Contributions to effective risk management : On the use of safety principles, economic tools and safety climate instruments

PhD thesis in Risk management and societal safetyFor an organization, effective risk management involves supporting informed decision-making for improved allocation of resources, as well as playing an active part in how the organization is governed and, ultimately, performs. The aim of this thesis is to contribute to effective risk management and, in particular, to two research areas. The first is a focus on approaches that are utilized to either achieve or conflict with the main purpose of risk management: a balance between value creation and protection. The second is to contribute to improved patient safety in the prehospital domain, particularly through the development of safety-climate theories and -instruments. The scientific contribution of this thesis consists of five papers, of which Papers I-III belong to the first research area and Papers IV and V to the second. The content of the papers is summarized briefly in the following. Paper I concerns regulatory HSE (health, safety and environment) interventions in the oil and gas industry. The background is a methodology for the evaluation of regulatory interventions, developed by two consulting agencies, in which the preferred method is to address uncertainties, mainly by the use of expected values. This approach is discussed in Paper I, as expected values may be very misleading when used in a context prone to potential major accidents. Paper I suggests another approach, which more adequately addresses risk, to obtain a balance between value creation and protection. A simple example is provided to highlight the difference between the approaches. The background for Paper II is a conflict related to the use of Vision Zero (VZ) as a guiding principle for managing production assurance risk in the oil and gas industry. Paper II addresses this conflict and discusses the rationality of complementing VZ with another principle: the ‘As Low As Reasonably Practicable’ (ALARP) principle. Paper II argues that the ALARP principle may serve as a practical tool to evaluate risk of production loss, including balancing different concerns. The intention of the proposed combined principle is to continually (over time) draw closer to the state of zero risk. Paper III focuses on the difficulty of performing economic evaluation as part of health technology appraisal for the helicopter emergency medical services (HEMS). The issue is that HEMS is a complex sociotechnical system; to address this, Paper III proposes a framework, using a systems model approach for evaluating the system as part of the economic evaluation. The purpose of the framework is to determine and highlight critical system elements. Paper III includes an example, to demonstrate how ‘missing’ crucial information may lead to unintended economic consequences. The research in Papers IV and V is based on data retrieved from a patient safety survey conducted in 2016 among workers in the emergency medical services (EMS) in Norway. In addition, Paper V is based on data retrieved from an equal survey in the Norwegian HEMS in 2012. Paper IV utilized the Norwegian version of the Hospital Survey on Patient Safety Culture (HSOPSC), to perform a safety climate study in the prehospital domain. In general, participants were asked to provide their view on different statements related to patient safety. Overall, acceptable psychometric properties were observed, and the outcome of Paper IV is a validated safety climate instrument for use in the EMS setting: the Prehospital Survey on Patient Safety Culture (PreHSOPSC). Building on Paper IV, Paper V utilized three different sets of data in a similar study. The study provided two major findings. First, a modified short version, PreHSOPSC-S, was validated for use in the EMS and HEMS settings. Second, new theories was developed: Based on a structural model, positive safety climate relations were demonstrated between organizational levels (from top and unit management, to the unit and individual levels), and finally on what may be considered as the outcome “product” of the prehospital domain; transitions and handoffs