Professor Jim Morgan

Telephone triage is a popular service globally but is under-represented in healthcare safety research and the definition of its safety is not well understood. Moreover, human factors frameworks for organisational learning are often designed for use in face-to-face healthcare and may be less reliable for detecting contributing factors in telemedicine. A systematic review of peer-reviewed literature in Scopus and PubMed databases to identify patient safety indicators and contributing factors to primary care telephone triage safety was conducted. Both qualitative and quantitative studies were included. No studies were excluded due to quality but Critical Appraisal Skills Programme tools supported commentary on quality considerations. 96 peer-reviewed articles met the requirements for inclusion, and definitions of, and contributing factors to safety were synthesised using the Systems Engineering Initiative for Patient Safety (SEIPS) as a ‘best-fit’ framework. Few studies defined safety. Most included studies measured ‘appropriateness’ of care/advice. Few research articles used data from actual incidents and/or near-misses. To reflect the various safety indicators “actionable, appropriate, and timely care, avoiding unavoidable deterioration or harm” is proposed as a working definition for telephone triage safety. Regarding contributing factors to telephone triage safety, most studies focused on individual worker and patient factors. Physical environment and organizational factors were under-researched, which is particularly pertinent since both are likely to differ from face-to-face care, unveiling noteworthy directions for future research. The review culminated in a list of contributory factors to patient safety in telephone triage with potential to use these to support incident investigation and system redesign.

The study aimed to examine the direct influence of specific moods (fatigue, anxiety, happiness) on risk in safety-critical decision making. It further aimed to explore indirect effects, specifically, the potential mediating effects of information processing assessed using a goodness-of-simulation task. Trait fatigue and anxiety were associated with an increase in risk taking on the Safety-Critical Personal Risk Inventory (S-CPRI), however the effect of fatigue was partialled out by anxiety. Trait happiness, in contrast was related to less risky decision making. Findings concerning the ability to simulate suggest that better simulators made less risky decisions. Anxious workers were generally less able to simulate. It is suggested that in this safety-critical environment happiness had a direct effect on risk decision making while the effect of trait anxiety was mediated by goodness-of-simulation.

To date no research has examined the effects of negative state on the perception of everyday injury risk. Instead, studies have focussed more broadly on the relationship between mood and self- reported optimism. The present study had two aims. Firstly, to assess the effect of incidental anxiety on implicit injury risk perception using a modified Implicit Association Test (IAT). Secondly, it sought to compare any effect with that on a conventional measure of risk perception (optimism). In line with previous research, anxious participants perceived more risk (were less optimistic). In contrast, there was no significant correlation between anxiety and the implicit perception of everyday injury risk. Theoretical and practical implications are discussed.

Although non-fatal injuries remain a frequent occurrence in safetycritical work, very few studies have examined the ways in which organisational systems and processes influence individual safety behaviour. Even fewer have explored the perceived factors contributing to accident risk using qualitative research methods. This short paper presents the initial results from a thematic analysis of ten interviews with On Track Machine (OTM) operatives. Issues arising from two key themes (fatigue, and safety communication and training) are briefly described. Implications, planned organisational response, and opportunities for further research are discussed.

Although non-fatal injuries remain a frequent occurrence in Rail work, very few studies have attempted to identify the perceived factors contributing to accident risk using qualitative research methods. This paper presents the results from a thematic analysis of ten interviews with On Track Machine (OTM) operatives. The inductive methodological approach generated five themes, of which two are discussed here in detail, ‘Pressure and fatigue’, and ‘Decision making and errors’. It is concluded that for companies committed to proactive accident risk reduction, irrespective of current injury rates, the collection and analysis of worker narratives and broader psychological data across safety-critical job roles may prove beneficial.

Background and Objectives: Workers were recruited from a UK further education college during a period of organisational downsizing. The study assessed the effects of a brief health psychology intervention on work-related stress in downsize survivors. Design and Methods: Sixty-six employees were randomly allocated to one of two conditions: one in which they were asked to create a work-related self-affirming implementation intention (WS-AII), or a control. Feelings of anxiety and depression were measured before and after the intervention or control task, and three weeks later. Job satisfaction, self-efficacy, and self-esteem were also measured. Results: There were statistically significant differences between the WS-AII condition and the control. Workers who created work-related self-affirming implementation intentions reported an immediate reduction in anxiety. This reduction was also observed in their appraisal of job-related anxiety three weeks later. There were no significant effects of WS-AII's on depression, job satisfaction or self-esteem. There was, however a significant effect on self-efficacy with workers in the WS-AII condition reporting greater self-efficacy. Conclusions: The present findings suggest that the integration of brief health psychology interventions, such as the WS-AII, into existing organisational practice may be of benefit to the well-being of employees.

Despite injury rates that are more than double that of other industries, to date, no research has examined risk perception in Police Service personnel. Equivocal findings across other high-risk industries suggest that, for frontline workers, risk perception is not homogenous. Risk appraisals of those closest to hazards are dependent on domain- or role-specific cognitive, social, and cultural factors. In turn, these are shaped by situational features specific to a particular work environment. The present study examined the magnitude and correlates of risk perception among Special Constables (SCs). SCs reported high levels of risk perception, associated with greater hazard exposure. Theoretical and practical implications are discussed.

The aim of the present pilot study was to assess the effect of a brief work-related self-affirming implementation intention (WS-AII) on the well-being of primary school teachers. Participants were randomly allocated to one of two conditions: one in which they were asked to create a WS-AII or one in which they were asked to create a control implementation intention (C-II). State anxiety was measured pre- and post-manipulation, self-efficacy at post-manipulation only, and emotions in teaching and emotion regulation at baseline and at a two-week follow-up. There were statistically significant differences between the WS-AII condition and the control. Teachers who created work-related self-affirming implementation intentions reported an immediate reduction in state anxiety. Positive effects extended over the two-week period, with teachers in the WS-AII condition also reporting more positive emotions in teaching and the use of reappraisal emotion regulation strategies rather than emotion suppression. Results suggest that the integration of the WS-AII into existing organisational practice may be of benefit to the well-being of teachers and other highly stressed workers.

Mindful organizing is a team-level capability that allows teams in high-risk environments to anticipate when something can potentially go wrong and adapt their operations just in time to protect the organizational system from negative consequences. This study aimed to extend our understanding of how mindful organizing affects employees’ propensity to engage in a broad range of safety citizenship behaviours through the mediation of participative safety self-efficacy. Participative safety self-efficacy is a psychological state that enables individuals to have confidence in their capability to engage in constructive behaviours that go beyond the formal requirements of their job description. A multilevel mediation model was tested using data collected from a large sample of chemical workers (N = 443) operating in fifty work teams. The findings showed that mindful organizing on a team level fosters both individual safety citizenship (helping; voice; initiative) and prescribed safety compliance through enhancing individual participative self-efficacy. This mediation relationship is significantly stronger for safety citizenship than for safety compliance.

Data for study on relationships between spontaneous self-affirmation, student-specific stress, and covariates; self-esteem, self-integrity, and habitual positive thinking.

Background: Student-specific stress is pervasive and impairs health and attainment. Experimentally induced self-affirmation can reduce stress, but little is known about the mechanisms underlying this effect, and the role of individual differences. The present study explores the relationship between spontaneous self-affirmation, student-specific stress, and overlapping constructs of positive self-regard during the COVID-19 pandemic. Methods: The study investigated inter-relationships between spontaneous self-affirmation, student-specific perceived stress and potential covariates including self-esteem, self-integrity and habitual positive self-thought. University students (N = 151) aged 18 to 50 responded to an online questionnaire including the Spontaneous Self-Affirmation Measure, College Student Stress Scale, Rosenberg Self-Esteem Scale, Habitual Index of Positive Thinking and Self-Integrity Scale. Results: Unexpectedly, regression analysis revealed that spontaneous self-affirmation was a positive predictor of student-specific stress, seemingly driven by relational affirmations. Self-esteem and habitual self-thought were negative predictors of student-specific stress, whilst self-integrity was not a predictor. Conclusions: Habitual positive self-thought may offer a sustainable solution to student-specific stress, but spontaneous self-affirmation does not. A reduction in defensive responses, elicitation of negative emotions, or use of conditional relationships in relational affirmation

Very little is known about the extent to which seemingly vulnerable younger and older adults appraise household risks and relatedly whether safety information focused on raising risk awareness influences intentions to reduce hazards in the home. The present study assessed age differences in accident experience, risk attitudes, household accident risk perceptions, comparative optimism, personal control, efficacy judgements, and intentions to remove household hazards. It also examined the predictors of these intentions. Thirty-eight younger adults (aged 18 to 25) and forty older adults (aged 65 to 87) completed study booklets containing all measures. There were significant age group differences for all accident experience and risk-related variables. Younger adults experienced more accidents, had riskier attitudes, and had significantly lower cognitive risk perceptions (i.e., they were less likely to be injured due to a household accident). They also had lower affective risk perceptions (i.e., they were less worried) about their accident risk and perceived more personal control over the risk compared with older adults. Young adults were comparatively optimistic about their risk while older adults were pessimistic. Older adults had higher response efficacy and intentions to reduce hazards in the home. Only worry, response efficacy, and risk attitudes predicted intention, however, these relationships were not moderated by age or efficacy appraisal. Although tentative theoretical and practical implications are presented, further research is required in order to better understand the objective and subjective risk associated with household accidents, and to determine the factors that may improve safety, particularly for those most vulnerable.

Student-specific stress is pervasive and impairs health and attainment. Experimentally induced self-affirmation can reduce stress, but little is known about the mechanisms underlying this effect, and the role of individual differences. The present UK-based study explores the relationship between spontaneous self-affirmation, student-specific stress, and overlapping constructs of positive self-regard. The study investigated inter-relationships between spontaneous self-affirmation, student-specific perceived stress and potential covariates including self-esteem, self-integrity and habitual positive self-thought. University students (N = 151) aged 18 to 50 responded to an online questionnaire including the Spontaneous Self-Affirmation Measure, College Student Stress Scale, Rosenberg Self-Esteem Scale, Habitual Index of Positive Thinking and Self-Integrity Scale. Unexpectedly, regression analysis revealed that spontaneous self-affirmation was a positive predictor of student-specific stress, seemingly driven by relational affirmations. Self-esteem and habitual self-thought were negative predictors of student-specific stress, whilst self-integrity was not a predictor. Habitual positive self-thought may offer a sustainable solution to student-specific stress, but spontaneous self-affirmation does not. A reduction in defensive responses, elicitation of negative emotions, or use of conditional relationships in relational affirmation may explain the positive relationship between spontaneous self-affirmation and student-specific stress.

Patient safety research has neglected to investigate telephone triage, particularly the NHS 111 service. As a complex sociotechnical system unlike face-to-face care, traditional patient safety frameworks may not address latent systemic issues in remote care: for example, the heightened reliance on technology, and increased onus on the patient to report their symptoms accurately. To address this research gap, this study applies macroergonomics principles to identify factors contributing to telephone triage patient safety. It aims to ascertain how telephone triage safety can be measured; identify system-specific risks and contributory factors for safety; and develop a generalisable, evidence-based, contributory factors framework, to improve organisational learning and change management.First, a bibliometric analysis identified a paucity of telephone triage research literature, especially in organisations using non-clinical triage (like NHS 111). A systematic review identified individual patient and worker factors were most often the focus of safety research, with less evidence considering wider work system factors. Secondly, a modified Macroergonomic Analysis and Design study situated NHS 111 within a complex ‘system of systems’, whereby safety is affected by service demands, and availability of follow-up services. Several variances (deviations from system design) were identified, including conflict between safety and efficiency targets. An observational study suggested technology usability led to workarounds with the potential to affect safety both positively and negatively. Finally, a modified Delphi study culminated in the development of an evidence-based contributory factors framework designed to improve organisational learning from incidents.In addition to the provision of a system-specific framework for incident investigation, this research addresses the paucity of research in telephone triage safety, contributing new knowledge about risks and factors influencing telephone triage safety performance. Additionally, the research offers an example of the integration of multiple Human Factors methods to conduct novel systems thinking research.

Prosocial safety behavior (PSB) is a critical element of workforce participation in the promotion of safety in the workplace. This study aims to examine the influence of various antecedents on PSB. Based on an analysis of the existing literature on prosocial behaviors, we investigate whether emotional intelligence (EI) and perceived organizational support (POS) significantly influence PSB. Furthermore, we analyze the mediating role of employees’ intrinsic motivation (IM) and affective commitment (AC) in these relationships. The research was conducted by administering an online questionnaire to a large sample of 488 workers employed in safety-critical industries based in the United States and the United Kingdom with the support of an online platform (N = 346; N = 142). Statistical analyses, conducted using a multi-group approach, revealed that EI had a direct effect on PSB in the two samples analyzed. In the US sample, we found that IM mediated the influence of EI and POS on PSB. In the UK sample, none of the mediation hypotheses were supported. The study provides insights into the individual and organizational factors that promote the development of a prosocial orientation in managing workplace safety issues, revealing the importance of recognizing the role of EI as a significant person-related antecedent supporting PSB. The statistical evidence from the study suggests that organizations that desire to facilitate the expression of PSB in their workforce may consider investing in training programs to enhance the EI of their employees and designing work conditions that facilitate high levels of intrinsic motivation.

In this study, we test whether different types of safety leadership styles predict different employees’ change-oriented discretionary communications about safety (i.e., safety voice) after controlling for proactive personality disposition to improve organizational sustainability. Building upon a multidimensional model of safety voice, which attempts to conceptualize different ways in which employees make suggestions about safety procedures, we developed four realistic scenarios in which we manipulated the supervisor’s safety leadership style, including: (1) transformational safety leadership, (2) transactional safety leadership, (3) passive safety leadership, and (4) control group (i.e., no leadership at all). We randomly assigned 103 participants to two of four scenarios and measured four facets of safety voice and proactive personality dispositions. The findings showed that after controlling for the respondents’ proactive personality, transformative safety leadership predicted promotive safety voice, transactional safety leadership predicted preventive safety voice, and passive safety leadership predicted hostile safety voice. These findings have a number of implications for our understanding of safety leadership and employees’ safety communications.

Understanding the factors that either facilitate or hinder the performance of specific safety behaviours is important in developing effective intervention strategies. A questionnaire to identify determinants of safety behaviours for safety-critical workers does not currently exist. This study reports the development and validation of the Safety Behaviour Change Questionnaire (SBCQ) based on the Theoretical Domains Framework (TDF). Following initial questionnaire development, a 3-stage testing procedure was adopted with three independent rail worker samples (totalling 620 participants), with a focus on three separate specific safety behaviours (removing slip/trip hazards, using PPE, safe tool storage). Explorative factor analysis (EFA) was used for the identification of the underlying structure of the initial set of items. Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit at the calibration and validation stages. The final version of the SBCQ questionnaire consisted of 13 factors and 26 items. Subsequent analysis of psychometric invariance confirmed the stability of the model factor structure across three distinct research sub-samples. These initial results suggest that the SBCQ demonstrates reliable, stable and valid properties, and that it can be utilised by safety managers and practitioners to guide the design of safety interventions for a range of safety behaviours.

The primary goal of our research was to validate a context-specific safety climate measure (the Heavy Vehicle Safety Climate Scale: HVSCS) in a sample of heavy mobile equipment operators (N = 277). An exploratory strategy was adopted, using exploratory factor analysis (EFA) to validate the items. The statistical results revealed a five-factor structure, with two factors at the organisational level and three factors at the group level. In addition, a nomological analysis showed that both organisational and supervisory safety climate factors presented distinct correlation patterns with other safety-related variables, including situational and routine violations, safety citizenship behaviour, context-specific safety behaviours and risk propensity. In this study we developed and psychometrically validated a context-specific safety climate tool for lone heavy vehicle drivers in the quarrying industry: the Heavy Vehicle Safety Climate Scale (HVSCS). It is hoped that the final 37-item HVSCS will be utilised by those managing heavy vehicle operations, particularly in the quarrying industry, to identify context-specific opportunities for safety climate improvements and in turn reduce the risk of safety incidents.

