails. In this analysis, one criticism may be that these effects are relatively few, theinvestment costs (the increased operating costs) are not provided a detailed description of, and other factors such as; effect on the environment, risk of simultaneous requirements of the HEMS helicopter with possible negative effect for the patient who most needs it, likelihood of accidents with associated negative effect are neither included in the cost-benefit analysis. Conclusion: Alternations to the working and resting periods for Norwegian HEMS operations that will result in a change from the current 24-h, continuous emergency readiness with the same crew, to a set-up with two, and up to three, different crews are not found to be socio-economically beneficial.publishedVersio

A comparative study on the frequency of simulation-based training and assessment of non-technical skills in the Norwegian ground ambulance services and helicopter emergency medical services

Background Inadequate non-technical skills (NTSs) among employees in the Norwegian prehospital emergency medical services (EMSs) are a risk for patient and operational safety. Simulation-based training and assessment is promising with respect to improving NTSs. The frequency of simulation-based training in and assessment of NTSs among crewmembers in the Norwegian helicopter emergency medical service (HEMS) has gained increased attention over recent years, whereas there has been much less focus on the Norwegian ground emergency medical service (GEMS). The aim of the study was to compare and document the frequencies of simulation-based training in and assessment of seven NTSs between the Norwegian HEMS and GEMS, conditional on workplace and occupation. Method A comparative study of the results from cross-sectional questionnaires responded to by employees in the Norwegian prehospital EMSs in 2016 regarding training in and assessment of NTSs during 2015, with a focus on the Norwegian GEMS and HEMS. Professional groups of interest are: pilots, HEMS crew members (HCMs), physicians, paramedics, emergency medical technicians (EMTs), EMT apprentices, nurses and nurses with an EMT licence. Results The frequency of simulation-based training in and assessment of seven generic NTSs was statistically significantly greater for HEMS than for GEMS during 2015. Compared with pilots and HCMs, other health care providers in GEMS and HEMS undergo statistically significantly less frequent simulation-based training in and assessment of NTSs. Physicians working in the HEMS appear to be undergoing training and assessment more frequently than the rest of the health trust employees. The study indicates a tendency for lesser focus on the assessment of NTSs compared to simulation-based training. Conclusion HEMS has become superior to GEMS, in terms of frequency of training in and assessment of NTSs. The low frequency of training in and assessment of NTSs in GEMS suggests that there is a great potential to learn from HEMS and to strengthen the focus on NTSs. Increased frequency of assessment of NTSs in both HEMS and GEMS is called for.publishedVersio