Given the complexity of healthcare and the ‘people’ nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.

Aim(s): To adapt and validate the HSOPS 2 instrument for the Italian context and to describe the current patient safety culture amongst healthcare personnel working in Italian hospitals. Design: Cross‐sectional study. Methods: We adapted and validated the HSOPS 2 instrument following the COSMIN guidelines: we performed a forward‐backward translation , calculated the content validity index, evaluated face validity, acceptability (percentage of participants responding to all items on the questionnaire and to every specific item), construct validity (confirmatory factor analysis), and internal consistency (Cronbach's alpha for each dimension). We then performed a cross‐sectional study following the guidelines of the original instrument: we categorised the responses into “positive,” “negative,” and “midpoints.” For each dimension we calculated the average percentage of positive responses. We repeated this process, dividing the responses by various sample characteristics (e.g., profession), and compared them using the chi‐square test. Data were collected between April and November 2023. Results: A total of 633 hospital personnel participated in the survey, and 473 completed the questionnaire in its entirety. The dimensions of “teamwork”, “supervisor”, “manager”, or “clinical leader support”, and “communication about error” emerged as dimensions with higher percentages of positive responses, while those that received lower percentages were “hospital management support for patient safety”, “staffing and work pace”, and “response to error”. We identified statistically significant differences in many dimensions between gender, profession, and clinical inpatient units. Conclusions: These findings provide a comprehensive overview of challenges and opportunities within the healthcare sector as regards patient safety culture and can inform the development of targeted interventions aimed at improving patient safety across healthcare organisations. Implications for the Profession and/or Patient Care: Proper assessment of safety culture, one of the main indicators of patient safety, can inform the development of effective strategies and interventions to enhance patient safety. Impact: What problem did the study address? To effectively assess patient safety culture, it is essential to use valid and reliable tools. It is crucial to proactively assess patient safety culture in hospital personnel, whether employed in clinical units, in management, or in support services, to develop initiatives aimed at improving patient safety. What were the main findings? The use of the adapted and validated version of the HSOPS 2 will produce valid and reliable evidence on patient safety culture. Perception of patient safety culture differs amongst respondents according to gender, profession, clinical setting. The dimensions of “hospital management support for patient safety”, “staffing and work pace”, and “response to error” were identified as those with the greatest need for improvement. Where and on whom will the research have an impact? Patient safety heavily impacts care at every level; therefore, this study could have an impact on healthcare organisations as well as healthcare workers, patients, and their families. By making available an instrument that can contribute to a proper assessment of patient safety culture, this study might contribute to the development of appropriate strategies and targeted interventions to improve patient safety, quality of care and satisfaction while decreasing adverse events and related costs. Reporting Method: The COSMIN guidelines were used for the validation of the instrument; the STROBE reporting guidelines were used for the cross‐sectional study. Patient or Public Contribution: No patient or public contribution.

Aim: To develop a systematic approach to detect and prevent clinical risks in complementary medicine (CM) and increase patient safety through the analysis of activities in homeopathy and acupuncture centres in the Tuscan region using a significant event audit (SEA) and failure modes and effects analysis (FMEA). Methods: SEA is the selected tool for studying adverse events (AE) and detecting the best solutions to prevent future incidents in our Regional Healthcare Service (RHS). This requires the active participation of all the actors and external experts to validate the analysis. FMEA is a proactive risk assessment tool involving the selection of the clinical process, the input of a multidisciplinary group of experts, description of the process, identification of the failure modes (FMs) for each step, estimates of the frequency, severity, and detectability of FMs, calculation of the risk priority number (RPN), and prioritized improvement actions to prevent FMs. Results: In homeopathy, the greatest risk depends on the decision to switch from allopathic to homeopathic therapy. In acupuncture, major problems can arise, mainly from delayed treatment and from the modalities of needle insertion. Conclusions: The combination of SEA and FMEA can reveal potential risks for patients and suggest actions for safer and more reliable services in CM.

Second victim syndrome (SVS) refers to the psychological trauma experienced by healthcare workers (HCWs) as a result of being involved in an adverse event (AE). Research on the prevalence of SVS and the support needed for HCWs who experience it is limited. A cross-sectional study was conducted at the Health Local Unit of Lecce, in Puglia, to identify the phenomenon of SVS among HCWs and recognize the forms of support received and desired. A validated questionnaire, IT-SVEST, was administered to doctors and nurses. The survey received responses from 250 HCWs, and 41% of respondents reported being involved in an AE that could cause SVS. Among the seven dimensions measuring the effects of the SVS and two outcome variables, the highest percentage of agreement was found for psychological distress (23.5%), followed by turnover intentions (19.8%) and physical distress (9.9%); 23.8% of the interviewees declared that they did not receive institutional support, and 9.9% identified help resources mostly in non-work-related support (9.9%), followed by supervisor support (9.3%). The multivariable binary logistic regression analysis showed a positive association between the occurrence of an AE and the medical doctor profession (OR = 4.267, p ≤ 0.0001), and affiliation to intensive care departments (OR = 5.133, p ≤ 0.0001) and male gender (OR = 2.069, p = 0.033). SVS is a serious problem that affects the entire health system, systematic surveys and appropriate institutional responses including formal support programs for affected HCWs are a priority.