What does safety commitment mean to leaders? A multi-method investigation

Introduction: Perceived management safety commitment as an aspect of safety climate or culture is a key influence on safety outcomes in organizations. What is unclear is how perceptions of management commitment are created by leaders. Method: To address this gap in the literature, we position safety commitment as a leadership construct viewed from the perspectives of the leaders who experience and demonstrate it. In this paper, an established multidimensional commitment framework is applied to leaders' safety commitment (consisting of affective, normative, and calculative commitment). Via an exploratory sequential mixed methods design combining interviews (n = 40) and surveys (n = 89), we investigate the applicability of this theoretical conceptualization to safety commitment. Results: The results indicate the multiple dimensions captured leaders' safety commitment well, safety commitment can be demonstrated via a range of behaviors, and the dimensions' association with behavioral demonstrations aligned with those of other types of commitment reported in the literature. Only affective safety commitment was consistently associated with demonstrations of safety commitment. The link between high levels of affective and normative safety commitment and demonstrations was more pronounced when participants perceived their company's safety climate more positively. Conclusions: Adopting a focus on leaders' experience of safety commitment offers opportunities for new research into the way in which safety commitment perceptions are shaped by leaders. Practical application: The findings can support leaders' reflection about their personal mindset around safety and support them in fostering strong safety climates and cultures. It further encourages organizations in creating work environments that in particular foster affective and normative safety commitments in leaders

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo