School of Public Health

Occupational Health and Safety Management Perceptions in Malaysian

Public Hospitals: Implications for the Implementation of Standardized
Management Systems

Nor Azimah Chew Binti Abdullah

This thesis is presented for the Degree of

Doctor of Public Health
of
Curtin University of Technology

March 2010

i
 DECLARATION

To the best of my knowledge and belief this thesis contains no material previously
published by any other person except where due acknowledgement has been made. This
thesis contains no material which has been accepted for the award of any other degree or
diploma in any university.

Signature: ___________________________
(Nor Azimah Chew Binti Abdullah)
Date: 1 March 2010

ii
 ABSTRACT

All industries in Malaysia, including government organizations, have had to comply with
the Occupational Safety and Health Act 1994 to fulfill their responsibilities as an
employer to ensure that workers have a safe workplace. The Occupational Safety and
Health Act 1994 requires employers to perform minimum duties to ensure the safety,
health and welfare of their workers, thus, the joint responsibility between employer and
employees in the government organizations are expected to ensure the safety of a
workplace. Although this regulation binds employers, the Social Security Organization
(SOCSO) statistics showed a fluctuation in industrial accidents, from 114,134 accidents
in 1995 to 85,338 accidents in 1998, then the accidents increased to 92,074 in 1999,
95,006 in 2000, and subsequently the accident was reduced to 85,926 in 2001 until
56,339 in 2007. As a consequence, the adoption of an effective OHS management system
as a tool to assist in meeting legal obligations should ensure the development of a safety
culture and provide the best approach to reduce accidents in an organization. Thus,
government organizations need to transform the philosophy of the Occupational Safety
and Health Act 1994 into reality and the implementation of an OHS management system
will assist in resolving OHS problems successfully and is also a means to legal
compliance. The purpose of this study was to evaluate the information about current
OHS practices that can influence the development and implementation of an effective
OHS management system and provide a systematic process for the implementation of a
OHS management system to enable the Malaysian public hospital sector to meet its OHS
obligations.

This study used a correlation quantitative non-experimental investigation, i.e. survey,

where the study focused on collecting and analyzing the data in a single study.
Proportionate stratified random sampling was used in selecting the respondents. 418
employees from three state hospitals in the northern region of Malaysia participated in
this study and that gave a response rate of 43.15%. The questionnaire was adapted from
the Safety Climate Assessment tool, where it was to identify perceptions of the hospital
employees regarding several OHS management elements and implication towards their
OHS performance. Analysis of data was done using SPSS version 12 and AMOS 4.0 and

iii
the outcomes of the data were evaluated and recommendations were made on the
strategies to introduce an effective implementation of an OHS management system in the
hospital sector in Malaysia.

From the structural equation modeling, this research demonstrated that a direct
relationship existed between the independent variables and dependent variables. The
reliability results revealed that the measurement constantly assesses what it is intended to
measure and all the scales shown reasonable validity in determining how well the concept
is defined by the measures. The findings of this study revealed that the general view of
employees with regard to their OHS practices was in the range of low to medium,
indicating a mixture of “disagree” to “almost agree”. Based on the perceptions of
employees to have effective OHS practices in the workplace, this study also disclosed
evidence that the critical elements of occupational health and safety management were
accident and injury procedures, leadership style, management commitment, health and
safety objectives and safety reporting procedures, and safety training. In addition, the
findings of this study reported five elements including health and safety objectives, safety
reporting, management commitment, the role of the supervisor, and leadership style were
seen to support the implementation of an effective OHS management system, however,
safety training was not significant but lack of safety training might hinder the effective
management of OHS. In sum, the significant results of this study were (1) management
commitment; (2) health and safety objectives; (3) training and competence; (4) role of
supervisors; (5) safety reporting; (6) leadership style; and (7) safety incidents: accidents
and injuries in the workplace. It seems that all elements of OHS management and one
dependent variable that are safety incidents were critical to ensure good practices of OHS
in the workplace.

Lastly, some implications of this study were this survey’s instrument can be an effective
measurement tool to demonstrate improvement and to reflect on how to improve
problematic areas in their workplace. Furthermore, employees’ perceptions are vital as a
realistic approach of determining whether an organization has attained an acceptable
level of safety in their workplace.
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 ACKNOWLEDGEMENTS

Praise be to Allah, the Cherisher and Sustainer of the world. And may peace and
blessings be upon the Seal of the prophets, Muhammad, his family and all his
companions. Special thanks to Allah S.W.T. for granting me strength and support
throughout my study.

I wish to express my gratitude to all those who have helped me in the completion of this
study. I would like to take this opportunity to convey my sincere appreciation to
Universiti Utara Malaysia and Curtin University of Technology for the scholarship
awarded to me to enable me to complete this study. My sincere thanks to Tan Sri Datuk
Dr. Ismail Merican, Director General of Health Malaysia for his endorsement and support
to conduct this study. Also I thank all respondents involved in the survey for their
cooperation.

My thanks and appreciation goes to my thesis committee chair, Dr. Kathryn Sauer for her
guidance and invaluable advice throughout my study. I am very indebted to my
supervisors, Professor Jeffery T. Spickett, Dr. Krassi B. Rumchev, Associate Professor
Satvinder S. Dhaliwal and Dr Yang Miang Goh for their indispensable constructive
ideas, sharp criticism, insight, guidance and patience. Without their support and
encouragement I would not have completed my study.

I wish to record my special appreciation to my dear family, Mummy, Elena, Danny,

Irene and Abdul Karim for their prayers, endless love, support and encouragement
throughout my life. Additional thanks go to my friends and fellow doctoral students
whose encouragement has been a continual source of motivation. Last but not least, I
must express my deep appreciation and gratitude to my husband, Mohd Jamil Mohd Noor
and my children, Mohd Al-Faatihah Muttaqin, Nur Syakirin Zakirah, Jannatul Firdaus,
Jannatul Adnin and Abdullah for their unfailing encouragement, patience, understanding
and courageous sacrifice and for having a belief in me in meeting the challenges I faced
throughout my study.

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 PUBLICATIONS RELATED TO THIS THESIS

Conference Proceedings

*# Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2008).

Occupational safety and health management in Malaysia: An overview. Paper
presented at the 4th National HRM Conference, 17 – 19 August 2008, Tiara Beach
Resort, Port Dickson, Negeri Sembilan.

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2008).

Managing safety: The role of safety perceptions approach to improve safety in
organizations. Paper presented at the 11th Conference & Exhibition on
Occupational Safety & Health (COSH2008), 26 – 27 August 2008, Kuala Lumpur
Convention Centre (KLCC), Kuala Lumpur.

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2008).

Validity and reliability of the safety climate measurement in Malaysia. Paper
presented at the 9th International Business Research Conference, 24 – 26 November
2008, Melbourne, Australia.

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2009).

Assessing employees’ perceptions on health and safety management in public
hospitals. Paper presented at the 10th International Business Research Conference,
16 – 17 April 2009, Dubai, United Arab Emirates.

Journal Publication

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2009, April).

Validity and reliability of the safety climate measurement in Malaysia. International
Review of Business Research Papers, 5 (3), 111 - 141.

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., & Dhaliwal, S. S. (2009, June).

Assessing employees’ perceptions on health and safety management in public
hospitals. International Review of Business Research Papers, 5 (4), 54 - 72.

* Abdullah, N. A. C., Spickett, J. T. , Rumchev, K. B., Dhaliwal, S. S., & Goh, Y. M.

(2009). Managing safety: The role of safety perceptions approach to improve safety
in organizations. International Business Education Journal, 2 (1), 41 – 51.

* The co-authors have kindly given permission to allow use of these works in this thesis.
# Best paper award, The 4th National Human Resource Management Conference 2008

vi
 TABLE OF CONTENTS
Page

Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Publications Relevant to This Thesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
List of Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

CHAPTER 1: INTRODUCTION
1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Background of the Study and the Research Problem . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Research Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3 Research Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4 The Scope of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.5 Organization of the Thesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

CHAPTER 2: LITERATURE REVIEW

2.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Literature Review Search Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Definitions of Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.3 An Overview of Health and Safety Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4 Theories on Safety Management Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.4.1 Occupational Health and Safety Management Systems . . . . . . . . . . . . . . 15
2.4.2 The Integration of Management Systems . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4.3 The Model of Safety Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.4.4 The Reciprocal Determinism Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.4.5 An Integrative Model of Organizational Climate and Safety . . . . . . . . . . 23

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 Page
2.5 Review of Previous Research Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.5.1 Occupational Health and Safety Management Systems . . . . . . . . . . . . . . . 25
2.5.2 Occupational Health and Safety Performance . . . . . . . . . . . . . . . . . . . . . . 29
2.5.3 Safety Culture/Safety Climate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.5.4 Cultural Factors in Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2.5.5 Demographic Factors in Health and Safety Activities . . . . . . . . . . . . . . . . 41
2.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

CHAPTER 3: RESEARCH METHODOLOGY

3.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.1 The Research Framework and the Hypotheses of the Study . . . . . . . . . . . . . . . . . . 45
3.2 Research Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.3 An Operational Definition of a Regional Hospital . . . . . . . . . . . . . . . . . . . . . . . . . 49
3.4 The Sampling Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
3.4.1 The Population of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
3.4.2 The Sample of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.5 The Development of Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
3.5.1 Selection of Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
3.5.2 Reverse-scored Items and Back-translation . . . . . . . . . . . . . . . . . . . . . . . . 54
3.5.3 Questionnaire Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.6 The Pilot Study and Expert Judgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
3.7 The Administration of the Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
3.7.1 The Data Collection Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
3.8 Analysis of the Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
3.8.1 Data Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.8.2 The Reliability and Validity of the Instruments . . . . . . . . . . . . . . . . . . . . 73
3.8.3 Hypotheses Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

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3.9 Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
3.10 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

CHAPTER 4: RESEARCH FINDINGS

4.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.1 Summary of Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.1.1 Number of Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
4.1.2 Test of Non-Response Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
4.1.3 Normality Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.2 The Demography of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.3 Safety Experts’ Feedback and the Pilot Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.4 The Validity and Reliability of the Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
4.4.1 Exploratory Factor Analysis (EFA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.4.2 Internal Reliability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.4.3 Concurrent Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.4.4 Confirmatory Factor Analysis (CFA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.4.4.1 Dependent Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.4.4.2 Independent Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
4.5 Descriptive Statistics for Safety Incidents/Accidents . . . . . . . . . . . . . . . . . . . . . . . 106
4.6 Hypotheses Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.6.1 Structural Model of the Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.6.2 Perception on Occupational Health and Safety Management Elements . . . 109
4.6.2.1 Priorities of Employee’s Perception . . . . . . . . . . . . . . . . . . . . . . 110
4.6.2.2 Relationships between Variables Using Crosstab with Chi-
Square Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

4.6.3 Elements of OHS Management that Support or Hinder the

Implementation of the OHS Management System . . . . . . . . . . . . . . . . . . . 120

4.6.4 Summary of Hypothesis Testing Results . . . . . . . . . . . . . . . . . . . . . . . . . . 131

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4.7 Strategies to ascertain the appropriateness and effectiveness of an OHSMS
implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
4.7.1 OHS Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
4.7.2 The establishment of safe person, safe place and safe system strategies
through the “Plan-Do-Check-Act” model . . . . . . . . . . . . . . . . . . . . . . . . . . 141
4.7.3 The determination of OHSMS elements for implementation priority . . . . 144
4.7.4 The implementation and development of OHSMS elements . . . . . . . . . . . 146

CHAPTER 5: DISCUSSION AND CONCLUSION

5.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
5.1 Validation of the Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
5.1.1 Scale Reliability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
5.1.2 Content Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
5.1.3 Construct Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
5.1.4 Concurrent Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
5.2 Number of Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
5.3 Hypotheses Testing Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
5.4 Cultural Issues in Malaysia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
5.5 Research Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
5.5. 1 Theoretical Contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
5.5.2 Methodological Contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
5.5.3 Managerial Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
5.6 Limitations and Future Research Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
5.6.1 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

5.6.2 Suggestions for Future Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

5.7 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
5.7.1 Significant Results from This Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
5.7.2 Intuitive Insights from Three Years Involvement in the Work . . . . . . . . . . 170
5.7.3 Suggestions for Implementing OHSMS in Malaysian Hospitals . . . . . . . . 171
5.7.4 Supportive and Barrier Factors and Suggestions How to Develop Positive
Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
5.7.5 An Overall Action Plan to Implement the OHSMS in Hospitals . . . . . . . . 178

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5.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
References
Appendices

xi
 LIST OF APPENDICES

Page

Appendix 1 An Overview of Health and Safety Issues . . . . . . . . . . . . . . . . . . . . . . . . 197

Appendix 2 List of Accredited Hospitals for the Malaysian Society for Quality in
Health (MSQH) Standards as at 31 December 2009 (74 Hospitals) . . . . . 235

Appendix 3 List of Hospitals in the Northern Region of Malaysia . . . . . . . . . . . . . . . 237

Appendix 4 Health and Safety Survey for the Pilot Study . . . . . . . . . . . . . . . . . . . . . . 239
Appendix 5 Health and Safety Survey (Revised for Final Survey) . . . . . . . . . . . . . . . 260
Appendix 6 Letter of Support from the Director General of Health Malaysia . . . . . . . 285
Appendix 7 Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Appendix 8 Consent Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Appendix 9 Approval from the Human Research Ethics Committee at Curtin
University of Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

Appendix 10 Study’s Total of Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290

Appendix 11 The Demography of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Appendix 12 Safety Experts’ Feedback and the Pilot Survey . . . . . . . . . . . . . . . . . . . . 294
Appendix 13 Normality Test for all variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Appendix 14 Exploratory Factor Analysis for Dependent Variables and Independent
Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306

Appendix 15 Concurrent Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

Appendix 16 Confirmatory Factor Analysis (CFA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Appendix 17 Relationships Between Variables Using Crosstab With Chi-Square
Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

Appendix 18 Logistic Regression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Appendix 19 Results of the Open-Ended Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351

xii
 LIST OF TABLES

Page
Table 2.1 Number of accidents, occupational diseases and compensation due to
industrial accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Table 2.2 Number of Accidents by Industries: 1997 – 2003 & 2006 – 2007 . . . . . . . . 214
Table 2.3 Occupational Health and Safety Statistics Report - Number of Incidence:
FY1997/98 – FY 2006/07 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Table 2.4 Occupational Health and Safety Statistics Report - Number of Frequency:
FY1997/98 – FY 2006/07 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Table 2.5 Occupational Health and Safety Statistics Report – Median Total
Compensation Payment: FY2000/01 – FY 2005/06 . . . . . . . . . . . . . . . . . . . 228
Table 2.6 The cost ($ million) of work-related injury and illness, by location of
workplace, 2005-06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Table 2.7 The cost ($ million) of work-related injury and illness, by industry of
workplace, 2005-06 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Table 2.8 Dimensions of safety climate in previous studies . . . . . . . . . . . . . . . . . . . . . 34

Table 2.9 Hofstede’s cultural index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Table 2.10 List of Malaysian ethnic values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Table 3.1 Information about the population and sample . . . . . . . . . . . . . . . . . . . . . . . . 51
Table 3.2 Breakdown of population and sample according to occupational groups . . . 52
Table 3.3 Communication about Health and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Table 3.4 Worker Participation/Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Table 3.5 Training and Competence in Health and Safety . . . . . . . . . . . . . . . . . . . . . . 57
Table 3.6 Reporting on Health and Safety Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Table 3.7 Work Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Table 3.8 Safety Satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Table 3.9 Management Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Table 3.10 Health and Safety Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Table 3.11 Errors and Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Table 3.12 The Role of a Supervisor in Health and Safety Issues . . . . . . . . . . . . . . . . . 65
Table 3.13 Safety Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Table 3.14 The Supervisor’s Leadership Style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Table 3.15 Factors and total number of items included in the initial instrument . . . . . . 68
Table 3.16 Results of Mahalanobis distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

xiii
 Page
Table 4.1 Total return of the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Table 4.2 Total of return from Hospital Sultanah Bahiyah, Alor Setar, Kedah
according to post . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Table 4.3 Total of return from Hospital Tuanku Fauziah, Kangar, Perlis according to
post . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Table 4.4 Total of return from Hospital Pulau Pinang, Georgetown, Pulau Pinang
according to post . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Table 4.5 Overall total of return according to post . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Table 4.6 Chi-Square test for early and late responses . . . . . . . . . . . . . . . . . . . . . . . . . 82
Table 4.7 Differences in major variables by early and late responses (Independent t-
test) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Table 4.8 Normality test for dependent variable: Safety Satisfaction and Feedback . . 300
Table 4.9 Normality test for dependent variable: Safety Incidents/Accidents . . . . . . . 301
Table 4.10 Normality test for independent variables: Safety Communication, Safety 302
Involvement, Training and Competence, and Safety Reporting . . . . . . . . . .
Table 4.11 Normality test for independent variables: Work Pressure and Management 303
Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table 4.12 Normality test for independent variables: Safety Objectives, the Role of the 304
Supervisor, and Safety Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table 4.13 Normality test for independent variable: Leadership Style . . . . . . . . . . . . . . 305
Table 4.14 Demographic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292

Table 4.15 Work Duration/Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

Table 4.16 Safety experts’ judgments: Deletion and addition of items in the revised
questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294

Table 4.17 Summary of feedback from safety experts and the pilot study regarding
items in the safety climate dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Table 4.18 Factor analysis for the items in the dependent variables (N = 418) . . . . . . . 306
Table 4.19 Factor analysis for the items in the independent variables (N = 418) . . . . . . 308
Table 4.20 Summary of statistics and Cronbach’s alpha . . . . . . . . . . . . . . . . . . . . . . . . . 91
Table 4.21 Interscale Correlations of the independent variables and two outcome
variables: Safety satisfaction and feedback and Safety incidents/accidents 311
(n = 418) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table 4.22 Acceptable cutoff values for fit indices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Table 4.23 Item parceling for safety satisfaction and feedback . . . . . . . . . . . . . . . . . . . . 313
Table 4.24 Goodness-of-fit values for safety satisfaction and feedback dimension . . . . 94
Table 4.25 Goodness-of-fit values for safety incidents/accidents dimension . . . . . . . . . 96

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 Page
Table 4.26 Item parceling for a supervisor’s leadership style . . . . . . . . . . . . . . . . . . . . . 313
Table 4.27 Goodness-of-fit values for the supervisor’s leadership style dimension . . . . 98
Table 4.28 Item parceling for the role of the supervisor . . . . . . . . . . . . . . . . . . . . . . . . . 314
Table 4.29 Goodness-of-fit values for the role of the supervisor dimension . . . . . . . . . . 99
Table 4.30 Goodness-of-fit values for the training and competence dimension . . . . . . . 100
Table 4.31 Goodness-of-fit values for safety objectives . . . . . . . . . . . . . . . . . . . . . . . . . 102
Table 4.32 Goodness-of-fit values for management commitment . . . . . . . . . . . . . . . . . . 103
Table 4.33 Goodness-of-fit values for safety reporting . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Table 4.34 Descriptive statistics for safety incidents/accidents . . . . . . . . . . . . . . . . . . . 107
Table 4.35 Goodness-of-fit values for the structural model of the instrument . . . . . . . . 108
Table 4.36 Standardized Factor loading of variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
Table 4.37 Priorities of employee’s perception on OHS management . . . . . . . . . . . . . . 110
Table 4.38 Analysis between level of education and safety satisfaction and feedback
with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Table 4.39 Analysis between level of education and training and competence with
gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Table 4.40 Analysis between level of education and health and safety objectives with
gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Table 4.41 Analysis between level of education and the role of the supervisor with
gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318

Table 4.42 Analysis between level of education and management commitment with
gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Table 4.43 Analysis between level of education and safety reporting with gender as
the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Table 4.44 Analysis between level of education and the supervisor’s leadership style
with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Table 4.45 Analysis between level of education and accidents with gender as the
control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322

Table 4.46 Analysis between level of education and injuries with gender as the control
variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Table 4.47 Analysis between length of employment and safety satisfaction and
feedback with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . 324
Table 4.48 Analysis between length of employment and training and competence with
gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

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 Page
Table 4.49 Analysis between length of employment and the role of the supervisor
with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Table 4.50 Analysis between length of employment and health and safety
objectives with gender as the control variable . . . . . . . . . . . . . . . . . . . . . 327
Table 4.51 Analysis between length of employment and management commitment
with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Table 4.52 Analysis between length of employment and safety reporting with
gender as the control variable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Table 4.53 Analysis between length of employment and the supervisor’s leadership
style with gender as the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Table 4.54 Analysis between length of employment and accidents with gender as
the control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Table 4.55 Analysis between length of employment and injuries with gender as the
control variable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Table 4.56 Relationship between levels of education, nine dimensions of health and
safety management, and gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Table 4.57 Relationship between length of employment, nine dimensions of health
and safety management, and gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Table 4.58 Logistic regression: Enter method for predicting the dependent
variable: safety satisfaction & feedback . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Table 4.59 Logistic regression: Forward method for predicting the dependent
variable: safety satisfaction & feedback . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Table 4.60 Logistic regression: Backward method for predicting the dependent
variable: safety satisfaction & feedback . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Table 4.61 Logistic regression: Final model for predicting the dependent variable:
safety satisfaction and feedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Table 4.62 Logistic regression: Enter method for predicting the dependent
variable: accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Table 4.63 Logistic regression: Forward method for predicting the dependent
variable: accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Table 4.64 Logistic regression: Backward method for predicting the dependent
variable: accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Table 4.65 Logistic regression: Final model for predicting the dependent variable:
accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Table 4.66 Logistic regression: Enter method for predicting the dependent
variable: injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Table 4.67 Logistic regression: Forward method for predicting the dependent
variable: injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Table 4.68 Logistic regression: Backward method for predicting the dependent
variable: injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
Table 4.69 Logistic regression: Final model for predicting the dependent variable:
injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Table 4.70 Summary of the logistic regression analysis . . . . . . . . . . . . . . . . . . . . . . . 348

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Table 4.71 Summary of hypothesis testing results . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Table 4.72 (a) OHS status: Satisfaction towards safety systems . . . . . . . . . . . . . . . . . . . 138
Table 4.72 (b) OHS status: Safety incidents/accidents . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Table 4.72 (c) OHS status: Accidents and near misses . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Table 4.72 (d) OHS status: Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Table 4.73 Results of the open-ended question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Table 5.1 Risk management should be performed in the plan-do-check-act
(PDCA) stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

xvii
 LIST OF FIGURES

Page
Figure 2.1 The Model of Managing Outstanding Safety . . . . . . . . . . . . . . . . . . . . . . . . 22
Figure 2.2 The Reciprocal Determinism Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Figure 2.3 An integrative model of health care working conditions on organizational
climate and safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Figure 3.1 The Conceptual Framework of this study . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Figure 3.2 Flowchart of the study process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Figure 4.1 A first order measurement model for safety satisfaction and feedback . . . 94
Figure 4.2 A first order measurement model for safety incidents/accidents . . . . . . . . . 96
Figure 4.3 A first order measurement model for the supervisor’s leadership style . . . . 97
Figure 4.4 A first order measurement model for the role of the supervisor . . . . . . . . . . 99
Figure 4.5 A first order measurement model for training and competence . . . . . . . . . . 101
Figure 4.6 A first order measurement model for safety objectives . . . . . . . . . . . . . . . . . 102
Figure 4.7 A first order measurement model for management commitment . . . . . . . . . 104
Figure 4.8 A first order measurement model for safety reporting . . . . . . . . . . . . . . . . . 105
Figure 4.9 Structural model of the instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Figure 4.10 Conceptual framework for the review on the implementation of OHSMS . . 137
Figure 4.11 Determination of the OHSMS element . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Figure 4.12 A conceptual framework of the OHSMS foundation . . . . . . . . . . . . . . . . . . 144
Figure 4.13 Framework for an OHSMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148

xviii
 ABBREVIATIONS

AEO Assistant Environmental Officer

DOSH Department of Occupational Safety and Health
CFA Confirmatory Factor Analysis
CIS International Occupational Safety and Health Information Centre, ILO
EFA Exploratory Factor Analysis
ERT Emergency Response Team
HIRARC Hazard Identification, Risk Assessment, Risk Control
HSE Health and Safety Executive
ILO International Labour Organization
ISO International Organization for Standardization
MBWA Management by walking around
NIOSH National Institute of Occupational Safety and Health
NOHSC National Occupational Health and Safety Commission Australia
OHS Occupational Health and Safety
OHSAS Occupational Health and Safety Assessment Series
OHSM Occupational Health and Safety Management
OHSMS Occupational Health and Safety Management System
OSH-MS Occupational Safety and Health - Malaysian Standard
PDCA Plan-Do-Check-Act
PPE Personal Protective Equipment
PPI Positive Performance Indicator
SEM Structural Equation Modeling
SIRIM Standards and Industrial Research Institute of Malaysia
SOCSO Social Security Organization
5S Seiri – Sorting; Seiton – Straighten; Seiso – Sweeping or Shining or Cleanliness;
Seiketsu – Standardizing; Shitsuke – Sustaining the discipline

xix
 CHAPTER 1

INTRODUCTION

1.0 Introduction
An important agenda in today’s world for every organization, especially in the
service industries, is to maintain its survival in the competitive environment. For
many decades, most organizations have focused on quality to ensure their
survival, but in recent years, the trend has shifted to include occupational health
and safety as a determinant of an organization’s competitiveness (LaMontagne
et al., 2004). Organizations have started to show interest in health and safety
management for the following reasons (Hale, Heming, Carthey and Kirwan,
1997):

• Regulatory interest to comply with the Occupational Health and Safety Act;
• Reports on major disasters that emphasized the failings of management to
protect the health and safety of their workers;
• Government requirements for occupational health and safety management
systems to assist organizations to comply with regulations; and
• Increased awareness of corporate responsibility.

In addition, many organizations have experienced problems in administering

health and safety in the workplace, as the “people” element had neglected
correct procedures in carrying out their jobs (Fleming & Lardner, 1999). Herbert
W. Heinrich, an expert in industrial safety, discovered that 88 percent of
disasters in industry were the result of human factors (Goetsch, 2005) and safety
experts estimated that they contributed to 80 – 90% of all industrial accidents
(Fleming & Lardner, 1999). Major disasters like Chernobyl had shown that
safety management is especially important in high reliability industries (Fleming
& Lardner, 1999). Furthermore, the poor attitude of management towards
occupational health and safety has been considered as the most important
underlying factor for poor accident records (Coyle, Sleeman & Adams, 1995).

1
In addition, Blegen, Pepper and Rosse (2005) indicated that previous studies
have identified the following factors as influencing workers’ injury:

• Supervisors’ attitudes, actions, expectations and communication

• Supervisors’ tasks that include safety
• Senior management and workers’ involvement in safety issues
• An organizations commitment to safety and willingness to solve safety
problems
• Attitude and behavior of workers

Consequently, to systematically prevent and control the possibility of accidents

and illnesses in the workplace and to comply with statutory requirements,
Occupational Health and Safety Management Systems (OHSMS) have become
one of the major strategies for addressing workplace safety and health
(LaMontagne et al., 2004). The system is a set of plans, actions and procedures
based on the common OHSMS, the system consists of five elements (policy,
organizing, planning and implementation, evaluation, and action for
improvement) to systematically manage health and safety in the workplace
(NOHSC, 1997). Many organizations have found that a good management
system and improvement of performance through an efficient management
system and a well-structured performance evaluation is vital to their survival
(Coelho & Moy, 2003). Previous research has revealed that excessive number of
injuries and accidents are caused by unsatisfactory or absence of health and
safety systems (Lin & Mills, 2001). Nevertheless, from studies on safety
systems, respondents perceived that there was a need to examine an
organization’s safety activities when its safety system was not working well
(Petersen, 2000).

The greatest problem in safety is the difficulty of measuring an organization’s

OHS performance (Petersen, 2000). Previously, numbers of accident were the
primary means of evaluating the effectiveness of a company’s safety program.
However, in recent years, audits are commonly used to gauge the effectiveness

2
of safety programs. Another measure of safety system effectiveness is through
perception surveys. Using perception surveys, Petersen (2000) identified that
“high achievement” organizations had a high degree of supportive relationships
which utilize the principles of group decision-making and the supervisor plays a
significant role in realizing this success. In addition, safety excellence happens
when supervisors, managers and executives are made accountable for the safety
performance of the group that they manage or supervise (Petersen, 2000).

The International Labour Organisation (ILO) highlighted that implementing an

OHS management system is a way to improve the safety culture in organizations
and at the same time comply with OHS regulations (Dias, 2005). However, the
Health and Safety Executive (UK) (HSE) (2002a) affirmed that a good health
and safety management system may only exist on paper and does not necessarily
improve OHS performance as two crucial components of any successful OHS
management system are management leadership and action and employee
involvement and agreement. Nevertheless, the assessment of a health and safety
management system is a proactive measure of an organization’s safety
performance (Kelly & Boucher, 2003). Hence, effective health and safety
management has been considered an important element when managing the
interaction between systems and people.

1.1 Background of the Study and the Research Problem

All industries in Malaysia, including government organizations, have had to
comply with the Occupational Safety and Health Act 1994 to fulfill their
responsibilities as employers to ensure that workers have a safe work-place.
Although this regulation binds employers, the Social Security Organization
(SOCSO) statistics showed a fluctuated number of industrial accidents, from
114,134 accidents in 1995 to 85,338 in 1998. The accidents increased to 92,074
in 1999, 95,006 in 2000, but subsequently fell to 85,926 in 2001 and 56,339 in
2007. Although there were reductions from 1995 to 1998, the numbers of
accident showed an increase in 1999 and 2000, with reductions from 2001 to
2007. There was an increase of almost 10,000 accidents from 1998 - 2000.

3
Based on a study by the Malaysian Ministry of Human Resources (2006), the
reasons given by employers for the increased numbers of accident from1998
(85,338) to 2000 (95,006), includes: (1) not being aware of the Occupational
Safety and Health Act 1994; (2) no time for Occupational Health and Safety
(OHS) matters; (3) insufficient allocation of resources for OHS; (4) OHS is not
an important element in business; and (5) the “accidents will not happen to me”
syndrome. As for employees, their non-compliance was basically due to
reasons such as (1) not aware of health and safety rules and regulations; (2)
OHS rules and regulations are difficult to follow; and (3) feelings of discomfort
when complying with OHS rules and regulations. Even worse was the common
belief that “accidents will happen, no matter what” instead of “accidents can be
prevented if the right precautions are taken” (Malaysian Ministry of Human
Resources, 2006). Furthermore, the current Human Resources Minister, Datuk
S. Subramaniam also stated that many employers and employees perceive safety
in the workplace as something "forced" upon them by legislation and said that
“at present, Malaysia has still not reached a stage where safety and health
concerns are adopted as part of the working culture” (Carvalho, 2008).

In addition, the Department of Occupational Safety and Health (DOSH), a

government enforcement agency, stated that compliance with the Act and its
regulations still needs significant improvement. Due to limitations of
manpower, DOSH only managed to comprehensively enforce legislation in
certain sectors such as manufacturing, construction, mining and quarrying. In
other sectors, DOSH's enforcement has been reactive, such that it was conducted
based on imminent issues, complaints or accidents (Malaysian Ministry of
Human Resources, 2006). As a result, DOSH needs to carry out inspections on
government organizations to find out how well they have complied with the
legislation and ascertain if the health and safety requirements of their employees
at the workplace are being met (Cruez, 2006).

The Occupational Safety and Health Act 1994 requires employers to perform
minimum duties to ensure the safety, health and welfare of their workers, and
joint responsibilities between employer and employees in government
organizations are expected to ensure safety in a workplace (Almeida, 2006).
4
Datuk Lee Lam Thye, former Chairman of National Institute of Occupational
Safety and Health (NIOSH) stated that the adoption of an effective OHS
management system assists in meeting legislative obligations; develop a safety
culture and the best approach to reduce accidents in an organization (Lee, 2000;
Lee, 2004; NST, 2002; Hamisah, 2003a; Almeida, 2006). Moreover, former
Malaysian Human Resources Minister, Datuk Dr. Fong Chan Onn urged all
organizations in high-risk industries be required to adopt the Occupational
Safety and Health Systems - Malaysian Standard (OSH-MS) as an accident-free
environment helps an organization to enhance its productivity and profitability
(Almeida, 2006).

The scenario of OHS management systems in Malaysia shows that since 1999,
OHSAS 18001 has been the only OHS management system being implemented
with 268 companies certified to this system (SIRIM, 2009). Most transnational
companies operating in Malaysia have their own OHS management systems.
Since there is no national standard for OHS management systems in Malaysia,
the government developed the Occupational Safety and Health Management
Systems – Malaysian Standard, based on the ILO standards, in 2003. Until 2005,
OSH-MS1722 was introduced but so far only private organizations are certified
to the standard. Besides these OHS management systems, the Healthcare
Quality Standard for hospitals was introduced after 1997 to ensure that
healthcare organizations monitor and improve their performance and implement
ways to continuously improve their healthcare system. So far only 74 out of 250
public and private hospitals have subscribed to Healthcare Quality Standard
(MSQH, 2009).

Government organizations in Malaysia, especially public hospitals, are required

to comply with the Occupational Safety and Health (OSH) Act 1994 which is
based on the principle of self-regulation. As such, the implementation of an
OHS management system in public hospitals and other government
organizations will assist in preventing OHS problems and is also a means to
facilitate legal compliance. However, there is currently a lack of research on the
effectiveness of the implementation of OHS management systems in various
sectors in Malaysia. Consequently, it is timely that research be conducted to see
5
the feasibility of implementing the OSH-MS1722 in public hospitals so as to
further improve their OHS practices and compliance.

This investigation evaluates the information about current OHS practices that
can influence the development and implementation of an effective OHS
management system for public hospitals in Malaysia. It also attempts to develop
an approach that can provide a practical OHS management system to assist
Malaysian public hospitals to meet their OHS obligations.

1.2 Research Objectives

The purpose of this study was to evaluate the information about current OHS
practices that can influence the development and implementation of an effective
OHS management system and provide a systematic process for the
implementation of an OHS management system to enable the Malaysian public
hospital sector to meet its OHS obligations. The study is guided by the
following research objectives:

i. to investigate the perception of hospital employees regarding the different

elements of OHS management;
ii. to examine whether the elements of OHS management are viewed as
supportive or preventive factors to the implementation of an OHS
management system in Malaysian public hospitals; and
iii. to recommend practical strategies for the development and implementation
of an effective OHS management system in Malaysian public hospitals.

1.3 Research Questions

To attain the above objectives, several research questions were addressed.

Objectives 1 and 2 were achieved through the following enquiries:

i. What is the perception of hospital employees regarding the OHS

management elements?

6
ii. Do the elements of OHS management act as supportive or preventive
factors to the implementation of OHS management system?
iii. Do demographic characteristics like age, gender, ethnicity, level of
education, length of employment and position affect employee perceptions
of OHS management?

Objective 3 can be achieved by identifying suitable strategies based on the

findings of prior surveys and reviewing the strategies adopted in other countries.

1.4 The Scope of the Study

There are many industries that contribute to the Malaysian economy, one of
which is the healthcare industry. Healthcare facilities include hospitals, clinics,
dental offices, out-patient surgery centers, birthing centres and nursing homes.
As stated earlier, this study was focused on the public hospital sector. The
public hospital: (1) is listed under the 1st schedule Occupational Safety and
Health Act 1994 – public services (DOSH, 2008); (2) provides basic healthcare
needs to the public and must maintain patient safety practices; (3) it has the
potential to make medical mistakes which might lead to injury, disability, longer
hospital stays, or longer recovery (Commonwealth of Massachusetts Group
Insurance Commission, 2005); (4) it has employees who are involved in
numerous health and safety issues associated with healthcare facilities including
bloodborne pathogens and biological hazards, potential chemical and drug
exposure, waste anesthetic gas exposures, respiratory hazards, ergonomic
hazards from lifting and repetitive tasks, laser hazards, hazards associated with
laboratories, and radioactive material and x-ray hazards; (5) it has the third
highest number of industrial accidents compared to other public service sectors
(SOCSO, 2009); and (6) it is in the healthcare industry and healthcare is a key
industry to the Malaysian economy – health tourism as there has been an
increasing number of foreigners seeking health treatment and services in
Malaysia (UNPAN, 2003).

This study is limited to the northern region of Peninsular Malaysia sampling

frame: (1) Hospital Sultanah Bahiyah, Alor Setar, Kedah; (2) Hospital Tuanku

7
Fauziah, Kangar, Perlis; and (3) Hospital Pulau Pinang, Georgetown, Pulau
Pinang.

1.5 Organization of the Thesis

This introduction chapter presents an outline of the thesis, the background of the
study and the problem statement, followed by research objectives, research
questions, and scope of the study. Chapter 2 examines the legislative systems
for occupational health and safety in Malaysia and Australia with an overview
of occupational of health and safety issues in both countries; selected theory and
literature of the subject matter with emphasis on: OHS management systems,
safety culture and climate, and health and safety performance. The methods
used in this study, instrument development, data collection procedure and data
analysis are discussed in Chapter 3. Chapter 4 details the study’s results. Finally,
Chapter 5 discusses the findings, suggests recommendations for future research,
and notes the limitations of the study and its contribution to research on the
topic.

8
 CHAPTER 2

LITERATURE REVIEW

2.0 Introduction
Health and safety at the workplace is mandatory for every employer who must
ascertain that employees’ health, safety and welfare requirements are met.
Attention given to the health and safety of employees is critical to the
enhancement of employees’ productivity as it emphasizes the organization’s
performance. Thus, employers need to be aware of their duties towards
employees so as to achieve a world-class health and safety performance. This
chapter reviews the relevant theory and literature of OHS management systems,
safety culture and climate and its relation with health and safety performance
and related literature review on the dimensions of the instruments for the
assessment of the desired performance. This review is divided into five major
parts. The first part elaborates on search strategy. In the second part, the
definitions of key terms of variables involved in this study are highlighted. The
third part focuses on the overview of health and safety issues in Malaysia and
Australia. The fourth part concentrates on theories of safety management
practices. In the last part, a review of the most relevant studies related to OHS
management systems; safety culture and climate and its relation with health and
safety performance; cultural factors in organizations; and demographic factors
in health and safety activities are demonstrated.

2.1 Literature Review Search Strategy

The steps to a comprehensive literature search are:

i. Develop a search strategy by identifying the topic and list down various
keywords and find all articles that match within those key words. The
keywords are as following:
• Safety climate
• Safety culture

9
 • Safety management
• Safety reporting
• Safety performance
• Leadership style and safety
• Safety communication
• Role of supervisor and safety
• Safety training
• Organizational climate and safety
• Health and safety management system
• Cultural factors
• etc.

ii. Identify relevant resources including books, journal articles, conference

papers, dissertations, websites, etc. Common databases are: ERIC
(Educational Resources Information Center), Dissertation Abstracts
Online, ABI/Inform (a worldwide business management and finance
database), Sociological Abstracts (sociology literature), MEDLINE
(biomedical literature including health care, clinical psychology,
gerontology, etc.), etc.

iii. If many irrelevant articles, narrow the key words to get relevant and
current articles.

iv. Search the literature comprehensively through the library, interlibrary

loan or any journal databases to obtain potential studies applicable to the
scope of study.

v. Keep record of the keywords used and compile a master list so that
similar study will only be searched once.

vi. Assess the articles by reading the title, abstract, problem statement,
research objectives, methods, results, conceptual frameworks, and future
research to determine if the articles meet the researcher’s needs.

10
vii. Integrate all the articles by comparing and contrasting all the articles
according to the researcher’s research questions.

2.2 Definitions of Key Terms

This section covers definitions of the variables involved in this study:

i. Health and Safety Management Systems

Robson et al. (2007) stated that there is no agreement on what constitutes an
OHSMS and its dimensions are broad. Gallagher (1997) defined health and
safety management systems as the organization of planning and review,
management organizational procedures, consultative actions and specific
program components to enhance health and safety performance.

The Civil Aviation Safety Authority, Australia (2002) explained safety

management systems as the combination of work practices, beliefs and
approaches to improve and manage all facets of an organization’s operations to
ascertain that an organization is free from accidents.

From these definitions of OHSMS, there appear three critical components: (1)
management planning and accountabilities; (2) consultation with workers; and
(3) certain program components such as training, incident/accident reporting and
investigation, monitoring and evaluation, etc. (Gallagher et al., 2003).

ii. Safety Performance

Measurement of safety performance consists of two approaches: (1) traditional
indicators; and (2) leading indicators. Examples of traditional indicators are
number of injury/accident, the lost time injury incidence, first aid cases and even
financial indicators (Eckhardt, 2002). Some of the leading indicators used by
most companies are (1) use of pre-task instruction cards, (2) use of job safety
analyses, (3) inspections, (4) employee safety improvement contacts, (5) safety
meeting attendance, (6) organizational planning and support: expectations and
involvement, goal setting and action planning, (7) industrial hygiene and safety

11
practices: design and construction, operation and maintenance, (9) safe
practices, (10) site training systems, (11) behavior management: on-going
feedback system and behavior observation system, and (12) performance
tracking (Eckhardt, 2002). Yule, Flin and Murdy (2007) even stated that some
examples of leading performance measures are safety audits, hazard analyses
and safety climate studies.

Recently, safety climate has been considered as one indicator of safety

performance as organizations started giving attention to organizational and
management impact on their performance (Nahrgang, Morgeson & Hofmann,
2007).

iii. Safety Climate and Safety Culture

The terms “culture” and “climate” have been used interchangeably in the
literature to reveal employees’ attitudes towards safety (Glendon & Stanton,
2000; HSE, 2002a). The Health and Safety Executive (HSE) (2002a) definition
of safety climate is the view of employees with regard to their safety practices in
the organization. Neal and Griffin (2002, p. 69) identified safety climate as
“perceptions of policies, procedures, and practices relating to safety in the
workplace”. Salminen and Seppala (2005) described safety climate as the
workers’ perceptions and views related to management’s approach towards risks
and safety. Consequently, this study considers safety climate as the perceptions
of workers related to safety practices, policies, procedures and safety conduct in
the workplace.

The term safety culture has numerous definitions according to various

disciplines. Hale (2000, p. 7) described safety culture as “the attitudes, beliefs,
and perceptions shared by natural groups as defining norms and values, which
determine how they react in relation to risks and risk control systems”. The
HSE (2002a) definition of safety culture is the collective corporate value that
results in positive view point and actions of all employees concerning safety and
health. According to Cooper (2000), there are three attributes of safety culture:
psychological (how people feel – safety climate), behavioural (what people do –

12
safety-related actions and behaviours), and situational (what the organization
has – policies, procedures, regulations, organizational structures, management
systems). Thus, the essence of the safety culture definition is the sharing of
common beliefs and values that safety is a priority.

After much debate on the meaning of climate and culture, Guldenmund (2000,
p. 222) came to the conclusion that safety climate represents “attitudes to safety
within an organization” while safety culture indicates “the strong convictions or
dogmas underlying safety attitudes specifically underlie all organisation's
attitudes”. Nevertheless, Williamson et al. (1997, p. 15) stated that “In
understanding the safety climate or culture of a workplace, the perceptions and
attitudes of the workforce are important factors in assessing safety needs”

iv. Organizational Climate

Organizational climate research has been carried out to determine factors that
influence employees’ perception of their workplace, such as leadership, roles of
management and communication, which have an effect on employees’ stimulus
to accomplish job outcomes (Neal, Griffin & Hart, 2000) and individual work-
life wellbeing like stress, morale, quality of work-life, employee engagement,
absenteeism, turnover and performance (McPherson, 2007). Glendon and
Stanton (2000, p. 198) described organizational climate as “the perceived
quality of an organization’s internal environment and is a more superficial
concept than organizational culture which describes the current state of an
organization”. Hanges, Aiken and Chen (2004) stated that organizational
climate conveys “how” organizations accomplished their goals through sharing
of ideas, goals, or obligations with their employees. Reichers and Schneider
(1990, p. 22) identified organizational climate as “the shared perception of the
way things are around here”. Stone et al. (2005) identified organizational
climate as employees’ views about their workplace attributes such as decision
making, leadership and work practices. Thus, the basis of organizational climate
is the common actions, approaches and opinions demonstrated by all employees
regarding their work environment.

13
v. Safety Communication
HSE (1999, p. 4) explained communication as “the style, frequency and
methods of communication and interaction between management and workforce
of an organization” and this is demonstrate through “regular conversations about
safety and risks … be aware of problems and discover solutions and openness of
communication to replace a culture of blame and distrust” (p. 5). Furthermore,
communication also expresses the transfer of information about health and
safety matters in the workplace (Fernandez-Muniz, Montes-Peon & Vazquez-
Ordas, 2007).

vi. Training and Competence

In general, training refers to instruction and practice for acquiring knowledge

and skills about rules, concepts, or attitudes necessary to function effectively in
a specified task. With regard to OHS, the definition of training consists of
instruction in hazard recognition and control measures, learning safe work
practices and proper use of personal protective equipment, and acquiring
knowledge of emergency procedures and preventive actions (Cohen & Colligan,
1998). In addition, safety training is defined as knowledge of safety given to
employees in order for them to work safely with no danger to their wellbeing
(Law, Chan & Pun, 2006).

vii. Leadership Style

Machin (2005, p.3) defined leadership style as the degree of concern the leaders
have for their employees’ (physical) welfare.

2.3 An Overview of Health and Safety Issues

Relevant health and safety legislation and health care standards in Malaysia and
Australia were reviewed. The overview of occupational accidents, diseases, and
compensation in Malaysia and Australia is also examined. A further discussion
of the health and safety issues is explained in Appendix 1.

14
2.4 Theories on Safety Management Practices

Work-related accidents and diseases are preventable by complying with the

Occupational Safety and Health Act, developing an awareness of occupational
safety and health hazards among workers, assessing the nature and extent of
hazards, introducing and maintaining effective control and evaluation measures,
organizational accident prevention programs, etc. This study examines five
models/strategies that can be used to overcome these problems: (1) an
occupational health and safety management system, (2) the integration of
management systems, (3) a model for managing outstanding performance, (4) a
reciprocal determinism model, and (5) an integrative model of organizational
climate.

2.4.1 Occupational Health and Safety Management Systems

The setting up of a safety and health management system through continuous

improvement in the workplace has been seen as one means to improve working
conditions and to satisfy legal compliance. There are various models and
methods of OHS management systems (European Agency for Safety and Health
at Work, 2002). Three models cited by this survey are the European Agency for
Safety and Health at Work, the National Occupational Health and Safety
Commission (NOHSC) and the ILO Occupational Safety and Health
Management Systems (ILO-OSH 2001).

The first model is the European Agency for Safety and Health at Work. The
2002 study on the use of occupational health and safety management systems in
the Member States of the European Union identified five ideal elements of an
effective occupational health and safety management system:

15
i. The OHS input – initiation

There are four variables under this category: management commitment and
resources; regulatory compliance; accountability, responsibility and authority;
and employee participation.

ii. The OHS process – formulation and implementation

There are five sub-elements under the formulation of the OHS process: OHS
policy/goals and objectives, performance measures, system planning and
development, baseline evaluation and hazard/risk assessment, and OHS
Management System manual and procedures. The implementation of the
process consists of four variables including (1) training, (2) hazard control
(process design, emergency preparedness and response, hazardous agent
management), (3) preventive and corrective action and (4) procurement and
contracting.

iii. The OHS output

The OHS output contains five sub-elements: (1) OHS goals and objectives, (2)
number of illness and injury, (3) workforce health, (4) changes in efficiency,
and (5) overall organization performance.

iv. OHS feedback

The communication system (document and record management system); and the
evaluation system (auditing and self-inspection, incident/accident investigation,
and medical surveillance program) are two variables involved in this section.

v. Improvement – open system elements

Three variables in this category are continual improvement, integration, and

management review.

16
The second model is the National Occupational Health and Safety Commission
(NOHSC). NOHSC (1997) stated that OHS management systems can be
classified as:

i. Traditional vs. innovative management

Traditional management focuses on the “key persons” involved in safety and

health management (supervisors and safety and health specialists) and
employee’s participation is not vital. On the other hand, innovative management
viewed employee obligation as crucial with the role of management in safety
and health management.

ii. Safe workplace strategy vs. safe person-control strategy

Safe workplace strategies point to the managing of hazards during the design
and implementation stage and safe person control centers on the supervision of
employee behavior.

The third model is the ILO Occupational Safety and Health Management
Systems. The ILO Occupational Safety and Health Management Systems
(ILO-OSH 2001) contain the following main elements:

i. Policy
- occupational safety and health policy
- worker participation

ii. Organizing
- responsibility and accountability
- competence and training
- occupational safety and health management system documentation
- communication

iii. Planning and implementation

- initial review

17
 - system planning, development and implementation
- occupational safety and health objectives
- hazard / risk prevention

iv. Evaluation
- performance monitoring and measurement
- investigation of work – related injuries, ill health, diseases and
incident/accident, and their impact on safety and health performance
- audit
- management review

v. Action for improvement

- preventive and corrective action
- continual improvement

In conclusion, the positive impact of occupational safety and health

management systems is now being acknowledged by governments, employers
and workers worldwide in countries that have developed occupational safety and
health management systems standards. Good occupational safety and health
practices can increase workplace efficiency, reduce risks of lost productivity and
accidents and minimize risks of legal action for workers' compensation.

2.4.2 The Integration of Management Systems

The integration of management systems is described as “a process of putting
together different function-specific management systems into a single and more
effective integrated management system (IMS)” (Beckmerhagen, Berg,
Karapetrovic & Willborn, 2003, p. 214).

The integrated management system proposed by Savic (2001) combines four

systems: the Quality Management System (ISO 9000: 2000), the Environment
Management System (ISO 14000), the Risk Management System (ISO 17000)
and the Health and Safety Management System (ISO 18000). According to
18
Savic (2001), “the planning of activities is carried out jointly on the level of
functions, (product quality, expenses, occupational safety and health,
environment safety), then the plans are realized and the checking of the plan
quality is carried out on the level of activity – i.e. is carried out on the process
itself” (p. 36). The integration of these systems will produce a synergetic effect
and is possible as all systems focus on risk reduction and this enables human
performance to be optimized.

Some benefits of integration from previous literature review as indicated by

Beckmerhagen, Berg, Karapetrovic and Willborn (2003), and Zutshi and Sohal
(2005) are:
• more focused and simple standards of management systems
• less paperwork needed for all management systems
• cost reduction in registration, auditing and implementation
• the elimination of repetitive policies, procedures and records for all
management systems
• enhanced communication among all levels in the organization as resources
are used and staff are trained effectively to understand the integrated
system
• coordination of documentation for all management systems
• objectives, resources and procedures are standardized in all functional
areas
• concurrent auditing for integrated systems
• an enhanced decision-making procedure due to the latest information
from an integrated management system

Organizations, however, face barriers in implementing this integrated system,

some of which indicated by Beckmerhagen, Berg, Karapetrovic and Willborn
(2003), and Zutshi and Sohal (2005) are:
• Employees perceive negatively to new changes. Education and training is
vital to change employees perception of the new system
• Lack of qualified personnel and the usage of consultants. Organizations
incur high cost and consultants cannot support maintenance of the system
all the time

19
• Fast reporting is needed to review the progress of the system
• Time-delays in integration as organizations need more time to implement
the new system
• Difficult to communicate new changes to employees as they are resistant
to the new system and have doubts about its added value
• Previous bad experience with the failure of other systems
• Always updating procedures and systems due to frequent adjustment of
regulations and guidelines

Besides the integration of the above-mentioned management systems, drawing

on HSE (2002b) research findings, it was seen that integration of behavioural
safety interventions into safety and health management system revealed
improvement of safety and health. Behaviour modification interventions are
accomplished by encouraging employees to increase the value of critical
behaviours in order to minimize risk and decrease the frequency of behaviours
that increase risk. For example, promote employees to wear personal protective
equipment to minimize risk at work.

In conclusion, organizations must tackle these challenges before making a

decision to implement an integrated system so as to ensure its smooth and
efficient running without interrupting the organization’s productivity.
Furthermore, these integration systems can be used as one determinant to ensure
survival of the organization in the current competitive market.

2.4.3 The Model of Safety Management

James Melville Stewart (2002) introduced a model of safety management

(Figure 2.1) through observation from various companies with an outstanding
safety recast in order to understand and identify excellence factors that
contributed to workplace safety and achievement of safety improvement. He
found that excellence in safety begins with management commitment.
Management is responsible and accountable for the safety and health of
workers. Stewart stated that the basic driver to safety is the “soft” factors
including management commitment, line ownership, and workforce

20
involvement. These factors are supported by safety systems and practices. The
outcome for this model is safe physical environment and safety-aware attitudes
and should result in outstanding safety performance.

This model is good in a way as it focused on outstanding safety performance

and its determinants that drive towards an outstanding safety performance.
Commitment of senior management is vital to increase safety and health
performance (Vassie, Tomas & Oliver, 2000). Management commitment is a
vital factor as managerial competence in occupational safety and health must at
least be commensurate with the risks inherent in the business undertaking and
must be as good as that required to operate the business successfully. The
managerial responsibility for occupational safety and health includes the risks
run by people in various work activities and the risks that those activities pose to
other workers and members of the public. Management commitment to
occupational safety and health is reflected in the ability of the upper-level
management to demonstrate an enduring, positive attitude towards occupational
safety and health, even in times of fiscal austerity, and to promote occupational
safety and health in a consistent manner across all levels within the
organization. Only when there is congruence between words, practice and
attitude of the manager’s and those of the management, employees will feel they
are part of the organization and safety performance will improve (Erickson,
2000).

Workers have the right to participate in any occupational safety and health
activity. The responsibility is seen in employees’ willingness to participate in all
activities that support the learning of the process, continual improvement
activities and employee’s desire to reinforce, support and correct one another
and this responsibility can only be exercised optimally in a supportive
organizational climate (Topf, 2000). Moreover, employee participation has been
identified as one determinant of successful occupational safety and health
management (Alli, 2001). It implies that workers’ involvement is a process
involving behaviour that is dynamic, action-oriented, and problem solving that
continuously seeks for improvement in a safety conscious environment.

21
 Line ownership
of safety

Safe
equipment
Involvement in
and physical
safety activities,
environment
Management training Outstanding
vision, safety
commitment Safety aware, performance
& drive Comprehensive trained &
safety systems committed
and practices workforce

Safety
organization,
specialists

The
The Essential The Main
Workplace The Results
Cornerstone Drivers
Outcomes

Figure 2.1: The Model of Managing Outstanding Safety

Source: Stewart (2002)

2.4.4 The Reciprocal Determinism Model

Cooper (2000) stated that Bandura’s reciprocal model is suitable for analyzing
organizational safety culture as it focuses on psychological, situational and
behavioral factors. Even accident causation models also acknowledge these
reciprocal relationships between the three factors. The reciprocal determinism
model adapted by Cooper (2000) indicates internal psychological factors like
safety climate as a subjective measurement, observable ongoing safety-related
behaviors and objective situational factors like a safety management system.
The reciprocal determinism is shown in Figure 2.2. In sum, it takes more than
one factor to determine excellence in safety performance.
22
 Internal
PERSONAL Psychological
Safety Climate Factors

External
CONTEXT Observable
ORGANIZATION
Factors
Safety management System

JOB
Safety Behavior

Figure 2.2: The Reciprocal Determinism Model

Source: Cooper (2000)

2.4.5 An Integrative Model of Organizational Climate and Safety

The organizational climate construct comprises individual perceptions of the

workplace environment like leadership, roles, and communication (Neal, Griffin
& Hart, 2000). Figure 2.3 illustrates dimensions that are critical to ensure the
effectiveness of the outcome process. The core structural domain consists of
two critical factors like leadership and organizational structural characteristics.
These factors are input to the next stage that is process domain. Supervision,
work design, group behavior, quality are the factors developed from the input
process. These are crucial and affect the efficiency of the outcome: workers’ and
patients outcomes. The input and process domain constitutes an organizational
climate that ought to predict a specific safety climate. In sum, organizational
attributes like leadership, supervision, work design, communication process, etc.
influence employees to be motivated and as a result contribute to the
improvement of health and safety matters in their organizations.

23
 Organizational structural
Core Leadership characteristics
structural • Values • Communication processes
domains • Strategy/style • Governance
• Information technology

Quality emphasis
Work design
• Patient centeredness
Supervision • Manageable workload
Process Group behavior • Patient safety
• Style • Resources/training
domains • Collaboration • Innovation
• Employee • Rewards
• Consensus • Outcome measurement
recognition • Autonomy
• Evidence-based practice
• Employee safety

Health care worker outcomes Patient outcomes

Outcomes • Satisfaction • Patient satisfaction
• Intention to leave • Critical outcomes

Figure 2.3: An integrative model of health care working conditions on organizational climate and safety
Boxes outlined with dotted lines represent domains of organizational climate. Boxes outlined with solid lines represent outcomes.
Core domains are in bold. Sub-constructs are bulleted underneath. The dotted arrows connecting core structural domains represent
direct effects on outcomes, which are mediated by the process domains.
Source: Stone et al. (2005)

24
2.5 Review of Previous Research Studies
Relevant research findings on OHS management systems; safety culture and
climate and its relation with health and safety performance; cultural factors in
organizations; demographic factors in health and safety activities; and related
literature reviews on the dimensions of the instruments are mentioned here.

2.5.1 Occupational Health and Safety Management Systems

The advancement of technology and the changes in work processes have alerted
organizations to dedicate their attention to organizational and management impacts
on safety performance particularly the function of health and safety management.
Petersen (2000) stated that excellence health and safety management must fulfill the
following six criteria:
i. Safety must be a core value of an organization through daily behavior-based
safety by supervisors and teams;
ii. There must be involvement by middle managers to ensure quality
performance of subordinates, supervisors or team performances to
demonstrate safety behavior in the workplace;
iii. Visibly demonstrated executive action;
iv. Obtain hourly involvement in meaningful daily activities;
v. Allow flexibility;
vi. Be perceived as positive by employees.

Furthermore, the benefits of a health and safety management system as indicated by

the Civil Aviation Safety Authority, Australia (2002) are as follows:
i. Market the safety standards of the organization’s operations;
ii. Guard against direct and indirect costs of incidents and accidents;
iii. Improve communication, morale and productivity of employees;
iv. Meet an organization’s legal responsibilities to manage safety at the
workplace.

25
Vassie and Lucas (2001) survey of health and safety management in the
manufacturing sectors indicated that empowered workers who played active health
and safety roles could result in health and safety performance improvements
although the empowerment was limited. Although employee participation and
involvement are crucial, the accountability and responsibility in the safety and
health must come from senior management as required by the Occupational Health
and Safety legislation (Vassie & Lucas, 2001). In addition, a company’s objective
and communication to all workers is the crucial aspect of effective health and safety
management as a lack of communication may hinder employee involvement
(Vassie & Lucas, 2001).

Previous research has suggested that management’s commitment to safety is a

significant determinant of employee involvement to safety (O’Toole, 2002). In
addition, employees’ perception of management’s action to safety can result in
accident reduction. Besides, as indicated by HSE (2002b), many aspects of
employees’ safety behavior can be influenced by management priority in safety that
includes:
• The success of safety initiatives;
• The reporting of near-miss occurrences, incidents and accidents;
• Employees working safely;
• Employees taking work related risks;
• Influencing production pressures;
• Implementing safety behavior and health interventions;
• The effectiveness and credibility of safety officers;
• The effectiveness and credibility of safety committees.

Marsh et al. (1995) stated that management commitment has a high impact on all
aspects of intervention. Besides management commitment, safety training and
safety policy are also important determinants to enhance safety performance. Lin

26
and Mills (2001) found that clear policy statements and safety training played an
important role in reducing the number of industrial accidents.

Cheyne, Oliver, Tomas and Cox (2002) conducted a study on employee attitudes
towards safety in the manufacturing sector in the UK. It identified safety standards
and goals, and safety management, which included personal involvement,
communication, workplace hazards and physical work environment as factors that
enhance safety activities in an organization. The study also found a good physical
working environment and employee involvement as key factors that contribute to
safety activities in organizations.

Clarke (2003) examined organizational structures and values on the safety attitude
and behavior of contingent, core and contract workers in the U. K. The findings of
the study indicated that organizational restructuring might damage mutual trust
between core workers and managers. The inclusion of contingent workers and
contract employees into the workforce of an organization could threaten the
integrity of safety culture and gradually destroy the trust of core employees towards
safety activities in an organization.

Besides the above studies, Bottani, Monica & Vignali (2009) examined 116
companies that implemented and not yet implemented safety management systems.
Their purpose was to evaluate the performance of safety management systems
among adopters and non-adopters companies. They reported that adopters
companies demonstrated excellent performance compare to non-adopters
companies. Additionally, Fernandez-Muniz et al. (2009) study on relation between
occupational safety management and firm performance was conducted among a
sample of 455 Spanish companies using structural equation modeling statistical
technique. They examined relationships between elements of occupational safety
management system including (1) policy; (2) incentives; (3) training; (4)
communication; (5) planning: preventive and emergency; (6) control and review:

27
internal control and benchmarking and performance measures including (1) safety
performance; (2) competitive performance; (3) economic-financial performance.
Their results showed that safety management had a positive impact on the three
dimensions of performance measures and concluded that there was a congruent
between employees’ protection and company’s competitiveness.

Even though the use of an OHS management system approach has gained
popularity, Gallagher, Underhill and Rimmer (2003) discovered some obstacles to
its effective implementation of an OHS management system. The barriers are (1)
lack of success in meeting the necessary requirement factors such as management
commitment, employee involvement, effective communication, etc.; (2) unsuitable
usage of audit tools to guarantee compliance; (3) difficulty of implemention in
certain sectors due to workforce attributes such as infamiliarity with OHSMS, lack
of resources, temporary employees that are not committed, under-trained, etc.
Besides these barriers, they also noted that research on the effectiveness of OHSMS
was still not in agreement due to (1) an inconsistent definition of what OHSMS is;
(2) the focus was more on individual correlation rather than on OHSMS; (3) no
reliable measures of OHS performance; and (4) inconsistent findings of empirical
research especially to denote association between OHSMS performance and injury
outcomes.

In addition to Gallagher et al. (2003), Robson et al. (2007) had done a systematic
literature review to integrate support on the effectiveness of OHSMS intervention
on workers health and safety and related economic outcomes. A comprehensive
examination of the 23 articles indicated that most studies showed positive findings
on OHSMS interventions, a few studies reported null results, but no negative
outcomes. The authors, however, concluded that “the evidence is insufficient to
make recommendations either in favor of or against particular OHSMSs” (p. 349)
as the current research knowledge fail to give significant outcomes.

28
In sum, although “OHSM has evolved internationally as the major strategy to
reduce serious social and economic problems of ill-health at work” (Gallagher,
Underhill & Rimmer, 2001, p.11), yet there is insufficient evidence in the empirical
research on the effectiveness of the implementation of OHS management systems.
However, there are studies that focus on OHS management but they concentrate on
the success of health and safety outcomes and lack any study that directly neither
investigated the effectiveness of the systems nor examined the support and barriers
of implementing an OHS management system.

2.5.2 Occupational Health and Safety Performance

The performance of an organization is critical to ensure its success and survival in
the marketplace. The National Occupational Health and Safety Commission
(NOHSC) (2002) indicated that an evaluation of OHS performance enables an
organization to discover OHS problems and take necessary preventive action.

Gallagher et al. (2001) affirmed that there are two categories of measurement for
occupational health and safety performance: (1) the traditional measures such as
Lost Time Injury frequency, accident statistics, and compensation claims; and (2)
Positive Performance Indicators (PPIs) including safety audits; the percentage of
sub-standard circumstances recognized and approved as an outcome of the safety
audit; and the percentage of workers getting training of OHS. However, the
outcome measures like Lost Time Injury frequency do not describe the appropriate
OHS performance as it measures what has happened (reactive measures) but the
PPIs tools are used to manage risk in the workplace and measuring how well an
organization is functioning through monitoring the processes (NOHSC, 2002).

Most companies assess their safety system using measures like number of accidents
and audits (Carder & Ragan, 2003), but using accident statistics to measure safety
performance is difficult when there is no accident to analyze. Furthermore, a near
miss, an incident that causes no injury cannot be used to measure safety

29
performance, as it is not an evidence of accident although it can give an alert for the
future. As for audits, previous research reported a negative correlation between
audit and accidents (Carder & Ragan, 2003). The current trend adopted by most
companies is to use safety climate (Nahrgang, Morgeson & Hofmann, 2007).
Traditional measures were found to have some limitations such as (1) they are not
sensitive in providing useful information about safety problems of a specific work
site; (2) do not provide a means to evaluate risk exposure of employees; and (3) are
invariably retrospective (Seo et al., 2004, p. 429). Consequently, safety climate
tools give information about safety problem before any accident and injury arise as
they are thus “leading indicator” of safety performance (Seo et al., 2004).

Enhancing safety performance is important to the success of health and safety

management at work. Critical to this is the reciprocal relationship between safety
management and safety behavior within the safety culture in the organization
(Cooper & Phillips, 1995; Cooper, 2000). These reciprocal relationships reflect the
interrelationships between person, situational and behavioral factors to ascertain the
attainment of safe acts.

Lin and Mills (2001) survey findings stated that safety performance was influenced
by size of company and management and employee commitment to safety and
health. Company size plays an important role in achieving a high level of safety
performance. Previous research showed that smaller companies have poorer
standards compared to big companies (Lin & Mills, 2001). Furthermore, the
involvement of management and workers showed positive results in enhancing
safety performance as per Lin and Mills (2001) findings. The key to excellence in
health and safety performance is the involvement of senior management (Vassie,
Tomas & Oliver, 2000). Their findings indicated that safety awareness among all
workers is crucial to improve health and safety performance of a company.

30
To determine safety improvement in organizations, Donald and Young (1996)
conducted an intervention-based study on the attitude of employees in a UK power
generation company. The findings showed that the safety performance changes,
which indicated improvements in number of accidents and absenteeism.
Improvements were also detected in the general attitude towards safety.

In terms of manpower, organizations need to hire the right person for the right job
to ensure the minimization of workplace hazards. The study of Hassan, Nor Azimah
and Chandrakantan (2005) found that hiring practices is one aspect that requires
serious attention by companies as employees should be hired based on good safety
records from previous experience in other companies. Companies in particular
sectors should pool their resources to set up certification bodies to train and certify
employees in occupational safety and health. These external bodies can then set
industry wide safety and health standards, norms, and values that are accepted by
industry players. Employees can attain these standards and obtain certification
through safety training or any other means. Organizations can then use these
certifications as a criterion for selection and promotion of employees in specific
operational areas.

In conclusion, numerous indicators of safety performance have been used by

previous researchers, some focus on organizational performance and several
concentrate on individual performance. The choice of safety performance attributes
depends on the practical interest of researchers and whether they can get the
relevant data like numbers of accident and injury as these are confidential and most
organizations would not impart such data to outsiders. Moreover, empirical
evidence has proven that the measurement of health and safety management such as
safety climate instrument is correlated with safety practices (Shannon & Norman,
2009; Yule, Flin & Murdy, 2007), unsafe behavior (Neal et al., 2000; Tomas et al.,
1999), reduction in accidents (Huang, Ho, Smith & Chen, 2006), etc.

31
2.5.3 Safety Culture/Safety Climate
Previous studies by Mitchison and Papadakis (1999) have demonstrated that
effective safety management improves the level of safety in organizations and thus
can be seen to decrease damages and harm from accidents (as cited in Bottani,
Monica & Vignali, 2009). Safety management refers to the tangible practices,
responsibility and performance related to safety (as cited in Mearns, Whitaker &
Flin, 2003). Mearns et al. noted some common themes of safety management
practices: management commitment to safety, safety communication, health and
safety objectives, training needs, rewarding performance, and worker involvement.
They also maintained the associations between safety management, safety climate,
and safety culture. Safety climate is considered to be the precise indicator of
overall safety culture while safety management practices display the safety culture
of top management and as a result, good safety management practices are reflected
in the enhanced safety climate of all employees.

In addition, previous surveys have associated a weak safety culture with a decline in
safety performance. Some international examples of poor safety performance are
the Tokaimura Japan accident, the Chernobyl nuclear accident in 1986 and Three
Mile Island (U. S.) nuclear accident in 1979 (UK Advisory Committee on the
Safety of Nuclear Installation, 2003). As such, human interaction with its
environment is critical, hence safety culture comes into the work system to protect
employees from unsafe affects of operations. The development of a strong culture
will reinforce organizational absolute commitment to sustainable safe performance
(Railway Group Safety Plan, 2002).

Some symptoms of safety culture problems in an organization are: workers are

blamed for problems, the emergence of strong subcultures, employees are afraid to
report accidents or injuries, excessive sick-time, high turnover, lack of commitment
to process safety, lack of consistency in worker attitudes about what issues are
important, lack of preventive maintenance, lack of teamwork, poor housekeeping,
top management are unaware of the “real” condition of the plant and employees,

32
recurring problems, over-emphasis on behavioral safety (UK Advisory Committee
on the Safety of Nuclear Installation, 2003). An organization has to correct a
“weak” situation when some of these symptoms appear or there will be a decline in
performance.

As a result of accidents and injuries, organizations have been applying leading

indicators such as safety climate to assess their safety performance (Yule, Flin &
Murdy, 2007). Numerous studies have indicated that a safety climate anticipates
safety-related outcomes (Yule, Flin & Murdy, 2007), for example, accidents and
injuries (Huang, Ho, Smith & Chen, 2006), safety performance (Nahrgang,
Morgeson & Hofmann, 2007; Shannon & Norman, 2009) and workers’ safety
behavior (Neal et al., 2000; Tomas et al., 1999). Previous studies of Barling et al.
(2002); Brown and Holmes (1986); Hofman and Stetzer (1996); and Lee et al.
(1993) on the relationship between positive safety climate and lower number of
accidents demonstrated that positive safety attitude employees were less likely to be
involved in accidents (as cited in Clarke, 2006).

Table 2.8 presents several prior studies on safety climate and the dimensions being
measured. Unlike most studies in safety climate, Hsu, Lee, Wu, and Takano’s
(2007) study was comprehensive as they categorized safety climate into four levels:
organization, management, team, and individual. They reported that the
organizational level comprised safety policy features, for instance, top management
commitment, a reward system, a reporting system, and resource allocation while
management level included safety planning, control, and support factors like safety
training, safety activities, and safety management. Team level contains safety
implementation factors, for example, communication, coordination, and
cooperation in a work team and the individual level consists of safety
performance of frontline workers such as safety awareness, safety attitude and
safety behavior.

33
 Table 2.8: Dimensions of safety climate in previous studies

Studies Climate Dimensions

Brown & Holmes (1986) management concern, management activity, risk perception

Budworth (1997) management commitment, supervisor support, safety

systems, safety attitudes, safety reps

Cheyne et al. (2002) communication, individual responsibility, safety standards

and goals, personal involvement, workplace hazards,
physical work environment
Cooper (1995) management commitment, management actions, personal
safety commitment, perceived risk levels, effects of work
pace, belief about accident causation, effects of job induced
stress, safety communication, emergency procedures, safety
training, and role of safety representatives
Cox & Cheyne (2000) management commitment, priority of safety,
communication, safety rules, supportive environment,
involvement in safety, personal priorities and need for safety,
personal appreciation of risk, work environment
Cox & Cox (1991) Personal skepticism, individual responsibility, work
environment, safety arrangements, personal immunity
Dedobbeleer & Beland (1991) management commitment, worker involvement

Salminen & Seppala (2005) organizational responsibility, workers’ concern about safety,
workers’ indifference in regards to safety, and the level of
safety actions
Hsu et al. (2007) organizational level: top management commitment, reward
system, reporting system, and resource allocation;
management level: safety training, safety activities, safety
management; team level: communication, coordination,
cooperation in a work team; individual level: safety
performance such as safety awareness, safety attitude and
safety behavior
Huang et al. (2006) management commitment, return-to-work policies, post-
injury administration, safety training
Williamson et al. (1997) personal motivation for safe behavior, positive safety
practice, risk justification, fatalism/optimism
Zohar (1980) importance of safety training programs, management
attitudes toward safety, effects of safe conduct on promotion,
level of risk at workplace, effects of required work pace on
safety, status of safety officer, effects of safe conduct on
social status, status of safety committee

34
Similarly, Cox and Cheyne (2000) examined three types of assessment to measure
safety climate: (1) the multiple measurement-organizational attribute approach, (2)
the perceptual-organizational attribute approach, and (3) the perceptual
measurement-individual attribute approach. The first approach focused on various
organizational attributes like structure, safety policy, systems and processes, and
reports and it can be measured through observation and audit. The second measured
organizational perceptions like commitment and the last examined individuals’
perceptions about their feelings and attitudes towards organizational issues like
commitment, responsibility, behavior, etc.

From prior studies, the most notable determinant is management attitude or action
toward safety. Management commitment to safety indicates the extent to which top
management demonstrates positive and supportive safety attitudes (Hsu et al.,
2007). Safety commitment has been described as a personal recognition and
participation in safety activities demonstrated by an attempt to enhance safety in the
workplace and comply with the safety goals (Cooper, 1995). A prior study by
Smith et al. (1978) noted that employees’ perception of management’s action to
safety had resulted in accident reduction (as cited in Yule, Flin & Murdy, 2007).
In addition, the Hong Kong Occupational Safety and Health Council (1998)
conducted a study of the safety climate in the hotel industry in Hong Kong. The
findings indicated that most senior managers had a positive response towards all
aspects of safety climate. Supervisory and front-line staff were particularly positive
towards factors like risk taking behavior, obstacles to safe behavior, contributory
influences and the reporting of accidents.

Supervision illustrates an attempt showed by supervisors in coaching and

supervising workers’ safety (Hsu et al., 2007). Empirical studies revealed that
supervisors play a vital role in ensuring safety in the workplace (Yule, Flin &
Murdy, 2007). From past research, they found that employees complied with safety
rules and procedures when they perceived that the action of their supervisor was
35
fair. In contrast, Brown et al. (2000) discovered that supervisors who demanded
more of their workers demonstrated negative influence on safety climate (as cited in
Yule, Flin & Murdy, 2007). Furthermore, they found that supervisors who
delegated job task motivated employees to acknowledge their safety accountability.

In addition, earlier studies discovered the link between safety training and increased
safety performance (Huang et al., 2006). Consequently, effective training facilitates
workers to have a sense of belonging and thus is more accountable for safety in
their workplace. Previous studies also found an association relating to training and
the improvement of healthy and safe working situation where elements such as
management support to safety training, goals setting, feedback from management,
incentives and rewards were critical in enhancing safety performance (Sattler &
Lippy, 1997).

The findings of Hsu et al. (2007) regarding Taiwanese and Japanese safety
leadership revealed that the Taiwanese leadership style was “Top-Down Directive”
where top management communicated safety policies and were involved in safety
activities. Their supervisors supervised safety issues carefully by performing the
“walking around” concept. They also reported that Japanese safety leadership was
more focused on “Bottom-Up Participative” where top management promoted
employees’ participation in any safety activities and were less willing to use
disciplinary measures against employees’ unsafe actions.

Havold and Nesset (2009) explained communication as “the extent to which an

organization provided an effective information exchange regarding internal safety
matters” (p. 4). In other words, communication is the style, frequency and methods
of interaction between management and workforce of an organization about safety
and risks at work. Open communication describes how safety information is
distributed between groups in an organization (Hsu et al., 2007). Therefore, the
purpose of communication is to convey safety goals and essential health and safety
information to employees so that they are familiar with their organization’s

36
direction and to encourage them to be more involved in safety activities. Clarke
(2006) discovered from previous studies like Hofmann and Morgeson (1999),
Mearns et al. (2003), and Parker et al. (2001) that effective communication has been
seen as a vital tool in safe working implementation. In addition, the findings of
Mearns et al. (1998) revealed that safety communication decreases safety risk and
thus, improves safety in the workplace (as cited in HSE, 2005).

The reporting system is the basis to discover the limitations and vulnerability of
safety management prior to accidents (von Thaden et al., 2003). In other words, it
indicates front-line workers’ willingness to give details of safety issues and
problems in the workplace. HSE (2005) stated that employees must be given
feedback concerning the action taken to their reporting. Clarke (1998) described
that incident/accident reporting can be perceived as an indicator of workers’
perceptions about managers’ commitment to safety. Her study revealed that
workers who perceived negatively about managers’ commitment to safety can
trigger employees’ unsafe acts.

Over the past decades, a great number of studies have been undertaken on safety
climate, nevertheless, there is inadequate agreement on relevant attributes to be
included in the safety climate concept (Williamson et al., 1997) and preference for
safety climate attributes depends on practical interest of researchers (Huang et al.,
2006). Furthermore, Salminen and Seppala (2005) also noted that most surveys
have constructed their own measures to assess safety climate and these have lead to
differing outcomes due to the dissimilarity in the instruments. Flin et al. (2000) and
Guldenmund (2000) discovered 27 safety climate studies that had a variety of items
with different factor structures and dissimilar definitions (as cited in Shannon &
Norman, 2009). Some researchers also replicated various safety climate scales but
the results were inconsistent (Flin et al., 2000). Previous safety climate studies
demonstrated that management safety commitment and workers’ safety
involvement were being replicated constantly (Salminen & Seppala, 2005;
Williamson et al., 1997).

37
In spite of numerous research on safety climate, Zohar (2008, p. 385), stated that
“merely developing more measurement scales and re-testing climate-behavior
relationships will hold back scientific progress”. For that reason, researchers should
focus on the psychometric analyses of the safety climate scales. To date, not many
studies have tried to verify the correlation between safety climate and the outcome
variables or examining the construct, criterion and content validity of the scale (Seo
et al., 2004; Havold & Nesset, 2009). Therefore, there is a necessity to develop a
more extensive tool and validate the scale comprehensively so that it can explain
the safety climate concept. In sum, a combination of different types of assessment
can ensure the high reliability of the safety climate measurement.

2.5.4 Cultural Factors in Organizations

Specific cultural factors are vital in determining patterns of work behavior in the
workplace as to better manage multicultural workforces and uncertainty in jobs.
This is important as a particular behavior may give low work value that may affect
workplace effectiveness. Professor Geert Hofstede, Emeritus Professor, Maastricht
University (2009) states that "Culture is more often a source of conflict than of
synergy. Cultural differences are a nuisance at best and often a disaster.” As such,
it is vital for managers to assess their existing local values to determine effective
change management.

Below are the dimensions of the cultural values in the Malaysian and Australian
workforces noted in 1980 (Hofstede, 2009).

i. Low vs. high power distance

Power distance is the extent to which the less powerful members of institutions and
organizations expect and accept that power is distributed unequally. In other words,
the degree to which an employee is comfortable in communicating or negotiating
with his/her superior (Abdullah & Gallagher, 1995). Malaysia has the highest
power distance where the relationship between an employee and his/her superior is
more on a hierarchical basis and employees show obedience to authority.

38
Australians on the other hand have a low power distance and the relationship with
employee is of a greater equality between societal levels. This dimension
emphasizes cooperative interaction and forms a stable culture in the workplace
(Hofstede, 2009).

ii. Individualism vs. a collectivism society

Individuality is the degree to which people are expected to stand up for themselves
and to choose their own affiliations while collectivism is the extent to which people
act predominantly as a member of a life-long group. Australia scored the second
highest behind the United States in individualism. Privacy is regarded as a cultural
norm and this individuality are emphasized when doing business and people speak
out, question, are confrontational, and are direct with their superiors. Malaysia is
high on the collectivism dimension where people are loyal to their group, dependent
on their organization and conflict avoidance. Decision making is according to what
is best for the group and the use of “we” mentality to refer to everybody in a group.

iii. Uncertainty avoidance

Uncertainty avoidance reveals the extent to which members of a society attempt to

cope with anxiety by minimizing uncertainty. In other words, this dimension
concentrates on how cultures adapt to changes and cope with uncertainty. Malaysia
has high uncertainty avoidance cultures that favor rules, regulations and controls
(e.g. about religion and food), structured situations, is less tolerant of deviant ideas,
consensus seeking, minimizing risks, prefers details, specific plans and employees
tend to remain longer with their present employer. Australia has a low uncertainty
avoidance culture that favors fewer rules, tolerates generalization, seeks individual
opinions, approves of risk taking, etc.

39
iv. Masculinity vs. femininity

This dimension focuses on the degree to which a society stresses achievement or

nurture. Masculinity cultures focus on competitiveness, assertiveness, ambition, and
the accumulation of wealth and material possessions, while “feminine” cultures
emphasis on relationship, environmental awareness, and the quality of life. A higher
Masculinity Index indicates that the country’s culture is more masculine. Australia
can be categorized as a masculine country while Malaysia is in the middle.

Table 2.9 indicates Hofstede’s cultural dimension index undertaken in Australia and
Malaysia.

Table 2.9: Hofstede’s cultural index

Dimensions PDI IDV MAS UAI LTO
Country
Australia 36 90 61 51 31
Malaysia 104 26 50 36 -
PDI: Power Distance; IDV: Individuality; MAS: Masculinity; UAI:
Uncertainty avoidance; LTO: Long-term orientation
Source: Hofstede (2009)

Further, some Malaysian examples that are relevant to workplace efficiency as

revealed by Abdullah (1994) were as follows:
• A soft-spoken Malay ethnic is perceived to be passive and ineffective when
he/she deals at the cross-cultural level. On the other hand, a foreigner who is
trying to defend his point loudly may be perceived as an impolite person by a
Malaysian.

40
• A self-interest person is considered as a deviant person by a Malaysian as the
“we” orientation shows that Malaysian people are concerned for others and
sometimes in the extreme can be regarded as a busybody.
• Extreme loyalty to a superior shows that Malaysian people are obedient and
blindly obey authority without questioning their action, for example, practices
like “The boss is always right” or nepotism.
• The concept of face-saving by trying to protect other people’s dignity is a
Malaysian attitude as “loss of face is more painful than any physical pain”.
• Actions especially by Malay people must be in accordance with the religion of
Islam.
• A list of Malaysian ethnic values is illustrated in Table 2.10.

In sum, managers must not ignore the cultural values practised by their employees
and there is a need to build suitable shared practices so as to create a workforce that
is able to confront with challenges in the future.

2.5.5 Demographic Factors in Health and Safety Activities

Studies have shown differences exist between age groups where older individuals
were more uncertain of taking risks compared to the younger generation (Thomas,
1999). Kotwal and Lerner (1995) study (as cited in Sattler & Lippy, 1997) on
warning labels reported that:
"Older subjects generally used signal words that implied greater hazards to
represent the amount of risk involved in a given situation. Since older users
have indicated that a given signal word implies a lower level of hazard than the
same word implies for younger users, it may be necessary to apply relatively
strong signal words for older users in order to connote a given level of hazard."

Even a researcher like Desaulniers (1991) described individuals who were 40 and
above were likely to take preventative measures in reaction to warnings (as cited in
Sattler & Lippy, 1997).

41
 Table 2.10: List of Malaysian ethnic values
Malays
Respect for Friendliness Good manners Indirect
elders (sopan santun)
Spirituality Politeness Faith in God Food and
(Tawakal) ceremonies
Humility Loyalty Obedience Tacit reciprocal
obligations
Face Apologetic Fairness Tolerance
Tact Formalities Sincerity Deference to
elders
Generosity Accommodating Courtesy Cooperation
(gotong-royong)
Patience Trustworthiness Self-respect Rituals
(hormat diri)
Harmony/peace Discipline Honesty Compliance
Sensitivity to Non-
feelings confrontational
Chinese

Food Money Respect for Generosity

hierarchy
Hard work Perseverance Integrity Prosperity
Success Position Honesty Gambling/risk
taking
Diligence Face Entrepreneurship Wealth
Education Thrift Pragmatic/practical Family
oriented
Happiness Harmony

Indians
Fear of god Participation Loyalty Brotherhood
Sense of belonging Hard work Karma Modesty
Family Security Harmony Food
Source: Abdullah (1992)

42
As for gender studies, Sattler and Lippy (1997) and Thomas (1999) discovered that
female employees were more likely to comply with warnings as they searched for
and read warning messages and this attitude lead to safety preventative measures.
However, researchers cannot be certain that gender might be the main issue in the
differences as the variation might be due to other factors like being more
knowledgeable of the hazards, frequency of application, proficiency, etc.
Consequently, Malle (1996) supported this finding as “men view risks as less
dangerous compared to women”.

In sum, dissimilarity in studies on gender, age, and length of employment existed as

tacit knowledge and complacency in an individual, and different work-related roles
contribute to the differences in the research findings. As such, managers cannot take
for granted that senior employees are more experienced than their younger
colleagues and thus management of health and safety is excellent. The more
experienced they are, the more they want to violate safety rules and procedure as
one-way short-cuts in doing work.

2.6 Conclusion
The globalization of workplaces has lead to a rise in health and safety risks and
problems of productivity reflected through work-related accidents and ill-health
incidence. These costs affect society, companies, and workers as well as their
families. The economic cost resulting in compensation, lost-work days,
interruption of production, medical expenses, retraining, etc. is a burden to
companies’ competitiveness. Therefore, there is a need for new solutions for these
emerging occupational health and safety (OHS) problems. To meet the challenges
posed by these changes, revamping safety and health practices through strategies to
improve performance is critical so as to motivate the workforce create a safe and
healthy environment that will lead to the decrease of work-related accidents and ill-
health. Consequently, giving attention to occupational safety and health is a priority

43
that enhances the morale of workers as well as reducing companies’ economic
costs.

In conclusion, governments, employers and workers in countries that have

developed OHS management system standards, are now acknowledging the positive
impact of an OHS management system. Good occupational health and safety
practices can increase workplace efficiency, reduce risks of lost productivity and
accidents and reduce risks of legal action for workers' compensation.

44
 CHAPTER 3

RESEARCH METHODOLOGY

3.0 Introduction
The purpose of this chapter is to discuss the methodology utilized to achieve the research
objectives presented earlier. The research framework and hypotheses, research design, survey
instrument development, data collection and data analysis procedure are described in detail.

This chapter consists of five main sections. The initial section gives information on the research
framework and its hypotheses; research design, specifically the research flowchart process;
operational definition; research setting and the sampling procedures. The second part explains
the development of the survey instrument, a pre-test of the questionnaire, the administration of
the survey instrument, namely the data collection procedure. The last part explicates various
phases of the data analysis process, including data screening, construct validity, confirmatory
factor analysis and hypotheses testing.

3.1 The Research Framework and the Hypotheses of the Study

The conceptual framework for the study is presented in Figure 3.1. As can be observed, the
research focuses on the impact of health and safety management and demographic variables on
two dependent variables: satisfaction of employees towards their safety system and number of
safety incident/accident. Safety incident/accident was categorized into accidents and injuries.
There are two types of independent variables in this study: health and safety management and
demographic characteristics. In this study, the latent variable health and safety management
consists of six independent variables: a supervisor’s leadership style, the role of the supervisor,
management commitment, training and competence, health and safety objectives, and safety
reporting. The second latent variable, demographic characteristics consist of variables like age,
gender, ethnics, level of education, length of employment, and position.

45
 Independent variables
Dependent variables
HEALTH & SAFETY
MANAGEMENT EMPLOYEE
OUTCOME
• Supervisor’s Leadership
Style • Safety Satisfaction
• Role of Supervisor & Feedback
• Management Commitment
• Training and Competence
• Health and Safety
Objectives
• Safety Reporting

SAFETY-RELATED
DEMOGRAPHIC OUTCOME
CHARACTERISTICS
• Safety
• Age Incident/Accident
• Gender o Accidents
• Ethnics o Injuries
• Level of education
• Length of employment
• Position

Figure 3.1: The Conceptual Framework of this study

46
From the conceptual framework in Figure 3.1, the following hypotheses were proposed:

1. H1a: The presence of health and safety management elements will have an
association on the level of education and gender.

H1b: The presence of health and safety management elements will have an
association on the length of employment and gender.

2. H2a: Health and safety management elements and demographic characteristics

have a significant relationship with satisfaction towards safety systems
in the workplace.

H2b: Health and safety management elements and demographic characteristics

have a significant relationship with accidents in the workplace.

H2c: Health and safety management elements and demographic characteristics

have a significant relationship with injuries in the workplace.

3. H3: All the independent variables (supervisor’s leadership style, role of

supervisor, management commitment, training and competence, health
and safety objectives, and safety reporting) will have a direct
relationship with the dependent variables (safety satisfaction and
feedback, and safety incident/accident)

3.2 Research Design

This study focuses on a quantitative non-experimental research design, i.e. surveys. The purpose
of a survey research is to generalize the sample findings of a population as it provides a numeric
description of trends, attitudes or opinions by studying a sample of that population (Creswell,
2003). According to Polgar and Thomas (2000), surveys are commonly used in research for the
purpose of (1) establishing the attitudes, opinions or beliefs of persons concerning certain issues,

47
(2) studying characteristics of population on certain variables, and (3) collecting information
about the demographic characteristics (age, gender, income, etc.) of populations. Reasons for
choosing this design are that the researcher can collect all the completed responses within a
reasonable period of time and it is cost-effective. (Sekaran, 2003). The nature of the survey is
cross-sectional, with the data collected at one point in time.

A diagrammatic representation of the study flowchart process is shown in Figure 3.2. Currently
the Malaysian government has developed the OHS management system and introduced it to
public in 2005 but so far implementation has not been realized in the government sector. As
such, this survey highlights to the government the perception of hospital employees especially on
the barriers and supportive elements of health and safety management to enable the
implementation of the OHS management system in public hospitals. In view of the fact that
employers are accountable for the health, safety and welfare of their employees, they have the
obligation to manage the issues of occupational health and safety appropriately. One effective
means to perform this responsibility is through the implementation of an OHS management
system.

This study discovers interrelationships among significant variables from the aspects of
occupational health and safety management and health and safety performance.

The design for this population is random sampling focusing on state hospitals in the northern
region of Malaysia. The strategy is justified because the services offered to the community in all
public hospitals are similar and employees are transferable within public hospitals in Malaysia.
The sample of this study is Malaysian state hospital employees stratified by occupational groups:
doctor, nurse, medical officer, management officer, medical support staff and management
support staff. This study used self-administered questionnaires as its method of data collection.

48
 Government OHS
Legislation

OHSMS MS1722
(Has not been Identify elements from various
implemented in the systems to investigate the
government sector) feasibility of implementation

Evaluate the perception of

Implementation of hospital staff
OHS management
system to comply with
legislation • Elements of OHS
management
• Supports to the
implementation of a
OHS system
• Barriers to be overcome

Supportive structure of
implementation

Figure 3.2: Flowchart of the study process

3.3 An Operational Definition of a Regional Hospital

As there is no standardized definition of the term “rural” or “regional”, describing “rural” or
“regional” has been controversies in developed and developing countries. Couper (2003)
asserted that numerous factors that must be included in explaining the term, the health service
available, geographic location (outside metropolitan area), demography (population), primary
industry (agriculture), socio-cultural issues, schooling, recreational facilities, general services,
etc. For the purpose of this study, definition of “regional” healthcare relates to “the provision of
health services to areas according to geographic location outside metropolitan centers where

49
there is no ready access to many specialists, intensive and/or high technology care ……”
(Couper, 2003, p. 2).

There are two types of hospital in Malaysia: (1) government or public hospitals; and (2) private
hospitals. There are 135 public hospitals (as at 9 February 2010) and 122 private hospitals in
Malaysia (Malaysian Ministry of Health, 2010). Public hospitals are divided into four types:
(1) State Hospital - 14 hospitals; (2) District Hospital with Expertise - 33 hospitals; (3) District
Hospital without Expertise - 83 hospitals; and (4) Psychiatric Hospital - 5 hospitals (Malaysian
Ministry of Health, 2010).

This study is confined to the public general hospitals in the northern part of Malaysia which
includes (1) Georgetown, Pulau Pinang; (2) Alor Setar, Kedah; (3) Kangar, Perlis. Although
there are 74 general, district and private hospitals accredited to the Malaysian Society For
Quality in Health (MSQH) Standards (as at 31 December 2009) (see Appendix 2), the selection
of these hospitals does not indicate whether one hospital is better or worse than another hospital
but determines the major role these selected general hospitals play in providing health care
services to local populations and also to their local economies; and to ensure the improvement of
OHS performance of these health care providers.

3.4 The Sampling Procedure

3.4.1 The Population of the Study

The target population is the employees of the three state hospitals in the northern region of
Peninsular Malaysia. The survey was conducted on state hospitals because they have more
employees, thus providing better statistical power. Furthermore, employees of public hospitals
can easily move between public hospitals. Hence the survey will be able to provide an overview
of the situation in public hospitals (please refer to Appendix 3 for the hospitals in the northern
region of Malaysia). Table 3.1 shows the total number of employees and sample size of the three
state hospitals in the northern region.

50
 Table 3.1: Information about the population and sample
No. Hospital No. of Employees Samples size
(as at 2007)

1. Hospital Sultanah Bahiyah, Alor Setar, 2,508 331

Kedah
2. Hospital Tuanku Fauziah, Kangar, 1,327 297
Perlis
3. Hospital Pulau Pinang, Georgetown, 3,038 341
Pulau Pinang
TOTAL 6,873 969

3.4.2 The Sample of the Study

A sample is a part of the population from which it was drawn. This survey used stratified
proportional random sampling according to occupational group: doctor, nurse, medical officer,
management officer, medical support staff and management support staff. Stratified sampling
can be used whenever the population can be segregated into smaller sub-populations according
to standardized identifiable attribute of interest (Sekaran, 2003). With a probability sample,
every member of the population has an equal (or known) chance of being included. The
procedure for sampling these employees was using the random number table.

Sample size refers to the number of participants investigated in a study. Sample size
determination is crucial as larger samples are a waste of time, resources and money, and very
small samples could result in incorrect outcomes (and thus avoid a Type II error) (Cohen, 1988).
The sample size for research activities according to Krejcie and Morgan (1970) needs to indicate
a given population as inadequate or too much data is a waste of time. They also noted that
sample sizes larger than 30 and less than 500 are suitable for most research. A sample size of 30
is normally used as a cutoff value as the sampling distribution of 30 or more is regarded as
normally distributed (Dawson & Trapp, 2004). Thus, this study used level of significance (or

51
type I error) of 0.05 as the researcher is willing to accept a 5 percent chance in rejecting the null
hypothesis.

Table 3.1 shows the appropriate sample size of this study: 969 employees while Table 3.2
illustrates population and sample size according to occupational groups. The sample size (n =
969) is determined using Krejcie and Morgan's (1970) table of sample sizes assuming alpha levels
of 0.05.

Table 3.2: Breakdown of population and sample according to occupational groups

Hospital Hospital Tuanku Fauziah, Hospital Sultanah Bahiyah, Hospital Pulau Pinang,
Kangar, Perlis Alor Setar, Kedah Georgetown, Pulau Pinang
Post
Population Sample % Population Sample % Population Sample %
of of of
sample sample sample
Doctor 126 29 9.8 348 45 13.6 432 48 14.1

Nurse 605 134 45.1 1,186 157 47.4 1287 144 42.2

Officer 24 6 2.0 16 2 0.6 15 3 0.9

(management)
Supporting staff 131 30 10.1 633 84 25.4 877 98 28.7
(management)
Officer (medical) 53 12 4.0 66 9 2.7 61 7 2.1

Supporting staff 388 86 29.0 259 34 10.3 366 41 12.0

(medical)
TOTAL 1,327 297 100 2,508 331 100 3,038 341 100

3.5 The Development of Survey Instruments

A survey using a questionnaire was adopted in order to obtain an understanding of the relevant
issues based on the study’s objectives. The survey approach was employed as it is the most
common technique to evaluate safety-critical factors and participants remain anonymous (Kho,
Carbone, Lucas, & Cook, 2005; von Thaden et al., 2003). The first phase was to examine earlier
literature reviews on related studies.

52
3.5.1 Selection of Survey Instruments

Management systems including ILO-OSH 2001, BS 8800: 2004 (BSI Business Information,
2006), OHSAS 18001: 2007, AS/NZS 4801: 2001 (AS/NZS, 2001; SAI Global Limited, 2006),
ISO 14001: 2004 (Environmental Management Systems), and SafetyMAP audit tool were
reviewed. The documents were selected as it is commonly recognized that they are of
appropriate international standard. They indicated key OHS management system elements,
which are appropriate to be used in various industries, and are simple to interpret.

Besides that, numerous surveys on safety climate and safety culture were also reviewed. After a
comprehensive review of management systems standards and audit and safety culture and safety
climate tools, the instrument for this study has been adapted from the Safety Climate Assessment
tool developed by Flin, Mearns and Burns (2004) from the University of Aberdeen. Justification
of the chosen instrument was based on Singla, Kitch, Weissman & Campbell (2006) suggestion
that “Choice of instruments will depend on the intended use, the target population, reliability,
validity, and other considerations” (p. 105) and “no one survey is perfectly suited to all
applications…” (p. 113). Consequently, the chosen instrument fit this survey as the purpose of
this study was to “evaluate the information about current OHS practices that can influence the
development and implementation of an effective OHS management system …”. Furthermore,
Williamson et al. (1997, p. 15) stated that “In understanding the safety climate or culture of a
workplace, the perceptions and attitudes of the workforce are important factors in assessing
safety needs”. Therefore, the chosen instrument has the capacity to give precise measurement of
the overall safety climate across numerous departments in the hospitals by assessing attitudes
and experiences about safety climate in their workplace.

This instrument was adapted and modified slightly by replacing the original term “patient safety”
with “health and safety” throughout the instrument. The questionnaire was intended to identify
perceptions on the implications of safety climate dimensions towards their OHS performance in
public hospitals in Malaysia. Fishbein and Ajzen (1975) stated that “Attitude is an important
concept that is often used to understand and predict people's reaction to an object or change and
how behaviour can be influenced” (as cited in Page-Bucci, 2003, p. 2)

53
The scale used by Flin et al. (2004) grouped the dimensions into the following ten sections:
communication, work duties, safety satisfaction, senior management, errors and incidents, role of
supervisors, training and competence, safety rules, reporting, and supervisor leadership style
(refer Appendix 4). This scale has been used in the pilot survey of this study.

3.5.2 Reverse-scored Items and Back-translation

Negatively-worded items in attitude surveys were reverse-scored so that a total positively-

oriented score is achieved as negative items were not easy to understand and the items had a
discouraging effect upon participants (Bradley, Royal & Bradley, 2008). Furthermore, a
negatively-worded item is an approach to decrease patterned answers from respondents (Stewart
et al., 2006). For example, “Staff are afraid to ask questions about health and safety when
something that does not seem right has happened” has a scale of 1 = strongly disagree to 5 =
strongly agree and this scale has been reversed to 5 = strongly disagree to 1 = strongly agree.

Since the national language of Malaysia is Bahasa Malaysia, the questionnaire had to be
translated into Bahasa Malaysia to assist respondents to answer the survey confidently. There are
various techniques in translating a questionnaire: (1) Back-translation, (2) Bilingual technique,
(3) Committee approach, and (4) Pretest procedure (Brislin, 1970). For this survey, the
researcher used a back-translation method. For back-translation, according to Brislin (1970, p.
186), a researcher should use two bilinguals: translating from the source to the target language,
and translating back from the target to the source. A decentering process should be employed to
ensure that the source and target language are identical in meaning by revising the original
English questions so that both versions have the same meaning (Brislin, 1970).

Based on Brislin’s (1970) suggestion, the process for back-translation of this study was as
follows:
1. Two competent translators familiar with the content involved in the source language
questionnaires were recruited.

54
2. One translator was given two weeks to translate the questionnaire from the source to the
target language.
3. Another bilingual translated back from the target to the source language. The time period
given was two weeks.
4. Two translators were invited to assess the original and back-translated versions for errors in
differences in meaning.
5. The materials were tested on the target language-speaking respondents, some were given
the English version and others the translation.

3.5.3 Questionnaire Design

Overall the final questionnaire survey seeks information on the following two sections: (1)
demographic of respondents; (2) survey regarding OHS management adapted from Flin et al.
(2004) that consists elements like safety communication, safety involvement, training and
competence, safety reporting, work pressure, safety satisfaction, management commitment,
health and safety objectives, errors and incidents, the role of a supervisor in health and safety,
safety rules, and a supervisor’s leadership style (refer to Appendix 5). Individual scale scoring
was computed by summing the item scores and dividing by the total number of items. The
following illustrates the measurements used in this survey:

i. Communication about Health and Safety

Measures consisted of scales related to participants’ perception about the safety communication
in their current department/unit/ward which included 7 items. Responses were taken on Likert-
type five-point scales ranging from “strongly disagree” (1) to “strongly agree” (5). Table 3.3
outlines the health and safety communication items. 4 items were worded to reflect negative
safety communication – for example, “Important health and safety information is often lost
during shift changes” were scaled in reverse strongly disagree (5) to strongly agree (1).

55
 Table 3.3: Communication about Health and Safety

1. Health and safety issues that may affect me are well communicated.

2. Staff will freely speak up if they see something that may negatively
affect health and safety at work.

3. Staff have the freedom to question the decisions or actions about

health and safety of those with more authority.

*4. Staff are afraid to ask questions about health and safety when
something that does not seem right has happened. (Reversed)

*5. Problems often occur in the exchange of information about health

and safety across hospital departments / units. (Reversed)

*6. Important health and safety information is often lost during shift
changes. (Reversed)

*7. I receive no communication about health and safety in any form

from top management. (Reversed)

*negative item

ii. Safety Participation/Involvement

The safety participation scale consisted of 3 items which

measured the extent to which employees are involved in health and safety activities in their
organization. The items are accompanied by a 5-point rating scale ranging from “strongly
disagree” (1) to “strongly agree” (5). Table 3.4 summarizes the worker participation items.
Higher values reflected more positive worker participation.

56
 Table 3.4: Worker Participation/Involvement

1. I know the person who represents me in the Health and Safety

Committee.

2. I am involved in health and safety initiatives at work such as the

health and safety committee.

3. I am clear about my responsibilities for health and safety.

iii. Training and Competence in Health and Safety

Participants responded to four items asking the extent to which they agreed about their training
and competency in health and safety. Table 3.5 shows the items of training and competence in
health and safety. Responses were made on a 5-point scale ranging from ‘‘strongly disagree” (1)
to ‘‘strongly agree” (5).

Table 3.5: Training and Competence in Health and Safety

1. I understand the health and safety requirements for my job.

2. I understand the health and safety risks in my job.

3. My training has covered the health and safety risks I face in my job.

4. I am always certain what to do to ensure high standards of health and

safety in my work.

57
iv. Reporting on Health and Safety Matters

The five items that measured reporting on health and safety matters are presented in Table 3.6.
Each item was responded to using a 5-point scale ranging from ‘‘strongly disagree” (1) to
‘‘strongly agree” (5). One item was worded to reflect negative reporting and the scale was
reversed to “strongly disagree” (5) to “strongly agree” (1).

Table 3.6: Reporting on Health and Safety Matters

1. All health and safety incidents are reported here.

2. I am encouraged to report health and safety incidents.

3. I think that reporting health and safety incidents makes a difference to

safety here.

4. People are willing to report health and safety incidents here.

*5. I think it is a waste of time reporting health and safety errors/near misses
because nothing gets done about it. (Reversed)

*negative item

v. Work Pressure

Eight items measured the perceptions of whether work pressure interferes with the ability to
comply with safety practices as in Table 3.7. Responses were made on a 5-point scale ranging
from ‘‘Strongly disagree” (1) to ‘‘Strongly agree” (5). 4 items were worded to reflect negative
perception about work pressure. For example: “If I didn’t take a risk now and again, I wouldn’t
get my work done” and the scale was reversed to “strongly disagree” (5) to “strongly agree” (1).

58
 Table 3.7: Work Pressure

1. Health and safety issues are never sacrificed to get more work done.

2. We have enough staff to handle the workload.

*3. Staff work longer hours than what is considered to be best for their health and
safety. (Reversed)

*4. We work in “crisis mode” when trying to do too much, too quickly.
(Reversed)

*5. If I didn’t take a risk now and again, I wouldn’t get my work done.
(Reversed)

6. I am able to take scheduled rest breaks and still get my work done.

7. I am satisfied with my current work schedule.

*8. There is pressure from other hospital departments/units to get more work
done. (Reversed)

*negative item

vi. Safety Satisfaction

Seventeen items were developed to measure the satisfaction of employees regarding the
effectiveness of various safety systems in the workplace, such as wearing protective masks,
wearing gloves, safety induction, safety audits, workplace design, etc. Table 3.8 shows
respondents evaluated the extent of their satisfaction with these 17 safety measures, for example:
“Hospital Health and Safety Committee”. This indicator was measured subjectively and
respondents were required to describe their degree of satisfaction with a 5-point Likert scale
ranging from “Highly Dissatisfied” (1) to “Highly Satisfied” (5).

59
 Table 3.8: Safety Satisfaction

How satisfied are you with the following aspects of the safety system?

1. Disposable personal protective equipment (e.g. gloves, masks).

2. Uniforms and aprons.

3. Lead coats (for x-ray).

4. Personal alarms.

5. Police presence.

6. Security guard presence.

7. Controlled entry to department/unit/ ward.

8. Hospital safety induction.

9. Department/unit/ward safety induction.

10. Safety audits/inspections.

11. Hospital Health and Safety Committee.

12. Department/unit/ward Health and Safety Committee.

13. Workplace design.

14. Housekeeping/cleaning.

15. Competency of co-workers.

16. Occurrence/incidence reporting system.

17. Investigation and follow-up measures after injuries and accidents have taken
place.

60
vii. Management Commitment

Table 3.9 illustrates seven items concerning the perceptions regarding the management
commitment towards health and safety in the hospital. Responses were made on a 5-point scale
ranging from ‘‘Strongly disagree” (1) to ‘‘Strongly agree” (5). 3 items were worded to reflect
negative perception about management commitment and the scale was reversed to “strongly
disagree” (5) to “strongly agree” (1). For example: “Senior managers seem interested in health
and safety only after an adverse event happens”.

Table 3.9: Management Commitment

1. I know who the Senior Managers are.

*2. Senior Managers seem interested in health and safety only after an adverse event
happens. (Reversed)

3. The actions of Senior Managers show that health and safety is a top priority.

*4. Senior Managers put their budget before safety. (Reversed)

5. Senior Managers genuinely care about the health and safety of people at this hospital.

*6. The hospital’s procedures are only there to cover the backs of Senior Managers.
(Reversed)

7. I trust Senior Managers to act on safety concerns.

*negative item

61
viii. Health and Safety Objectives

Five items explain the perceptions about health and safety goals were shown in Table 3.10. For
instance: “Top management has set out a clear vision for health and safety in this hospital”.
Responses were made on a 5-point scale ranging from ‘‘Strongly disagree” (1) to ‘‘Strongly
agree” (5).

Table 3.10: Health and Safety Objectives

1. Top management has set out a clear vision for health and safety in this
hospital.

2. My supervisor discusses in specific terms who is responsible for achieving

performance targets in health and safety.

3. Top management emphasizes the importance of having a collective sense of

mission for health and safety.

4. Top management articulates a compelling vision of the future for health and
safety.

5. My supervisor makes it very clear what one can expect to receive when
performance goals for health and safety are achieved.

ix. Errors and Incidents

Table 3.11 shows fourteen items regarding the perceptions of employees about errors and
incidents in the hospital. Seven items concerned errors and seven items described incidents in the
hospital. For measuring errors, responses were made on a 5-point scale ranging from ‘‘Strongly
disagree” (1) to ‘‘Strongly agree” (5). For surveying errors, 3 items were worded to reflect
negative perception about errors in the workplace and the scale was reversed to “strongly

62
disagree” (5) to “strongly agree” (1). For example: “When an event is reported, it feels like the
person is being written up, not the problem”.

For incident items, two items were used to measure accidents and near misses. Participants were
asked to indicate the number of work-related accidents and near misses that they had witnessed
in the past 30 days. An association of such accidents or near misses was made across five
categories ranging from (1) none; (2) 1 – 2; (3) 3 – 5; (4) 6 – 10; and (5) more than 10.

Participants were also asked to report the number of injuries as a result of the following problems
at work: moving and handling; needlestick and sharp injuries; slips, trips or falls; exposure to
dangerous substances (including radiation); and work related stress that they experienced in the
past 12 months. Exposure to such injuries was calculated as the number of exposures across the
five categories ranging from (1) none; (2) 1 – 2; (3) 3 – 5; (4) 6 – 10; and (5) more than 10.

Subjective indicators were selected as it is difficult to acquire objective data since organizations
are afraid of making accident data public because of the possible legal outcomes (Fernandez-
Muniz et al., 2009). Furthermore, Fernandez-Muniz et al. noted that many studies have used self-
reporting elements of safety performance as outcome variables and the results showed positive
association between objective and subjective assessment of performance. Vinodkumar and Bhasi
(2009) also pointed out that organization accident frequencies are inaccurate for researcher to use
due to their under-reporting value.

63
Table 3.11: Errors and Incidents

Part 1: Errors

1. We are informed about errors/mistakes that happen in this department/unit/ ward.

2. In this department/unit/ward, we discuss ways to prevent errors/mistakes from

happening again.

3. We are given feedback about changes put into place based on event/incident reports.

*4. Staff feel mistakes are held against them. (Reversed)

*5. When an event is reported, it feels like the person is being written up, not the problem.
(Reversed)

6. Mistakes have led to positive changes here.

*7. Staff worry that mistakes they make are kept in their personnel file. (Reversed)

*negative item

Part 2: Incidents

8. In the last month, how many incidents did you see that inadvertently harmed staff?

9. In the last month, how many errors or near misses did you see that could have harmed
staff?

10. During the last year how many times have you been injured or felt unwell as a result of
the following problems at work?

a. Moving and handling.

b. Needlestick and sharp injuries.

c. Slips, trips or falls.

d. Exposure to dangerous substances (including radiation.)

e. Work related stress.

64
x. The Role of a Supervisor

Measures consisting of eleven items related to participants’ perception about the role of their
supervisor are shown in Table 3.12. Responses were taken on Likert-type five-point scales
ranging from “strongly disagree” (1) to “strongly agree” (5). Three items were worded to
reflect negative role of supervisor – for example, “Whenever pressure builds up, my supervisor
wants us to work faster, even if it means taking shortcuts” were scaled in reverse strongly
disagree (5) to strongly agree (1).

Table 3.12: The Role of a Supervisor in Health and Safety Issues

1. My supervisor says a good word when he/she sees a job done according to established
safety procedures.

2. My supervisor is well qualified in health and safety.

*3. My supervisor seems interested in health and safety only after an adverse event
happens. (Reversed)

4. My supervisor seriously considers staff suggestions for improving health and safety for
workers.

5. I feel very confident about my supervisor’s skills to deal with health and safety issues.

*6. Whenever pressure builds up, my supervisor wants us to work faster, even if it means
taking shortcuts. (Reversed)

7. The actions of my supervisor show that health and safety is a top priority.

8. My supervisor is known to be successful at the things he/she tries to do.

9. I trust my supervisor to act on health and safety concerns.

10. My supervisor knows about the work that needs to be done.

*11. My supervisor overlooks health and safety problems that happen over and over.
(Reversed)

*negative item

65
xi. Safety Rules

Table 3.13 contains three items concerning perceptions regarding the safety rules in the hospital.
Responses were made on a 5-point scale ranging from ‘‘Strongly disagree” (1) to ‘‘Strongly
agree” (5). One item was worded to reflect negative perceptions about management commitment.
For example, “The rules are too strict and I can work better without them”.

Table 3.13: Safety Rules

1. The written safety rules and instructions are easy for people to understand and
implement.

*2. The rules are too strict and I can work better without them. (Reversed)

3. The rules always describe the safest way of working.

*negative item

xii. The Supervisor’s Leadership Style

A supervisor’s leadership style was measured with ten items as in Table 3.14. Participants
indicated on a 5-point scale ranging from (1) ‘‘Not at all”; (2) “Once in a while”; (3)
“Sometimes”; (4) “Fairly often”; and (5) ‘‘Frequently if not always”. They were asked to judge
how frequent their supervisor performs each style.

66
 Table 3.14: The Supervisor’s Leadership Style

My Supervisor …….

1. Provides me with assistance in exchange for my efforts.

2. Instills pride in me for being associated with him/her.

3. Talks enthusiastically about what needs to be accomplished.

4. Specifies the importance of having a strong sense of purpose.

5. Spends time teaching and coaching.

6. Acts in ways that build my respect.

7. Gets me to look at problems from many different angles.

8. Helps me to develop my strengths.

9. Suggests new ways of looking at how to complete assignments.

10. Has a strong sense of justice.

xiii. Open-ended Question

The last question that respondents had to answer was open-ended. They were invited to make
comments on their workplace occupational health and safety practices.

3.6 The Pilot Study and Expert Judgments

A pilot study was carried out to evaluate every item in the survey in terms of item quantity and
overall reliability. Its purpose was to confirm whether the items were easily understood, to
ascertain the time required to manage the survey, and to determine its ease of use. The study was
done in two phases: (1) distribution of the English questionnaire, and (2) distribution of the
Bahasa Melayu questionnaire. The results of this pilot study and comments received from
participants were used to modify any unclear wording in the questionnaire. The pilot study was

67
conducted at a district hospital in the northern region of Malaysia: Hospital Jitra, Kedah,
Malaysia.

The original scale as in Table 3.15 and the full version as in Appendix 4 was pilot tested on
respondents and the safety expert’s judgments. Content validity was also examined to ensure that
each item really explains the meanings in the concept (Hair, Anderson, Tatham & Black, 1998).
Ten safety experts: seven practitioners from various industries and three academicians from three
public universities evaluated the items and their suitability in each dimension.

Table 3.15: Factors and total number of items included in the initial instrument
Factor Description Number of Rating scale
item
Safety Perception about safety 7 1 = strongly disagree to 5 =
communication communication including strongly agree
openness in communication
Training & Attitudes to acquire knowledge 6 1 = strongly disagree to 5 =
competence and skills about risks in job strongly agree
Health & Safety Attitudes and perception relating 8 1 = strongly disagree to 5 =
reporting to feedback about incidents strongly agree
Work pressure Perceptions of individual job 9 1 = strongly disagree to 5 =
duties relating to safety issues strongly agree
Safety satisfaction Attitudes and perceptions 17 1 = highly dissatisfied to 5 =
relating to aspects of safety highly satisfied
measures in the workplace
Management Perceptions of management 13 1 = strongly disagree to 5 =
safety commitment to safety issues strongly agree
commitment
Errors and Attitudes and perceptions about 14 • 1 = strongly disagree to 5
incidents errors and incidents in the = strongly agree (errors – 7
workplace items)
• Categorical frequency
(incidents – 7 items)
Role of supervisor Perceptions of supervisor’s role 28 1 = strongly disagree to 5 =
in safety and in ensuring safety in the strongly agree
health workplace
Safety rules Perceptions of rules about safety 3 1 = strongly disagree to 5 =
in the workplace strongly agree
Supervisor’s Perceptions of leadership style in 14 1 = not at all to 5 =
leadership style ensuring safety in the workplace frequently
TOTAL 119

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3.7 The Administration of the Survey Instruments
In order to have a good total response, data collection procedure must be well administered.

3.7.1 The Data Collection Procedure

Data were collected from Malaysian state hospital employees stratified by occupational groups:
doctor, nurse, medical officer, management officer, medical support staff and management
support staff. In an effort to increase total response, a letter of support from the Director General
of Health, Malaysian Ministry of Health was obtained prior to data collection (refer Appendix 6).
Administration of the survey was conducted by the researcher.

Firstly, as the researcher required a list of employees’ names from the three state hospitals,
letters were written to the Directors of the State Hospitals (Perlis, Kedah and Pulau Pinang)
requesting their consent for a name list of hospital employees. Two weeks after appointments
with respective Human Resources (HR) departments of each state hospital, the researcher
received a contact list of hospital employees. From the list, a sample was chosen using stratified
proportionate random sampling according to occupational groups: doctor, nurse, medical officer,
management officer, medical support staff and management support staff. The random number
table was used to attain this sample. The researcher then destroyed the contact list as it was
confidential.

Secondly, the researcher distributed the Information sheet (Appendix 7) and consent form
(Appendix 8) to the selected respondents. Two weeks prior to the distribution of the survey, all
selected employees received a letter (as per the information sheet in Appendix 7) with two copies
of consent forms (one for the researcher and one for the participant’s record) asking for their
participation in the survey. The information sheet was to assist in making informed choices.
Employees were told that the study was designed to assess their perceptions on the health and
safety practices in their hospitals. To encourage frankness, employees were given written
assurance that their responses would be kept confidential. The consent form explained that
participants may withdraw from the study at any stage and withdrawal would not interfere with
routine care of the survey. A week later, the researcher collected the signed consent forms.

69
Lastly, the researcher distributed the survey to the participants who had indicated their agreement
to participate in the survey. Due to the travelling time to the hospitals, the survey was delivered
in three stages: (1) Hospital Tuanku Fauziah, Kangar, Perlis; (2) Hospital Sultanah Bahiyah, Alor
Setar, Kedah; and (3) Hospital Pulau Pinang, Georgetown, Pulau Pinang. A survey packet
containing a covering letter, a set of questionnaires and a postage-paid return envelope were
delivered to respondents through inter-office mail. To increase the survey’s total response,
follow-ups were performed using the codes on the returned envelope. Three weeks after the
surveys were first distribute, the researcher sent a reminder notice to all participants. Two weeks
later, the researcher made reminder telephone calls to those employees who had not completed
the survey.

3.8 Analysis of the Data

The data analysis was done using statistical analysis from the Statistical Package for Social
Science (SPSS) version twelve and AMOS version 4.0 (Arbuckle, 1999). Significance was set
at a two-tail with an alpha level of 0.05. There are two levels of analysis: (1) validity and
reliability analysis using SPSS and AMOS; and (2) hypotheses testing using SPSS.

For the first stage, reliability testing focused on internal consistency for all instruments using
Cronbach’s alpha. To assess the validity of the instrument, analysis such as content validity,
concurrent validity, and construct validity have been utilized. A priori of analyzing exploratory
factor analysis and confirmatory factor analysis (measurement model and structural model) was
decided for this study.

The second stage of the analysis involved the chi-square test of independence and logistic
regression.

The following are the processes undertaken before and during data analysis.

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3.8.1 Data Screening
Before proceeding to the statistical analysis, raw data must be examined to ensure its accuracy.
Some of the steps considered were:

i. Data Cleaning Process

To ensure the accuracy of the data being coded and entered into the data file, a verification
procedure was completed during which data were examined using descriptive statistics and
graphic representations of the variables (Tabachnick & Fidell, 2007). Data cleaning can be
achieved by frequency tables, histograms, bar stem-and-leaf displays, and box plots (Meyers,
Gamst, & Guarino, 2006). Summarization of variable values can be obtained from a frequency
table, for example, demographic variables. Descriptive methods were used to simplify and
characterize the data through measures of central tendency, variability, association and graphic
displays. Stem-and-leaf plots give visual description of a variable’s distribution. Excessive
scores can be recognized from the box plots.

The researcher produced frequencies of responses to each item and looked for out-of-range
values for responses as this survey required a response between 1 and 5. The values of each
variable must be “within range”, i.e. within the valid values range.

ii. Missing Data

Missing data is a common problem in data analysis and thus must be taken care of as it has a
negative effect on statistical power and the end result is biased statistical findings such as upward
or downward measures of central tendency, and downward correlation coefficients (Tsikriktsis,
2005). Some of the reasons for the missing values were: errors in data entry, respondents refused
to answer certain sensitive questions like income, the failure of respondents to complete the
whole questionnaire, and respondents had no opinions or possessed inadequate information to
answer the question (Hair et al., 1998, Tabachnick & Fidell, 2007, Tsikriktsis, 2005).

The researcher used descriptive statistics as an investigative tool to identify the randomness of
missing data where examination of variables with and without missing data was distinguished.

71
The method of addressing missing data used by researcher in this study was mean substitution
where all missing values were replaced with the mean of that variable.

iii. Treatment of outliers

Outliers are cases with extreme values on a single variable (univariate) or on a combination of
variables (multivariate) (Meyers, Gamst & Guarino, 2006). Some causes of outliers are data
entry errors, unusual events, unexplainable observations, unusual or unique combine patterns
(Hair et al., 1998). Univariate outliers were identified by examining the frequency distribution or
box plot of each variable (Tabachnick & Fidell, 2001). Multivariate outliers were detected using
Mahalanobis distance statistics where each case is evaluated using a chi-square distribution with
a stringent alpha level of 0.001 (Hair et al., 1998, Tabachnick & Fidell, 2001). A possible
solution for these outliers is elimination (Meyers, Gamst & Guarino, 2006).

The treatment of multivariate outliers for this study was done through SPSS regression using the
Mahalanobis distance where the outliers were evaluated using the chi-Square distribution
(Tabachnick & Fidell, 2001). Case label (IDRes) was used as the dummy dependent variable
and the remaining variables were treated as independent variables (Tabachnick & Fidell, 2001).
The decisive factor for multivariate outliers is Mahalanobis distance at p < 0.001 and it is
measured as χ2 with degrees of freedom equivalent to the number of variables, in this study: 94
variables. To determine the multivariate outliers, the Mahalanobis distance must be greater than
χ2 . Table 3.16 shows an example of the Mahalanobis distance results.

Table 3.16: Results of Mahalanobis distance

min = 22.239 max = 263.664
Chi-Square value = χ2 (DF, p-value)
= χ2 (94, 0.001)
= 142.119
Multivariate Outlier = Mahalanobis Distance > Chi-Square value
= 263.664 >142.119

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iv. Normality
The data obtained was analyzed for normality to ensure its suitability using standard univariate
analysis. Normality of data can be examined through statistical approaches like skewness and
kurtosis, the Kolmogorov-Smirnov test and graphical approaches, for example, histograms, stem-
and-leaf plots, and box plots. The variable’s frequency value distribution should approximate the
bell-shaped curve or a straight diagonal line (Hair et al., 1998, Meyers, Gamst & Guarino, 2006,
Tabachnick & Fidell, 2001).

As stated by Hair et al. (1998, p. 23), sample size affects a study’s finding where the outcome of
a smaller samples are either (1) “too little statistical power for the test to realistically identify
significant results” or (2) “too easily ‘overfitting’ of the data that they fit the sample very well
but yet have no generalizability”. Large sample sizes of more than 200 to 400 respondents also
have disadvantages for they can “make the statistical tests overly sensitive due to the increased
statistical power from the sample size” (Hair et al., 1998, p. 23).

v. Data Transformation
Data transformation is used to modify variables that violate the statistical assumptions of
normality, linearity, and homoscedasticity (Hair et al., 1998). The square root is applied to
correct a moderate violation, logarithms are used for a more extensive violation, and an inverse
square root is utilized to deal with a serious violation (Meyers, Gamst & Guarino, 2006). Square
root and logarithm transformations were utilized to accommodate skewed data in this study
(refer to Appendix 13).

3.8.2 The Reliability and Validity of the Instruments

The reliability and validity of a questionnaire is a vital process. This study utilized Cronbach’s
alpha to measure the reliability of the instruments. For validity, this study utilized content
validity, construct validity, and concurrent validity. Content validity was measured using the
assessments of safety experts. Construct validity (factor analysis) used exploratory factor

73
analysis (EFA) and confirmatory factor analysis (CFA) while concurrent validity used
correlation.

Reliability is the correlation between two scores ranging from 0 to 1.00 where Cronbach's alpha
is the most common form of internal consistency reliability coefficient. A lenient cut-off of 0.60
is common in exploratory research; the generally agreed upon lower limit for alpha is 0.70 (Hair
et al., 1998) and many researchers require a cut-off of 0.80 for a "good scale” (Dawson & Trapp,
2004). Thus, the cut-off alpha for this study during the pilot survey is 0.60 and any measures
below 0.60 were modified to ensure the questionnaire was clear and understood by participants.

Content validity refers to the degree to which a test measures an intended content area and is
determined by expert judgment. In other words, content validity is the extent to which the
questions measure all the important aspects of the concepts. Thus, to ensure all the items really
measure what they intend to measure, the content validity of the instrument was administered
according to the following: (1) safety experts were identified from public universities and the
industrial sector; (2) 119 questionnaire items were prepared under the content heading of the
following: communication, work duties, safety satisfaction, hospital management, errors and
incidents, the role of the supervisors, training and competence, safety rules, reporting, and the
supervisor’s leadership style; and (3) the safety experts examined the listing to obtain expert
opinions.

There are two types of factor analysis: exploratory and confirmatory (Worthington & Whittaker,
2006). Construct validity in this study was tested by exploratory factor analysis (EFA), and
confirmatory factor analysis (CFA) to verify whether the scale measure the intended constructs
(Worthington & Whittaker, 2006). Exploratory factor analysis is an inductive strategy (bottom-
up approach) used for summarization and data reduction where the data is illustrated in smaller
numbers of concepts compared to the original variables, while confirmatory factor analysis is a
deductive strategy (top-down approach) to verify the instrument’s construct validity (Meyers,
Gamst & Guarino, 2006). To execute factor analysis, the sample must be 100 or greater or a
minimum of five-to-one ratio between case and variable (Hair et al., 1998, Tabachnick & Fidell,
2007).

