The design of an impact evaluation of a health and safety management system in the National Health Service (NHS) was informed by a review of relevant literature, which identified a design comprising six main aspects. These were a longitudinal design; inclusion of comparison groups; an intervention that was of interest to the NHS; a participative style; multiple measurement methods and multiple indicators of effectiveness.
Field study data was generated using a prospective longitudinal before-and-after design with a multiple baseline. Seven NHS Trusts participated; two of which were used as comparison groups. The intervention was a safety management workbook, introduced only to the test group. Evaluation of the workbook impact on safety performance involved two identical phases, approximately 12 months apart. Each phase comprised of a staff opinion questionnaire survey, based on previously validated work; and a new HSE methodology involving analysis of accident data to derive costs, which could be linked to management root causes.
The most frequently encountered system failure was that of risk assessment, with planning, implementing, measuring and reviewing as the main root causes. Estimated extrapolated costs were between 0.06% and 1.44% of the running costs of the NHS. Responses from the questionnaires showed significant differences between the Trusts and a significant improvement in staff opinion in some safety climate dimensions.
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