Call-center-based telephone triage is an example of a complex sociotechnical system relying on successful interactions between patients, callers, and the integration of many digital technologies. Digital technologies such as computer decision support systems are used to standardize triage outcomes with little consideration of how these unique healthcare systems adapt to maintain functionality in response to real-world operating challenges. Using structured observations of call handlers in two call centers and guided by usability heuristics and the concept of ‘workarounds’, this paper aims to investigate the effects of technology design on workflow and system adaptations. Opportunities for improvement are highlighted, particularly, assessment prompts, and updating software to reflect dynamic real-world situations. Interactions between system components, especially technological and organizational processes affected workflow, making adaptations at the individual and organizational levels necessary to ensure callers could be triaged safely. System designers could consider these findings to improve systems and procedures during challenging periods.

BACKGROUND: There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS: The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS: The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS: The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.

© 2019 Elsevier B.V. Background: A recent review of primary care serious incidents suggests that diagnosis and assessment problems, underpinned by communication failures, involving the UK telephone triage service, NHS 111, may contribute to patient harm. Methods: The present study utilised conversation analysis to address the lack of evaluative research examining the NHS 111 system and in particular interactions between system components (call handler, computerized decision support system, patients/caller). Results: Analysis of audio recorded call interactions revealed interactional misalignment across four mapped call phases (eliciting caller details, establishing reason for call, completing the Pathways assessment, and agreeing the outcome). This misalignment has the capacity to increase the risk of system failure, particularly in relation to assessment problems and issues related to the accurate transfer of care advice. Our analysis suggests that efforts to enhance the NHS 111 system, similar telehealth services, and patient safety management more generally, should shift their focus from a limited set of individual components towards a system-specific interactionist perspective encompassing all elements. Conclusions: Further evaluative research is required in order to build a comprehensive evidence-base concerning the multiple interacting factors influencing patient safety in the NHS 111 system.

Call-center-based telephone triage is an example of a complex sociotechnical system relying on successful interactions between patients, callers, and the integration of many digital technologies. Digital technologies such as computer decision support systems are used to standardize triage outcomes with little consideration of how these unique healthcare systems adapt to maintain functionality in response to real-world operating challenges. Using structured observations of call handlers in two call centers and guided by usability heuristics and the concept of ‘workarounds’, this paper aims to investigate the effects of technology design on workflow and system adaptations. Opportunities for improvement are highlighted, particularly, assessment prompts, and updating software to reflect dynamic real-world situations. Interactions between system components, especially technological and organizational processes affected workflow, making adaptations at the individual and organizational levels necessary to ensure callers could be triaged safely. System designers could consider these findings to improve systems and procedures during challenging periods.

Despite a call for a systems approach to safety since the early 2000s, telehealth systems like those providing telephone triage have not yet been studied as such. Macroergonomic Analysis and Design (MEAD) is considered a useful systems thinking tool to identify system components, their interactions and subsequent safety outcomes for organisations. To promote transparency in systems thinking research, this paper outlines an iterative, modified MEAD methodology, aiming to identify system components, interactions, and risks for patient safety. Working with one telephone triage provider, the method extends previous macroergonomic analyses methods to uncover latent risks across the whole system, using a system scan (document scan and key stakeholder meetings), key informant (front line worker) interviews, analysis using mapping (Leximancer), validation of interview findings (thematic analysis, and focus groups), and usability observations. MEAD provides a useful starting point for human factors research in safety critical systems, identifying latent risks spanning multiple levels.

Telephone triage services are becoming increasingly commonplace in modern healthcare. Despite this widespread adoption, health researchers and practitioners seeking to understand evidence-based best practice face several challenges. Firstly, the few systematic reviews available yield small sample sizes, suggesting a small amount of research. Secondly, the rapid pace of development of telephone triage technologies means there may be temporal validity issues with the available research, given some of this research is relatively old. Thirdly, researchers use different terminologies to describe telephone triage, meaning evidence may be more difficult to find than if consistent terminology was used. This bibliometric analysis therefore aims to provide a macroscopic overview of telephone triage, to understand the scale and scope of the available evidence (i.e., where, when, and by whom research is conducted), for interested researchers and practitioners. Additionally, it aims to quantify the prevalence of terms used to describe telephone triage, to recommend consistent terminology use in future, to improve accessibility of research. To address these aims, literature searches using three different key terms: ‘telephone triage,’ ‘remote triage’ and ‘teletriage’ were conducted in Scopus and PubMed. Corresponding bibliometric data was visualised and analysed using VOSViewer. This bibliometric review identified 784 papers since the term ‘telephone triage’ first appears in 1980, confirming a paucity of literature in the field. An overview of telephone triage research up to 2021 is provided, which should serve as a useful foundation for future research and application of evidence-based practice. Gaps in telephone triage research are identified, and the use of consistent terminology is encouraged, with the aim of supporting telephone triage researchers in determining research priorities and improving the impact of future studies.