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The following defines the steps taken by this study in determining its Exploratory Factor
Analysis (EFA) process:
1. Identify the items to be used in EFA
2. Examine the correlation matrix to be used for an EFA (Bartlett-Test, anti-image-
correlation-matrix, Kaiser-Meyer-Olkin-Criteria [KMO])
3. Select type of analysis:
o extraction – First phase use Principal Components Analysis, second phase use
Principle Factor Analysis
o rotation – First phase use varimax method (orthogonal), and second phase use
oblimin method (unorthogonal)
4. Determine the number of factors via:
o screen plot
o eigen values (number factors with eigenvalues of 1.00 or higher) and percentage of
variance explained
5. Identify which items belong in each factor through the factor loadings
6. Drop items as necessary and repeat steps 4 to 5 until the number of factors are achieved
(use the number of factors that the theory would predict)
7. Repeat steps 3, 4 and 5 for the second phase
8. Name and define the factors
9. Examine the correlations amongst the factors
10. Examine the internal reliability for each factor

For exploratory factor analysis, in the first phase, principal components extraction with varimax
rotation was employed to reduce the data into factors that distinguish them into specific scales
(McDonald, Corrigan, Daly & Cromie, 2000; Tabachnick & Fidell, 2007). Varimax rotation is an
orthogonal rotation with an assumption that all the items are uncorrelated (Tabachnick & Fidell,
2007).

In the second phase, principal axis factoring analysis with oblique rotation was used to establish
the factor structure of the measurement (Tabachnick & Fidell, 2007). Direct oblimin is an

75
unorthogonal rotation with an assumption that all the items are correlated (Tabachnick & Fidell,
2007). The principle axis factoring extraction is used for the development of new scales and is
better generalized to confirmatory factor analysis (Worthington & Whittaker, 2006).

The minimum level of factor loadings must be more than ± 0.30, loadings of ± 0.40 is significant
and loadings of ± 0.50 or greater are most significant (Hair et al., 1998). However, sample size
plays a major role in determining significant factor loadings. Loadings of 0.30 is considered
significant for a sample sizes of 350 or greater (Hair et al., 1998). The Kaiser-Meyer-Olkin
(KMO) test was used to estimate whether the data was suitable for analysis and the level of
KMO must be 0.50 and above (Tabachnick & Fidell, 2007; Varonen & Mattila, 2000).

The steps taken in a Confirmatory Factor Analysis (CFA) are:

1. Identify the items to be used in CFA (based on final result in EFA)
2. Select type of analysis:
a. Measurement model – to confirm the instrument’s construct validity as identified by
exploratory factor analysis (EFA) by testing the relationships between the measures
(i.e., manifest/observed variables) and the constructs (i.e., latent variables)
b. Structural model – to determine direct or indirect relationship between all latent
variables
3. Measurement model analysis was done first – every latent variable (safety satisfaction and
feedback; safety incident/accident; supervisor’s leadership style; role of supervisor;
training and competence; health and safety objectives; management commitment; and
safety reporting) was measured individually with its manifest/observed variables and the
associated errors.
4. Construct a path diagram between the latent variable and its observed variables and the
measurement errors
5. Identify the fit indices to ascertain the appropriateness of the model using indices like Chi-
square (χ2), χ2 p-level, cmin/df ratio, root-mean-squared-error of approximation (RMSEA),
goodness-of-fit index (GFI), comparative fit index (CFI), normed fit index (NFI), Tucker-
Lewis Index (TLI)
6. If model is not fit, use modification indices (MI) to improve its fit indices

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7. Repeat steps 4, 5 and 6 for the structural model. Step 4 consists of a diagram between all
latent variables to determine its relationship

3.8.3 Hypotheses Testing

To test the interrelationships between research variables, logistic regression analysis was
utilized. Further analysis included correlation testing to determine the associations between each
response in each respective variable. Other tests also included the chi-square test of
independence to determine the relationship and differences of two variables and descriptive
statistics to simplify and characterize the data.

3.9 Ethical Issues

Prior to data collection, participants were informed of the purpose of this study through an
information sheet (Appendix 7) to assist participants to make informed choices. They were
requested to take part in the study, informed that their participation was voluntary and that they
had the right not to answer any questions or withdraw at any time from this study. They were
also informed that their names would not be recorded and given assurance that their responses
would be kept confidential. Participants who confirmed their agreement to participate in the
survey were asked to sign a consent form (Appendix 8). The data and information regarding this
study will be treated as confidential and kept safe in locked storage for the required period.
Ethical approval of this study was endorsed by the Human Research Ethics Committee at Curtin
University of Technology (Appendix 9). There is no ethics approval process from the public
hospitals in Malaysia which do not require the reporting of the Australian review body’s
approval.

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3.10 Summary
In this chapter, the researcher illustrated the research design of the study specifically the
sampling method. The sample was Malaysian state hospital employees stratified by occupational
groups: doctor, nurse, medical officer, management officer, medical support staff and
management support staff. Next, the development of the survey instrument and the
administration of the survey instrument particularly the data collection process were described.
Subsequently, a pre-test of the questionnaire was carried out. Then, various phases of the data
analysis process, including construct validity, correlation and hypotheses testing were clarified.
Finally, the ethical concern was highlighted.

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 CHAPTER 4

RESEARCH FINDINGS

4.0 Introduction
This chapter illustrates data analysis outcomes. The first part gives an overview of the data
collected. Next, the respondents’ profile is described. Descriptive statistics and analysis on the
goodness of measures to test the validity and reliability of the variables follow. Finally, the
results of hypotheses testing are expressed.

4.1 Summary of Data Collection

The following clarifies the number of response, response bias, and normality test of the survey.

4.1.1 Number of return

A total of 969 questionnaires were distributed to public hospital employees from three state
hospitals in the northern region of Malaysia. Responses were received from 536 employees, a
response of 55.3% (refer Table 4.1). A further 118 responses were excluded from the survey due
to:
• Many unanswered items in different sections throughout the whole survey (7 responses).
• Many two rating scales, e.g., “4”s and “3”s in different sections throughout the entire survey
(9 responses).
• Did not answer any items throughout the entire survey (102 responses).

Only 418 usable returns were used for analysis representing a total response of 43.15%.
Although this response was low, however, currently, most studies tend to have lower total
response, for example, Bottani, Monica and Vignali’s (2009) survey on performance
differences between adopters and non-adopters of safety management systems had 23.2%
responses; 22.4% for small size enterprises and 14.06% for medium size enterprises in Kongtip,
Yoosook and Chantanakul’s (2008) survey; Havold and Nesset (2009) found from Newell et al.

79
(2004) survey on the Navy Equal Opportunity/Sexual Harassment that the number of response
dropped from 60% in 1989 to 30% in 1999; and the total response in Vassie, Tomas and
Oliver’s (2000) study was 11.4% and 13.9% in UK and Spanish, respectively. According to
researchers from Malaysia, a total response of between 15 – 25 percent is what most researchers
in Malaysia receive (Rozhan, Rohayu & Rasidah, 2001). Even, McFarlane, Olmsted, Murphy
and Hill (2006) noted from a survey by Cull, Karen, O’Connor, Sharp and Tang (2005) that the
total response among physicians have dropped.

Table 4.1: Total return of the survey

Hospital Sample Initial Unused Useable

size returns returns returns
Hospital Sultanah Bahiyah, 331 161 7 154
Alor Setar, Kedah
Hospital Tuanku Fauziah, 297 216 9 207
Kangar, Perlis
Hospital Pulau Pinang, 341 159 102 57
Georgetown, Pulau Pinang
TOTAL 969 536 118 418

Tables 4.2, 4.3, and 4.4 as in Appendix 10 show the total of return from the respective state
hospitals according to post. Nurses were the majority respondents in Hospital Sultanah Bahiyah,
Alor Setar, Kedah and Hospital Tuanku Fauziah, Kangar, Perlis while management supporting
staff were the majority respondents in Hospital Pulau Pinang, Georgetown, Pulau Pinang. Table
4.5 in Appendix 10 shows the overall response from the three state hospitals according to post
and nurses were the majority respondents in this survey (182 out of 418 responses). This might
be due to higher proportion of sample selection during data collection.

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4.1.2 Test of Non-Response Bias
For a survey research, “it is very important to pay attention to response rates” (Groves, 2006, p.
647). Thus, the test of non-response bias is to discover possible bias in the sample as it might be
in conflict with survey generalizability and validity (Thomsen, 2000) as those who respond to
surveys answer questions in a different way than those who do not. In other words, if the non-
responders are significantly different from responders, then there is a possiblility of bias in the
survey (McFarlane, Olmsted, Murphy & Hill, 2006). Furthermore, Holbrook, Krosnick and
Pfent (2008, p. 500) expressed that “non-response bias will occur if respondents and non-
respondents differ on the dimensions or variables that are of interest to the researchers” and
“non-response bias can lead to inaccurate conclusions if data from the non-respondents would
have changed the overall results of the survey” (Draugalis & Plaza, 2009, p. 2). However, as
stated by McFarlane, Olmsted, Murphy and Hill (2006, p. 4175), “low total response are not
necessarily an indicator of response bias.

There are many ways to assess non-response bias in a survey: (a) compare respondents’
characteristics with known population parameters using sampling weight; (b) compare the
characteristics of respondents in a survey (subjective estimates); and (c) extrapolating the
attributes of non-responders based on the respondents traits using successive waves of a survey
and time trends analysis (Armstrong & Overton, 1977).

Four demographic variables (gender, ethnicity, level of education, and length of employment)
were chosen to test the non-response bias as they were available and significant to the survey
assessment (McFarlane, Olmsted, Murphy & Hill, 2006). A chi-square test was used to measure
the early and late responders based on the four demographic variables. Late responders were
classified based on the returned questionnaire after a follow up was done by reminder notice and
telephone to increase the number of response. Late responders play a role in poor data quality
and were seen as less reliable (Chandhok, 2008, p. 2098) and can be categorized as unwilling
respondents or similar to non-respondents (Armstrong & Overton 1977, Draugalis & Plaza,
2009).

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Table 4.6 shows the results of the non-response test. From the table, the p-values disclosed no
statistical significant (p > 0.05) between the late and early responders, thus, the analysis was
performed on all the 418 respondents.

Table 4.6: Chi-Square test for early and late responses

Variables χ2 p-value
Gender 0.254 0.614
Ethnicity 4.959 0.175
Level of education 5.141 0.076
Length of employment 0.448 0.799
Note: The critical values were not significant

Besides the chi-square test, an independent sample t-test was also used to determine whether
significant differences exist in the mean score for selected variables in this study among the early
and late responders. From Table 4.7, it was shown that the early and late responders did not
differ in terms of their responses to the study variables. Therefore, all the 418 respondents can be
used in the analysis.

Table 4.7: Differences in major variables by early and late responses (Independent t-test)

Variables Early responses Late responses t-value p-value

(N=284) (N=134)
M (SD) M (SD)
Supervisor’s 3.13 (0.85) 3.05 (0.89) 0.982 0.327
leadership style
Role of supervisor 3.54 (0.62) 3.46 (0.59) 1.278 0.202

Health and safety 3.57 (0.62) 3.48 (0.64) 1.332 0.184

objectives

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4.1.3 Normality Test

Appendix 13 (refer Tables 4.8 - 4.13) demonstrates the normality test for all the items used in
this survey. The tables show that most of the items skewed negatively or positively. For the
positive skewed items, square root was applied to correct the violation while the negative skewed
items were corrected using logarithm transformations.

4.2 The Demography of Respondents

Table 4.14 in Appendix 11 reveals the demographic information where the majority of
respondents were above the age of 40. About 78.7% (female) and 21.3% (male) comprised all six
ethnic groups of Malaysians, namely Malay (85.4%), Chinese (8.4%) and others (6.2%). The
majority of respondents were diploma holders (38.5%), and 35.2% Malaysian Certificate of
Education (MCE) holders. Job positions of the respondents were physicians, radiographers,
paramedics, pharmacists, respiratory therapists, nurses, and supporting staff (43.5% of the
respondents worked as nurse). About 36.8% of employees have worked between 1 to 5 years.

Table 4.15 in Appendix 11 shows the working mode and duration of the respondents. Generally
employees work for five to six days per week. About 52.6% of employees worked between 21 to
40 hours per week. As for the working mode, the majority worked in 3-shift work (51.2%)
while 48.8% worked in normal shifts.

4.3 Safety Experts’ Feedback and the Pilot Survey

The original scale of 119 Likert-type items was subjected to a pilot study and safety experts’
evaluation. From the survey, items were removed if they were reflected as inappropriate,
redundant, and confusing or consisted of extremely low item-total correlations. Some items were
perceived clear and relevant but needed modification as some in certain dimensions were rather
too long.

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Safety experts reviewed whether the items reflect the content domain implied by their label.
Accordingly, further items were refined to eliminate related items across categories and 25 items
were deleted from the initial group of 119. As a result, the final version was 94 items. Table 4.16
as in Appendix 12 illustrates summary of feedback from safety experts regarding items in all the
dimensions and their suggestions for each item according to the theme.

Table 4.17 shows the final version of the instrument after modification based on feedback from
safety experts and the pilot study, which groups the components into the following twelve
sections: communication, safety responsibility, work duties, safety satisfaction, management
commitment, health and safety goals, errors and incidents, role of supervisors, training and
competence, safety rules, reporting, and supervisor’s leadership style. The results revealed that
“the role of the supervisor” dimension had the most deleted items, i.e. 14.3 percent (17 items).
Overall the total number of items eliminated from specific factors were 21.0 percent (25 items)
and 10 items (8.4 percent) were relocated to another factor to ensure the items were with the
appropriate theme.

4.4 The Validity and Reliability of the Instrument

This study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test
the validity of the instrument. Types of EFA used in this study were content validity; concurrent
validity; and construct validity. Internal consistency reliability was used to test the reliability of
the scale.

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Table 4.17: Summary of feedback from safety experts and the pilot study regarding items in the
safety climate dimension

Factor Total items % of items % of items % of items Total

in original deleted relocate to taken from items in
scale from the another another revised
factor factor factor scale
Safety communication 7 - 0.8 (1) 0.8 (1) 7

Training & competence 6 - 1.7 (2) - 4

Health & safety reporting 8 2.5 (3) - - 5

Work duties 9 0.8 (1) - - 8

Safety satisfaction 17 - - - 17

Management 13 3.4 (4) 1.7 (2) - 7

commitment

Errors and incidents 14 - - - 14

Role of supervisor 28 13.5 (16) 0.8 (1) - 11

Safety rules 3 - - - 3

Supervisor’s leadership 14 0.8 (1) 3.4 (4) 0.8 (1) 10

style

Health & safety goals - - - 4.2 (5) 5

Safety responsibility - - - 2.6 (3) 3

TOTAL 119 21.0 (25) 8.4 (10) 8.4 (10) 94

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4.4.1 Exploratory Factor Analysis (EFA)

This study utilized exploratory factor analysis (EFA) to examine the factorial validity of the
constructs. The following process of EFA was done:

i. All 94 items of the final instrument were analyzed using factor analysis in SPSS software.

ii. There are two phases of factorial: (i) all the items were submitted to an exploratory factor
analysis with principle components extraction and varimax rotation to summarize and
reduce a large number of variables down to a smaller number of components, (ii) the
remaining items were then factorized using principle axis factoring extraction and direct
oblimin rotation to establish the factor structure of the measurement.
iii. Observe Bartlett-Test (significant must be less than 0.05), Kaiser-Meyer-Olkin-Criteria
[KMO] (value must be more than 0.60), and anti-image-correlation-matrix: measures of
sampling adequacy (MSA) value must be near or more than KMO value during the first
phase of the factor analysis.
iv. Observe the number of factors via:
a. screen plot
b. Total variance explained table - to determine eigenvalues of 1.00 or higher and
percentage of variance explained
v. Items in each factor were examined through the factor loadings in rotated component
matrix table.
vi. In the anti-image-correlation-matrix table, items were dropped when the MSA value was
less than the KMO value.
vii. Steps 3 to 6 were repeated until the number of factors as the theory were achieved
viii. Steps 3 to 6 were repeated for the second phase in the final analysis.
ix. From the rotated component matrix table, only factor loadings of more than ± 0.30 were
taken and the factors were labeled.

The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for this survey was greater than
0.60 and the Bartlett’s test of sphericity was significant (Tabachnick & Fidell, 2007; Varonen &

86
Mattila, 2000). The anti-image correlation matrix demonstrated that all measures of sampling
adequacy (MSA) were above the acceptable level of 0.50. Therefore, it was appropriate to factor
analyze the data.

The following are the results of the EFA for dependent and independent variables during the
second phase of factor analysis.

i. Exploratory Factor Analysis (EFA) for Dependent Variables

A priori criterion was set according to the number of factors extracted, i.e. 2 factors. This
technique is practical when a study tries to test a theory or replicate another study (Hair et al.,
1998).

Thirty one items of the dependent variables were submitted to an exploratory factor analysis with
principle axis factoring extraction and direct oblimin rotation. Table 4.18 in Appendix 14 shows
the factor analysis for the items in the dependent variables; where the rotated solution
demonstrated two factors which together explained 32.67%: (1) safety satisfaction and feedback
(21 items, α = 0.910), and (2) safety incident/accident (7 items, α = 0.762). The items left for
analysis were only 28 items.

The results suggested that four items from the safety incidents dimension were factored into the
safety satisfaction dimension, thus the new factor was renamed as safety satisfaction and
feedback. A further three items from the safety incidents dimension were eliminated from the
scale as the factor loadings were lower than 0.30 (SI4 = -0.147, SI5 = 0.222, SI7 = -0.090). The
KMO measure of sampling adequacy for the dependent variables was 0.860 and the Bartlett’s
Test of Sphericity was significant (χ2 = 5733.82, df = 465, p < 0.000). The measures of sampling
adequacy (MSA) were in the range of 0.712 to 0.935.

ii. Exploratory Factor Analysis (EFA) for Independent Variables

The 63 items of independent variables were first submitted to an exploratory factor analysis with
principle components extraction and varimax rotation. During factor analysis with principle
components extraction and varimax rotation, 22 items were dropped, thus only 41 items were
left. These 41 items were then factorized using principle axis factoring extraction and direct

87
oblimin rotation. A further two items from the safety rules dimension were eliminated from the
instrument as one item had a factor loading lower than 0.30 (rule1 = 0.247) while another item
(rule2 = -0.315) was a single item in a factor. A retained factor must have at least three items to
define a factor (Seo et al., 2004; Varonen & Mattila, 2000).

Thirty nine items were factored into six factors which explained 54.40% of the variance: (1) the
role of the supervisor (8 items, α = 0.913), (2) a supervisor’s leadership style (10 items, α =
0.945), (3) training and competence (6 items, α = 0.823), (4) health and safety objectives (5
items, α = 0.877), (5) management commitment (5 items, α = 0.740), (6) safety reporting (5
items, α = 0.764).

From Table 4.19 in Appendix 14, the results suggested that the role of the supervisor only
maintained 8 out of 11 items. The supervisor’s leadership style retained its ten items while health
and safety objectives sustained its 5 items. The result also revealed that two items from safety
involvement was factored into the training and competence dimension. The items factored into
this dimension give the impression that safety involvement is considered as part of the
competence dimension needed to ensure involvement and commitment towards safety in the
workplace. Furthermore, the original scale developed by Flin, Mearns and Burns (2004) included
these items in the training and competence dimension.

As for the management commitment factor, it can be seen that this factor retained 4 out of 7
items and one item from safety communication dimension factored into management
commitment dimension. This item was originally included in the management commitment scale
as per Flin, Mearns and Burns (2004) instrument. Furthermore, support from management
toward safety activities in the workplace is crucial. Lack of commitment from management is
linked with higher industrial accident (Cooper, 1995) and gives the notion that unsafe actions or
attitude towards safety do happen in organizations. One item from work pressure dimension was
factored into the safety reporting dimension and this factor was labeled as safety reporting. This
is so as one item from the work pressure dimension was only a general question regarding
inclusion of health and safety issues while performing tasks.

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The KMO measure of sampling adequacy for the independent variables was 0.937 and the
Bartlett’s Test of Sphericity was significant (χ2 = 10,742.89, df = 820, p < 0.000). Measures of
Sampling Adequacy (MSA) were in the range of 0.817 to 0.966.

4.4.2 Internal Reliability

The internal consistency reliability coefficient for all instruments was calculated using
Cronbach’s alpha. With all items in the original scale, the Cronbach’s alpha for the pilot study
was 0.948 (n = 52).

Table 4.20 presents the Cronbach’s alpha, mean and standard deviation for the summated scale
of the final instrument after factor analysis. The Cronbach’s alpha for all dimensions in the scale
were in the range of 0.740 to 0.945. Overall, Cronbach’s alpha for the scale was 0.949. Thus, the
coefficient of the revised instrument was above the acceptable level of 0.70 (Hair et al., 1998).
The table also shows that the highest mean was contributed by safety reporting (mean = 3.90, SD
= 0.52) while the lowest mean was from the safety incident/accident dimension (mean = 1.58,
SD = 0.54).

4.4.3 Concurrent Validity

Bivariate correlations were used to analyze concurrent validity between independent variables
and two outcome factors (Cooper & Schindler, 2008; Johnson, 2007; Seo et al., 2004). The item-
level analysis from Table 4.21 in Appendix 15 reveals that some items showed weak or negative
relationships with other items in the measurement. Although safety incident/accident associated
negatively and some weakly with all dimensions of the independent variables and safety
satisfaction and feedback (dependent variable), they also substantiated a predictive relationship.
For instance, the negative correlation between safety incident/accident (dependent variable) and
the independent variables such as the role of the supervisor (r = -0.156; p > 0.01); health and
safety objectives (r = -0.175; p > 0.01); management commitment (r = -0.225; p > 0.01); safety
reporting (r = -0.106; p > 0.05); and safety satisfaction and feedback (r = -0.123; p > 0.05)
indicated that improvement in the independent variables predicted a decreased in the safety

89
incident/accident. In addition, a positive relationship between independent variables implicated
enhanced independent variables and thus predicted an increased in the dependent variable, i.e.
safety satisfaction and feedback (refer Table 4.21 in Appendix 15).

The direction of these associations was consistent with prior studies (Huang et al., 2006;
Johnson, 2007). Kline (2005) indicated that the non-significant relationships between
independent variables and safety incident/accident (dependent variable) might be due to the
consequence of mediating variables (as cited in Johnson, 2007). Thus, structural equation
modeling was used to test this analysis to determine whether mediator variables existed in this
study. It was found that there was a direct relationship between all the independent variables with
the outcome variables: safety satisfaction and feedback, and safety incident/accident.

The correlation analysis indicated that scores on the 6 dimension scales of the independent
variables were generally moderately dependable. Further, the association between all items was
not near unity (correlation value not equal to 1), thus implying that the instruments are not
measuring a single construct (von Thaden et al., 2003). A correlation of less than 0.20 revealed
a weak association (Sorra & Nieva, 2004), for example, safety incident/accident with safety
reporting = -0.106; role of supervisor = -0.156; health and safety objectives = -0.175; and safety
satisfaction and feedback = -0.123. It was also found that safety incident/accident did not
correlate with two independent variables: leadership style (r = -0.004; p > 0.05); and training and
competence (r = -0.073; p > 0.05).

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 Table 4.20: Summary of statistics and Cronbach’s alpha

Dimension # of item Mean SD α

Safety satisfaction and feedback 21 3.5222 0.50890 0.910

Safety incident/accident 7 1.5783 0.53795 0.762

Role of supervisor 8 3.5161 0.60841 0.913

Supervisor’s leadership style 10 3.1060 0.86490 0.945

Training and competence 6 3.6958 0.59777 0.823

Health and safety objectives 5 3.5402 0.62893 0.877

Management commitment 5 3.5435 0.58754 0.740

Safety reporting 5 3.8995 0.57847 0.764

TOTAL 67 OVERALL α 0.949

Dependent Variables 28 0.861

Independent Variables 39 0.949

4.4.4 Confirmatory Factor Analysis (CFA)

To further validate the instrument structure, a confirmatory factor analysis (CFA) was conducted
through the use of AMOS 4.0 (Arbuckle, 1999). The following process of CFA was carried out:

i. All the 94 items during the final analysis in exploratory factor analysis (EFA) were used in
CFA. The same factor structures proposed by EFA were used in the CFA analysis.
ii. Two types of analysis were done accordingly:
a. The measurement model was done first to confirm the instrument’s construct validity
as identified by exploratory factor analysis (EFA)

91
 b. The structural model was done in the second stage after the measurement model was
adequately fit to determine the direct or indirect relationship between all latent
variables
iii. For the measurement model analysis, a path diagram was constructed for every latent
variable (safety satisfaction and feedback; safety incident/accident; the supervisor’s
leadership style; the role of the supervisor; training and competence; health and safety
objectives; management commitment; and safety reporting) with their manifest/observed
variables and the associated errors. This analysis was done individually for every latent
variable.
iv. Fit indices like Chi-square (χ2), χ2 p-level, cmin/df ratio, root-mean-squared-error of
approximation (RMSEA), goodness-of-fit index (GFI), comparative fit index (CFI),
normed fit index (NFI), Tucker-Lewis Index (TLI) were identified to ascertain the
appropriateness of the model
v. Modification indices (MI) were used when the model was not fit in order to improve its fit
indices
vi. Steps 3 to 5 were repeated for the structural model. Step 3 consisted of a diagram between
all latent variables to determine its relationship

Eight measurement models of this survey were tested as in step 3 to confirm the instrument’s
construct validity as identified by exploratory factor analysis (EFA). Measurement models test
relationships (i.e., paths) between the measures (i.e., manifest/observed variables) and the
constructs (i.e., latent variables) (Tabachnick & Fidell, 2007). Items with factor loading below
0.3 were considered not significant and eliminated from the measurement model (Hair et al.,
1998).

There are three types of goodness-of-fit measures: “(1) absolute fit measures – measures the
overall model fit, both structural and measurement models, with no adjustment for the degree of
overfitting that might occur; (2) incremental fit measures – compare the proposed model to
baseline model specified by the researcher; and (3) parsimonious fit measures – adjust the

92
measures of fit to provide comparison between models with differing numbers of estimated
coefficient” (Hair et al., 1998, p. 611).

From previous studies, Byrne (2001), Hair et al. (1998), Nasser & Wisenbaker (2003) and
Tabachnick & Fidell (2007) reported the acceptable cutoff values for the fit indices as per Table
4.22 in Appendix 16. Usually most studies reported multiple indices as good-fitting models give
a reliable outcome, and comparative fit index (CFI) and root-mean-squared-error of
approximation (RMSEA) are often reported (Tabachnick & Fidell, 2007). This study reported
numerous goodness-of-fit indices suggested by researchers to assess measurement adequacy: chi-
square (χ2), χ2 p-level, cmin/df ratio, root-mean-squared-error of approximation (RMSEA),
goodness-of-fit index (GFI), comparative fit index (CFI), normed fit index (NFI), Tucker-Lewis
Index (TLI). Since χ2 is sensitive by sample size, which will yield an inflated chi-square
statistic or Type I error, it is recommended to use other fit indices too (Evans, Glendon & Creed,
2007; Hsu et al., 2008).

4.4.4.1 Dependent Variables

There are two dependent variables in this study: (a) safety satisfaction and feedback; and (b)
safety incident/accident. The following shows the confirmatory factor analysis (CFA) for both
dependent variables.

i. Safety Satisfaction and Feedback

The safety satisfaction and feedback dimension identified through the exploratory factor analysis
contained twenty one items, where four items from safety feedback dimension were factored into
the safety satisfaction dimension. The results of the confirmatory factor analysis (CFA) for this
dimension are shown in Figure 4.1. The diagram shows that the factor loading of each observed
variable was from 0.53 to 0.92.

The CFA for this latent was conducted on the parceling level of analysis. Item parceling was
used to aggregate two or more items together as an alternative to improve model fit (Meade &
Kroustalis, 2006; Worthington & Whittaker, 2006). Furthermore, item parceling is more reliable

93
 and normally distributed (Hall, Snell & Foust, 1999). Item parceling was established according
to the systematic random selection from similar domains (Fletcher & Perry, 2007). Five parcels
were created to represent the safety satisfaction and feedback dimension as in Table 4.23 in
Appendix 16.

error Observed/manifest variable Latent variable

e1 SSPAR1
.92
e2 SSPAR2
.89
.83 Safety Satisfaction
e3 SSPAR3 & Feedback
.83
.26
.53
e4 SSPAR4

e5 FEEDPAR

Figure 4.1: A first order measurement model for Safety Satisfaction and Feedback

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

Table 4.24: Goodness-of-fit values for safety satisfaction and feedback dimension

Model χ2 d.f. Χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 25.878 5 5.176 0.000 0.975 0.100 0.986 0.983 0.972 0.491
Model
Re-specified 8.002 4 2.000 0.092 0.992 0.049 0.997 0.995 0.993 0.398
Model

Initially, Table 4.24 shows that the hypothesized model represents a poor fit with almost all the
indices being below the recommended value. Thus, possible improvements to model fit was done
through correlated the error terms as suggested by modification indices (MI). Marsh and

94
Grayson (1995, p. 177) indicated that “method effect refers to the influence of a particular
method that inflates a correlation among the different traits measured with the same method” and
Joreskog and Sorbom (1996, p. 222) revealed that “where measures are repeated, as in a scale,
there is a tendency for measurement errors … to correlate over time due to memory or other
retest effects” (as cited in Evans, Glendon and Creed, 2007). Furthermore, modification indices
(MI) refer to “misspecified error covariances” due to item characteristics like related item
content or respondent attributes like social desirability (Byrne, 2001). As a result, only one error
term was allowed to correlate within the same factor in this study where the re-specified model
was a better fit, χ2 = 8.002, p < 0.000 (Figure 4.1).

ii. Safety Incident/Accident

The safety incident/accident dimension identified through the exploratory factor analysis
contained seven items. The results of the confirmatory factor analysis (CFA) for this dimension
are shown in Figure 4.2. The CFA for this latent was conducted on the individual level of
analysis where all the seven observed items were analyzed with its latent and errors. The diagram
shows the factor loading of each observed variable was from 0.41 to 0.72.

Table 4.25 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only two
error terms were permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 20.882, p < 0.000 (Figure 4.2).

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 error Observed/manifest variable Latent variable

e1 incident8
.59
e2 incident9 .59
.60
e3 incident10a
.72
.64
e4 incident10b Safety Incidents
.72
.41
e5 incident10c
.46

e6 incident10d
.22
e7 incident10e

Figure 4.2: A first order measurement model for Safety Incidents/Accidents

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

Table 4.25: Goodness-of-fit values for safety incidents/accidents dimension

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 169.635 14 12.117 0.000 0.877 0.163 0.828 0.817 0.743 0.545
Model
Re-specified 20.882 12 1.740 0.052 0.986 0.042 0.990 0.977 0.983 0.559
Model

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4.4.4.2 Independent Variables
There are six independent variables in this study: (a) a supervisor’s leadership style; (b) the role
of the supervisor; (c) training and competence; (d) health and safety objectives; (e) management
commitment; and (f) safety reporting. The following shows the confirmatory factor analysis
(CFA) for all the independent variables.

i. The Supervisor’s Leadership Style

The supervisor’s leadership style dimension identified through the exploratory factor analysis
contained ten items. The results of the confirmatory factor analysis (CFA) for this dimension are
shown in Figure 4.3. The diagram shows the factor loading of each observed variable was from
0.85 to 0.92.

The CFA for this latent was conducted on the parceling level of analysis and established
according to randomly selected items from similar domains. Tables 4.26 in Appendix 16 shows
five parcels were created to represent the supervisor’s leadership style dimension.

error Observed/manifest variable Latent variable

e1 parstyle1
.91
e2 parstyle2 .85

.92 Leadership
e3 parstyle3 .88 Style
.24
.89
e4 parstyle4

e5 parstyle5

Figure 4.3: A first order measurement model for the supervisor’s leadership style

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

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 Table 4.27: Goodness-of-fit values for the supervisor’s leadership style dimension

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 18.431 5 3.686 0.002 0.982 0.080 0.994 0.991 0.987 0.496
Model
Re-specified 7.632 4 1.908 0.106 0.993 0.047 0.998 0.996 0.996 0.399
Model

Table 4.27 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only one
error term was permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 7.632, p < 0.00 (Figure 4.3).

ii. The Role of the Supervisor

The role of the supervisor dimension identified through the exploratory factor analysis contained
eight items. The results of the confirmatory factor analysis (CFA) for this dimension are shown
in Figure 4.4. The diagram shows the factor loading of each observed variable was from 0.77 to
0.92.

The CFA for this latent was conducted on the parceling level of analysis and established
according to randomly selected items from similar domains. Tables 4.28 in Appendix 16 shows
four parcels were created to represent the role of the supervisor dimension.

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 error Observed/manifest variable Latent variable

e1 parsuper1
.77
e2 parsuper2 .92
-.62
Role of
.92 Supervisor
e3 parsuper3 .89

e4 parsuper4

Figure 4.4: A first order measurement model for the role of the supervisor

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

Table 4.29: Goodness-of-fit values for the role of the supervisor dimension

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 22.420 2 11.210 0.000 0.976 0.156 0.984 0.983 0.953 0.328
Model
Re-specified 1.756 1 1.756 0.185 0.998 0.043 0.999 0.999 0.996 0.166
Model

Table 4.29 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only one
error term was permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 1.756, p < 0.000 (Figure 4.4).

99
iii. Training and Competence
The training and competence dimension identified through the exploratory factor analysis
contained six items, with two items from safety involvement dimension factored into this
dimension. The confirmatory factor analysis (CFA) for this latent was conducted on the
individual level of analysis where all the six observed items were analyzed with its latent and
errors. The results of the CFA for this dimension are shown in Figure 4.5. The diagram shows
the factor loading of each observed variable was from 0.54 to 0.86.

Table 4.30 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only three
error terms were permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 6.383, p < 0.000 (Figure 4.5).

Table 4.30: Goodness-of-fit values for the training and competence dimension

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 100.040 9 11.116 0.000 0.922 0.156 0.910 0.903 0.850 0.542
Model
Re-specified 6.383 6 1.064 0.382 0.995 0.012 1.000 0.994 0.999 0.398
Model

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 error Observed/manifest variable Latent variable

e1 training1

e2 training2 .86
.86
-.32 e3 training3 .57
-.42 .43 Training &
.61 Competence
e4 training4 .54
.68
e5 consul2

e6 consul3

Figure 4.5: A first order measurement model for training and competence

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

iv. Health and Safety Objectives

The safety objectives dimension identified through the exploratory factor analysis contained five
items. The confirmatory factor analysis (CFA) for this latent was conducted on the individual
level of analysis where all the five observed items were analyzed with its latent and errors. The
results of the CFA for this dimension are shown in Figure 4.6. The diagram shows the factor
loading of each observed variable was from 0.57 to 0.86.

Table 4.31 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only two

101
error terms were permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 3.371, p < 0.000 (Figure 4.6).

error Observed/manifest variable Latent variable

e1 goal1

.75
e2 goal2
.86

.80 Health & Safety

e3 goal3 Objectives
.80
.29
.57
e4 goal4
.23

e5 goal5
Figure 4.6: A first order measurement model for safety objectives
Latent constructs are shown in ellipses, and observed variables are shown in rectangles

Table 4.31: Goodness-of-fit values for safety objectives

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 29.479 5 5.896 0.000 0.973 0.108 0.978 0.974 0.956 0.487
Model
Re-specified 3.371 3 1.124 0.338 0.997 0.017 1.000 0.997 0.999 0.299
Model

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v. Management Commitment

The management commitment dimension identified through the exploratory factor analysis
contained five items, where one item from safety communication dimension was factored into
this dimension. The confirmatory factor analysis (CFA) for this latent was conducted on the
individual level of analysis where all the five observed items were analyzed with its latent and
errors. The results of the CFA for this dimension are shown in Figure 4.7. The diagram shows
the factor loading of each observed variable was from 0.48 to 0.85.

Table 4.32: Goodness-of-fit values for management commitment

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 30.330 5 6.066 0.000 0.973 0.110 0.949 0.940 0.899 0.470
Model
Re-specified 6.450 3 2.150 0.092 0.994 0.053 0.993 0.987 0.977 0.296
Model

Table 4.32 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only two
error terms were permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 6.450, p < 0.000 (Figure 4.7).

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 error Observed/manifest variable Latent variable

e1 manager3
.30
.53
e2 manager5
.66

.56 Management
e3 manager6 Commitment
.85

.48
e4 manager7
-.39

e5 comm7

Figure 4.7: A first order measurement model for management commitment

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

vi. Safety Reporting

The safety reporting dimension identified through the exploratory factor analysis contained five
items, where one item from work pressure dimension was factored into this dimension. The
confirmatory factor analysis (CFA) for this latent was conducted on the individual level of
analysis where all the five observed items were analyzed with its latent and errors. The results of
the CFA for this dimension are shown in Figure 4.8. The diagram shows the factor loading of
each observed variable was from 0.39 to 0.84.

Table 4.33 shows the hypothesized model that represents a poor fit. After taking into
consideration the modification indices (MI) suggestion for model fit improvement, only two

104
error terms were permitted to correlate within the same factor in this study where the re-specified
model was a better fit, χ2 = 3.927, p < 0.000 (Figure 4.8).

error Observed/manifest variable Latent variable

e1 report1

.84
e2 report2
.62
.41
.39
e3 report3 Safety Reporting
.65
.29
.44
e4 report4

e5 duty1

Figure 4.8: A first order measurement model for safety reporting

Latent constructs are shown in ellipses, and observed variables are shown in rectangles

Table 4.33: Goodness-of-fit values for safety reporting

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 66.132 5 13.226 0.000 0.947 0.171 0.887 0.880 0.774 0.440
Model
Re-specified 3.927 3 1.309 0.269 0.996 0.027 0.998 0.993 0.994 0.298
Model

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4.5 Descriptive Statistics for Safety Incidents/Accidents

Table 4.34 describes frequency of safety incidents/accidents in three hospitals. The findings
show that majority of the respondents (68%) reported that they witnessed accidents for the past
one month and 70% respondents witnessed near misses for the last thirty days. As for injury due
to moving or handling tasks, it was found that 64% informed that they did not have any injury
while doing those particular tasks. 79% respondents stated that they were not exposed to any
needlestick and sharp injuries while 73% of respondents revealed that they did not have any
injury due to slips, trips or falls. Majority of respondents (61%) told that they did not have any
injury due to exposure to dangerous substances and 74% of respondents described that they felt
unwell due to exposure to work related stress.

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Table 4.34: Descriptive statistics for safety incidents/accidents

Results Frequency (%)

N = 418 Frequency (%)
Witness incidents None 283 (67.7) NO 283 (67.7)
1-2 96 (23.0) ) )
3-5 33 (7.9) ) YES ) 135 (32.3)
6 - 10 5 (1.2) ) )
More than 10 1 (0.2) ) )
Witness near misses None 293 (70.1) NO 293 (70.1)
1-2 103 (24.6) ) )
3-5 17 (4.1) ) YES ) 125 (29.9)
6 - 10 4 (1.0) ) )
More than 10 1 (0.2) ) )
Injuries or unwell None 269 (64.4) NO 269 (64.4)
due to moving & 1-2 108(25.8) ) )
handling 3-5 32 (7.7) ) YES ) 149 (35.6)
6 - 10 8 (1.9) ) )
More than 10 1 (0.20) ) )
Needlestick & sharp None 331 (79.2) NO 331 (79.2)
injuries 1-2 69 (16.5) ) )
3-5 13 (3.1) ) YES ) 87 (20.8)
6 - 10 5 (1.2) ) )
More than 10 - ) )
Injuries or unwell None 305 (73.0) NO 305 (73.0)
due to slips, trips or 1 - 2 89 (21.3) ) )
falls 3-5 21 (5.0) ) YES ) 113 (27.0)
6 - 10 3 (0.7) ) )
More than 10 - ) )
Injuries or unwell None 258 (61.7) NO 258 (61.7)
due to exposure to 1-2 83 (19.9) ) )
dangerous 3-5 33 (7.9) ) YES ) 160 (38.3)
substances 6 - 10 24 (5.7) ) )
More than 10 20 (4.8) ) )
Injuries or unwell None 109(26.1) NO 109 (26.1)
due to exposure to 1-2 130 (31.1) ) )
work related stress 3-5 90 (21.5) ) YES ) 309 (73.9)
6 - 10 59 (14.1) ) )
More than 10 30 (7.2) ) )

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4.6 Hypotheses Testing

To determine the direct or indirect relationship of all variables, the hypotheses identified in this
study were tested using structural equation modeling (SEM) through AMOS version 4. Besides
SEM, a chi-square test of independence was carried out to answer objective 1 and logistic
regression analysis to identify support and barriers in objective 2.

4.6.1 Structural Model of the Instrument

A structural equation modeling (SEM) was used to test the model to determine whether the six
dimensions of health and safety management influenced the safety incident/accident and safety
satisfaction and feedback directly or indirectly. All items were computed into composite
variables to test the relationship between all independent variables and two dependent variables.
The results of the structural model are shown in Figure 4.9.

Table 4.35: Goodness-of-fit values for the structural model of the instrument

Model χ2 d.f. χ2/d.f. p-value GFI RMSEA CFI NFI TLI PNFI
Hypothesized 0.371 1 0.371 0.542 1.000 0.000 1.000 1.000 1.014 0.036
Model

Table 4.35 shows the initial model that represents a good fit, χ2 = 0.371 (Figure 4.9). Results
indicated a direct positive relationship between all six dimensions of health and safety
management (the role of the supervisor, the supervisor’s leadership style, health and safety
objectives, health and safety training, management commitment and safety reporting) with safety
satisfaction and feedback, and a direct negative relationship between four dimensions of health
and safety management (the role of the supervisor, health and safety objectives, management
commitment and safety reporting) and a positive relationship between two independent variables
(the supervisor’s leadership style and health and safety training) with safety incidents/accidents
(refer Table 4.36 in Appendix 16).

