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dissemination/communication. Specifically, smaller hospitals with strong formal leadership engaged in higher levels of major event dissemination/communication. Informal leadership did not exhibit significant relationships with any of the patient-safety learning events. The authors argued that formal leadership and the extent to which senior management is committed to and values patient safety is an important influence on learning from patient safety events. In addition, senior leaders may be more visible in smaller than larger hospitals and consequently may be more effective in disseminating major events (Ginsburg et al., 2010). 29
Hansez and Chmiel (2010) carried out a cross-sectional survey to examine the relationship between management commitment to safety (as well as job demands and job resources) and safety behaviour in terms of situational and routine violations. Their sample consisted of 3,506 employees of an energy company in Belgium, of which the majority were employees (64.8%), followed by direct supervisors (17.7%), executives (15%) and top management (0.6%). They found that perceived management commitment to safety was associated with a reduced number of self-report routine and situational violations. Watson et al. (2005) examined the impact of management commitment to safety (as well as co-worker safety norms and trust in the supervisor) on perceptions of workplace safety and self-report risk taking behaviours. The authors used a cross-sectional survey drawing on a sample of 408 production workers in a steel manufacturing company. The results indicated that when management was perceived as valuing safety, employees reported lower levels of risk-taking behaviour (but no significant associations were found with perceptions of workplace safety). On the other hand, co-worker safety norms were associated with reduced levels of risk-taking behaviour and positive perceptions of workplace safety. Finally, trust in the supervisor was associated with positive perceptions of workplace safety only (Watson, et al., 2005). Management commitment to safety is also associated with actual time spent on safety-related activities (Rudmo & Hale, 2003). Rudmo and Hale (2003) examined the impact of safety attitudes on behavioural intentions and actual behaviours in a sample of 210 senior managers working in a company supplying aluminium products. They found that high levels of management commitment to safety, low levels of fatalism and high levels of risk awareness are particularly important attitudes for managers as they were linked with behavioural intentions and actual engagement in safety activities (Rudmo & Hale, 2003). Mearns et al. (2003) examined the relationship between safety climate, safety management practices (i.e. actual practices used to maintain safety) and safety performance (using both self-report and company accident data) in 14 offshore installations. Survey data was collected in two separate years (the sample size was N=682 and N=806 respectively) with a total of nine offshore installations providing data across both years. Of relevance to this review was the