Telephone triage services are becoming increasingly commonplace in modern healthcare. Despite this widespread adoption, health researchers and practitioners seeking to understand evidence-based best practice face several challenges. Firstly, the few systematic reviews available yield small sample sizes, suggesting a small amount of research. Secondly, the rapid pace of development of telephone triage technologies means that there may be temporal validity issues with the available research, given some of this research is relatively old. Thirdly, researchers use different terminologies to describe telephone triage, meaning evidence may be more difficult to find than if consistent terminology was used. This bibliometric analysis therefore is aimed at providing a macroscopic overview of telephone triage, to understand the scale and scope of the available evidence (i.e., where, when, and by whom research is conducted), for interested researchers and practitioners. Additionally, it is aimed at quantifying the prevalence of terms used to describe telephone triage, to recommend consistent terminology for future use, and to improve accessibility of research. To address these aims, literature searches using three different key terms: “telephone triage,” “remote triage,” and “teletriage” were conducted in Scopus and PubMed. Corresponding bibliometric data was visualised and analysed using VOSviewer. This bibliometric review identified 784 papers since the term “telephone triage” first appears in 1980, confirming a paucity of literature in the field. An overview of telephone triage research up to 2021 is provided, which should serve as a useful foundation for future research and application of evidence-based practice. Gaps in telephone triage research are identified, and the use of consistent terminology is encouraged, with the aim of supporting telephone triage researchers in determining research priorities and improving the impact of future studies.

© Springer International Publishing AG, part of Springer Nature 2019. Safety climate is an important leading indicator of safety performance and reflects the priority of safety within industrial operations. Previous research has identified safety climate as a multilevel and multidimensional construct, which involves the interaction of multiple social agents at various levels of organisations, including managers, supervisors, and work-groups. The present paper tests the mediation role of two types of safety supervision styles, safety monitoring supervision (SMS) and safety communication supervision (SCS), on the relationship between organisational safety climate (OSC) and relevant group outcomes for safety management. Results found that on one hand, OSC affects performative safety management dimensions of work-groups, through the influence of SMS. On the other hand, SCS seems to exercise a mediation role of the effects of OSC on work dimensions supporting psychological health and the quality of the psychosocial environment.

Despite a downward trend in injury rates in UK workplaces, accident occurrence remains an on-going issue for the rail workforce. Results from the RSSB annual survey reveal that there were 164 major injuries in 2016/17. Safety climate is defined as “shared perceptions with regard to safety policies, procedures and practices.” Many studies have examined the positive effects of safety climate on safety performances by individuals, teams, organizations. Despite widespread attempts to measure safety climate, the validity of measurement tools has not been systematically tested in the rail industry. The primary goal of our research was to validate Zohar and Luria’s (2005) Multilevel Safety Climate Scale in a sample of rail infrastructure workers (N = 528). A cross-validation strategy was adopted. Half of the data were used to conduct exploratory factor analysis (EFA), with the remaining data submitted to confirmative factor analysis (CFA). The statistical results reveal a three-factor structure with organizational safety climate (OSC), supervisor safety communication (SSC), supervisor safety monitoring (SSM). A nomological analysis showed that SSC and SSM presented distinct correlation patterns with other measures of relevance for safety, risk and health management. SSM was found more strongly related with variables such as: safety priorities; safety systems; reporting attitudes; safety compliance. On the other hand, SSC was mainly related with measures refereed to distinct forms of organizational support: supervisor support; peer support; support to change. Overall, our findings showed the validity of a multidimensional approach on the study of safety climate and safety supervision in the rail industry.