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 .37

SUPERVISOR
.34
.75
.08 .13
.16 STYLE r1
.01 1
.24 .17
.36
.07 -.12 SATISFYFEED
.20 .23 TRAINING
.28
.12
.15 .16
.21 .39
.16 .03 .27
.16 .14 OBJECTIVES r2
.17 -.06 1
.20 .21 .34
-.18
.15 COMMITMENT INCIDENT
-.02
.15 .33

REPORTING

Figure 4.9: Structural model of the instrument

4.6.2 Perception on Occupational Health and Safety Management Elements

Descriptive statistics particularly mean and chi-square analysis were used to determine the
perception of hospital employees regarding the health and safety management dimension with
two dependent variables: safety satisfaction and feedback; and safety incident/accident. These
analyses were used to answer the study’s objective 1: to investigate the perception of hospital
employees regarding the different elements of occupational health and safety (OHS)
management.

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4.6.2.1 Priorities of Employee’s Perception

Descriptive statistics were used to measure the elements of occupational health and safety
management that is perceived to be the most important among employees. Employee’s
perception of occupational health and safety management was measured by eight elements as
shown in Table 4.37. Among the elements, safety reporting element was perceived as fairly high
with a mean of 3.9 and a standard deviation of 0.58, while the safety incident/accident element
was perceived as rather low with a mean score of 1.58 and a standard deviation of 0.54. As
indicated by the survey results, the means of employees’ perception on occupational health and
safety practices were between the ranges of 1.58 to 3.9, thus indicating a mixture of “disagree” to
“almost agree”. The results indicated that the general view of the employees with regard to their
occupational health and safety practices were low.

Table 4.37: Priorities of employee’s perception on OHS management

Variables Mean SD
Safety reporting 3.89 0.57
Training & competence 3.69 0.59
Management commitment 3.54 0.58
Safety objectives 3.54 0.62
The role of the supervisor 3.51 0.60
The supervisor’s leadership style 3.10 0.86
*Safety satisfaction & feedback 3.52 0.50
*Safety incident/accident 1.57 0.53
* Dependent variables

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4.6.2.2 Relationships between Variables Using Crosstab with Chi-Square Analysis
The chi-square test of independence was utilized to investigate if two variables have
relationships (dependent) or no relationship (independent) where “significant” results meaning
that “we are able to reject the null hypothesis” and this significant result confirms that “there is
some relationship between the variables” (Tabachnick & Fidell, 2007). Although one of the
general rules of the chi-square test of independence is that there must be a minimum of five
observations expected in each cell, but this assumption has been violated in this study as the test
is not reliable test when numerous response variables are examined (Lavassani, Movahedi &
Kumar, 2009). Furthermore, “a standard (and conservative) rule of thumb (due to Cochran) is to
avoid using the chi-square test for contingency tables with expected cell frequencies less than 1,
or when more than 20% of the contingency table cells have expected cell frequencies less than 5”
(The University of North Texas Health Science Center, n.d.). However, surveys such as Larntz
(1978), Lewontin and Felsenstein (1965), Roscoe and Byars (1971), Slakter (1966), and Yarnold
(1970) revealed that the chi-square test is “generally applicable even if a significant proportion of
the expected values are less than 5” and based on Lewontin and Felsenstein (1965:31), “the chi-
square statistic will be correctly distributed as long as all of the expected values are 1 or greater”
(as cited in Hamilton, 2009).

Analysis was done in two stages. Stage 1 was between levels of education with nine variables
including safety satisfaction and feedback; training and competence; health and safety
objectives; the role of the supervisor; management commitment; safety reporting; the
supervisor’s leadership style; accidents; and injuries with gender as the control variable. Stage 2
comprised length of employment with nine variables including safety satisfaction and feedback;
training and competence; health and safety objectives; the role of the supervisor; management
commitment; safety reporting; the supervisor’s leadership style; accidents; and injuries with
gender as the control variable.

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i. Stage 1 analysis

Stage 1 consists of analysis between levels of education with nine variables with gender as the
control variable. Subjects were classified into three education levels: a high school education;
certificate or diploma education; and a university degree.

a. Gender, level of education and safety satisfaction and feedback

Table 4.38 in Appendix 17 indicates the relationship between three variables where the row is
the effect or dependent variable, the column is the causal or independent variable and control
variable, in this case, gender as there might be a relationship between safety satisfaction and
feedback and level of education for men and women.

About 47% of males with a school level of education were more likely to feel comfortable about
their satisfaction towards the safety system in their workplace. About 50% of females with a
school level of education were more likely to feel comfortable about their satisfaction towards
the safety system in their workplace.

Overall, it was seen that the findings for females were significant compared to males, and
females were more likely to feel comfortable about their satisfaction towards the safety system in
their workplace than were males. However, the significance reported for females is slightly
above the 0.05 level (0.096 to be exact) where χ2 = 7.894, df = 4, p < 0.10. This indicated that
there was a relationship or difference between these two variables for females and females with a
school level of education felt that their safety system was just acceptable.

b. Gender, level of education and training and competence

Table 4.39 in Appendix 17 shows the relationship between the level of education and training
and competence with gender as the control variable. About 50% of males with a school level of
education were more likely to feel that their safety training and competence was acceptable to
ensure a good health and safety management in their workplace. About 46% of females with a

112
certificate or diploma education level were more likely to feel that their safety training and
competence was acceptable to ensure a good health and safety management in their workplace.

Overall, it was seen that the findings for females were significant compared to males, and
females were more likely to feel training and competence were just satisfactory, where χ2 =
13.392, df = 4, p < 0.05. This indicated that there was a relationship or difference between these
two variables for females and females with a certificate and diploma education level felt that
safety training and competence in their workplace was just adequate to increase their knowledge
on health and safety matters.

c. Gender, level of education and health and safety objectives

Table 4.40 in Appendix 17 illustrates the relationship between the level of education and health
and safety objectives with gender as the control variable. About 49% of males with a school
level of education were more likely to feel that they understand the clear health and safety
objectives of their organizations to ensure a good commitment towards health and safety matters
in their workplace. About 45% of females with a school level of education were more likely to
feel that they were comfortable with the health and safety objectives of their organizations to
ensure a good commitment towards health and safety matters in their workplace.

Overall, it was seen that both male and female employees with a school level of education were
more likely to feel that they understand the clear health and safety objectives of their
organizations. However, the significance reported for males is slightly above the 0.05 level
(0.056 to be exact) where χ2 = 9.214, df = 4, p < 0.10 and significant chi-square reported for
female was χ2 = 11.385, df = 4, p < 0.05. This indicated a significant relationship or difference
existed between these two variables and that males and females with a school level of education
perceived that their health and safety objectives were understandable.

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d. Gender, level of education and the role of the supervisor

Table 4.41 in Appendix 17 demonstrates the relationship between the level of education and the
role of the supervisor with gender as the control variable. Overall, it was seen that both male
(42%) and female (48%) employees with a school level of education were more likely to
perceive that their supervisor’s role in health and safety matters was not up to expectation, where
no significant relationship or difference was shown between male and female subjects. This
indicated that there was no relationship between these two variables for both males and females
and that the employees with a school level of education perceived no difference about their
supervisor’s role in health and safety matters.

e. Gender, level of education and management commitment

Table 4.42 in Appendix 17 discloses the relationship between the level of education and
management commitment with gender as the control variable. Overall, it was seen that males
with a school level of education (49%) and females with a certificate and diploma level of
education (48%) were more likely to perceive that their manager’s commitment towards health
and safety matters was just satisfactory, and both p-values for males and females were not
significant. This indicated that there was no relationship between these two variables for both
males and females and males with a school level of education and females with a certificate and
diploma level of education perceived no difference about their management commitment
towards health and safety matters.

f. Gender, level of education and safety reporting

Table 4.43 in Appendix 17 displays the relationship between the level of education and safety
reporting with gender as the control variable. Overall, it was seen that males with a school level
of education (42%) and females with a certificate and diploma level of education (54%) were
more likely to perceive that their safety reporting system is effective. However, the significance
reported for males and females were slightly above the 0.05 level (to be exact 0.098 for males
and 0.082 for females), where p < 0.10. This indicated that there was a relationship or difference
between these two variables for both males and females and that the employees perceived no
difference about their safety reporting system.

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g. Gender, level of education and the supervisor’s leadership style

Table 4.44 in Appendix 17 expresses the relationship between the level of education and the
supervisor’s leadership style with gender as the control variable. Overall, it was seen about 72%
of males with a school level of education perceived that their leader did not show any
involvement in health and safety matters compared to the females, where the chi-square =
20.492, df = 4, p < 0.000. This indicated that there was a relationship between these two
variables for males and males with a school level of education perceived that their supervisor did
not guide employees regarding health and safety matters in their workplace. As for the females
(52%), no significant results were found.

h. Gender, level of education and accidents

Table 4.45 in Appendix 17 exhibits the relationship between the level of education and accidents
with gender as the control variable. Overall, it was found that 52% of females with a school level
of education perceived that accidents or near-misses have not occurred in the past thirty days
compared to males, where results were significant, the chi-square = 6.711, df = 2, p < 0.05. This
indicated that there was a relationship between these two variables for females and females with
a school level of education perceived that accidents or near-misses had not occurred for the past
thirty days. As for the males (45%), no significant results were found.

i. Gender, level of education and injuries

Table 4.46 in Appendix 17 reveals the relationship between the level of education and injuries
with gender as the control variable. Overall, it was found that the test was not significant for both
males and females. This indicated that there was no relationship between these two variables and
both males (47%) and females (48%) with a school level of education perceived no difference
about injuries like needlestick and sharp injuries; slipping, tripping or falling; moving and
handling; exposure to substances; and work stress that they experienced for the past twelve
months.

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ii. Stage 2 analysis

Stage 2 consists of analysis between lengths of employment with nine variables with gender as
the control variable. Subjects were classified into four lengths of employment: less than or equal
to 2 years; 2.1 to 6 years; 6.1 to 15 years; and 15.1 years and above.

a. Gender, length of employment and safety satisfaction and feedback

Table 4.47 in Appendix 17 shows the relationship between the length of employment and safety
satisfaction and feedback with gender as the control variable. Overall, it was found that the test
was not significant for both males and females with p-value more than 0.05. This indicated that
there was no relationship between these two variables for males and females. Males with a length
of employment from 2.1 to 6 years (35%) and females with a length of employment from 15.1
years onwards (28%) perceived no difference towards the safety system in their workplace and
were comfortable with their safety system.

b. Gender, length of employment and training and competence

Table 4.48 in Appendix 17 reveals the relationship between the length of employment and
training and competence with gender as the control variable. Overall, it was found that 37% of
males with a length of employment from 2.1 to 6 years perceived that they were comfortable
with their safety training in the workplace compared with the females, where the chi-square =
16.740, df = 6, p < 0.05. This indicated that there was a relationship or difference between these
two variables for males and males with a length of employment from 2.1 to 6 years (37%)
perceived that their safety training was acceptable to ensure a good health and safety
management in their workplace. As for the females (28%), no significant results were found.

c. Gender, length of employment and the role of the supervisor

Table 4.49 in Appendix 17 demonstrates the relationship between the length of employment and
the role of the supervisor with gender as the control variable. Overall, it was found that the test
was not significant with a p-value more than 0.05. This indicated that there was no relationship

116
between these two variables where both males and females perceived no difference of their
supervisor’s role to maintain the health and safety matters in their workplace although males
with a length of employment from 2.1 to 6 years (35%) and females with a length of employment
from 15.1 years and above (27%) perceived that they were comfortable with their supervisor’s
role in managing health and safety issues in the workplace.

d. Gender, length of employment and health and safety objectives

Table 4.50 in Appendix 17 illustrates the relationship between the length of employment and
health and safety objectives with gender as the control variable. Overall, it was found that the test
was significant, where for males with a length of employment from 2.1 to 6 years, the chi-square
= 14.200, df = 6, p < 0.05 and for females with a length of employment of less than or equal to 2
years, the chi-square = 16.196, df = 6, p < 0.05. This indicated that there was a relationship
between these two variables among both gender where males (40%) and females (29%)
perceived differently of their health and safety objectives in the workplace.

e. Gender, length of employment and management commitment

Table 4.51 in Appendix 17 explains the relationship between the length of employment and
management commitment with gender as the control variable. Overall, it was found that the test
was only significant for males (33%) with a length of employment from 2.1 to 6 years, where the
chi-square = 14.614, df = 6, p < 0.05 and not significant for females (27%) with a length of
employment from 15.1 years and above. This indicated that there was a relationship between
these two variables for males, for they perceived differently than females regarding management
commitment showed by their superior.

f. Gender, length of employment and safety reporting

Table 4.52 in Appendix 17 shows the relationship between the length of employment and safety
reporting with gender as the control variable. Overall, it was found that the test was not
significant for both males (33%) with a length of employment from 2.1 to 6 years and females
(31%) with a length of employment from 15.1 years and above, with p-values more than 0.05.

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This indicated that there was no relationship between these two variables where both males and
females perceived no difference of the safety reporting system in their workplace.

g. Gender, length of employment and the supervisor’s leadership style

Table 4.53 in Appendix 17 displays the relationship between the length of employment and the
supervisor’s leadership style with gender as the control variable. Overall, it was found that the
test was not significant for both genders with p-values more than 0.05. This indicated that there
was no relationship between these two variables where both males (41%) and females (27%)
perceived no difference of the leadership style shown by their superior, although 41% of males
with a length of employment from 2.1 to 6 years perceived that their supervisor did not lead them
in managing health and safety issues while 27% of females with a length of employment from
15.1 years and above perceived that their supervisor rarely directed them in health and safety
issues.

h. Gender, length of employment and accidents

Table 4.54 in Appendix 17 presents the relationship between the length of employment and
accidents with gender as the control variable. Overall, it was found that the test was not
significant for both males and females with p-values more than 0.05. This indicated that there
was no relationship between these two variables where both males and females perceived no
difference about the occurrence of accidents or near-misses in the past thirty days although 28%
of males and 34% of females with employment of 15.1 years and above perceived that they had
not witnessed any occurrence of accidents or near-misses in the past thirty days.

i. Gender, length of employment and injuries

Table 4.55 in Appendix 17 reveals the relationship between the length of employment and
injuries with gender as the control variable. Overall, it was found that the test was not significant
for males (35%) and significant for females with the chi-square = 9.325, df = 3, p < 0.05. This
indicated that there was a relationship between these two variables where 28% of females with
employment of 15.1 years and above perceived that they experienced injuries like needlestick

118
and sharp injuries; slips, trips or falls; moving and handling; exposure to substance; and work
stress for the past twelve months.

iii. Summary of the chi-square analysis regarding perception on the health and safety
management elements
The first analysis as in Table 4.56 in Appendix 17 was done between levels of education, nine
dimensions of health and safety management, and gender. Level of education was classified into
three: high school, certificate and diploma, and university degree education. Overall analysis
showed that significant results were found among female employees with a school level, and
certificate and diploma education. As for males, only those with a school level of education were
found significant.

Female employees with a school level of education perceived that safety satisfaction, health and
safety objectives, and accident prevention are important variables of the health and safety
management dimension while female employees with a certificate and diploma level perceived
that training and competence and safety reporting are important variables of the health and safety
management dimension. As for male employees with a school level education, they perceived
that health and safety objectives, safety reporting, and leadership style are important variables of
the health and safety management dimension.

The second analysis as in Table 4.57 in Appendix 17 was done between the length of
employment, nine dimensions of health and safety management, and gender. Length of
employment was classified into four: less than or equal to 2 years; 2.1 to 6 years; 6.1 to 15
years; and 15.1 years and above. Overall analysis showed significant results among female
employees with less than or equal to 2 years, and 15.1 years and above of employment. As for
males, only those with 2.1 to 6 years of employment were found significant.

Female employees with less than or equal to 2 years of employment perceived that health and
safety objectives is an essential variable of the health and safety management dimension while
female employees with 15.1 years and above perceived that injury prevention is an essential

119
variable of the health and safety management dimension. As for male employees with 2.1 to 6
years of employment, they perceived that training and competence, health and safety objectives,
and management commitment are essential variables of the health and safety management
dimension.

4.6.3 Elements of OHS Management that Support or Hinder the Implementation of the
OHS Management System

Logistic regression was utilized to investigate which elements of OHS management prevent or
support the implementation of the OHS management system in Malaysian public hospitals. The
purpose of logistic regression is to accurately predict the category of outcome for individual
cases using the most parsimonious model through incorporating all predictor variables that are
useful in predicting the response variable.

A reduced model was developed using three types of elimination test in logistic regression: enter,
forward and backward. The process started with the full model (all independent variables
included) and proceeded for possible elimination using the “enter” method. The forward and
backward methods were also applied and results compared with the enter method. For the final
model, only those predictors from the three steps that can significantly predicted the dependent
variable were chosen for analysis. This is because the final model is more efficient and
parsimonious version of the full model (Bowie, 2006). Menard (2002) stated that stepwise or
backward procedures have been accepted widely in purely predictive research and exploratory
research (as cited in Bowie, 2006). Backward elimination reduces the risk of failing to find a
relationship when one exists (Menard, 2002, as cited in Bowie, 2006, p. 55). In stepwise logistic
regression variables are entered or removed based on their importance (Menard, 2002, as cited in
Bowie, 2006, p. 55).

The following significance tests can be used in binary logistic regression: the Omnibus Tests of
Model Coefficients, and Hosmer and Lemeshow chi-square test of goodness of fit. The Hosmer
and Lemeshow test (also called the chi-square test) is the recommended test for an overall fit
model due to its robustness rather than the traditional chi-square test (Garson, 2009). A non-

120
significant result (p > 0.05) can be concluded as the model adequately fits the data. The
Omnibus Tests of Model Coefficients states the significance level by the traditional chi-square
method (Garson, 2009). A significant result (p < 0.05) indicated that the model adequately fits
the data, where at least one of the predictors is significantly associated with the dependent
variable.

This study intends to determine to what extent the independent variables may have an impact on
the dependant variables: safety satisfaction and feedback, and safety incident/accident: accidents
and injuries. The measurement of outcome variables: safety satisfaction and feedback, and safety
incident/accident: accidents and injuries were modified to dichotomous variables, and for that
reason, a logistic regression was performed to answer this study’s objective 2: to determine
whether the perception of OHS management elements prevent or support the implementation of
the OHS management system in Malaysian public hospitals.

i. Safety satisfaction and feedback

The first dependent variable in this study was safety satisfaction and feedback. The dimension
had two dichotomous measures: 0 = not satisfied with the safety system and 1 = satisfied with
the safety system. The “0” level of the dependent was used as the reference value and the “1”
level as predicted value. Twelve independent variables including the role of the supervisor, the
supervisor’s leadership style, training and competence, safety reporting, management
commitment, safety objectives, age, gender, ethnicity, education level, job position, and length of
employment were considered in the logistic regression models.

The “enter” method of logistic regression model was first estimated with the twelve factors (the
role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

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Table 4.58 in Appendix 18 concludes the “enter” method of logistic regression analysis. Four
predictors (education level: university degree; health and safety objective; management
commitment and safety reporting) made a statistically significant contribution in explaining the
variance in safety satisfaction and feedback. Employees who were satisfied with the safety
system in the hospitals predicted that a university degree level of education (25%); health and
safety objective (slightly more than 5 times); management commitment (almost 2 times); and
safety reporting (slightly over 1.5 times) compared with employees who were not satisfied with
the safety system. The results of the Omnibus Tests of Model Coefficients “goodness of fit” for
this “enter” model was a chi-square value of 139.657, df = 18, p-value = 0.000. The results of
significance can be concluded that there was an adequate fit of the data to the model. The
Hosmer and Lemeshow test showed a non-significance result, where the chi-square = 8.086, df =
8, p-value = 0.425. It can be concluded that the model sufficiently fits the data.

In the second step, a “forward stepwise” (likelihood ratio) was estimated using the twelve factors
(the role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

Table 4.59 in Appendix 18 shows the “forward stepwise” method of logistic regression analysis.
Five predictors (education level: school level; education level: certificate and diploma level;
health and safety objective; management commitment; and safety reporting) made a statistically
significant contribution in explaining the variance in safety satisfaction and feedback.
Employees who were satisfied with the safety system in the hospitals predicted that university
degree (22%); health and safety objective (over 5 times); management commitment (over 2
times); and safety reporting (slightly over 2 times) compared to those employees that were not
satisfied with the safety system. The results of the Omnibus Tests of Model Coefficients
“goodness of fit” for this “forward” model was a chi-square = 127.259, df = 5, p-value = 0.000.
The results of significance can be concluded that there was adequate fit of the data to the model.
The Hosmer and Lemeshow test showed a significant result, where the chi-square = 15.907, df =
8, p-value = 0.044. It can be concluded that the model did not adequately fit the data.

122
In the third step, a “backward stepwise” (likelihood ratio) was estimated using the twelve factors
(the role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

Table 4.60 in Appendix 18 shows the “backward stepwise” method of logistic regression
analysis. Four predictors (education level: university degree; health and safety objective;
management commitment; and safety reporting) made a statistically significant contribution in
explaining the variance in safety satisfaction and feedback. Employees who were satisfied with
the safety system in the hospitals predicted that university degree of education level (26%);
health and safety objective (almost 6 times); management commitment (almost 2 ½ times); and
safety reporting (slightly over 2 times) compared to those employees who were not satisfied with
the safety system. The results of the Omnibus Tests of Model Coefficients “goodness of fit” for
this “backward” model was a chi-square = 130.019, df = 6, p-value = 0.000. The results of
significance can be concluded that there was adequate fit of the data to the model. The Hosmer
and Lemeshow test showed a non-significance result, where the chi-square = 8.532, df = 8, p-
value = 0.383. It can be concluded that the model adequately fits the data. In the last step, an
“enter” method was estimated using the four factors (education level, health and safety
objectives, management commitment, and safety reporting) as predictors. The categorical data
was put in “first to last order”.

Table 4.61 in Appendix 18 illustrates the final model using the “enter” method logistic
regression analysis. Four predictors (education level: university degree; health and safety
objective; management commitment; and safety reporting) made a statistically significant
contribution in explaining the variance in safety satisfaction and feedback. Employees whose
education was at university level were almost 22% more likely to be satisfied with the safety
system in the hospitals compared to employees who were not satisfied with the safety system.
Employees who complied with the health and safety objectives in their workplaces were almost
5.5 times likely to be satisfied with the safety system in the hospitals compared to employees

123
who were not satisfied with the safety system. Employees who perceived that their management
team demonstrated positive and higher commitment towards health and safety in their
workplaces were almost 2.5 times more likely to be satisfied with the safety system in the
hospitals compared to employees who were not satisfied with the safety system. Employees who
always comply with safety reporting procedures were found to be slightly over 2 times more
likely to be satisfied with the safety system in the hospitals compared to employees who were not
satisfied with the safety system. The results of the Omnibus Tests of Model Coefficients
“goodness of fit” for this “enter” model was a chi-square = 127.259, df = 5, p-value = 0.000. The
results of significance can be concluded that there was an adequate fit of the data to the model.
The Hosmer and Lemeshow test showed a significant result, where a chi-square = 15.907, df = 8,
p-value = 0.044. It can be concluded that the model did not adequately fit the data.

Overall, it was seen that only four variables significantly predicted the variance in “safety
satisfaction and feedback”. Thus the formula to be developed from this model is:

Z = b0 + b1X1 + b2X2 + b3X3 + b4X4

Logit (Safety satisfaction and feedback) = -12.523 - 1.496 (education level: university degree) +
1.669 (health and safety objectives) + 0.826 (management commitment) + 0.713 (safety
reporting).

ii. Safety incident/accident: Accidents

The second dependent variable in this study was accidents. The dimension had two dichotomous
measures: 0 = witness no accident and near misses and 1 = witness an accident and near misses.
The “0” level of the dependent was used as the reference value and the “1” level as predicted
value. Twelve independent variables including the role of the supervisor, the supervisor’s
leadership style, training and competence, safety reporting, management commitment, safety
objectives, age, gender, ethnicity, education level, job position, and length of employment were
considered in the logistic regression models.

124
In the first step, the “enter” method of logistic regression model was estimated with the twelve
factors (the role of the supervisor, the supervisor’s leadership style, training and competence,
safety reporting, management commitment, safety objectives, age, gender, ethnicity, education
level, job position, and length of employment) as predictors. The categorical data was put in
“first to last order”.

Table 4.62 in Appendix 18 displays the “enter” method logistic regression analysis. Three
predictors (the role of the supervisor; the supervisor’s leadership style; and management
commitment) made a statistically significant contribution in explaining the variance in accidents.
Employees who had witnessed no accident predicted that the role of the supervisor (slightly more
than 50%); the supervisor’s leadership style (almost 1.5 times); and management commitment
(slightly more than 50%) were important to ensure excellent conditions of health and safety
matters compared to employees who had witnessed an incident. The results of the Omnibus Tests
of Model Coefficients “goodness of fit” for this “enter” model was a chi-square = 36.604, df =
18, p-value = 0.006. The results of significance can be concluded that the data adequately fits to
the model. The Hosmer and Lemeshow test showed a non-significance result, where a chi-square
= 6.810, df = 8, p-value = 0.557. It can be concluded that the model sufficiently fits the data.

In the second step, a “forward stepwise” (likelihood ratio) was estimated using the twelve factors
(the role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

Table 4.63 in Appendix 18 shows the “forward stepwise” method of logistic regression analysis.
One predictor (management commitment) made a statistically significant contribution in
explaining the variance in accidents. Employees who had witnessed no incident/accident
predicted that committed management (almost 60%) are important to ensure excellent
conditions of health and safety matters compared to employees who had witnessed an
incident/accident. The results of the Omnibus Tests of Model Coefficients “goodness of fit” for
this “enter” model was a chi-square = 16.360, df = 1, p-value = 0.000. The results of significance

125
can be concluded that there was an adequate fit of the data to the model. The Hosmer and
Lemeshow test showed a significant result, where a chi-square = 13.089, df = 6, p-value =
0.042. It can be concluded that the model did not adequately fit the data.

In the third step, a “backward stepwise” (likelihood ratio) was estimated using the twelve factors
(the role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

Table 4.64 in Appendix 18 shows the “backward stepwise” method of logistic regression
analysis. Three predictors (the role of the supervisor; the supervisor’s leadership style; and
management commitment) made a statistically significant contribution in explaining the variance
in accidents. Employees who had witnessed no accident predicted that the role of the supervisor
(almost 60%); leadership style (almost 1.5 times); and committed management (slightly over
50%) were important to ensure excellent conditions of health and safety matters compared to
employees who had witnessed an accident. The results of the Omnibus Tests of Model
Coefficients “goodness of fit” for this “enter” model was a chi-square = 22.696, df = 4, p-value =
0.000. The results of significance can be concluded that there was an adequate fit of the data to
the model. The Hosmer and Lemeshow test showed a non-significance result, where the chi-
square = 4.286, df = 8, p-value = 0.830. It can be concluded that the model adequately fits the
data.

In the last step, an “enter” method was estimated using the three factors (the role of the
supervisor, leadership style, and management commitment) as predictors. Table 4.65 in
Appendix 18 illustrates the final model using the “enter” method logistic regression analysis.
Three predictors (the role of the supervisor, leadership style, and management commitment)
made a statistically significant contribution in explaining the variance in accidents. Employees
who perceived the involvement of supervisors in health and safety matters were almost 60%
more likely to have no accidents in the workplace compared to employees who perceived their
supervisor not to be involved in health and safety matters. Employees who perceived fair

126
leadership style in managing health and safety matters were almost 1.5 times more likely to
reduce accidents in the workplace compared to employees who perceived that leadership style is
not fair. Employees who perceived their management were committed in health and safety
matters were slightly over 50% more likely to have no accidents in the workplace compared to
those who perceived their management not committed in health and safety matters. The results
of the Omnibus Tests of Model Coefficients “goodness of fit” for this “enter” model was a chi-
square = 22.696, df = 3, p-value = 0.000. The results of significance can be concluded that there
was an adequate fit of the data to the model. The Hosmer and Lemeshow test showed a non-
significance result, where the chi-square = 9.086, df = 8, p-value = 0.335. It can be concluded
that the model adequately fits the data.

Overall, it was seen that only three variables were significantly predicted the variance in
accidents. Thus the formula to be developed from this model is:

Z = b0 + b1X1 + b2X2 + b3X3

Logit (Accidents) = 2.470 - 0.514 (the role of the supervisor) + 0.369 (leadership style) - 0.643
(management commitment).

iii. Safety incident/accident: Injury

The third dependent variable in this study was injury. The dimension had two dichotomous
measures: 0 = had no injury and 1 = had an injury. The “0” level of the dependent was used as
the reference value and the “1” level as predicted value. Twelve independent variables were
considered in the logistic regression models.

In the first step, the “enter” method logistic regression model was estimated with the twelve
factors (the role of the supervisor, the supervisor’s leadership style, training and competence,
safety reporting, management commitment, safety objectives, age, gender, ethnicity, education
level, job position, and length of employment) as predictors. The categorical data was put in
“first to last order”.

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Table 4.66 in Appendix 18 displays the “enter” method of logistic regression analysis. Five
predictors (gender: female; length of employment: 2.1 – 6 years; length of employment: 6.1 – 15
years; the role of the supervisor; and management commitment) made a statistically significant
contribution in explaining the variance in injuries. Employees who had experienced an injury
predicted that gender: female (almost 2 times); length of employment: 2.1 – 6 years (slightly
over 4 times); length of employment: 6.1 – 15 years (almost 2.6 times); the role of the supervisor
(slightly more than 50%) and management commitment (slightly over 60%) compared to those
employees that had not experienced an injury. The results of the Omnibus Tests of Model
Coefficients “goodness of fit” for this “enter” model was a chi-square = 36.007, df = 18, p-value
= 0.007. The results of significance can be concluded that the data was adequately fit to the
model. The Hosmer and Lemeshow test showed a non-significance result, where the chi-square =
2.999, df = 8, p-value = 0.934. It can be concluded that the model sufficiently fits the data.

In the second step, a “forward stepwise” (likelihood ratio) was estimated using the twelve factors
as predictors. The categorical data was put in “first to last order”.

Table 4.67 in Appendix 18 shows the “forward stepwise” method logistic regression analysis.
Three predictors (length of employment: 2.1 – 6 years; length of employment: 6.1 – 15 years;
and management commitment) made a statistically significant contribution in explaining the
variance in injuries. Employees who had experienced an injury predicted that “length of
employment: 2.1 – 6 years” (almost 3 times); “length of employment: 6.1 – 15 years” (slightly
over 2 times); and management commitment (slightly over 50%) compared to employees who
had not experienced an injury. The results of the Omnibus Tests of Model Coefficients
“goodness of fit” for this “enter” model was a chi-square = 20.432, df = 4, p-value = 0.000. The
results of significance can be concluded that there was an adequate fit of the data to the model.
The Hosmer and Lemeshow test showed a non-significance result, where the chi-square = 7.147,
df = 8, p-value = 0.521. It can be concluded that the model adequately fits the data.

In the third step, a “backward stepwise” (likelihood ratio) was estimated using the twelve factors
(the role of the supervisor, the supervisor’s leadership style, training and competence, safety
reporting, management commitment, safety objectives, age, gender, ethnicity, education level,

128
job position, and length of employment) as predictors. The categorical data was put in “first to
last order”.

Table 4.68 in Appendix 18 shows the “backward stepwise” method of logistic regression
analysis. Four predictors (gender: female; length of employment: 2.1 – 6 years; length of
employment: 6.1 – 15 years; and the role of the supervisor) made a statistically significant
contribution in explaining the variance in injuries. Employees who had experienced an injury
predicted that “gender: female” (almost 2 times); “length of employment: 2.1 – 6 years” (almost
3.5 times); “length of employment: 6.1 – 15 years” (slightly over 2 times); and the role of the
supervisor (slightly over 60%) compared to those employees who had not experienced an injury.
The results of the Omnibus Tests of Model Coefficients “goodness of fit” for this “enter” model
was a chi-square = 27.224, df = 7, p-value = 0.000. The results of significance can be concluded
that there was an adequate fit of the data to the model. The Hosmer and Lemeshow test showed a
significant result, where the chi-square = 16.039, df = 8, p-value = 0.042. It can be concluded
that the model did not adequately fit the data.

For the final step, an “enter” method was estimated using the three factors (gender, length of
employment, and the role of the supervisor) as predictors. The categorical data was put in “first
to last order”. Table 4.69 in Appendix 18 illustrates the final model using the “enter” method of
logistic regression analysis. Four predictors (gender: female; length of employment: 2.1 – 6
years; length of employment: 6.1 – 15 years; and the role of the supervisor) made a statistically
significant contribution in explaining the variance in injuries. Female employees were almost 2
times more likely to experience an injury compared to male employees. Employees who worked
from 2.1 to 6 years in the hospital were almost 3.5 times more likely to experience an injury
compared to other senior employees who are regularly exposed to health and safety matters.
Employees who worked from 6.1 to 15 years in the hospital were slightly over 2 times more
likely to experience an injury compared to other employees who are regularly exposed to their
health and safety matters. Employees who perceived supervisors involved in health and safety
matters were slightly over 60% more likely to have met an injury in the workplace compared to
employees who perceived their supervisors not involved in health and safety matters. The results
of the Omnibus Tests of Model Coefficients “goodness of fit” for this “enter” model was a chi-

129
square = 27.224, df = 6, p-value = 0.000. The results of significance can be concluded that there
was an adequate fit of the data to the model. The Hosmer and Lemeshow test showed a non-
significance result, where the chi-square = 6.877, df = 8, p-value = 0.550. It can be concluded
that the model adequately fits the data.

Overall, it was seen that only four variables were significantly predicted the variance in
“injuries”. Thus the formula to be developed from this model is:

Z = b0 + b1X1 + b2X2 + b3X3 + b4X4

Logit (Injuries) = 3.834 + 0.596 (gender: female) + 1.184 (length of employment: 2.1 to 6
years) + 0.722 (length of employment: 6.1 to 15 years) - 0.501 (the role of the supervisor).

iv. Summary of logistic regression analysis

Table 4.70 in Appendix 18 illustrates the summary of the logistic regression analysis. The
results show that three dependent variables were analysed with all independent variables. It was
found that only four independent variables (education level: university degree, health and safety
objectives, management commitment, and safety reporting) made a statistically significant
contribution in explaining the variance in safety satisfaction and feedback.

It was found that only three independent variables (the role of the supervisor, the supervisor’s
leadership style, and management commitment) made a statistically significant contribution in
explaining the variance in accidents.

It was found that only four independent variables (gender: female, length of employment: 2.1 – 6
years, length of employment: 6.1 – 15 years, and the role of the supervisor) made a statistically
significant contribution in explaining the variance in injuries.

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4.6.4 Summary of Hypothesis Testing Results

Table 4.71 shows the summary of the overall hypothesis testing of this study.

Table 4.71: Summary of hypothesis testing results

Objective 1 Hypothesis Supported Rejected

to investigate H1a: The presence of health • Safety satisfaction • The role of the
the perception of and safety & feedback supervisor
hospital management • Training & • Management
employees elements will have an competence commitment
regarding the association with the • Health & safety • Injuries
different level of education objectives
elements of and gender. • Safety reporting
OHS • Leadership style
management • Accidents
H1b: The presence of health • Training & • Safety satisfaction
and safety competence & feedback
management • Health & safety • The role of the
elements will have an objectives supervisor
association with the • Management • Safety reporting
length of employment commitment • Leadership style
and gender. • Injuries • Accidents

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 Objective 2 Hypothesis Safety satisfaction & feedback

Supported Rejected

to examine whether H2a: Health and safety • Health & safety • The role of the
the elements of OHS management objectives supervisor
management are elements and • Management • Leadership style
viewed as supportive demographic commitment • Training &
or preventive factors characteristics have • Safety reporting competence
to the a significant • Education level: • Gender: Male &
implementation of relationship with University degree Female
OHS management satisfaction towards • Education level:
system in Malaysian safety systems in the school level,
public hospitals workplace. certificate &
diploma
• All types of age
• All types of
ethnicity
• All types of job
position
• All types of
length of
employment

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 Objective 2 Hypothesis Accidents

Supported Rejected

to examine whether the H2b: Health and safety • The role of • Health &
elements of OHS management elements the supervisor safety
management are and demographic • Leadership objectives
viewed as supportive characteristics have a style • Safety
or preventive factors to significant relationship • Management reporting
the implementation of with accidents in the commitment • Training &
OHS management workplace. competence
system in Malaysian • Gender: Male
public hospitals & Female
• All types of
education
level
• All types of
age
• All types of
ethnicity
• All types of
job position
• All types of
length of
employment

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 Objective 2 Hypothesis Injuries

Supported Rejected

to examine whether H2c: Health and safety • The role of • Health & safety
the elements of OHS management supervisor objectives
management are elements and • Gender: • Safety reporting
viewed as supportive demographic Female • Training &
or preventive factors characteristics have • Length of competence
to the a significant employment: • Leadership style
implementation of relationship with 2.1 – 6 years • Management
OHS management injuries in the • Length of commitment
system in Malaysian workplace. employment: • Gender: Male
public hospitals 6.1 – 15 years • All types of
education level
• All types of age
• All types of
ethnicity
• All types of job
position
• Length of
employment: Less
than or equal to 2
years
• Length of
employment: 15.1
years & above

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 Objective 2 Hypothesis Supported Rejected

to examine whether H3: All the independent Yes

the elements of OHS variables (the
management are supervisor’s leadership
viewed as supportive style, the role of the
or preventive factors supervisor, management
to the implementation commitment, training
of OHS management and competence, health
system in Malaysian and safety objectives,
public hospitals and safety reporting)
will have a direct
relationship with the
dependent variables
(safety satisfaction and
feedback, and safety
incident/accident)

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4.7 Strategies to ascertain the appropriateness and effectiveness of an OHSMS
implementation

Based on the analysis of the hypotheses, Figure 4.10 is an approach that can be used to
implement an occupational health and safety management system effectively. From this
approach, some strategies are recommended to effectively implement the OHS
management systems. These are to answer objective 3 of the study: to recommend
practical strategies for the development and implementation of effective OHS
management system in Malaysian public hospitals.

Figure 4.10 is a proposal that consists of various phases in implementing a successful OHSMS.
The phases are: (1) OHS outcome from this study’s findings; (2) Establishment of safe person,
safe place and safe system strategies; (3) Determination of OHSMS elements for implementation
priority; and (4) Implementation and development of OHSMS elements; and (5) Safety audit or
safety review.

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 OHS OUTCOMES
Review on general OHS status
and current OHS status including
(1) existing safety management
practices and (2) supports and
barriers of safety management
practices
Safety audit
or
Safety review

Establishment of safe person, safe

place and safe system strategies
through “Plan-Do-Check-Act”
model

Implementation and
Determination of OHSMS
development of OHSMS
elements for
elements
implementation priority

Sequence

Feedback Information

Figure 4.10: Conceptual framework for the review on the implementation of OHSMS
(Partly adapted from Law, Chan & Pun, 2006)

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4.7.1 OHS Status

Tables 4.72 (a) – (d) describe the findings of the overall OHS status in the state hospitals.
From Table 4.72 (a), about 68% of the respondents emphasized that they were not satisfied with
the effectiveness of various safety systems in their workplace. From Table 4.72 (b), the survey
noted that almost 83% of the respondents perceived that incident/accident (i.e. accidents and
injuries) happened in their organization. Tables 4.72 (c and d) also demonstrate whether
employees had witnessed any accidents and near misses over the past one month and
experienced injuries over the past twelve months. With regard to accidents and near misses,
Table 4.72 (c) shows about 39% had witnessed occasional accidents and near misses in the past
one month while Table 4.72 (d) reveals that about 80% of the respondents experienced injuries
during the past twelve months.

Table 4.72 (a): OHS status: Satisfaction towards safety systems

Not satisfied Satisfied Total

Safety satisfaction 285 (68.2%) 133 (31.8%) 418
and feedback

Table 4.72 (b): OHS status: Safety incidents/accidents

No incidents There are incidents Total

Safety 72 (17.2%) 346 (82.8%) 418
incident/accident

Table 4.72 (c): OHS status: Accidents and near misses

No Yes Total
Witness accidents 255 (61%) 163 (39%) 418
and near misses

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 Table 4.72 (d): OHS status: Injuries

None Yes Total

Experienced injuries 85 (20.3%) 333 (79.7%) 418

Existing health and safety management practices were used as a measure for OHS management.
The results for the specific OHS status were:

i. Female employees with a school level of education perceived that safety satisfaction,
health and safety objectives, and accident prevention are important variables of the health
and safety management dimension.
ii. Female employees with a certificate and diploma level of education perceived that
training and competence and safety reporting are important variables of the health and
safety management dimension.
iii. Male employees with a school level of education perceived that health and safety
objectives, safety reporting, and leadership style are important variables of the health and
safety management dimension.
iv. Female employees with employment of less than or equal to 2 years perceived that health
and safety objectives is an essential variable of the health and safety management
dimension.
v. Female employees with employment of 15.1 years and above perceived that injury
prevention is an essential variable of the health and safety management dimension.
vi. Male employees with employment of 2.1 to 6 years perceived that training and
competence, health and safety objectives, and management commitment are essential
variables of the health and safety management dimension.

