Ergonomics journal April 2006
'Patient safety dring medication administration: the influence of organisational and individual variables on unsafe work practices and medication errors.' GJ Fogarty and M McKeon.
Used structural equation modelling to measure organisational climate to see how it affected unsafe medication administration behaviours including the role of stress and morale.
As in other high risk industries failure to follow procedures is a major contributor to medication errors with over half being due to violations. People who violate procedures are 1.4 times as likely to commit other types of errors (note - this study seems to have included violations as a type of error). The size of this influence and the suggestion that the psychological pathways to violations and errors are different has led people to say that they should be treated as different safety outcomes.
Violations are typically associated with attitude and behaviours whilst errors are associated with deficiencies in skill and information processing.
Another significant difference is that violations are intentional so that people know they are committing them whereas errors are unintentional so people do not always know they have made them. This means that people can self report violations and that may be a way of learning more about the organisation.
The study used self-reporting of perceptions of the organisation and of violations and errors.
Violations are intentional actions but not intended to do harm. This study has shown that violations are most likely when the individual is distressed and morale is low; and that these individual states are influenced by organisational climate.
It is proposed that more frequent monitoring of organisational and safety climate, and individual stress and morale will help in preventing violations.