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Trinchero, EFO 2017, 'Workplace relationships, psychological capital, employees' performance, accreditation and safety culture : the case of healthcare professionals in Italian acute care settings', PhD thesis, Southern Cross University, Lismore, NSW.

Copyright EFO Trinchero 2017


Patient safety is a crucial issue in healthcare organisations all over the world. The Italian healthcare system is not an exception, and there is a growing agenda to increase safety processes of care. The ability to influence safety culture among clinical staff has been widely recognised as one of the main mechanisms that can be used to affect patients’ outcomes. The thesis identifies the lack of viable safety framework models to assess safety culture within the Italian healthcare sector. Hence, it uses three theoretical frameworks – Blau’s (1964) Social Exchange Theory (SET), Positive Organisational Behaviour (POB) (Luthans, Youssef & Avolio 2007) and Cooper’s (2000) framework of safety culture – to operationalise a new comprehensive model of patient safety culture, and to test whether SET factors (supervisor-employee relationships, supervisor-employee relationships safety-related, and engagement) predict accreditation and safety culture in a causal chain. The main theoretical contribution of the research project is that it uses for the first time SET and POB to conceptualise the impact of workplace relationships on accreditation and safety culture in the healthcare sector. Moreover, it delivers a new structured definition of accreditation culture, and it develops new knowledge about the impact of workplace relationships on psychological, behavioural and situational aspects of accreditation and safety culture in the healthcare sector. Finally, the findings provide healthcare managers with an empirically robust model for examining accreditation and safety culture within Italian hospitals. The research results emphasise the role and responsibilities of hospitals’ top and middle management to guide staff involved in the processes of care in the right direction. The research acknowledges limitations regarding the use of self-report surveys to collect data among professionals in the Italian acute care settings. The choice of this research method relies on the willingness to deliver a model that allows hospitals to run internal, functional, and competitive benchmarking of their results, and the feasibility of the approach was paramount in developing the research design. Since the reliability of this model has been proven using Italian hospitals’ data, further research is needed to re-test it to confirm the generalisability of the model. Finally, future research should also address and improve the ability of the model to fully capture the psychological component of safety culture, that in the proposed model has been assessed using the Katz-Navon, Naveh and Stern (2005) priority of safety construct, adopted from Zohar (2000) (Trinchero, Farr-Wharton & Brunetto 2017)