In sum, based on the perceptions of the respondents, it was discovered that:

i. Accidents and injury procedures must be reviewed from time to time to ensure a free-
accident-and-injury working place is realized.
ii. The leadership style and role of the supervisor should be emphasized to ensure that
leaders are more involved in health and safety matters in the workplace.

139
iii. Management commitment is critical in revealing effective management of OHS in the
workplace.
iv. Health and safety objectives and safety reporting procedures should be reviewed
periodically to ensure effective OHS management.
v. Safety training should be given to all employees to ensure they are alert and take
precautious in any aspects of health and safety to ensure hazards and risks are eliminated
or reduced while performing work.

Some of the reasons for this dissatisfaction based on the open-ended question (refer Table 4.73 in
Appendix 19) were:

i. No continuous education and training on OHS

ii. Lack of awareness training

iii. Personal protective equipment (PPE) not of good quality

iv. Hospital environment not conducive for effective working

v. Sharing of OSH information is lacking

vi. Workstation design not comfortable

vii. Ergonomic issues are on the increase

viii. The role of a supervisor is not consistent

ix. No effective safety communication

x. Exposure to dangerous substances without enough protection

xi. Cooperation among top management and employees is neglected

xii. Staff are experiencing more work stress

xiii. Improper disposal of waste

xiv. Safety rules not displayed

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OHS support is a prerequisite for effective OHS management. OHS status also comprises the
findings on the existing support on OHS management but these supports can also be barriers of
effective OHS management. The results were:

i. Staff with the university level of education felt that health and safety objectives and
safety reporting were not updated from time to time to ensure the effective management
of OHS. The same goes for management commitment. Staff perceived that their
management was not fully committed in health and safety matters.
ii. Female staff and those with an employment length of between 2.1 to 6 years perceived
that the safety incident/accident in their workplace was not taken seriously.
iii. The ineffective role of the supervisor, management commitment and leadership style
were seen to have an association with numerous accidents and near misses in the
workplace.
iv. Female staff and those with an employment length of between 2.1 to 15 years perceived
that the role of the supervisor is vital to prevent injuries from happening frequently.

In conclusion, five measures such as health and safety objectives, safety reporting, management
commitment, the role of the supervisor, and leadership styles were seen to be supportive in
effective OHS management but if not managed efficiently, these variables can be a barrier at a
later stage. Although safety training was not significant, its lack might hinder the effective
management of OHS.

4.7.2 The establishment of safe person, safe place and safe system strategies through the
“Plan-Do-Check-Act” model

Mearns and Flin (1995) affirmed that “the identification of hazards and their corresponding
control measures provides the foundation for a safety program and essentially determines the
scope, content and complexity of a successful occupational health and safety management
system (OHSMS)” (as cited in Makin & Winder, 2008, p. 935). Thus, effective risk
management concentrates on blending three elements that exist in an organization: people,
physical workplace and management (Makin & Winder, 2008). They reported that three

141
strategies such as safe place, safe person, and safe system are used in dealing with hazards
introduced by the combination of these three elements.

Safe place strategies concentrate on a risk assessment process and hierarchy of control to remove
hazards in the physical workplace. Some examples of safety management elements are
inspection, job hazard analysis, accident control, hazard elimination, etc. (Law, Chan & Pun,
2006). Safe person strategies emphasize the human factor in providing employees with the
necessary knowledge, skill and abilities to deal with hazards around them. Examples of the
safety management elements are safety training, safety rules, personal protection program, safety
and health awareness, etc. (Law, Chan & Pun, 2006). Safe system strategies highlight hazards
resulting from management aspects like poor supervision, lack of leadership, lack of feedback
and poor communication, etc. Some safety management elements included regular feedback,
open communication, goal setting, accountability, safe working procedures, etc. (Makin &
Winder, 2008). The “Plan, Do, Check, Act” cycle should be employed directly over the three
strategies as in Figure 4.11 to allow the OHSMS elements to be materialized with emphasizes on
leadership and commitment and be reviewed at the end of the cycle.

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 Leadership &
Commitment

Policy

Identify requirements

Management
Plan
Review PLAN
ACT

Organize

CHECK DO

Monitor Implement
& control

Figure 4.11: Determination of the OHSMS element (Adapted from RSC, 2009)

143
4.7.3 The determination of OHSMS elements for implementation priority

This phase illustrates six health and safety management elements that must be prioritized as the
foundation for effective OHSMS implementation is risk assessment. An effective procedure for
implementing OHSMS elements as in Figure 4.12 is to practise these six elements one at a time
to ensure their effectiveness.

Figure 4.12: A conceptual framework of OHSMS foundation

(Adapted from Yu & Hunt, 2004)

Case

Stage 1: Review safety policy and safety plan

The safety policy must be described clearly and disseminated to all employees. The safety plan
developed must be integrated into the organizational strategic plan. Management must review
the safety policy periodically according to needs and make strong commitments in terms of
resources and priority for safety issues.

Stage 2: Examine hazard identification and control plans

All workers must be involved in the risk assessment process from the initial stage to the
controlling stage by defining their roles and responsibilities clearly. A sense of belonging to a

144
program facilitates workers to be committed and motivated in providing honest contributions to
any health and safety programs. Further, periodic training enables employees to upgrade their
knowledge and skills to perform their work efficiently.

Stage 3: Evaluate safety management practices

To enable employees to be more motivated and committed, job empowerment, regular feedback,
safety education and training, safety rules and procedures, etc. must be assessed to ensure a
constant decline in unsafe practices.

Stage 4: Assess incident/accident investigation and emergency plans

Define the incident/accident investigation and emergency plans clearly and inform the affected
employees. A continuous attempt through teamwork must be explained to ensure safety
conformance to reduce the cost of accidents.

Stage 5: Evaluate safety communication and documentation

The management of health and safety matters including hazard identification, safety standards
and procedures, safety roles and responsibilities, etc. must be documented and disseminated to
all employees. Safety committees and safety teams must be set up to manage the communication
of these safety practices. Employees’ job descriptions and work instructions must include safety
roles and responsibilities to be performed.

Stage 6: Review safety program and audits

Safety programs must be continuously assessed to determine all safety practices are allied to the
safety policy. Audit tools are used to give feedback to employees to ensure constant safety
enhancement.

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4.7.4 The implementation and development of OHSMS elements
The last phase in this framework is to implement the OHSMS. Some strategic issues in the
implementation of an OHSMS according to Yu and Hunt (2004) are:
i. Organizational and cultural changes
Successful implementation needs a modification of the organizational culture and safety
management attitude.

ii. Employees full commitment and involvement

Successful implementation needs employees’ commitment and involvement from the
beginning of the process.

iii. Clarity of roles and expectations

Roles and expectations needed to be clearly defined to all employees so that they really
know how to handle their jobs according to procedure.

iv. Long-term focus

Implementation of an OHSMS is a long-term development and thus, management and

employees must implement each element with persistence to ensure the success of such a
system.

The following Figure 4.13 is a framework of the OHSMS. There are five vital elements needed
to ensure its success: policy, organizing, planning and implementing, measuring performance,
and reviewing performance. An initial status review is a must before implementation. This initial
review is to ensure that the organization has evaluated risk assessment conditions every now and
then to determine the effectiveness of the OHSMS implementation.

The fundamental elements in an OHSMS consist of safety policy and management commitment.
Organizing comprises (1) responsibility and accountability, (2) competence and training, (3)
OHSMS documentation, and (4) communication.

146
Planning and implementation includes (1) initial review, (2) system planning, development and
implementation, (3) OHS objectives, and (4) hazard prevention.

Measuring and reviewing performance includes (1) performance monitoring and measurement,
(2) investigation of work related injuries and OHS performance, (3) audit, and (4) management
review.

Key stages to an OHSMS : (1) establish senior management commitment to an OHSMS, (2)
develop a safety policy, (3) allocate roles and make statements of safety responsibility and
accountability for all job levels, (4) put in place risk management procedures, setting goals to
identify and mitigate system weaknesses, (5) establish a hazard reporting system to control risk,
(6) establish an accident and incident reporting system, (7) train all staff and assess competence
on safety critical aspects of performance, (8) monitor, investigate and analyze adverse events, (9)
review staff/organization performance and OHSMS.

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 Initial status
review

Policy

Organizing

Audit

Planning and
implementing

Measuring
performance

Reviewing
performance

Information link

Control link

Figure 4.13: Framework for an OHSMS

(Partly adapted from RSC, 2009)

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 CHAPTER FIVE

DISCUSSION AND CONCLUSION

5.0 Introduction
The present study outlines the development of a health and safety management model that has
denoted six dimensions: a supervisor’s leadership style; the role of the supervisor; training and
competence; health and safety objectives; management commitment; and safety reporting. These
six dimensions represent the independent variables of this study. Safety satisfaction and
feedback; and safety incidents/accidents comprising of accidents and injuries were the two
outcome variables. This chapter discusses the research findings in three sections: the first
explains the findings from the instrument validation, the second describes the hypotheses testing
results, and the final section discusses the limitations of the study, its contribution to both
theoretical and managerial practices and directions for future research and contains
recommendations.

5.1 Validation of the Instrument

The results of the validation phase are a vital step in the requirement of a valid and reliable
instrument. As most of the scales appeared to be skewed, transformation was examined, but was
not executed as “factor analysis is generally robust to non normality” (Glendon & Litherland,
2001, p. 168)

5.1.1 Scale Reliability

The internal consistency reliability coefficient for the pilot study was 0.948 and the revised scale
was 0.949. The Cronbach’s alpha for all dimensions in the revised (final) scale were in the range
of 0.740 to 0.945. The results revealed that the measurement constantly assesses what it is
intended to measure (Cooper & Phillips, 2004; Seo et al., 2004); indicated adequate internal
consistency (Glendon & Litherland, 2001); and higher scores emphasized greater or a stronger
sense of safety practices in the workplace (Huang et al., 2006).

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5.1.2 Content Validity
Content validity defines to what extent a single item in a measure relates its meaning to the
underlying theoretical concept. Content validity assessment by safety experts disclosed that 25
items were deleted from the initial group of 119 items as they were inappropriate, redundant, and
comprised low item-total correlations. Thus, the revised instrument comprised of 94 items. Even
though the assessments were subjective, content validity was ascertained to persistent procedures
(Havold & Nesset, 2009). Furthermore, Seo et al. (2004) reported that results of content validity
showed evidence that “clear operational definitions of supervisor, management, and upper
management should be given at the start of the questionnaire to avoid confusion” (p. 434).

5.1.3 Construct Validity

The results of the exploratory factor analysis (EFA) permit this study to refine the instrument
measurement to enhance its usability and validity. The usage of EFA is an initial procedure
before confirmatory analysis (Gerbing & Hamilton, 1996 as cited in Seo et al., 2004). All the
scales revealed reasonable validity in determining how well the concept is defined by the
measure (Hair et al., 1998).

Although the safety climate scale in this study differed from other studies, the items in each
factor were able to indicate the conceptual definition of the underlying construct. As found in
other studies like Brown and Holmes (1986) and Zohar (1980), the usage of the same safety
climate instrument failed to produce the same factor structure. Some possible explanations for
these differences are cultural factors, different management styles (Glendon & Litherland, 2001),
different safety practices and distinct work environments (Varonen & Mattila, 2000).

Some of the dimensions are, to some extent, not similar with previous studies particularly on
safety communication, safety rules, work pressure, and feedback about errors/mistakes. There is
strong evidence that (1) the items in the safety rules dimension are more consistent with other
factors, for instance, one item fell into the role of the supervisor but was eliminated due to a
lower factor loading; (2) four items of feedback about errors/mistakes were loaded into the safety
satisfaction dimension; (3) one item in the communication dimension was included in the

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management commitment dimension; (4) two items of safety involvement were factored into the
training and competence dimension; and (5) one item of work pressure was incorporated into
the safety reporting dimension. Overall, four items were eliminated, i. e. SI4 = -0.147, SI5 =
0.222, SI7 = -0.090 and rule1 = 0.247, where the factor loadings were less than 0.30 (Hair et al.,
1998). These findings are consistent with Havold & Nesset’s (2009) study, who found that (1)
items in safety rules dimension were factored into the safety satisfaction dimension, and (2)
items about feedback in the learning culture dimension were factored into the communication
dimension. Consequently, difficult items were eliminated from the final scale before
confirmatory factor analysis (CFA) was executed.

The Kaiser-Meyer-Olkin-Criteria (KMO) measure of sampling adequacy for all the constructs
was above 0.60 and the Bartlett’s Test of Sphericity was significant suggesting that correlations
among all the items existed (Cooper & Philips, 2004; Lin, Tang, Miao, Wang & Wang, 2008).
Even though the respondents answered the same questionnaire and employees were from the
hospital sector, nevertheless, the occupational categories varied, as a result, the factor analysis of
the safety climate scale were very context dependent (Salminen & Seppala, 2005).

Eight measurement models that are safety satisfaction and feedback, safety incidents/accidents,
the supervisor leadership style, the role of the supervisor, management commitment, training and
competence, health and safety objectives, and safety reporting were tested to disclose further
confirmation of the scale construct validity. The measurement model indicated that many items
contained correlated errors within each latent variable. This is consistent with Seo et al. (2004)
study on “a cross-validation of safety climate scale”. Overall, it was seen that the instrument
presented good evidence of construct validity confirm by the goodness-of-fit indices. A valid and
reliable safety climate instrument gives information concerning safety problems prior to
accidents and injuries (Seo et al., 2004). Furthermore, Guldenmund (2000) indicated that
“research should not be undertaken to develop new safety climate measurement instruments, but
should rather focus on the validity of the constructs …”

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5.1.4 Concurrent Validity
Correlation analysis was applied to determine criterion validity among the scales as to confirm
support of concurrent criterion validity (Seo et al., 2004). Moderate to higher correlations
between safety climate scales revealed that the constructs were dependable as reflected by this
study’s findings. Results also suggested that the six components of safety climate were
negatively correlated with safety incidents/accidents and positively correlated with each other.
The safety incident/accident showed a weak correlation with other dimensions and this may have
resulted from infrequent incidences (Seo et al., 2004). The outcome is also congruent with
Huang et al. (2006); and Vinodkumar and Bhasi (2009) findings of safety climate and self-
reported injury that stipulated safety climate is a crucial factor anticipating self-reported injury.
In addition, this analysis is aligned with Johnson’s (2007) study on the predictive validity of
safety climate where the positive and negative directions of the relationship showed improved
safety climate predicted reduction in injury frequency in the workplace and vice versa. Seo et al.
(2004) also indicated that “significant negative correlation coefficients suggested that the higher
perceived safety climate was, the fewer the number of accidents or near-misses” (p. 438). The
study of Varonen and Mattila (2000, p. 768) reported that the correlation of safety climate with
accidents demonstrated “the better the safety climate of the company, the lower the number of
accidents”. Although the correlation coefficient of role of supervisor and safety
incident/accident was statistically significant at the 0.01 level, the results must be clarified with
care as “the statistical significance may be the result of abundant degrees of freedom rather than
real association” (Seo et al., 2004, p. 443).

Similarly, Evans, Glendon & Creed (2007) revealed that the positive correlation of safety climate
implied a higher perception of operational safety, and thus, “support the notion that safety
climate scales were measuring an aspect of perceived safety performance” (p. 678). This view is
supported by Zimolong and Elke (2006) who discovered from previous research that high safety
performances were correlated with elements including strong safety management commitment,
interaction between workers and supervisors, and open communication on safety. Furthermore,
they also indicated that significant relationships existed between performance and
comprehensive training, managerial style, good communication channels, empowerment, good

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relations between management and workers, the allocation of safety activities, and strong
commitment from top management and supervisors.

5.2 Number of Response

Number of response is vital in a survey research as low response can lead to bias on overall
outcome (Burkell, 2003) and thus the results cannot be trusted (Draugalis & Plaza, 2009). In
addition, Hernon and Schwartz (2000, p. 119) revealed that ‘‘insufficient attention has focused
on return rates and whether the population is truly represented’’ (cited in Burkell, 2003). In
addition, “the higher the level of nonresponse, the greater the potential bias” (Burkell, 2003, p.
246).

The results revealed that overall participation of 43.15 % of this study was low with 47% of
employees from Hospital Sultanah Bahiyah, Alor Setar, Kedah; 70% of employees from Hospital
Tuanku Fauziah, Kangar, Perlis; and 17% of employees from Hospital Pulau Pinang. This low
response was supported by studies like Bottani et al. (2009); Havold and Nesset (2009); Kongtip
et al. (2008); and Vassie et al. (2000). Further supporting was from a team of Malaysian
researchers that revealed “response of between 15 – 25 percent is what most researchers in
Malaysia received” (Rozhan et al., 2001). It was also seen that participation from all physicians
from the three hospitals and respondents from Hospital Pulau Pinang were among the lowest.
This findings was in line with previous studies and the reasons might be due to the demanding
job arrangement of the physician, the respondents’ time is precious, respondents have negative
response for the closed-ended questions, survey was too long, stereotyping and think that some
of the questions as “don’t make sense” (Price, 2000). Further strategies like electronic survey,
mixed-mode survey, short questionnaire (McFarlane et al., 2006), face-to-face administration,
incentives (Burkell, 2003), average waiting period for follow up call attempt, etc. should be
designed to increase higher response of survey. Burkell (2003, p. 255) stated that these strategies
“do not eliminate the dilemma but merely represent a best possible response to an impossible
problem”.

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5.3 Hypotheses Testing Results

i. Priorities of employee’s perception

This study’s results showed that the general views of employees with regard to their OHS
practices were in the range of low to medium as the means of employees’ perceptions on
occupational health and safety practices were between the ranges of 1.58 to 3.9, thus indicating a
mixture of “disagree” to “almost agree”. Evidence from previous research demonstrated that
employees’ awareness and involvement of health and safety were a matter of being "forced"
upon them by legislation (Carvalho, 2008) and employees discovered that the legislation,
regulations and requirements of health and safety were not easy to understand as the issue was
really complex (HSE, 2005). The results of this study are consistent with prior studies as the
perception of employees on occupational health and safety practices were in the range of low to
medium since most employees perceived that safety and health legislation is not easy to
understand and they are being “forced” to comply with the legislation. In addition, Health and
Safety Executive(HSE) observed that there was also a trend to look at health and safety practices
as preventing quick and effective working. Therefore, if this type of perceptions were ignored by
the management and employees not given proper training, then it could lead to negative
consequences for individuals and the organization. In consequence, the findings of previous
studies showed a relationship between employee pessimism and poor safety performance (Oyan,
2000). When management blames the employee for injury and accident, OHS performance is
lower (Erickson, 2000). For that reason, an organizational culture/climate is vital in determining
that employees and employers give a high priority to implementing best practice in health and
safety. Lin and Mills (2001) found from previous research that the leadership of the organization
needs to play a major role in safety, as management is accountable for most “humanware”
problems.

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ii. Perceptions on the Elements of Occupational Health and Safety Management
The chi-square test of independence was used to examine the statistical significance of the
differences or relationships between the independent and dependent variables. Consistent with
Williamson et al. (1997, p. 15), who stated “in understanding the safety climate or culture of a
workplace, the perceptions and attitudes of the workforce are important factors in assessing
safety needs”, empirical evidence from this study can be used to give information about safety
problems before any accidents and injuries arise and it can be used as a “leading indicator” of
safety performance (Seo et al., 2004). Hence, based on the perceptions of employees to have
effective OHS practices in the workplace, the results of this study found that critical elements of
occupational health and safety management were accident and injury procedures, leadership
style, management commitment, health and safety objectives and safety reporting procedures,
and safety training. This is in accordance with studies done by Lin and Mills (2001); Neal,
Griffin and Hart (2000); Stewart (2002); Stone et al. (2005); and Vassie, Tomas and Oliver
(2000) whose results showed that these elements are essential to safety performance.

This study, in line with Huang et al. (2006); and Seo et al. (2004), indicated that management
commitment, the role of the supervisor and safety training were significant factors in the
prevention of accidents in the workplace. However, Mearns et al. (2003) reported that reactive
management commitment implied a higher number of unsafe incidences. The findings by
Mearns et al. might be true for this study as only male employees with a school level of
education perceived that their leaders did not show adequate commitment in their health and
safety duty. Congruent with the study by Hsu et al., (2007), safety leadership denoted that top
management and supervisors must be involved in safety activities and this study found that
supervisors and top management were involved in health and safety activities in their workplace.
Furthermore, safety reporting is also critical as an indicator of workers’ perceptions about
managers’ commitment to safety (Clarke, 1998). This study’s finding is consistent with Clarke’s
study where employees perceived that safety reporting is a vital element in managing OHS in the
workplace.

Although there is a lack of studies that focus on the impact of demographic factors like gender,
age, education, position level, and tenure on organizational climate (Kuenzi & Schminke, 2009),

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however, Hastings et al. (1995) supported this survey by reporting that demographic factors have
a significant influence on employees’ performance (as cited in Rose & Schelewa-Davies, 1997).
This survey has attempted to seek the perceptions of both men and women employees in relation
to health and safety issues that affect them at work. Therefore, as stated by the Health and Safety
of Women in Construction (HASWIC) (1997, p. 15), “Analysis by gender is important to
identify where there are significant gender-based differences in occupational injuries and
illness”.

Prior studies on different age and safety climates by Glendon and Litherland (2001) and
Vinodkumar and Bhasi (2009) found that differences existed between junior and senior
employees regarding safety climate. However, the results of this study differ from these previous
studies, where junior and senior employees perceived no difference in the OHS practices in their
organization. One possible explanation for this is the workplace culture where junior employees
perceive their seniors as providing guidance and motivation in health and safety.

Prior studies like Sattler and Lippy (1997) and Thomas (1999) discovered that female employees
complied with warnings. This study’s findings are consistent with these studies, where female
employees were found to perceive that the OHS management elements are critical to effective
OHS practices. Malle (1996) strengthened this study’s findings and pointed out that “men view
risks as less dangerous compared to women”.

As for length of employment, Vinodkumar and Bhasi (2009) reported dissimilar findings of
safety climate among different lengths of employment as they denoted that “experience is
believed to refine skill, improve efficiency and influence attitude towards work and especially
towards safety at workplace” (p. 7). The results of this study are consistent with their findings
where different lengths of employment were perceived differently regarding the importance of
the OHS management elements. In addition, empirical evidence discovered associations between
more experienced employees and improved safety as reduction in injuries was linked with senior
employees (Lauver & Lester, 2007). This study’s findings differ from Lauver and Lester, where
senior employees were more involved with injuries in the workplace. However, previous
findings also revealed that increased tenure was related to more injuries as more responsibility

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was given which was perceived as an extra work risk (Lauver & Lester, 2007). This study’s
finding is consistent with this prior study where senior employees were involved with injuries in
the workplace.

The results of this study concerning levels of education differ from those reported by Thomas
(1999). In her study, no significant differences between subjects of different education levels and
usage of personal protection equipment were found. This study reveals dissimilar findings
between subjects of different education levels and OHS management elements, for example,
employees with a school level of education perceived that health and safety objectives, safety
reporting, leadership style, and accidents procedure are critical elements of OHS management
while employees with a certificate or diploma level perceived that training and competence, and
safety reporting are critical elements of OHS management.

In sum, to ensure the survival of organizations, improvement of performance through efficient

management systems and well-structured performance evaluation are vital (Coelho & Moy,
2003). Carder and Ragan (2003) also supported this argument and highlighted that (1)
management commitment and employee involvement, (2) work site analysis, (3) hazard
prevention and control, and (4) safety and health training are the major elements of an effective
safety program. In addition, enhanced safety in the workplace produces increased “safe acts”
(Hilyer, Leviton, Overman & Mukherjee, 2000). Although the studies highlighted above were
undertaken in western countries, the findings have some general application in the Malaysian
setting. The findings of this study showed that the Carder and Ragan criteria were perceived as
significant in providing a conducive working environment to protect employees from any health
and safety problems.

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iii. Elements of OHS Management that Support or Hinder the Implementation of an
OHS Management System
Logistic regression analysis was applied to examine which elements of OHS management
prevent or support the implementation of the OHS management system in Malaysian public
hospitals.

Consistent with prior research of Hsu et al. (2007) on leadership and management commitment,
Clarke (1998) on safety reporting, Cox and Cheyne (2000) on safety rules, and Hong Kong
Occupational Safety and Health Council (1998) on the role of the supervisor, the findings of
this study reported that five elements, health and safety objectives, safety reporting, management
commitment, the role of the supervisor, and leadership style were seen to support the
implementation of an effective OHS management system.

Furthermore, the Contra Costa Health Services (2003) survey at the General Chemical-
Richmond Works Facility reported that managers and employees were unmotivated when
communication of a safety vision was unreliable, but, in the case of this study, it was found that
health and safety objectives were significant. One possible reason for this might be health and
safety objectives were communicated effectively to all employees. However, a previous study
by Varonen and Mattila (2000) reported that “supervision alone may not influence the safety
climate and the behavior of workers” (p. 767). Besides, workers had an attitude of “resigned
acceptance” as to safety performance when supervisors and managers were uncertain of health
and safety requirements. As a consequence, although these five elements were seen to support
the implementation of OHSMS, but it also could be a barrier to the implementation if not
managed effectively.

In addition, safety training was seen to be a barrier to the implementation of OHSMS. The results
of this study on safety training, however, differ from those reported in other studies such as
Cohen and Jense (1984); Cooper and Phillips (2004); Reber and Wallin (1984) (as cited in
Huang et al., 2006). In their studies, Huang et al. (2006) noted that safety training was reported
to have significant consequence in enhancing safety performance and related to low number of

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accident. This study’s findings, in contrast, indicated that safety training was not significant but
a lack of it might hinder the effective management of OHS.

In sum, Bottani, Monica and Vignali (2009) further confirmed that “accidents are mainly due to
human errors or lack of coordination, which accounts for 24% and 46% of the accident causes”
(p. 158). What is more, the ILO’s philosophy of prevention and protection in the field of
occupational safety and health affirmed “and whereas condition of labour exist ……. to produce
unrest so great that the peace and harmony of the world are imperiled; and an improvement of
those conditions is urgently required; as, for example, by the regulation of the hours of work,
including the establishment of a maximum working day and week … the protection of the
workers against sickness, disease and injury arising out of his employment …” (Alli, 2001, p. 3).
Thus, consistent communication of safety and health legislation, regulations and requirements
and safety and health training regarding their work duties are vital to enhance safety
performance. This will also ensure that the significant elements will not be barriers to the
implementation of OHSMS.

iv. Strategies to ascertain the appropriateness and effectiveness of an OHSMS

implementation

It is not an easy task to implement an effective OHSMS in an organization as it might encounter

support or hindrance. Lack of resources and relevant expertise has been seen as one difficulty in
fulfilling the requirements of OHSMS implementation. Nevertheless, Reese (2009) highlighted
that participation from everyone in the workplace is vital to ensure effective implementation and
emphasized that safety training and education is crucial to the avoidance of accidents. Moreover,
Gustin (2008, p. 1) indicated that “safety is a condition of employment” and consequently
everyone has to “make a commitment and assume responsibilities”. The ILO (2005) reported that
occupational accidents and ill-health are avoidable and cooperation among all people with a
positive commitment will ensure this mission can be achieved. However, individual
accountability is the main factor in a safety mission where it must be expanded to all departments
and starting from the management to all employees (Murphy, 2003). In addition, he added that
safety does not “just happen” and a committed team will reduce the frequency of injury resulting

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in a safer, compliant and more efficient workplace. Prior studies also demonstrated a reduction in
illness/injury incidence, lowered lost-time frequency, and less compensation in companies which
implemented an OHSMS (Bottani, Monica & Vignali, 2009; Robson et al., 2007). Larsson,
Pousette and Torner (2008) also indicated that increased manager safety behavior enables
improvement in employee safety behavior. Robson et al. (2007) also noted that management
commitment to OHS is critical to ensure the success of OHSMS implementation although there
is not enough support from previous studies to make suggestion either in favor of or against
OHSMS and also research on OHSMS is inconclusive (Gallagher et al., 2003).

In sum, this study maintains a strong commitment from top management and good employee
involvement are critical elements for effective OHS management with support from supervisors
in determining their role effectively. Failure to blend every element efficiently will limit the
effectiveness of implementing an OHSMS. Safety training was also seen to enhance employee
knowledge and participation in health and safety as a lack of training and under-committed
employees will be unlikely to be involved in an OHSMS.

5.4 Cultural Issues in Malaysia

Professor Geert Hofstede discovered that cultural factors frequently produce disagreement
between people in an organization rather than collaboration. Some of the dimensions of cultural
values in Malaysia he noted are:

i. High power distance

Malaysia has a high power distance. This means that the liaison between employer and employee
is based on a chain of command where employees are obedient to their superiors. This is actually
good in a way as committed management can use their power to control employees to obey their
commands. Employees have a high opinion of their superiors and would not call them by their
first name but with a respect due “Mr …”.

In addition, this study’s results found that management commitment, the role of the supervisor,
and leadership style were significant, thus, giving the impression that a high power distance

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dimension is better in developing employees’ good safety attitudes. Another critical factor is that
the number of accidents have decreased from 114, 134 in 1995 to 56,339 in 2007, a reduction of
almost 49% in 12 years. This shows that high power distance is used to influence employees to
ascertain if they take good care of their health and safety while at work.

At times, this high power distance creates disharmony among employees and their superiors
when certain decisions were made against the value of the employee(s). For example, if the
safety reporting procedure in an organization is not effective, the employee(s) will voice the
matter to their superiors. This will create a strained relationship between the employee(s) and
their superiors.

ii. A collectivism society

Malaysia is high on the collectivism dimension as employees are loyal to their group and always
think of “we” rather than “I”. Employees are more concerned with others and tend to protect
other people’s dignity, sometimes to the extreme. This is true in public hospitals as the
employees’ duties are to serve their community, thus, they work in a group trying to solve
common problems in their workplace. They are multi-racial and hold something in common to
improve and serve their multi-racial patients effectively. Furthermore, they have a “gotong-
royong” (to work together or help one another to accomplish a certain task) spirit in carrying out
tasks and are sensitive to other people’s feelings.

iii. High uncertainty avoidance

Malaysia has a high uncertainty avoidance culture where an organization has a structured design
which follows rules and procedures, consensus decision making, minimizes risk, in which
employees are loyal to their employer especially working with government agencies. These
public employees tend to remain longer with their employer as working with the government
guarantees certain benefits like a retirement fund and medical benefits. Most Malaysian
employees try to minimize risks by working with government agencies.

With rules and procedures, it can force employees to comply with the organization’s rules to
ensure a safe and healthy working environment. For example, the results of this study show that

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health and safety objectives and safety reporting dimension were found to be significant. This
demonstrates that public hospital employees are high on uncertainty avoidance where they
perceive that health and safety objectives are important to give them guidance while safety
reporting is necessary to voice their opinions about unsafe acts and unsafe conditions in the
workplace.

iv. Masculinity-Femininity culture: middle of the road

Malaysia was found to be in the middle regarding this masculinity-femininity culture where at
one stage employees are more competitive, assertive, ambitious and have the desire to
accumulate wealth, but at certain period, they are more focused on relationships, environmental
awareness and the quality of life. This shows that employees deserve to be treated with dignity
and respect but at times they like styles to empower others, to be more competitive especially
during promotion and career enhancement. This study’s results revealed that public employees
are concerned about injuries they may experience as this will affect their quality of life and show
their working environmental is not safe.

5.5 Research Contributions

This study addresses a number of research gaps. Contributions from this study can be seen from
three aspects: theoretical, methodological, and managerial.

5.5.1 Theoretical Contribution

The theoretical value of this study is that it takes into account the factors that impede the
implementation of an OHSMS. Although there has been considerable research on an OHSMS,
mainly on integrated management systems and auditing of an OHSMS, there is limited research
on developing strategies based on the elements of OHS management before implementing an
OHSMS. This study provides early research in identifying support and barrier factors from the
OHS management elements before implementing an OHSMS. As a consequence, this study
supports the work of Gallagher et al. (2003) on barriers to success of OHSMS where there is a
need to identify factors that influence the implementation of such systems.

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5.5.2 Methodological Contribution

Most studies either do not validate their instrument or only focus on construct validity using
exploratory factor analysis (EFA). This study takes a different perspective by using content
validity, concurrent validity and construct validity to validate the instrument used in order to
meet standards for vigorous research. Construct validity was completed using two types of
validation test: exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using
structural equation modeling (SEM).

Most previous studies focused on the normal SPSS software to analyze the relationship of the
independent and dependent variables. This study utilized structural equation modeling (SEM) to
analyze the relationship between the independent variables and dependent variables. SEM was
commonly used in safety climate research to determine the associations between variables. SEM
includes analysis techniques such as covariance structure analysis, latent variable analysis,
confirmatory factor analysis, path analysis, multiple regression and linear structural relation
analysis. SEM is also a powerful tool for multiple latent and predictor variables measurement. As
the aim of this research is, generally, to disclose associations between variables, i.e., to show that
one variable has a relationship with another variable, thus, SEM is based on “causal”
relationships that explain changes in variables where exogenous constructs (independent
variables) will result in changes in endogenous constructs (dependent variables).

5.5.3 Managerial Implications

Numerous significant managerial implications have resulted from this study that should assist
management in making decisions on health and safety issues.

Firstly, a health and safety management instrument is a beneficial assessment tool for hospitals
as it is important for risk management assessment. Employees’ perceptions are vital as a realistic
approach of determining whether an organization has attained an acceptable level of safety in
their workplace.

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Secondly, this survey instrument can be an effective measurement tool to demonstrate
improvement and to reflect on how to improve problematic areas in the workplace. It can be used
to compare departments within a hospital system to identify areas that require special attention.

Thirdly, this tool can also be used to improve compliance with the Occupational Safety and
Health Act 1994, thereby reducing exposure to risk in the workplace. Furthermore, employees
might continue to be more motivated to improve safety when they realize that management is
more visible and supportive of safety activities and they feel valued when their safety is being
taken care of properly.

Lastly, this tool provides for employee feedback through follow-up to the survey findings where
it is useful for change management. This can be done through focusing on scores of the
dimensions of health and safety management that were prearranged from high to low, where the
dimension with the lowest score can be targeted for improvement. Also general areas of
weakness can emerge thus indicating targets for improvement.

5.6 Limitations and Future Research Directions

The present study has some limitations that should be mentioned. From these limitations, further
research could be suggested to improve this type of study.

5.6.1 Limitations
One limitation is the cross-sectional inquiry, making the outcomes only relevant to the point
during the study and incapable of creating causal implications as all variables were examined
concurrently. For example, this study design could not tell whether safety climate/safety
management predicts safety satisfaction or vice versa. Nevertheless, this study is valuable for
introducing groundwork for future research.

Another limitation is the low response in this survey. This study total response was only 43%
which was not as high as desired, but the response of 15 – 25 percent is common in Malaysia

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(Rozhan, Rohayu & Rasidah, 2001). One possible explanation was the low response among the
medical staff, especially physicians (Singer et al., 2007).

A further limitation of this study is that performance measures used in this study were restricted
to employee and safety related outcomes. Employee outcomes concentrate on safety satisfaction
and safety related outcomes focus on numbers of safety incident/accident. The safety related
outcomes focus on the traditional or reactive measures with subjective measures used to examine
this variable. Reactive and proactive assessments were used to measure the safety satisfaction
dimension.

Another constraint is the proportionate sampling frame used by this study focusing on individual
responses. The results are not free from biases as each stratum is sampled exactly in proportion
to its size in the population. Imbalance exists with certain stratum where a smaller percentage of
the population exists and so does not represent the stratum.

Fifthly, there are many industries that contribute to the Malaysian economy, one of which is the
healthcare industry. Healthcare facilities include hospitals, clinics, dental offices, out-patient
surgery centers, birthing centers and nursing homes in all fourteen states in Malaysia. However,
the focus of this study was on hospitals, namely public state hospitals in the three states in the
northern region of Malaysia and it excluded data gathering from healthcare facilities in all
fourteen states in Malaysia.

An additional limitation is associated with the existence of non-significant relationships between

coefficients that reduce the significance and strength of correlation coefficients (Johnson, 2007).

Finally, this study focus is on limited measures of health and safety management scales. More
rigorous methodology should be considered to enable a more systematic analysis of these
measurements (Glendon & Litherland, 2001). Additional work is required to examine the
properties of health and safety management instruments to ensure that they have valid outcome
measures. Moreover, triangulation measures like observations or interviews could further
highlight more significant results (Glendon & Litherland, 2001).

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5.6.2 Suggestions for Future Research

After discussing the limitations of the study, it is practical to suggest possibilities for further
research reflected from the limitations recognized above.

Firstly, future studies should use a longitudinal research design. Longitudinal research assessing
the standard measures for health and safety management in hospitals is required as it would
provide additional and even stronger support for the effects reported in this study. This type of
design would be better for examining the development of efficient health and safety management
and for tracking problematic areas in the hospital. This also would permit more precise
evaluation of the causality direction that cannot be achieved in cross-sectional studies.

Secondly, the low response among physicians and medical officers could be improved using
other means of data collection, internet-based questionnaires or interviews. Since medical staff
have limited time to complete and return a questionnaire, the instrument may need to be reduced
in extent to maximize the total response.

Thirdly, this study focuses on the subjective measures in its outcome variable. Future research
may discover further measures that are more objective (Huang et al., 2006) that could provide a
tangible measure of safety performance to be used as an industry-wide benchmark, the results of
which could be correlated with actual safety performance.

Next, future research should focus on a disproportionate sampling frame. The proportion of each
stratum is varied as some groups are small relative to the larger population. To produce
meaningful data, more representation of the smaller groups in the bigger population can be done
using a disproportionate sampling frame.

Fifthly, this study focuses on only three state hospitals in the northern region of Malaysia.
Further research should focus on all types of healthcare facilities in the fourteen Malaysian states
to ensure that it does not restrict the generalizability (the degree that the results can be
generalized from the study sample to the entire population) of the findings to all healthcare

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facilities. Application to other types of healthcare facilities, especially rural hospitals, would
enable researchers to understand its reliability in other settings. It is possible that perceptions of
respondents in all healthcare facilities on health and safety management at their workplaces may
be different as a result of their ability to deal with various types of health and safety problems.
Furthermore, it allows comparisons across different locations.

Subsequently, the existence of non-significant relationships between coefficients in this study

will reduce the significance and strength of correlation coefficients. Thus, further research should
replicate this study to explore the function of possible mediators and moderators in affecting the
indirect relationship between OHS management variables.

Lastly, the limitation measure of health and safety management scales needs additional work to
examine the properties of health and safety management instruments to ensure they have valid
outcome measures. The elements of OHS management should be exhaustive and include
elements like employees’ knowledge and compliance with safety, emergency preparedness,
safety motivation, etc. to examine the state of health and safety practices at any period of time.

Future study is required to further refine this instrument using structural equation modeling
(SEM) to come out with a model of good fit, produce parsimonious measures and develop
standard measures for examining health and safety management in hospitals. Standardization of
the measures will facilitate organizations to exploit evidence-based implications for effectively
managing health and safety in their workplaces. The establishment of such databases will assist
the managerial level to keep track of their performance. In addition, triangulation measurement
will enable a researcher to have more in-depth findings to clarify significant findings.

Besides addressing the limitation of this study, further research is required to assess possible
relationships between OHSMS pre-implementation and the improvement of safety levels in
public hospitals focusing on the psychological climate like role clarity, social support,

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possibilities for development, etc. that influence safety behavior. To determine changes in safety
levels, a longitudinal design is suitable.

5.7 Recommendations
The following are some insights from this study:

5.7.1 Significant Results from This Study

This section describes the initial OHS status review of this survey’s findings. This review
focuses on general OHS status, current OHS practices, and support and barriers factors of the
OHS management elements.

Overall, the OHS status of the three state hospitals is as follows: (1) 68.2% of employees are not
satisfied with the safety systems in their workplace; (2) 82.8% of employees perceived that
incident/accident have happen in their workplace over the past twelve months; and 79.7% of
employees stated that they experienced injuries in their workplace, especially female employees.

The significant results of this study based on current OHS practices, and support and barriers
factors of the OHS management elements were (1) management commitment; (2) health and
safety objectives; (3) training and competence; (4) the role of the supervisors; (5) safety
reporting; (6) leadership style; and (7) safety incidents/accidents: accidents and injuries in the
workplace. It seems that all elements of OHS management and one dependent variable, safety
incidents/accidents, were critical to ensure good practices of OHS in the workplace.

In sum, based on the perceptions of the respondents, it was discovered that:

i. Management commitment is critical in revealing effective management of OHS in the
workplace. This is so as management, who is responsive and proactive, may turn any
challenges in the workplace into opportunities to encourage more positive thinking and
action on preventing health and safety hazards. This will lead to compliance in health and
safety legislation, for instance, S. 15 (2) (e) of the Occupational Safety and Health Act
1994: to provide and maintain a working environment that is safe and without risks to the
health and welfare of employees.

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ii. The leadership style and the role of the supervisors should be emphasized and made
consistent so that leaders are more involved in managing the health, safety and welfare of
employees in the workplace. This can be done by introducing a management awareness
program to alert them of their responsibilities and accountabilities towards the health,
safety and welfare of employees.

iii. Accident and injury procedures must be continuously reviewed to ensure an accident-and-
injury free working place is realized. Incidents/accidents can be avoided or reduced through
effective risk management in the workplace. (Refer Table 5.1 for the risk management
stages.) Accurate record keeping is also vital to assist Department of Occupational Safety
and Health (DOSH) officers in making inspections.

iv. Health and safety objectives and safety reporting procedures should be reviewed
periodically to ensure effective OHS management. Health and safety objectives act as
guideline for employees to know their direction in performing their health and safety roles.
These objectives must be measurable and attainable. Safety reporting is also important as
employees should give feedback on any violation of health and safety acts or unsafe
conditions in the workplace.

v. Safety training should be given to all employees to ensure they are alert and aware of all
aspects of health and safety so that hazards and risks are eliminated or reduced while
performing work. Furthermore, basic knowledge on how to perform their jobs safely is
vital to avoid accidents and injuries. This will lead to compliance in health and safety
legislation, for instance, S. 15 (2) (c) of the Occupational Safety and Health Act 1994: to
provide information, instruction, training and supervision to ensure, as far as practicable,
the safety and health of employees while at work.

