The assessment of Patient Safety Culture (PSC) is often conducted using a quantitative approach based on questionnaires or a qualitative one focused on the deployment of Patient Safety Culture Maturity Models (PSCMM). These two approaches suffer from a number of limitations and their resolution is only possible by exploiting the possible complementarity that exists between them. Indeed, to overcome their inherent limits, it is imperative to merge the two PSC approaches in a single approach called quali-quantitative evaluation of PSC. This article fits into this context and aims to materialise the merger of PSC approaches through their co-deployment. This will make it possible to capitalise the scores of the HSOPSC dimensions in terms of PSC maturity levels.

Purpose

The assessment of patient safety culture (PSC) is a major priority for healthcare providers. It is often realized using quantitative approaches (questionnaires) separately from qualitative ones (patient safety culture maturity model (PSCMM)). These approaches suffer from certain major limits. Therefore, the aim of the present study is to overcome these limits and to propose a novel approach to PSC assessment.

Design/methodology/approach

The proposed approach consists of evaluating PSC in a set of healthcare establishments (HEs) using the HSOPSC questionnaire. After that, principal component analysis (PCA) and K-means algorithm were applied on PSC dimensional scores in order to aggregate them into macro dimensions. The latter were used to overcome the limits of PSC dimensional assessment and to propose a quantitative PSCMM.

Findings

PSC dimensions are grouped into three macro dimensions. Their capitalization permits their association with safety actors related to PSC promotion. Consequently, a quantitative PSC maturity matrix was proposed. Problematic PSC dimensions for the studied HEs are “Non-punitive response to error”, “Staffing”, “Communication openness”. Their PSC maturity level was found underdeveloped due to a managerial style that favors a “blame culture”.

Originality/value

A combined quali-quantitative assessment framework for PSC was proposed in the present study as recommended by a number of researchers but, to the best of our knowledge, few or no studies were devoted to it. The results can be projected for improvement and accreditation purposes, where different PSC stakeholders can be implicated as suggested by international standards.

Background

A positive Patient Safety Culture (PSC) is considered as the main barrier to adverse events (AEs) that affect healthcare quality and safety. Thus, the assessment of PSC became a priority for healthcare providers in order to identify problematic areas that need improvement actions.

Method

A cross sectional multi-center study was conducted to evaluate quantitatively PSC in 10 Algerian healthcare establishments (HEs) within the framework of the Algerian Observatory of Safety Culture (ASCO Project). The French version of the HSOPSC was used as a measurement tool where it was administered to participants (N = 1370) using convenience sampling.

Results

A total of 1118 respondents, all professional categories included, participated in this study. The response rate was estimated at 69% of the sample size (N = 1370). After statistical processing, 950 questionnaires were retained. Internal consistency was above 0.7 for all dimensions. Problematic PSC dimensions were identified, mainly ‘Non-punitive response to error’, ‘Staffing’ and ‘Communication openness’.

Conclusions

This article sheds light on the critical situation of PSC in the Algerian national health system. Quantitative findings were introduced in the framework of the Algerian Safety Culture Observatory project that will serve as a baseline for different stakeholders to guide long-term promotion actions.

Purpose

This study aims to improve the reliability of emergency safety barriers by using the subjective safety analysis based on evidential reasoning theory in order to develop on a framework for optimizing the reliability of emergency safety barriers.

Design/methodology/approach

The emergency event tree analysis is combined with an interval type-2 fuzzy-set and analytic hierarchy process (AHP) method. In order to the quantitative data is not available, this study based on interval type2 fuzzy set theory, trapezoidal fuzzy numbers describe the expert's imprecise uncertainty about the fuzzy failure probability of emergency safety barriers related to the liquefied petroleum gas storage prevent. Fuzzy fault tree analysis and fuzzy ordered weighted average aggregation are used to address uncertainties in emergency safety barrier reliability assessment. In addition, a critical analysis and some corrective actions are suggested to identify weak points in emergency safety barriers. Therefore, a framework decisions are proposed to optimize and improve safety barrier reliability. Decision-making in this framework uses evidential reasoning theory to identify corrective actions that can optimize reliability based on subjective safety analysis.