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5.7.2 Intuitive Insights from Three Years Involvement in the Work
This study did not detect any trend of poor OHS practices at the state hospitals. All three
practised positive OHS management with the Department of Environmental Health as a
secretariat to look after the issue of OHS in the hospitals.

Based on two interviews with Assistant Environmental Officers (AEO) from the Department of
Environmental Health at Hospital Sultanah Bahiyah, Alor Setar, Kedah and Hospital Tuanku
Fauziah, Kangar, Perlis, the following are the OHS practices in their hospitals and all public
hospitals in Malaysia, in general.
i. Both hospitals already have their own OHS Policy from the Ministry of Health and the
policy was demonstrated at strategic places in the compounds of the hospital buildings.

ii. There are 2 committees in the hospitals – the OHS Committee (Secretary is the AEO) and
the Disaster Management Committee.

iii. Employees in the hospitals undergo training – e.g. in-house training on short courses, e.g.
OHS orientation (2 times per year), Personal Protective Equipment, Standard Operating
Procedure, 5S, auditing, infection control training, ERT, fire drills, etc. These training
sessions were given mainly to medical staff and related areas.

iv. Medical employees have to attend continuous medical education - e.g. 2 courses per year
for nurses and medical assistants.

v. Among the nurses group, the nurses form a mentor-mentee group to discuss issues
relating to their work and try to solve problems.

vi. The investigations in the hospitals are more focused on reactive rather than proactive
measures.

vii. Management is not very serious in performing its OHS role.

viii. Some of the problems that seem to be barrier to effective OHS management:

a. Staffing – not enough staff to handle the work load

b. Training – non-medical staff lack exposure to health and safety training

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 c. Little budget for OHS issues

d. Lack of top management understanding and commitment towards OHS issues

From my observation, employee shortage plays an important role to determine whether OHS
matters are managed properly according to the rules and procedures. When faced with a shortage
of staff, training will not be a priority as the management cannot find replacements to do the job.
Even risk assessment is a secondary matter. However, employees will only be alerted to any
serious safety issues if there is a pandemic or epidemic of contagious, infectious or viral
illnesses, e.g. bird flu, H1N1, etc. For normal health and safety issues in the workplace, they feel
complacent and possess the attitude of “it won’t happen to me” syndrome and think of accidents
“as a matter of chance” only.

5.7.3 Suggestions for Implementing OHSMS in Malaysian Hospitals

To comply with the OHS legislation, the management and employees must employ the
participation/involvement approach to improve their workplace environment focusing on (1)
psychosocial factors especially the mental stress of workers so that employees are motivated to
work in more relaxed way and be optimistic and adapt to changes in working life without
treating health and safety issues “as a matter of chance”. Examples of psychosocial risks are:
work stress, hostility and violence, sexual harassment and other forms of harassment - mobbing,
and discrimination at work; (2) health and safety risks in the workplace due to an increase in
hazards. Both management and employees must take preventive measures so as to minimize
health and safety risks and ensure staff are only exposed to acceptable risk limits; and (3)
rewards and incentive schemes in terms of financial incentive or non-financial incentive like
praise, employee of the month or awards to promote employee involvement to deal with safety
effectively.

Successful implementation needs modification of organizational culture and a safety

management attitude. The following initial input of management of change must be practised
before utilizing any OHSMS.

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i. Develop a safety policy. Policy gives the hospital direction regarding safety issues. It
reflects the involvement and commitment of all employees in maintaining a safe work
environment. It must define the rights, responsibilities of all employees, and types of
measures used to ensure safety in the workplace. This policy must be communicated to
all employees and other people at work so that they understand their rights and
responsibilities.

ii. Establish a higher management commitment as a motivation force, a flexible

organizational structure, and ensure there are enough resources to assist OHS programs.
Managers are role models to support health and safety issues. Furthermore, management
is responsible for the accountability of health and safety in the workplace. It also must
support health and safety activities with sufficient resources. A flexible organization
structure is critical as employees are more welcome to approach managers regarding any
unsafe acts or conditions in the workplace. Managers can do this by performing
“management by walking around” (MBWA) conducting friendly-surveys on health and
safety matters.

iii. Compliance with the OHS legislations through safety rules and procedures. Rules and
procedures must be obeyed and followed by all employees to ensure a safe and healthy
work environment exists. For example, standard and safe operating procedure in
performing the duties of a nurse in steps, making sure all steps are followed without any
shortcuts.

iv. Accountability and responsibility of management and employees. Even though health and
safety are management responsibilities, employees also are required to work safely as it is
an essential of their job requirement to perform responsibility to ensure the safety of
themselves and their friends while at work. This can be done by allocating what roles to
perform and make statements of safety responsibility and accountability for all job levels.
As a condition of employment, management is accountable for their health and safety
performance. This can be done, for example, by participating in health and safety
programs, attending health and safety meetings, etc.

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v. Employee involvement in the activities of health and safety programs. This is to ensure
employees feel that they have some control over their jobs and feel wanted. For example,
involve them in health and safety committees, and assist in inspections, etc. Furthermore,
employees are always in contact with potential hazards around them.

vi. Training and education must be arranged for all staff, especially new employees, to
assess competence on safety critical aspects of performance to ensure employees possess
enough knowledge to work safely. On-going training in work procedures facilitates
employees to meet their responsibilities and accountabilities to do their jobs safely.

vii. Perform “hazard identification, risk assessment, risk control” (HIRARC) to ensure
hazards and risks are minimized at the workplace. (Refer Table 5.1 on how to do
HIRARC)

viii. Establish an accident and incident reporting system, a hazard reporting system to control
risk, incident/accident investigation and emergency plans. The systems and plans should
be reviewed periodically to reflect changes in personnel, policies, procedures, guidelines,
types of resources available, etc.

ix. Preventive action to protect employees from any disaster. It acts as a corporate
responsibility of hospitals to look after the safety of employees. One example is to have a
Disaster Recovery Plan that helps prevent any dangerous effects caused by unforeseen
and unplanned events either man-made or natural causes.

x. Procurement conforms to safety standards in hospitals. This is to ensure that contractors

comply with the safety standards and safety legislation. One method is to give contracts
to reliable contractors who fulfill the terms and conditions of a proposed procurement.

xi. Communication and feedback systems to ensure dissemination of OHS information. This
information must be relevant, accurate and timely. It is the primary responsibility of
management to provide essential information to work safely. This is to assist employees’
understanding in performing their OHS responsibilities. Employees must have
accessibility to this information, for example through circulars, fact sheets posted on
noticeboards and through health and safety committees, etc.

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xii. Monitor and evaluate the system and performance to detect any discrepancy.
Performance and system review acts as a means to find out the effectiveness of the
management strategies and actions that were implemented. This can be done by detecting
any discrepancy between standards of planning and actual situations.

Thus, the promotion of OHSMS should be included in the Ministry of Health strategic planning
so as to be attached to its current and long-term working program thus creating awareness and
understanding of the importance of OHSMS to achieve good OHS practices. The Ministry of
Health also should work on a pilot implementation of the above input so as to evaluate its
effectiveness.

Table 5.1: Risk management should be performed in the plan-do-check-act (PDCA) stages
PLAN: ESTABLISH THE RISK ASSESSMENT APPROACH
1. Planning:

o Define risk assessment approach (e.g. safe place, safe person, safe
system strategies)
o Identify hazards and risks
o Analyze and evaluate hazards and risks
o Identify and evaluate various risk control options
o Select appropriate control option for each hazard and risk
o Management approves residual risks

2. Informing: Top management informs managers and employees regarding

risk management to get their voluntarily and continuous involvement in
improving the workplace.

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DO: IMPLEMENT AND OPERATE THE RISK ASSESSMENT APPROACH
3. o Define management actions, resources, priorities, roles and
responsibilities
o Correlate to risk control plan for managing identified risks
o Implement controls
o Define how to measure effectiveness of controls
o Implement procedures for detection of incident/accident
CHECK: MONITOR AND REVIEW THE RISK ASSESSMENT APPROACH
4. o Execute monitoring and review procedures
o Regularly review effectiveness of selected control techniques
o Measure effectiveness of controls
o Regularly review risk assessments and update residual risks
ACT: MAINTAIN AND IMPROVE THE RISK ASSESSMENT TECHNIQUES
5. o Implementation of identified improvements to risk assessment
techniques

o Take appropriate preventive and corrective actions

o Review lessons learned

o Communicate taken actions

o Meet documentation requirements

o Ensure documents are controlled

o Ensure records are controlled

6. On the basis of the results from the monitoring stage, successful techniques
were continuously conducted, while unsuccessful techniques were reviewed
for the planning of further improvement actions.
7. Continuous improvement process.

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5.7.4 Supportive and Barrier Factors and Suggestions How to Develop Positive Factors
OHS support is a precondition of an effective OHS management in the workplace. This study’s
results found that supports can also be barriers of effective OHS management. This is so as some
employees (for example: employees with a length of employment of less than 2 years to 6 years
and employees with a school, certificate and diploma level of education) perceived the following
factors as support to OHS management, while some employees (for example: employees with a
length of employment of more than 6 years and with a degree and above level of education)
identified factors which can act as barriers to effective OHS management. The following factors
contribute as supportive and barriers towards effective OHS management: (1) management
commitment; (2) health and safety objectives; (3) training and competence; (4) the role of the
supervisors; (5) safety reporting; (6) leadership style; (7) safety incidents/accidents: accidents
and injuries in the workplace; (8) satisfaction towards safety systems in the workplace. Besides
these eight factors, employees also stated that safety communication is important in managing
OHS issues.

In addition, the following factors can be developed as constructive factors towards effective OHS
management.
i. Training and competence – should be an on-going process and focus on continuous
education for all employees, including office and medical employees. The training should
deal with general OHS issues and specific OHS procedures for working safely. General
OHS issues include OHS awareness training, new employee orientation, communication
of company safety rules, hazard communication training, etc. Specific OHS training
includes supervisor training on their responsibilities, equipment and machinery training,
accident investigation, job safety analysis, air-borne and blood-borne diseases, disaster
recovery techniques, etc.

ii. Health and safety objectives – must be reviewed continuously to ensure effective
compliance to OHS legislation. This will ensure safe work practices among all employees
as they have guidance helping them to perform their responsibilities.

iii. Management commitment - cooperation and involvement among top management with
enough resources like budget to ensure effective implementation of any OHS programs.

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 As management commitment and employee involvement are complementary, visible top
management involvement is critical so that employees know that management's
commitment is serious and that managers must be accountable for meeting their
responsibilities.

iv. Safety incidents/accidents – always review the procedure of accidents and injuries to
ensure employees are exposed to acceptable risk limits. This can be done by conducting
frequent worksite inspections so that new or previously missed hazards are identified.
Investigate accidents and "near miss" incidents so that causes and methods of prevention
can be established.

v. Satisfaction towards safety systems – dissatisfaction among employees concerned

personal protective equipment (PPE) which was not of good quality, the hospital
environment was not conducive for working, workstation designs were not comfortable,
there was improper disposal of waste and exposure to dangerous substances without
enough protection, ergonomic issues, and work stress. These factors should be dealt as
precautions to protect employees’ health, safety and welfare at the workplace and can be
done through on-going training, relevant information and communication through tool-
box talks with employees.

vi. Safety reporting – be reviewed periodically to get feedback frequently. Feedback is

important to determine problem areas of the working environment so that corrective
action can be quickly taken.

vii. Leadership style – be a role model to show employees the importance of working safely,
become more involved and non-discriminatory in tackling health and safety issues.
Create a win/win situation where employees’ capabilities are recognized through praise,
awards, etc. This will enable an environment of trust to be created.

viii. The role of the supervisors – they must be more involved and committed to look after the
health, safety and welfare of employees. This can be achieved by providing leadership
and collaborative direction to all employees through open communication to generate
creativity and innovate employees in managing OHS matters. Practise new ways of
supervising, and not the traditional methods of top-down, an autocratic style to coach and

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 motivating, ordering, and telling employees to listen. This will enable employees to be
motivated, productive and have mutual respect.

ix. Effective safety communication - sharing of OHS information. Display safety rules so
that employees acquire current knowledge on health and safety matters. Some effective
ways are through health and safety committees involving employees, weekly tool box
talks and management by walking around (MBWA). Try to convey hospital strategies in
terms of priorities and sub-priorities. For example, key priorities: Improving OHS
performance and sub-priorities: Improving the reporting of hazards, lifting the standard of
housekeeping.

Failure to consider and address the above OHS management dimensions effectively can prove a
hindrance to any OHS activities and thus the implementation of an OHSMS will be unsuccessful.

5.7.5 An Overall Action Plan to Implement the OHSMS in Hospitals

OSH Master Plan 2015 (OSH-MP 15) which was launched by the Prime Minister of Malaysia on
2 May 2009 is an action framework to enrich knowledge, awareness and commitment towards
OHS in decreasing industrial accidents and work-related illnesses in the workplace. OSH-MP 15
acts as a strategic vision and direction for health and safety matters. Under strategic initiatives:
strengthen the capacity of government to influence OHS outcomes (in strategy 1: fostering and
enhancing government leadership and practices), by 2015, all organizations have to implement
OHSMS. For that reason, the Ministry of Health has to conform to the strategic planning of the
Malaysian government by implementing the initial input before being certified to any OHSMS in
Malaysia. Furthermore, implementing OHSMS shows that Ministry of Health is displaying their
commitment and corporate responsibility to safety and health and this will strengthen their
corporate image. By being certified to OHSMS, an organization is capable of controlling its OHS
risks and improves its performance.

Although there is no universally standardized agreed system on OHSMS, some common

elements in all management systems are: (1) policy; (2) planning; (3) implementation and
operation; (4) performance assessment; and (5) management review and continual improvement.

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Implementation of an OHSMS is a long-term development and thus, management and employees
must implement each element with persistence to ensure the success of such a system.
Implementation of an OHSMS should be carried out in the plan-do-check-act (PDCA) stages as
follows:

i. Plan – document OHS policy and planning that focuses on legal responsibilities, hazards
and risk identification and assessment, and establish objectives and targets that deal with
employees’ safety.
ii. Do – execute the implementation stage such as introducing preventive and protective
measures, emergency prevention and response, training and competence,
communication and awareness, procurement, contracting and management of change.
iii. Check - maintain the OHSMS practically through monitoring and measurement,
investigating incidents/accidents, implementing corrective action, and auditing to ensure
the effectiveness of the OHSMS.
iv. Act – management conduct a review to ensure continuous improvement of the OHSMS.

In Malaysia, there are two OHSMS: (1) OHSAS 18001: 2007; and (2) MS1722: 2005. MS1722
is a Malaysian Standard on OHSMS based on the International Labour Organization’s standard
OSH MS 2001. The requirements of this standard are equivalent to OHSAS 18001.

In conclusion, the overall action plan to implement an OHSMS is (1) initial input of management
of change must be embraced; (2) perform “hazard identification, risk assessment and risk
control” (HIRARC) as this is a fundamental task in everyones job; (3) establish rewards and
incentives to motivate employees involvement; (4) do an initial status review to ensure that the
organization evaluates risk assessment conditions every now and then to determine the
effectiveness of the OHSMS implementation; and (5) select which OHSMSs to be certified and
go to the nearest certification bodies like SIRIM, NIOSH, etc. to obtain more information on
certification and auditing of the OHSMS.

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5.8 Conclusion
The purpose of the study was to investigate the current practices and attitudes of hospital
employees towards the management of OHS that can provide workable implementation of an
OHS management system to enable Malaysian public hospital sector to meet its OHS
obligations. The results of the study were examined using construct, content and concurrent
validity and internal consistency reliability. This study has confirmed an empirical relationship
between the six dimensions of safety climate and two outcome variables: safety satisfaction and
feedback, and safety incidents/accidents. All the constructs demonstrated an acceptable internal
consistency. The instrument also confirmed a rational validity in assessing what they are
supposed to measure. In conclusion, consistent safety perceptions and attitudes on organizational
safety climate justify further research as the perceptions and attitudes may differ among
individuals and general perceptions about safety problems in the workplace should be
longitudinal in order to compare any changes in the safety climate study. Moreover, the safety
climate scale should be replicated to test the consistency of the factor construct in a study across
different industries. Furthermore, barriers or supports to implement OHSMS are critical to enable
effective implementation.

For the implementation of OHSMS in all public hospitals in Malaysia, the Ministry of Health
should consider putting into practice the strategies proposed by this study. Firstly, the Ministry of
Health should improve the OHS outcomes in public hospitals as revealed by this study’s findings
by focusing on two crucial elements, management leadership and action and employee
involvement and agreement. Then a risk assessment should be undertaken through plan-do-
check-action (PDCA) strategy to deal with hazards at the workplace. Later, an OHSMS should
be chosen either certified to OHSAS 18000 or MS 1722 from the certification bodies. A yearly
audit will be done by the certification body. As a consequence, implementation of an OHSMS
will ensure that the numbers of injury and accident will be reduced and thus improve the safety
culture (the shared values and beliefs of an organization) of public hospitals and comply with
OHS regulations.

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 Appendix 1

2.3 AN OVERVIEW OF HEALTH AND SAFETY ISSUES

2.3.1 The Legislative Framework of the Occupational Health and Safety

This section examined the occupational health and safety legislation in Malaysia and Australia.

i. Legislative Framework for the Occupational Health and Safety in Malaysia

Health and safety is not a new phenomenon in Malaysia. Since end of 19th century, 120 years
ago, Malaysia has its own health and safety legislation. Before 1994, the main Occupational
Health and Safety legislation in Malaysia was the Factories and Machinery Act 1967 that
provided limited coverage of safety, health and welfare of workers at the workplace. As this
prescriptive legislation could not deal with new occupational health and safety issues, hence, in
1994, the Occupational Safety and Health Act was formulated where it focused on the safety and
health protection to all workers. Changes from the prescriptive style of health and safety
legislation was based on Lord Robens Report 1972 that emphasis on self-regulation approach,
that is the primary responsibility to ensure safety and health at work lies with those who create
the risks and those who work with the risks. The concept of self-regulation encourages
consultation, cooperation and participation of workers and management in efforts to upgrade the
standards of safety and health at the workplace. Today the key laws on OHS in Malaysia are the
Factories and Machinery Act 1967 and the Occupational Safety and Health Act 1994.

Below are the five eras of health and safety legislation in Malaysia:

a. Steam Boiler Safety Era – Before 1914

In 1878, the inspection of the safety aspect of steam boilers was introduced as tin mines used
steam boilers in their operations. Four allied Malay states or Negeri-Negeri Melayu Bersekutu
(Perak, Selangor, Pahang and Negeri Sembilan) had their own steam boiler enactments. The first
steam boiler regulation was the Selangor Boiler Enactment 1892. Followed by Perak Boiler in

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1903. By 1908, all the Allied Malay States had a uniform steam boiler legislation that was
enforced by inspectors of boiler.

b. Machinery Safety Era – 1914 till 1952

The steam boiler enactment was replaced by Machinery Enactment 1913 on 1 January 1914.
Besides inspection of steam boilers, inspectors had to inspect machineries, including combustion
engines, water turbines and other related auxiliary machineries. Later in 1932, the Machinery
Enactment of 1913 was abolished and replaced with Machinery Enactment of 1932 where
registration and inspection of installation were enforced. Inspectors were put under the Mineral
Department as machineries were used in the mining sector.

c. Industrial Safety Era – 1952 till 1970

In 1952, the Machinery Branch under the Mineral Department was renamed Machinery
Department and split from the Mineral Department as most inspections had progressed to other
industries besides mining. In 1953, all of the machinery enactments of the Allied Malay States
(Negeri-Negeri Melayu Bersekutu), Non-Allied Malays States (Negeri-Negeri Melayu Tidak
Bersekutu) and Strait States (Negeri-Negeri Selat) were abolished and replaced with the
Machinery Ordinance 1953. With the enforcement of this ordinance, roles of inspectors had been
expanded to cover the safety of workers besides steam boiler and machinery safety.

d. Industrial Safety and Hygiene Era – 1970 till 1994

In 1970, the Machinery Ordinance 1953 was abolished and replaced with the Factory and
Machinery Act 1967 and eight regulations under the act. This act was to overcome the
weaknesses in the Machinery Ordinance 1953, where workers’ were not protected if they worked
in a workplace that doesn’t use machinery. Provisions relating to industrial health are also added.
The function and responsibilities of inspectors were reorganized and the name of the department
was changed to Factory and Machinery Department. Generally, the Act was drafted to provide
minimum standards of safety, health and welfare of workers at workplace consisting of 5
employees or more and at premises which machinery were being used, including factories,
building construction sites and works of engineering construction. This era also viewed the

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existence of activities including the formation of the Anti-Pollution Section in the year 1971;
formation of Industrial Hygiene Unit in the year 1971 and upgrade of its status to Industrial
Hygiene Section in the year 1980; start of petroleum safety activities with the formation of
Petroleum Safety Section in the year 1985; start of special inspection activities to prevent major
industrial accident; industrial safety and health activity exercises with expert help from
International Labour Organization in the year 1987; formation of C.I.S in 1988; and formation
of Major Hazards Section in the year 1991.

e. Occupational Safety and Health Era – After 1994

Occupational Safety and Health Act 1994 (Act 514) was gazetted on February 1994 where all
industries are covered. Industrial sectors that are covered are as follows: (1) manufacturing; (2)
mining and quarrying; (3) construction; (4) agriculture, forestry and fishing; (5) utilities – gas,
electric, water and sanitary services; (6) transport, storage and communication; (7) wholesale
and retail traders; (8) hotels and restaurants; (9) finance, insurance, real estate, business service;
and (10) public services and statutory authorities. This legislation also covers 90% of employees
and exempts those working on ships and in the armed forces.

Before 1994, the legislation of health and safety in Malaysia were more of a prescriptive style
where it focused on machinery and workplace hazards and individuals at work must improve the
dangerous conditions after being inspected by enforcement officers. This is so as employers
perceived government to be accountable for OHS matters and workplaces need to be inspected to
improve hazardous working conditions. However, this prescriptive legislation could no longer
cope with constant changes from the rapid industrialization.

Based on the Western Australia health and safety legislation, Occupational Safety and Health
Act 1994 was introduced where the principle of self-regulation was adopted. Self-regulation
approach ensures accountability and cooperation of employers and workers to achieve a safe
workplace through proactive actions. This proactive action is done through duty of care
provision. Furthermore, compliance officers have become an auditor to audit organizations
health and safety performance instead of inspectors.

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The purpose of Occupational Safety and Health Act 1994 is to promote and stimulate
occupational safety and health awareness among workers and to create organizational effective
safety and health measures. There are three main principles in this Act: (1) self-regulation, where
employers must develop a good policy and orderly management system to be carried out; (2)
consultation, where employers, employees and the government must negotiate to settle issues
and problems relating to occupational safety and health at the workplace; and (3) co-operation,
where employers and employees must co-operate to take care, nurture and to increase the quality
of occupational safety and health at the workplace. This Act replaced any conflict in existing
occupational safety and health laws such as the Factory and Machinery Act 1967. The
Occupational Safety and Health Act 1994 complements any existing legislative provision and if
there are any conflicts, the Occupational Safety and Health Act 1994 will overcome it.

This Act also provide for the appointments of enforcement officers, establishment of National
Council for Occupational Safety and Health, formation of policy and arrangement of measures to
protect safety, health and welfare of people at work and others who might be endangered by the
activities of people at work. The powers to enforce, to inspect and the liabilities for breaking the
law are also clearly defined.

In conjunction with this Act, in April 1994, the Department of Factory and Machinery has been
renamed as the Department of Occupational Safety and Health (DOSH). DOSH carries out
enforcement of (1) Occupational Safety and Health Act 1994; (2) Factories and Machinery Act
1967; and (3) Petroleum Act (Safety Measures) 1984.

ii. Legislative Framework for the Occupational Health and Safety in Australia
Australian health and safety legislation is control by a framework of Acts, Regulations and
support material including codes of practice and standards. Each states and territories in
Australia (Australia Capital Territory, New South Wales, Northern Territory, Queensland, South
Australia, Tasmania, Victoria, Western Australia, and Federal Government) has their own
Occupational Health and Safety (OHS) legislation (CCH, 1996). The legislations are:

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• Federal – The Occupational Health and Safety (Commonwealth Employment) Act 1991
administered by Comcare Australia;
• New South Wales – The Occupational Health and Safety Act 1983 administered by New
South Wales WorkCover Authority;
• Victoria – The Occupational Health and Safety Act 1985 administered by Victorian Work
Cover Authority;
• Queensland – The Workplace Health and Safety Act 1995 administered by Workplace
Health and Safety Queensland;
• South Australia – South Australian WorkCover Authority;
• Western Australia – The Occupational Safety and Health Act 1984 administered by
WorkSafe Western Australia;
• Tasmania – The Workplace Health and Safety Act 1995 administered by Workplace
Standards Tasmania;
• Australian Capital Territory – The Occupational Health and Safety Act 1989
administered by ACT WorkCover;
• Northern Territory – NT Work Health Authority;

There are also OHS statutes covering the mining industry in some states. Initially, all states and
territories in Australia adopted the 19th century British health and safety legislation (particularly
the 1878 Factories Act, and later 1901 Act), which is a prescriptive legislation that relied upon
detailed, highly technical specification standards. Later on, all of the statutes are reform to be
based on the UK Robens model where duty of cares is included. Even some states go further than
the Robens model in some respects (The National Research Centre for Occupational Health and
Safety Regulation, 2002). In 1985, the federal government legislated the establishment of the
National Occupational Health and Safety Commission (NOHSC). NOHSC is a tripartite body,
with members appointed by federal, state and territory governments, and members appointed by
the Australian Chamber of Commerce and Industry, and the Australian Council of Trade Unions
with functions including initiate research, collect statistics, and develop national standards.
State and territory governments must adopt NOHSC standards before they have any legal force
due to the Federal Parliament’s constitutional limitations.

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iii. Discussion of Legislative Framework for Occupational Health and Safety
From the review of the OHS legislation in Malaysia and Australia, it was discovered that the
current OHS legislation used by both countries utilize the same philosophy of self-regulation
where all parties no matter employer, employee or other people at work have to be responsible
for the health and safety in the workplaces. One distinct aspect is the amount of OHS legislation,
where Malaysia has only one OHS legislation to be enforced throughout the 14 states but in
Australia, there are nine OHS legislation enforced by the states and territories. Although these
states have their own OHS legislation but the philosophy behind the OHS legislation still apply
the self-regulation approach. Nevertheless, the primary aim of the OHS legislation is to promote
safety and health awareness and to instill a safety and health culture among workers.

Another dissimilarity that might exist is on the cultural issues in both countries where it will
minimize the enforcement of the legislation. Thus, support from government in terms of
developing the right culture is also critical to ensure effective enforcement of the OHS
legislation. Furthermore, the occupational safety and health legislation should be reviewed and
upgraded from time to time so that it covers issues like safety, health and welfare of all
employees as the growth of precarious employment can contribute to workers’ protection and
thus reduce companies’ costs like insurance, medical costs, lost-time injury, etc. Lack of political
will, insufficient resources, lack of management’s involvement within enterprises, inadequate
preventive measures, inadequate utilization of existing preventive measures at workplaces, and
the relaxed enforcement of the authorities should be given critical consideration as to maintain
motivated employees to comply with the legislation.

2.3.2 Healthcare Standards

This section looked into the healthcare standards in Malaysia and Australia.

i. The Australian Council on Healthcare Standards (ACHS): EQuIP Standards

EQuIP was launched in mid 1996 by the Australian Council on Healthcare Standards (ACHS).
EQuIP provides continuous quality improvement tools to health care organizations through

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continual review of performance, assessment and accreditation (ACHS, 2002). There are six
functions in the EQuIP Framework: (1) Continuum of care; (2) Leadership and management; (3)
Human resources; (4) Information management; (5) Safe practice and the environment; and (6)
Improving performance.

The Continuum of care comprises of four standards: (1) principles of service provision, access
and entry to the health care organization; (2) principles of consumer/patient assessment; (3)
principles of care planning, delivery and evaluation; and (4) principles of separation and
continuing management.

The Leadership and management consists of four standards: (1) the role of the governing body
and the need for strong leadership and direction; (2) the implementation of risk management
principles including the development of an organization-wide risk management policy and a risk
management system; (3) the need for strong leadership in improving performance; and (4)
promotes consumer participation and addresses the need to involve consumers.

The human resources management function covers all staff, including permanent, casual, visiting
staff and volunteers and has one standard: supports the delivery of quality and safe care and
service.

There are three standards in the information management: (1) management of the sources of data
and information; (2) creation of information from data and its use within the organization; and
(3) systems for information technology.

Safe practice and the environment function contains of one standard: to ensure a safe, functional
and healthy environment for staff, consumers/patients and visitors through effective management
of safety risks, buildings, plant, equipment, utilities, consumables, supplies and waste.

Improving performance summarize the need for a systematic approach to continuous quality
improvement and the evaluation of quality improvement outcomes.

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EQuIP benefits to the organization according to Ferry, Robinson and Beaufils (1998) include:

• development of a culture which strives for continual improvement

• focus on customer satisfaction
• enhanced communication between staff
• improved coordination of patient care services
• an acceptance of continual change
• accreditation no longer seen as a threatening process but rather a learning experience.

ii. The Malaysian Society for Quality in Health (MSQH) Standards

The healthcare standards in Malaysia centered on quality of healthcare in the healthcare industry
and are limited to quality in Malaysian hospitals whether public or private hospitals. The
principle of these healthcare standards is consumer-focused. The Malaysian standards has been
adopted from the Australian Council of Healthcare Standards and modified to suit local needs
and conditions.

The Ministry of Health Malaysia and the Association of Private Hospitals of Malaysia
established the Malaysian Society for Quality in Health (MSQH) in 1997 with the goal of
ensuring continuous quality improvement in healthcare services and facilities especially in
Malaysian hospitals (MSQH, 2009). The MSQH has the responsibility to develop and review the
Malaysian Hospital Accreditation Standards for patient care and facility's operation to retain high
professional standards of care. These standards will ensure healthcare organizations to monitor
and improve their performance and to implement ways to continuously improve the healthcare
system. A WHO Consultant from Australian Council of Healthcare Standards has been
providing the guidance in the development of the Malaysian Hospital Accreditation Program.
The Australian approach has been adapted with some changes to suit local needs and conditions.
The quality of healthcare is a main interest of the government, stakeholders, healthcare providers
and consumers of health services due to: (1) wide variation exists in the standards of services
between public and private healthcare providers, (2) to establish common national and
internationally recognized standards, (3) to provide the best possible care to the patients, and (4)

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to ensure the right person doing the right things right with the right process and equipment, in the
right (safe) environment to the right patient with the right (good) outcome.

MSQH standards focus into five (5) major areas: (1) organization and management, (2) human
resource and management, (3) policies and procedures, (4) facilities and equipment, and (5)
quality improvement activities. These standards provide the basis for organizational assessment
of the delivery of quality patient care and services, and the utilization of available resources.
These standards are applicable to all types of hospitals - public and private, large and small,
urban and rural.

As at 31 December 2009, there are 74 public and private hospitals in Malaysia accredited with
these standards (refer Appendix 2 for listing).

iii. Discussion of the Healthcare Standards

The similarity of this healthcare standard in both countries is the focus of quality improvement of
the organizations’ performance. Although Malaysia healthcare standards pursued the guidance of
Australian healthcare standards, the areas covered is not the same as some changes had been
done to suit the Malaysian needs. Furthermore, this standard is a voluntary basis. This standard
also support and documents a well-organized and administered health care delivery system.

With multiracial population in both countries, the success of this healthcare standard depends
upon the political stability and continuous social development from government in the
accomplishment of improved standard of living, assured social harmony, and support for health
equity to determine concurrent improvement of healthcare services. Consequently, continuous
efforts and fine-tune from hospitals are critical to determine that their quality of patient safety is
enhanced. With certification of this healthcare standard, hospitals undergo evaluation process in
enhancing their performance.

2.3.3 Occupational Health and Safety Management Systems

This section explored the occupational health and safety management systems in Malaysia and
Australia and the ILO OSH Management Systems.

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i. Occupational Health and Safety Management Systems in Malaysia

Department of Standards Malaysia (DSM) is the National Standards Body for Malaysia
established under Standards of Malaysia Act 1996. Standards and Industrial Research Institute of
Malaysia (SIRIM) Berhad is appointed as the sole national standards development agency by
DSM (SIRIM, 2009).

SIRIM QAS International Sdn. Bhd., a wholly owned subsidiary of Standards and Industrial
Research Institute of Malaysia (SIRIM) Berhad is the leading certification, inspection and testing
body in Malaysia for Occupational Health and Safety Management Systems Certification
Scheme. SIRIM QAS International Sdn. Bhd. is accredited by DSM (Department of Standards
Malaysia) and UKAS (United Kingdom Accreditation Service).

OHSAS 18001 has been the only OHS management systems in Malaysia since 1999 that is
OHSAS 18001: 1999. OHSAS 18001 is a copyright of British Standards Institute, United
Kingdom but not a British Standard (SIRIM, 2009). OHSAS 18000 has been developed to be
compatible with the ISO 9001: 1994 (Quality) and ISO 14001: 1996 (Environmental)
Management Systems standards.

OHSAS 18001 is an abbreviation for Occupational Health and Safety Assessment Series
(OHSAS). Currently there are two series of the OHSAS - (1) OHSAS 18001: 2007 –
Specification; and (2) OHSAS 18002: 2008 - Guidelines for the implementation of OHSAS
18001. OHSAS 18001 was issued on 15 April 1999 and OHSAS 18002 was introduced in 2000.
The standard was developed in response to urgent customer demand for a recognizable
Occupational Health and Safety Management System standard against which a company's
management systems can be assessed and certified. The arrangement specifies the necessity for
the establishment of an occupational health and safety (OHS) management system in any
organization to facilitate the organization to control its OHS risks and improve its performance.
As such, OHSAS 18001 focus on occupational health and safety of employee at the workplace.

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Every organization that has certification of OHSAS 18001 will be monitored closely through
surveillance audit so that they comply with the OHSAS 18001 elements. A certificate of
conformity will be granted to those organizations, which have demonstrated that they meet the
requirements of the OHSAS 18001: 2007 - Occupational Health and Safety Management
Systems. Re-certification will be issued after three years. According to SIRIM (2009), those
companies that have OHSAS 18001 certification showed an improvement in their OHS
performance where there were reduction in major and minor accidents, decreased in medical
leaves, declined in medical costs and improved safety culture.

However, certification to OHSAS 18001 does not ensure compliance to Occupational Health and
Safety legislation but in the long run, the obligation to apply the OHSAS requirements with the
concept of continuous improvement will drive the organizations to progress towards legal
compliance.

According to SIRIM (2009), in Malaysia, so far, as at 31 December 2008, there are 268
companies that have Occupational Health and Safety Management System (OHSAS 18001)
certification. These companies comprise of (1) 20 companies from the construction sector; (2)
60 companies from the chemical and material sector; (3) 30 companies from the electrical and
electronic sector; (4) 99 companies from the food, agriculture and forestry sector; (5) 39
companies from the mechanical and automotive sector and (6) 20 companies from the service
sector.

Most of the large companies like Petronas, Shell, Mobil, Motorola and others have their own
model of Occupational Health and Safety Management System. Transnational companies
operating in Malaysia have their own OHS management systems.

Up until OHSAS 18001 was introduced, there is no standard system in Malaysia yet and not all
organizations have the Occupational Health and Safety Management System. With the aim to
protect workers from the hazards at work and to prevent accidents from occurring, the Malaysian
government has formulated the Occupational Safety and Health Management System – the
Malaysian Standard in 2003 (OSH-MS 1722:2003). This standard was based on the ILO OSH

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MS 2001. Implementation of the OHS management systems through continuous improvement in
the workplace is a mean to legal compliance. Due to this problem Malaysian government intends
to introduce the Malaysian Standard by 2004 (Hamisah Hamid, 2003b) but it was only realized
in 2005. In 2005, Malaysian government appointed SIRIM Berhad as the certification body for
MS1722. Thus, MS 1722 Part 1: 2003- Requirements and MS 1722 Part II: 2005 – Guidelines
were introduced to the public. Since the requirements of this standard are equivalent to OHSAS
18001, auditing and certification to this standard is performed at the same time. So far, as at 8
May 2009, there were 42 companies from the private sector certified to this standard.

ii. Occupational Health and Safety Management Systems in Australia

Bottomley (1999a, p.3) defined occupational health and safety management system as:
• The South Australian Safety Achiever Bonus Scheme definition: “An orderly
arrangement of interdependent activities and related procedures that drives an
organisation’s OHS(W) performance.”

• Definition that AS/NZS 4801 and AS/NZS 4804 used: “that part of the overall
management system which includes organizational structure, planning activities,
responsibilities, practices, procedures, processes, and resources for developing,
implementing, achieving, reviewing and maintaining the health and safety policy and so
managing the health and safety risks associated with the business of the organization.”

The Australian Occupational Health and Safety Management Systems are (1) AS/NZS 4801:
2001 Occupational Health and Safety Management Systems – Specification with guidance for
use, (2) AS/NZS 4804 Occupational Health and Safety Management Systems – General
guidelines on principles, systems and supporting techniques. There are five elements in AS/NZS
4801 Occupational Health and Safety Management Systems – Specification with guidance for
use: (1) Occupational Health and Safety Policy, (2) planning, (3) implementation, (4)
measurement and evaluation, and (5) management review.

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To achieve effective OHS performance, audit tools that integrate crucial elements of an OHSMS
are used. The Australian audit systems include (1) Western Australia’s WorkSafe Plan, (2)
South Australia’s Safety Achiever Business System, (3) Victoria’s SafetyMAP, (4)
Queensland’s TriSafe Management Systems Audit, (5) New South Wales’ CPSC Guidelines,
and (6) Commonwealth’s ComCare’s SRC Risk Management Model.

Bottomley (1999b) revealed that there are five key elements in Western Australia’s WorkSafe
Plan: (1) management commitment, (2) planning, (3) consultation, (4) hazard management, and
(5) training. As indicated by Victorian WorkCover Authority (2006), SafetyMAP (Safety
Management Achievement Program) is an audit tool that evaluate an organization's health and
safety management system. There are five elements in SafetyMAP: (1) health and safety policy,
(2) planning, (3) implementation, (4) measurement and evaluation, and (5) management review.
The South Australia’s Safety Achiever Business System consists of (1) commitment and policy,
(2) planning, (3) implementation, (4) measurement, and (5) review (Gallagher et al., 2003).

iii. The ILO Occupational Health and Safety Management Systems

The ILO Guidelines (ILO, 2001a) on occupational safety and health management systems (ILO-
OSH 2001) were adopted at a tripartite meeting of experts in April 2001. It focuses on the same
specification as other international standards and is compatible with other management systems
standard. ILO-OSH 2001 stressed that OHS should be a line management responsibility at the
organization and encourage integration of their model with other management systems. ILO
OSH-MS 2001 centers on two levels: (1) a national level for implementing a national framework
for policy on occupational health and safety; and (2) organizational level as it is the
responsibility of employers to assure the health and safety conditions of their employees.

The ILO –OSH Management System consist of the following components:

• Policy – contains 2 elements: (1) OHS policy and (2) workers participation
• Organizing – includes 4 factors: (1) responsibility & accountability, (2) competence &
training, (3) OHS documentation and (4) communication

209
• Planning and Implementation – comprises of 4 aspects: (1) initial review; (2) system
planning, development and implementation; (3) OHS objectives and (4) hazard
prevention
• Evaluation – covers of 4 features: 1) performance monitoring and measurement; (2)
investigation; (3) audit; (4) management review
• Action for improvement involves 2 elements:(1) preventive and corrective action; and (2)
continual improvement

iv. Discussion of Occupational Health and Safety (OHS) Management Systems

The similarity in all OHS management systems is to maintain a healthy workforce, to retain a
safe system of work, to support the wellbeing of the employees, and to achieve a good safety
outcome. The common principle in the OHS management systems is almost similar whereby
these principals are in use: commitment and policy, planning, implementation, measurement and
evaluation, and management review. Furthermore, all the OHS management systems in both
countries are applicable to any organization who wants to eliminate or minimize its OHS risks
despite of size, type or level of maturity. It can also be used to comply with relevant OHS
legislation, and standards and codes of practice in both countries. Accountability from the
management is critical to ensure the success of the implementation.

In Australia, there are eight OHS management systems but in Malaysia, there is one OHS
management system to be subscribed by organization that is OSHAS 18001.

For an effective OHS management systems, several researches recognized that determinants like
recognition and rewards programs; collaboration and sharing effort; measures to strengthen
senior management values; better communication systems; allocation of resources; incorporate
OHS planning into the organization strategic plans; etc. are critical for good performance.
Moreover, a primary basis for national OHS programs is the government’s commitment to
implement it.

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2.3.4 An Overview of Occupational Accidents, Diseases and Compensation
This section examined the occupational accidents, diseases and compensation in Malaysia and
Australia.

i. Occupational Accidents, Diseases and Compensation in Malaysia

Occupational safety and health performance varies enormously between countries, economic
sectors, sizes of enterprises, and groups at particular risk (Alli, 2001). There is significantly
difference between small and large organizations in term of workplace fatalities. Alli (2001)
concluded that economic sectors such as agriculture, forestry, mining, manufacturing and
construction have the highest prevalence in occupational deaths. The same goes for small
workplaces compared to large enterprises. Specific workforces at risk are women, home-based
workers, part-time workers, contract workers and drivers (ILO, 2000).