Findings

A real case study of a liquefied petroleum gas storage in Algeria is presented to demonstrate the effectiveness of the proposed methodology. The results show that the proposed methodology provides the possibility to evaluate the values of the fuzzy failure probability of emergency safety barriers. In addition, the fuzzy failure probabilities using the fuzzy type-2 AHP method are the most reliable and accurate. As a result, the improved fault tree analysis can estimate uncertain expert opinion weights, identify and evaluate failure probability values for critical basic event. Therefore, suggestions for corrective measures to reduce the failure probability of the fire-fighting system are provided. The obtained results show that of the ten proposed corrective actions, the corrective action “use of periodic maintenance tests” prioritizes reliability, optimization and improvement of safety procedures.

Research limitations/implications

This study helps to determine the safest and most reliable corrective measures to improve the reliability of safety barriers. In addition, it also helps to protect people inside and outside the company from all kinds of major industrial accidents. Among the limitations of this study is that the cost of corrective actions is not taken into account.

Originality/value

Our contribution is to propose an integrated approach that uses interval type-2 fuzzy sets and AHP method and emergency event tree analysis to handle uncertainty in the failure probability assessment of emergency safety barriers. In addition, the integration of fault tree analysis and fuzzy ordered averaging aggregation helps to improve the reliability of the fire-fighting system and optimize the corrective actions that can improve the safety practices in liquefied petroleum gas storage tanks.

Liquefied petroleum gas (LPG) storage fires and explosions occur due to uncontrolled gas leaks and the gradual breakdown of associated safety barriers. By installing an effective safety barrier, these accidents can be greatly reduced. However, this study assesses the probability of failure of emergency safety barriers (ESBs) to help decision makers understand how they can support decisions to reduce the risks associated with LPG storage. In this context, an extension of the event tree analysis is proposed named emergency event tree analysis (EETA). The aim of this paper is to develop an integrated approach that uses interval type-2 fuzzy sets and Analytic Hierarchy Process (AHP) method and emergency event tree analysis to handle uncertainty in the failure probability assessment of emergency safety barriers (ESBs). In addition, a case study on the failure probability assessment of the emergency safety barriers of the LPG plant in Algeria based on the proposed methodology is provided and carried out to illustrate its effectiveness and feasibility. The results demonstrated the ability of interval type-2 fuzzy sets and the AHP method to provide highly reliable results and to evaluate the failure probability of emergency safety barriers in emergencies situations. However, the classical event tree analysis (CETA) does not take into account the possibility of assessing the emergency consequences of different accident scenarios. Consequently, it only allows you to estimate the occurrence probability of accident scenarios. The results of this study show that the value of the probability of failure of the emergency safety barriers can be used to estimate the probability of occurrence of emergency consequences under different accident scenarios, improved the reliability and help prioritize emergency improvement measures. The study provides scientific and operational references for analyzing emergency consequences of the various accident scenarios in all fields such as petrochemical, maritime industry, and health occupational.

The fire-fighting system is one of the proactive technical barriers related to liquefied petroleum gas storage tank safety. This paper presents an integrated approach that uses fuzzy set theory, an improved-dependent uncertain ordered weighted averaging operator and fault tree analysis to handle uncertainty in the unavailability assessment of fire-fighting systems. In this study, the center of area is used to defuzzify triangular fuzzy numbers. Furthermore, for the fire-fighting system fault tree, importance analysis, including Fussell–Vesely importance measure and risk reduction worth of basic events, are performed to identify the weak links of the fire-fighting system. In addition, a real case study on a fire-fighting system for a liquefied petroleum gas storage system in an LPG unit in Algeria is provided to illustrate the effectiveness of the proposed methodology. The research results show that the proposed methodology makes it possible to assess the unavailability of the entire system by analyzing weak links. Consequently, some suggestions are given to take preventive–corrective actions in advance, in order to reduce the failure probability of fire-fighting system and assist the practitioners in setting priorities for improving safety procedures in liquefied petroleum gas storage tanks. The study provides references for analyzing safety barriers in a complex system.