Table 2.1 shows the accidents and occupational diseases statistics. Although there are
regulations to bind employers, SOCSO statistics show a rise and fall number of industrial
accidents, from 114,134 accidents in 1995 to 85,338 in 1998, then an increased to 92,074 in
1999, 95,006 in 2000, afterwards to 56,339 accidents in 2007. There was even a fluctuation in
the disease statistics. In 1997, the number of diseases was 832 cases, then declined to 178 cases
in 1998, and later increased to 278 cases in 2000. What is more, the Director-general of
Department of Occupational Safety and Health (DOSH), Datuk Dr Johari Basri said that in
2007, 4,873 notices were issued to employers to improve workplace dangers with 215 companies
being compounded and 108 companies charged under Section 15 of the Occupational Safety and
Health Act 1994 (Sujata, 2008). This phenomenon was due to employers’ non-compliance with
the Occupational Safety and Health Act 1994 (New Straits Times, 2002). One of the main
aspects of employer’s non-compliance was the failure on the part of the management to develop
safety and health systems at the workplace.

As the reporting of occupational accidents and diseases improves, organizations are becoming
increasingly aware of the associated economic costs. They include costs for lost work time and
productivity, compensation and medical expenses by the social security system, and accident
damage. Even, Cruez (2004) stated that accidents in the workplaces have increased organizations

211
expenditure through its direct and indirect cost. Nonetheless, it is clear from the available
statistics that the reporting of occupational accidents and diseases improves and this might be
due to the awareness of the associated economic costs. In addition, the cooperation of companies
with the enforcement body to ensure health, safety and welfare of their workers plays an
important role in this development.

Table 2.2 illustrates that economic sectors such as agriculture, forestry and fishing;
manufacturing; construction; trading; services and public services have the highest prevalence in
occupational deaths and accidents reported. For example, the manufacturing industry
demonstrated insignificant decreased in industrial accidents, from 36,968 accidents in 1997 to
41,331 accidents in 2000 and dropped to 21,609 accidents in 2006. Similarly, the number of
industrial fatalities in manufacturing industry also revealed irrelevant reduction where there were
387 deaths reported in 1997, decreased to 232 deaths in 1999, and then increased to 282 deaths
in 2000. The fluctuated amount can be attributed to the increase of industrial development where
more technological innovations are being used in the workplace. In addition, new types of
occupational diseases have increased through the usage of new chemical substances. The
increased activities in the industrial sectors provide workers with real health hazards. On the
other hand, the decrease number of accidents may reveal restricted social security coverage
(ILO, 2000) or even, there might be cases where under-reporting of statistics had happened
especially hazard contributed from modern working arrangement.

Hinze (2005, p. 2) reported that “injury under-reporting is a major problem because every injury
that gets swept under the table is an injury whose root cause will never be investigated.” Hence,
the availability of accurate statistics on industrial accidents and occupational diseases reflects
some difficulties in the development of occupational health and safety and there is a need to
support significant analyses in discovering the causes of occupational accidents and diseases and
promote effective prevention policies (ILO, 2005).

212
 Table 2.1: Number of accidents, occupational diseases and compensation due to industrial
accidents

No. Year Number of No of reported Compensation

reported industrial Occupational recipients
accident diseases
1. 1995 114, 134 - 182,763
2. 1996 106,508 - 179,936
3. 1997 86,589 832 194,421
4. 1998 85,338 178 196,668
5. 1999 92,074 192 209,821
6. 2000 95,006 278 228,705
7. 2001 85,926 204 230,344
8. 2002 81,810 216 239,372
9. 2003 73,858 189 247,790
10. 2004 69,132 194 255,381
11. 2005 61,182 - 252,439
12. 2006 58,321 263 259,081
13. 2007 56,339 341 286,891
Source: SOCSO Annual Reports 1995 – 2007 (2009)

As a result of the accidents and diseases, workers who were injured or killed on duty, or who
become infected with diseases in the course of their employment found themselves unable to
earn a living. A few decades ago, there was very little support for these problems and employees
were eliminated from the workforce. With this in mind, Malaysia has set up a system that
compensates occupational accidents and diseases to lessen the burden of employees through the
Employees Social Security Act 1969 for preventive and rehabilitative programs. Social Security
Organization (SOCSO) enforced this act. There are two schemes to compensate workers who are
earning less than RM3,000 for employment injury (which includes occupational diseases) and
invalidity: (1) Employment Injury Insurance Scheme, and (2) Invalidity Pension Scheme. The
Employment Injury Insurance Scheme provides an employee with protection for (1) accidents
that occur while commuting and working; and (2) diseases from exposure at the workplace. The
Invalidity Pension Scheme is a non-occupational related scheme and covers an employee against
invalidity or death due to any cause not connected with his employment.

213
From Table 2.1, the figures for compensation recipients are enormous. The compensation had
increased from 182,763 in 1995 to 286,891 in 2007. Although there is a downward trend in
occupational accidents but workers' compensation costs increased. According to SOCSO, the
annual mean value for compensation claims for 1990 – 1994 was 154.3 million and the cost had
increased to 577.3 million in 1998 – 2002. Even the Director-general of Department of
Occupational Safety and Health (DOSH), Datuk Dr Johari Basri pointed that compensation paid
by SOCSO for those involved in industrial and commuting accidents had increased from
RM959mil in 2006 to RM1.06bil in 2007 (Sujata, 2008). The statistics point not only to the
economic costs, but also to the social burdens associated with such costs and the suffering of
individual workers and their families.

Table 2.2: Number of Accidents by Industries: 1997 – 2003 & 2006 - 2007
Year 1997 1998 1999
Industries No. of Death No. of Death No. of Death
cases reported cases reported cases reported
reported reported reported
Agriculture, Forestry 23296 265 12678 34 12753 132
& Fishing
Mining & Quarrying 760 18 739 8 756 14

Manufacturing 36968 387 37261 228 40730 232

Electricity, Gas, 364 14 979 12 592 11

Water & Sanitary
Services
Construction 3510 81 3573 104 4747 146

Trading 9235 126 12986 139 14685 127

Transportation 3245 88 4050 78 4462 91

Financial Institutions 363 7 700 15 627 8

& Insurance
Services 3723 56 5294 94 5987 65

Public Services 5125 265 7078 334 6735 83

TOTAL 86589 1307 85338 1046 92074 909

214
Table 2.2: Number of Accidents by Industries: 1997 – 2003 & 2006 - 2007

Year 2000 2001 2002

Industries No. of Death No. of Death No. of Death

cases reported cases reported cases reported
reported reported reported
Agriculture, Forestry 11893 115 12424 75 9456 69
& Fishing

Mining & Quarrying 626 11 573 7 545 12

Manufacturing 41331 282 35642 243 33523 214

Electricity, Gas, 537 8 499 13 516 14

Water & Sanitary
Services

Construction 4873 159 4593 89 5015 88

Trading 15452 151 13774 192 13685 134

Transportation 4778 98 4382 91 4439 90

Financial Institutions 687 11 602 6 567 9

& Insurance

Services 6581 72 5950 106 5924 87

Public Services 8248 97 7487 136 8140 141

TOTAL 95006 1004 85926 958 81810 858

215
Table 2.2: Number of Accidents by Industries: 1997 – 2003 & 2006 - 2007

Year 2003 2006 2007

Industries No. of Death No. of Death No. of Death
cases reported cases reported cases reported
reported reported reported
Agriculture, Forestry 6947 40 3567 37 3255 352
& Fishing

Mining & Quarrying 536 8 394 8 362 55

Manufacturing 29780 213 21609 188 19607 3622

Electricity, Gas, 510 8 509 15 476 105

Water & Sanitary
Services

Construction 4654 95 3686 64 3703 589

Trading 13395 151 11430 127 11658 1664

Transportation 4104 108 3610 78 3639 638

Financial Institutions 572 7 538 2 612 157

& Insurance

Services 5617 84 4832 69 4718 830

Public Services 7743 108 8146 145 8309 1543

TOTAL 73858 822 58321 733 56339 755

Source: SOCSO Annual Reports 1997 – 2003, 2006 - 2007 (2009)

216
ii. Occupational Accidents, Diseases and Compensation in Australia
There are 11 workers’ compensation systems in Australia. Below is the information about the
compensation systems and agencies accountable for administering workers’ compensation as at
30 June 2008 (Commonwealth of Australia, 2009).
a. New South Wales
Policy: WorkCover NSW
Current legislation: Workplace Injury Management and Workers Compensation Act 1998
and Workers Compensation Act 1987

b. Victoria
Policy: Victorian WorkCover Authority (WorkSafe Victoria)
Current legislation: Accident Compensation Act 1985 and Accident Compensation
(WorkCover Insurance) Act 1993

c. Queensland
Policy: Department of Employment and Industrial Relations
Current legislation: Workers’ Compensation and Rehabilitation Act 2003

d. Western Australia
Policy: WorkCover WA
Current legislation: Workers’ Compensation and Rehabilitation Act 1981

e. South Australia
Policy: WorkCover SA
Current legislation: Workers’ Rehabilitation and Compensation Act 1986 and
WorkCover Corporation Act 1994

f. Tasmania
Policy: Department of Justice and WorkCover Tasmania
Current legislation: Workers’ Rehabilitation and Compensation Act 1988

217
g. Northern Territory
Policy: Department of Employment, Education and Training
Current legislation: Work Health Act 1986

h. Australian Capital Territory

Policy: Office of Industrial Relations
Current legislation: Workers’ Compensation Act 1951

i. Commonwealth
The following shows that there are three policies under the Commonwealth.

Policy 1: Comcare - Department of Education, Employment and Workplace Relations

Current legislation: Safety, Rehabilitation and Compensation Act 1988

Policy 2: Seacare - Department of Education, Employment and Workplace Relations

Current legislation: Seafarers Rehabilitation and Compensation Act 1992

Policy 3: MRCS - Military Rehabilitation and Compensation Commission

Current legislation: Military Rehabilitation and Compensation Act 2004

Table 2.3 shows the number of claims and incidence statistics. The statistics show insignificant
reduction in number of claims and number of incidence, from 153030 claims in FY1997/98 to
132055 claims in FY2006/07. The statistic shows that manufacturing industry has the highest
number of claims. As for the number of incidence, there was an insignificant reduction in the
statistics. In FY1997/98, the amount was 20.8 per 1000 employees, and then declined to 14.2 per
1000 employees in FY2006/07. Initially, the mining sector has the highest number of incidence
in FY1997/98 (43.3 per 1000 employees), then in the later years the manufacturing, construction,
and transport and storage sectors have the highest accidents.

218
Table 2.4 shows the number of frequency (per million hours worked) and number of claims
statistics. There was a reduction in the statistics, where, in FY1997/98, the number of frequency
was 12.2 per million hours worked, and then declined to 8.8 per million hours worked in
FY2006/07. Initially, the mining sector has the highest number of incidence in FY1997/98 (19.6
per million hours worked), then in the later years the manufacturing, and transport and storage
sectors have the highest accidents.

Table 2.5 shows the median total compensation payment from FY2000/01 to FY 2005/06 and the
number of claims statistics. There was an increased in the total compensation payment, where, in
FY2000/01, the total compensation was $5,300, and then increased to $6,100 in FY2005/06.
The mining sector has the highest compensation payment throughout the year from FY2000/01
to FY 2005/06.

219
Table 2.3: Occupational Health and Safety Statistics Report – Number of Incidence: FY1997/98
– FY 2006/07

Year FY1997/98 FY1998/99 FY1999/00

Industries No. of No. of No. of No. of No. of No. of
Claims Incidence Claims Incidence Claims Incidence
(per 1000 (per 1000 (per 1000
employees) employees) employees)
Agriculture, 5980 33.2 6135 32.3 6205 32.0
Forestry and
Fishing
Mining 3380 43.3 2500 32.8 2350 31.5
Manufacturing 37250 36.4 35135 35.5 33955 33.2
Electricity, Gas 1465 23.2 1250 19.6 1145 18.1
and Water Supply
Construction 13990 37.0 13565 33.1 14005 30.8
Wholesale Trade 8275 18.5 7710 17.1 7755 17.5
Retail Trade 14320 13.3 13800 12.1 15395 13.1
Accommodation, 6515 16.4 6755 16.5 7020 16.4
Cafes and
Restaurants
Transport and 12030 36.4 11560 33.4 11510 33.2
Storage
Communication 2895 21.7 2190 15.8 1860 11.5
Services
Finance and 1570 5.3 1520 5.0 1335 4.3
Insurance
Property and 8905 11.3 9885 11.6 9895 10.9
Business Services
Government 4725 13.7 4635 13.2 4940 14.7
Administration
and Defence
Education 6130 10.5 6105 10.1 6655 10.9
Health and 15800 20.3 16555 20.6 16425 19.9
Community
Services
Cultural and 3455 18.1 3300 16.5 3085 14.5
Recreational
Services
Personal and 5700 20.7 5690 21.0 5660 19.8
Other Services
Not Stated 645 ** 1210 ** 610 **
TOTAL 153030 20.8 149495 19.7 149810 19.1
** data suppressed because relative standard error is greater than 50%
Financial year from 1 July – 30 June
Source: The Australia Safety and Compensation Council (ASCC) Online Statistics Interactive
National Workers' Compensation Statistics Databases

220
Table 2.3: Occupational Health and Safety Statistics Report - Number of Incidence: FY1997/98 –
FY 2006/07

Year FY2000/01 FY2001/02 FY2002/03

Industries No. of No. of No. of No. of No. of No. of
Claims Incidence Claims Incidence Claims Incidence
(per 1000 (per 1000 (per 1000
employees) employees) employees)
Agriculture, 5880 29.1 5765 26.6 5565 30.4
Forestry and
Fishing
Mining 2240 29.9 2320 30.4 2300 27.9
Manufacturing 31405 30.3 29675 30.2 29280 29.1
Electricity, Gas 980 14.6 930 14.0 805 11.0
and Water Supply
Construction 13630 31.4 12395 28.6 12865 28.7
Wholesale Trade 7045 17.8 6625 17.0 6305 15.9
Retail Trade 15330 13.0 14105 11.5 13880 10.8
Accommodation, 6835 15.1 6705 15.0 6695 15.1
Cafes and
Restaurants
Transport and 11580 32.3 11640 33.4 11385 32.7
Storage
Communication 1665 10.6 1545 11.3 1530 11.1
Services
Finance and 1395 4.4 1455 4.5 1390 4.2
Insurance
Property and 9985 10.2 10005 10.1 10565 10.4
Business Services
Government 4750 12.5 5400 13.2 5850 13.7
Administration
and Defence
Education 6615 10.6 6430 9.9 6780 10.0
Health and 16175 18.9 16225 18.4 16340 17.9
Community
Services
Cultural and 3135 15.0 3090 14.2 2895 13.0
Recreational
Services
Personal and 5880 20.8 5840 19.7 5785 18.5
Other Services
Not Stated 205 ** 165 ** 125 **
TOTAL 144740 18.1 140320 17.4 140345 16.9
** data suppressed because relative standard error is greater than 50%
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

221
Table 2.3: Occupational Health and Safety Statistics Report – Number of Incidence: FY1997/98 –
FY 2006/07

Year FY2003/04 FY2004/05 FY2005/06

Industries No. of No. of No. of No. of No. of No. of
Claims Incidence Claims Incidence Claims Incidence
(per 1000 (per 1000 (per 1000
employees) employees) employees)
Agriculture, 5150 27.3 4940 26.5 4705 25.9
Forestry and
Fishing
Mining 2380 26.3 2415 24.2 2340 19.1
Manufacturing 28430 29.3 28565 29.1 27770 28.8
Electricity, Gas 820 11.0 905 12.0 705 8.3
and Water Supply
Construction 14090 28.2 14365 26.4 14200 25.0
Wholesale Trade 6435 16.1 6615 16.8 7025 17.7
Retail Trade 13940 10.8 13500 10.0 12865 9.4
Accommodation, 6560 14.4 6550 13.2 6345 13.3
Cafes and
Restaurants
Transport and 11485 30.5 11225 28.4 11180 27.6
Storage
Communication 1515 10.4 1365 9.4 1315 8.2
Services
Finance and 1365 4.2 1220 3.7 1220 3.5
Insurance
Property and 10665 10.1 11005 10.3 10335 9.1
Business Services
Government 5620 12.8 5530 12.2 4910 10.8
Administration
and Defence
Education 6865 9.9 6740 10.0 6565 9.1
Health and 17280 18.6 17635 18.4 16475 16.2
Community
Services
Cultural and 2715 12.1 2695 11.0 2750 10.9
Recreational
Services
Personal and 5930 19.2 6045 18.9 5535 17.1
Other Services
Not Stated 75 ** 115 ** 330 **
TOTAL 141325 16.7 141440 16.2 136575 15.2
** data suppressed because relative standard error is greater than 50%
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

222
Table 2.3: Occupational Health and Safety Statistics Report – Number of Incidence: FY1997/98
– FY 2006/07

Year FY2006/07
Industries No. of Claims No. of Incidence
(per 1000 employees)
Agriculture, Forestry and 4625 25.3
Fishing
Mining 2445 19.0
Manufacturing 26695 27.6
Electricity, Gas and Water 750 9.1
Supply
Construction 14130 22.1
Wholesale Trade 6665 15.5
Retail Trade 12495 9.2
Accommodation, Cafes and 6270 12.4
Restaurants
Transport and Storage 10765 25.7
Communication Services 1185 7.2
Finance and Insurance 1160 3.1
Property and Business Services 8955 7.6
Government Administration 5155 10.8
and Defence
Education 6430 9.0
Health and Community 16030 15.2
Services
Cultural and Recreational 2550 9.7
Services
Personal and Other Services 5290 16.1
Not Stated 460 **
TOTAL 132055 14.2
** data suppressed because relative standard error is greater than 50%
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

223
Table 2.4: Occupational Health and Safety Statistics Report – Number of Frequency: FY1997/98
– FY 2006/07

Year FY1997/98 FY1998/99 FY1999/00

Industries Number No. of Number No. of Number of No. of
of Claims Frequency of Claims Frequency Claims Frequency
(per million (per million (per million
hrs worked) hrs worked) hrs worked)
Agriculture, 5980 16.5 6135 16.3 6205 16.3
Forestry and
Fishing
Mining 3380 19.6 2500 14.4 2350 13.9
Manufacturing 37250 18.9 35135 18.3 33955 17.2
Electricity, Gas 1465 12.2 1250 9.8 1145 9.4
and Water
Supply
Construction 13990 18.4 13565 16.4 14005 15.2
Wholesale Trade 8275 9.4 7710 8.7 7755 8.9
Retail Trade 14320 9.8 13800 9.0 15395 9.5
Accommodation, 6515 12.0 6755 12.3 7020 11.8
Cafes and
Restaurants
Transport and 12030 18.2 11560 16.9 11510 16.6
Storage
Communication 2895 11.5 2190 8.5 1860 6.1
Services
Finance and 1570 2.9 1520 2.7 1335 2.3
Insurance
Property and 8905 6.3 9885 6.5 9895 6.1
Business Services
Government 4725 7.7 4635 7.5 4940 8.4
Administration
and Defence
Education 6130 6.3 6105 6.0 6655 6.6
Health and 15800 14.0 16555 14.2 16425 13.9
Community
Services
Cultural and 3455 13.1 3300 11.9 3085 10.2
Recreational
Services
Personal and 5700 12.8 5690 13.1 5660 12.1
Other Services
Not Stated 645 np 1210 np 610 np
Total 153030 12.2 149495 11.6 149810 11.2
** data suppressed because relative standard error is greater than 50%
np data not available due to confidentiality restrictions
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

224
Table 2.4: Occupational Health and Safety Statistics Report – Number of Frequency: FY1997/98
– FY 2006/07
Year FY2000/01 FY2001/02 FY2002/03
Industries Number No. of Number of No. of Number of No. of
of Claims Frequency Claims Frequency Claims Frequency
(per million (per (per million
hrs worked) million hrs hrs worked)
worked)
Agriculture, 5880 15.4 5765 13.6 5565 15.7
Forestry and
Fishing
Mining 2240 13.0 2320 13.5 2300 12.0
Manufacturing 31405 15.9 29675 15.8 29280 15.0
Electricity, Gas 980 8.0 930 7.4 805 6.0
and Water
Supply
Construction 13630 15.9 12395 14.8 12865 14.6
Wholesale Trade 7045 9.2 6625 8.8 6305 8.2
Retail Trade 15330 9.5 14105 8.4 13880 7.9
Accommodation, 6835 10.9 6705 11.0 6695 11.0
Cafes and
Restaurants
Transport and 11580 16.5 11640 17.2 11385 16.4
Storage
Communication 1665 5.7 1545 6.0 1530 5.8
Services
Finance and 1395 2.4 1455 2.5 1390 2.3
Insurance
Property and 9985 5.8 10005 5.7 10565 5.9
Business Services
Government 4750 7.1 5400 7.5 5850 7.8
Administration
and Defence
Education 6615 6.5 6430 6.2 6780 6.2
Health and 16175 13.2 16225 13.0 16340 12.6
Community
Services
Cultural and 3135 11.0 3090 10.2 2895 9.5
Recreational
Services
Personal and 5880 13.1 5840 12.6 5785 11.6
Other Services
Not Stated 205 np 165 np 125 **
Total 144740 10.7 140320 10.4 140345 10.1
** data suppressed because relative standard error is greater than 50%
np data not available due to confidentiality restrictions
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

225
Table 2.4: Occupational Health and Safety Statistics Report – Number of Frequency: FY1997/98
– FY 2006/07

Year FY2003/04 FY2004/05 FY2005/06

Industries Number No. of Number No. of Number of No. of
of Claims Frequency of Claims Frequency Claims Frequency
(per million (per million (per million
hrs worked) hrs worked) hrs worked)
Agriculture, 5150 14.9 4940 14.3 4705 14.3
Forestry and
Fishing
Mining 2380 11.7 2415 10.7 2340 8.6
Manufacturing 28430 15.4 28565 15.1 27770 15.2
Electricity, Gas 820 5.9 905 6.4 705 4.6
and Water
Supply
Construction 14090 14.3 14365 13.5 14200 12.9
Wholesale Trade 6435 8.5 6615 8.8 7025 9.3
Retail Trade 13940 8.0 13500 7.2 12865 6.9
Accommodation, 6560 10.8 6550 9.8 6345 9.9
Cafes and
Restaurants
Transport and 11485 15.5 11225 14.6 11180 14.5
Storage
Communication 1515 5.7 1365 5.0 1315 4.5
Services
Finance and 1365 2.3 1220 2.0 1220 1.9
Insurance
Property and 10665 5.9 11005 5.9 10335 5.3
Business Services
Government 5620 7.5 5530 7.1 4910 6.3
Administration
and Defence
Education 6865 6.1 6740 6.2 6565 5.7
Health and 17280 13.3 17635 13.0 16475 11.4
Community
Services
Cultural and 2715 9.1 2695 8.2 2750 8.3
Recreational
Services
Personal and 5930 12.1 6045 11.7 5535 10.8
Other Services
Not Stated 75 ** 115 np 330 np
Total 141325 10.1 141440 9.7 136575 9.2
** data suppressed because relative standard error is greater than 50%
np data not available due to confidentiality restrictions
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

226
Table 2.4: Occupational Health and Safety Statistics Report – Number of Frequency: FY1997/98
– FY 2006/07

Year FY2006/07
Industries Number of Claims No. of Frequency
(per million hrs
worked)
Agriculture, Forestry and Fishing 4625 13.7
Mining 2445 8.6
Manufacturing 26695 14.9
Electricity, Gas and Water Supply 750 4.9
Construction 14130 11.5
Wholesale Trade 6665 8.3
Retail Trade 12495 6.9
Accommodation, Cafes and 6270 9.5
Restaurants
Transport and Storage 10765 13.7
Communication Services 1185 3.9
Finance and Insurance 1160 1.7
Property and Business Services 8955 4.5
Government Administration and 5155 6.3
Defence
Education 6430 5.7
Health and Community Services 16030 10.9
Cultural and Recreational Services 2550 7.6
Personal and Other Services 5290 10.5
Not Stated 460 np
TOTAL 132055 8.8
** data suppressed because relative standard error is greater than 50%
np data not available due to confidentiality restrictions
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

227
Table 2.5: Occupational Health and Safety Statistics Report – Median Total Compensation
Payment: FY2000/01 – FY 2005/06

Year FY2000/01 FY2001/02 FY2002/03

Industries Number Median Total Number Median Total Number Median Total
of Claims Compensation of Claims Compensation of Claims Compensation
Payment Payment Payment

Agriculture, 5880 $4,200 5765 $4,300 5565 $4,500

Forestry and
Fishing
Mining 2240 $10,000 2320 $10,300 2300 $9,400
Manufacturing 31405 $5,700 29675 $6,100 29280 $5,900
Electricity, Gas and 980 $6,000 930 $7,800 805 $7,500
Water Supply
Construction 13630 $6,800 12395 $7,100 12865 $6,900
Wholesale Trade 7045 $5,500 6625 $5,900 6305 $5,800
Retail Trade 15330 $4,100 14105 $4,400 13880 $4,400
Accommodation, 6835 $3,700 6705 $3,600 6695 $3,500
Cafes and
Restaurants
Transport and 11580 $5,000 11640 $5,400 11385 $5,400
Storage
Communication 1665 $7,500 1545 $9,100 1530 $9,400
Services
Finance and 1395 $8,200 1455 $8,200 1390 $8,100
Insurance
Property and 9985 $5,300 10005 $5,600 10565 $5,600
Business Services
Government 4750 $6,000 5400 $6,100 5850 $6,300
Administration and
Defence
Education 6615 $5,300 6430 $6,400 6780 $7,200
Health and 16175 $4,700 16225 $5,000 16340 $4,900
Community
Services
Cultural and 3135 $4,900 3090 $5,300 2895 $5,300
Recreational
Services
Personal and Other 5880 $6,700 5840 $6,600 5785 $7,400
Services
Not Stated 205 $28,300 165 $16,800 125 $12,400
Total 144740 $5,300 140320 $5,700 140345 $5,700
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

228
Table 2.5: Occupational Health and Safety Statistics Report – Median Total Compensation
Payment: FY2000/01 – FY 2005/06

Year FY2003/04 FY2004/05 FY2005/06

Industries Number Median Total Number Median Total Number Median Total
of Claims Compensation of Claims Compensation of Claims Compensation
Payment Payment Payment

Agriculture, 5150 $4,700 4940 $4,800 4705 $5,100

Forestry and
Fishing
Mining 2380 $10,600 2415 $10,200 2340 $10,400
Manufacturing 28430 $6,300 28565 $6,300 27770 $6,100
Electricity, Gas and 820 $8,000 905 $8,200 705 $7,900
Water Supply
Construction 14090 $7,100 14365 $7,200 14200 $7,300
Wholesale Trade 6435 $6,000 6615 $6,200 7025 $5,900
Retail Trade 13940 $4,700 13500 $4,900 12865 $5,100
Accommodation, 6560 $3,600 6550 $3,900 6345 $3,500
Cafes and
Restaurants
Transport and 11485 $6,000 11225 $6,400 11180 $6,300
Storage
Communication 1515 $8,500 1365 $8,100 1315 $8,300
Services
Finance and 1365 $9,000 1220 $9,100 1220 $9,500
Insurance
Property and 10665 $5,600 11005 $5,600 10335 $5,300
Business Services
Government 5620 $7,200 5530 $6,800 4910 $7,700
Administration and
Defence
Education 6865 $7,600 6740 $7,600 6565 $7,800
Health and 17280 $4,900 17635 $4,900 16475 $5,200
Community
Services
Cultural and 2715 $5,600 2695 $5,700 2750 $5,200
Recreational
Services
Personal and Other 5930 $7,200 6045 $7,000 5535 $8,100
Services
Not Stated 75 $11,300 115 $9,300 330 $2,600
Total 141325 $6,000 141440 $6,100 136575 $6,100
Financial year from 1 July – 30 June
Source: The ASCC Online Statistics Interactive National Workers' Compensation Statistics
Databases

229
Some of the benefits given by the compensation offices are income replacement payments (also
known as weekly payments), medical treatment benefits, permanent impairment entitlements,
and death benefits.

There are three types of scheme funding manage by each jurisdiction as to meet liabilities
(Comcare, 2004):
• centrally funded (government agency): Queensland, South Australia, and Commonwealth
(Comcare and MRCS)

• Hybrid (involves both the public and private sector): New South Wales, and Victoria

• privately underwritten (insurer functions are provided by the private sector, through
approved insurance companies and self-insuring employers): Western Australia,
Tasmania, Northern Territory , Australian Capital Territory, and Commonwealth
(Seacare)

Australian Safety and Compensation Council (ASCC) (2008) described occupational disease as:
“All employment-related diseases which result from repeated or long-term exposure to an
agent(s) or event(s) or which are the results of a single traumatic event where there was a long
latency period”. There are eight priority disease groups: musculoskeletal disorders, mental
disorders, noise induced hearing loss, infectious and parasitic diseases, respiratory disease,
contact dermatitis, cardiovascular diseases and occupational cancers. The following are some
findings about the diseases:

• Musculoskeletal disorders - the compensated claims declined

• Mental disorders - overall incidence of compensated claims went up over the time
period assessed with a slight reduction in 2004–05

230
• Noise induced hearing loss - the incidence of compensated deafness claims decreased
significantly over the time period assessed. An increase was observed between 2002–03
and 2004–05

• Infectious and parasitic diseases - the amount of compensated claims for infectious
disease showed a declining trend

• Respiratory disease - compensated claims increased

• Contact dermatitis - the amount of compensated claims declined significantly

• Cardiovascular disease - the amount of compensated claims showed a decreasing trend

• Occupational cancer - the amount of compensated claims for cancer went up

Table 2.6 shows the work-related injury and illness by location of workplace. It was found that
New South Wales incurred the highest cost and the lowest cost incurred by Northern Territory.
The overall cost for Australia was $57,400 million in 2005-2006. Table 2.7 shows the work-
related injury and illness by industry. Manufacturing sector incurred the highest cost of $9,300
million and Electricity, Gas and Water Supply sector incurred the lowest in 2005-2006.

231
Table 2.6: The cost ($ million) of work-related injury and illness, by location of workplace,
2005-06

Jurisdiction Injury Disease Total

Total cost ($ millions)
Australian Capital Territory 1 400 700 2 100
Tasmania 1 200 400 1 600
South Australia 2 900 1 500 4 400
Queensland 8 100 4 000 12 100
Northern Territory 600 200 800
New South Wales 13 700 5 500 19 200
Western Australia 4 300 1 500 5 800
Victoria 6 000 5 400 11 400
Australia 38 200 19 200 57 400
Units are rounded to the nearest $100 million
Source: ABS State Accounts (Catalogue No. 5220.0), November 2007

Table 2.7: The cost ($ million) of work-related injury and illness, by industry of workplace,
2005-06

Jurisdiction Injury Disease Total

Total cost ($ millions)
Manufacturing 6 100 3 200 9 300
Health and Community Services 4 300 2 400 6 700
Construction 4 200 2 100 6 300
Retail Trade 3 600 1 700 5 300
Transport and Storage 3 000 1 400 4 400
Property and Business Services 2 800 1 300 4 100
Education 2 000 1 200 3 200
Government Admin and Defence 1 600 1 000 2 600
Personal and Other Services 1 600 900 2 500
Wholesale Trade 1 700 800 2 500
Accommodation, Cafes and 1 700 600 2 300
Restaurants
Agriculture, Forestry and Fishing 1 600 700 2 300
Mining 1 200 500 1 700
Cultural and Recreational 1 000 400 1 400
Services
Finance and Insurance 600 400 1 000
Communication Services 700 300 1 000
Electricity, Gas and Water Supply 500 300 800
Australia 38 200 19 200 57 400
Units are rounded to the nearest $100 million
Source: ABS State Accounts (Catalogue No. 5220.0), November 2007

232
iii. Discussion of the Occupational Accidents, Diseases and Compensation

In the early years, accidents and diseases statistic showed a fluctuation amount. This might be
due to the increase of industrial development where more technological innovations are being
used in the workplace. In addition, new types of occupational diseases have increased through
the usage of new chemical substances. The increased activities in the industrial sectors give
workers with real health hazards.

Furthermore, many of the global safety and health issues are associated with the globalization of
economic, political, social, and cultural forces. According to ILO (2001b), globalization
contribute vital effect to the working life and the conditions of work, where some countries are
capable to take advantage of market economy, while others have become more marginalized,
disintegrated, and impoverished. As such, market forces and economic growth have not been
able to guarantee social justice, employment, and development to all (ILO, 2001b). This will lead
to occupational safety and health impacts and ergonomic impacts on workers in particular and on
the local community in general (ILO, 2001b).

The socio-cultural forces in both countries have multi-cultural society where there are various
ethnics performing work in various industries. Each ethnic has their own cultures and believes
on how to perform their work although there might be a working culture in an organization to be
compliance by all workers. This has lead to work-related accidents and diseases, which cause
higher economic costs as public awareness of occupational safety and health tends to be low.
This must be changed and action needs to be promoted and accelerated collaboratively between
government and other players in various industries as to enhance working environment to
encourage productivity improvement. Moreover, the rights of workers to work in a safe and
healthy working environment are the core principles of occupational safety and health that must
be abided by employers. This is stated under Article 23 of United Nations Universal Declaration
of Human Rights 1948 where “Everyone has the right to work, to free choice of employment, to
just and favorable conditions of work …..” (Alli, 2001, p. 20). Therefore, employers must
prevent and protect workers from occupational risks. However, workers also have the duty to
ensure their safety and other persons’ safety while at work. This can be done through proper

233
education, training and information on occupational safety and health. Hence, these duties of
cares of both employers and employees are stated under the Occupational Safety and Health Act.

Government plays vital role in ensuring appropriate legislation and enforcement to ascertain
improvement in working conditions and working environments as to protect workers for their
well-being. Government intervention will help improve workers’ quality of life and thus,
maintain the standard of occupational safety and health practices among all companies whether it
is manufacturing or services. Furthermore, self-regulation philosophy of the safety and health
legislation will ensure every workers and employers know their responsibilities to improve
workplace conditions and safety of themselves from the risk of work. There also should be a
tripartite collaboration between government, union and employers to enforce and further enhance
this self-regulation legislation.

234
 Appendix 2

List of Accredited Hospitals for the Malaysian Society for Quality in Health (MSQH)
Standards as at 31 December 2009 (74 Hospitals)

State No. Hospital

Perlis 1. Hospital Tengku Fauziah, Kangar
Kedah 2. Hospital Baling
3. Hospital Langkawi
4. Hospital Jitra
5. Hospital Yan
Pulau Pinang 6. Lam Wah Ee Hospital
7. Loh Guan Lye Specialist Centre
8. Pantai Mutiara Hospital
9. Hospital Seberang Jaya
10. Hospital Kepala Batas
11. Gleneagles Medical Centre Penang
12. Penang Adventist Hospital
Perak 13. Hospital Bahagia
14. Hospital Changkat Melintang
15. Ipoh Specialist Hospital
16. Hospital Parit Buntar
17. Hospital Fatimah Ipoh
18. Hospital Sungai Siput
19. Hospital Grik
20. Hospital Batu Gajah
21. Hospital Kuala Kangsar
Selangor 22. Assunta Hospital
23. Hospital Tengku Ampuan Jemaah
24. KPJ Selangor Specialist Hospital
25. Subang Jaya Medical Center
26. Sunway Medical Centre
27. KPJ Damansara Specialist Hospital
28. Hospital Kuala Kubu Baru
29. KPJ Ampang Puteri Specialist Hospital
Wilayah Persekutuan 30. Gleneagles Intan
31. Hospital Kuala Lumpur
32. Pantai Medical Centre
33. Pantai Hospital Cheras
Negeri Sembilan 34. Hospital Jelebu
35. Hospital Port Dickson
36. Hospital Tuanku Ja'afar Seremban
37. Columbia Asia Medical Centre
38. KPJ Seremban Specialist Hospital

235
 State No. Hospital
Melaka 39. Hospital Melaka
40. Mahkota Medical Centre
41. Pantai Medical Centre Ayer Keroh
42. Hospital Jasin
Johor 43. Hospital Batu Pahat
44. Hospital Kluang
45. Hospital Pontian
46. KPJ Johor Specialist Hospital
47. Hospital Segamat
Pahang 48. Hospital Muadzam Shah
49. Hospital Sultan Hj Ahmad Shah, Temerloh
50. Hospital Jengka
51. Hospital Tengku Ampuan Afzan
Kelantan 52. Hospital Machang
53. Hospital Tengku Anis
54. Hospital Jeli
Terengganu 55. Hospital Besut
56. Hospital Hulu Terengganu
57. Hospital Kemaman
58. Hospital Setiu
Sabah 59. Hospital Kudat
60. Hospital Kunak
61. Hospital Mesra Bukit Padang
62. Hospital Sipitang
63. Hospital Ranau
64. Hospital Kota Belud
65. Hospital Papar
66. Hospital Tambunan
67. Hospital Tenom
68. Hospital Lahad Datu
Sarawak 69. Normah Medical Specialist Hospital
70. Hospital Miri
71. Hospital Serian
72. Hospital Sarikei
73. Hospital Kanowit
74. Hospital Sibu

236
 Appendix 3

List of hospitals in the northern region of Malaysia

No. State Types of hospital Name of hospital No. of bed

1. Kedah State hospital Hospital Alor Setar 812
KM 6, Jalan Langgar
05460 Alor SetarKedah
Darul Aman
2. District hospital Hospital Sultan Abdul Halim 498
with expertise Jalan Lencungan Timur
Bandar Aman Jaya
08000 Sungai Petani
Kedah Darul Aman
3. Hospital Kulim 274
Jalan Mahang
09000 Kulim
Kedah Darul Aman
4. Hospital Langkawi 110
Bukit Teguh
07000 Langkawi
Kedah Darul Aman
5. District hospital Hospital Baling 160
without expertise Jalan Hospital
09100 Baling
Kedah Darul Aman
6. Hospital Sik 93
08200 Sik
Kedah Darul Aman
7. Hospital Jitra 103
Jalan Changlun
06000 Jitra
Kedah Darul Aman
8. Hospital Kuala Nerang 72
06300 Kuala Nerang
Kedah Darul Aman
9. Hospital Yan 89
06900 Yan
Kedah Darul Aman

237
 No. State Types of hospital Name of hospital No. of bed
10. Perlis State hospital Hospital Tuanku Fauziah 404
Jalan Kolam
01000 Kangar

11. Pulau Pinang State hospital Hospital Pulau Pinang 1090

Jalan Residensi
10990 Pulau Pinang

12. District hospital Hospital Seberang Jaya 314

with expertise Bandar Baru
Jalan Tun Hussein Onn
10450 Seberang Jaya
Pulau Pinang

13. Hospital Bukit Mertajam 242

Jalan Kulim
14000 Bukit Mertajam
Pulau Pinang

14. District hospital Hospital Balik Pulau 71

without expertise 11000 Balik Pulau
Pulau Pinang

15. Hospital Kepala Batas 108

Jalan Bertam 2,
13200 Kepala Batas
Seberang Perai Utara
Pulau Pinang

16. Hospital Sungai Bakap 105

14200 Sungai Jawi
Seberang Perai Selatan
Pulau Pinang

238
 Appendix 4

HEALTH AND SAFETY SURVEY FOR PILOT STUDY

Please be informed that I, Nor Azimah Chew Abdullah, am currently pursuing my doctoral study
in the field of health and safety at Curtin University of Technology, Australia. For this purpose, I
am now conducting a survey to solicit views of employees in medical services on safety culture
at workplace, specifically those that being practiced at various public hospitals in Malaysia.

The questionnaire is anonymous and your participation is completely voluntary and you are free
to withdraw at any time. Individual responses will only be seen by the researcher. It will
eventually be no specific names of individual respondents to be mentioned in the final analysis
of the survey.

Your individual participation is vital to the success of this survey and also critical to the
completion of my doctoral study. Please return your completed questionnaire in a self -addressed
envelope provided, possibly not later than 30 July 2007.

Should there be any clarifications needed, please contact Nor Azimah Chew Abdullah at Faculty
of Human and Social Development, Universiti Utara Malaysia, 06010 Sintok, Kedah or at 04-
9283863/017-5465620.

Please be acknowledged that your views and opinions on the matter would be highly appreciated.
Thank you for participating.

239
 BACKGROUND DETAILS

This section is about some of your background details. This will enable me to compare the views of
different groups of staff, and it will help in the analysis of the survey results.

1. About you
1.1 Gender:

Male Female

1.2 Age:
Less than 20 years 20 – 24 years 25 – 29 years

30 – 34 years 35 – 39 years 40 years and above

1.3 Ethnicity

Malay Chinese Indian

Others : ___________ (Please specify)

1.4 Highest level of education

Std 6 SRP/PMR/LCE SPM/MCE

STPM/STP/HSC Diploma Degree

Others: __________________ (Please specify)

240
1.5 Your salary scale:

Below RM500 RM500 – RM1,500

RM1,501 – RM2,500 RM2,501 – RM3,500

RM3,501 – RM4,500 RM4,501 and above

1.6 Do you manage other people as part of your job?

Yes No

1.7. Indicate your present department/unit.

1.8. Indicate your present job position.

Administration/Clerk Physician Radiographer

Ambulance/Paramedic Pharmacists Technicians

Respiratory Therapist Nurse Dietician

Others (please state): ___________________________________

1.9. Length of your service at this hospital.

________ years _________ months

(Please fill)

1.10. Indicate the length of your service at present department/unit/ward.

________ years _________ months

(Please fill)

241
1.11 Indicate whether your job requires you to follow shift work arrangements.

Yes No

1.12 Indicate number of hours you are required to work in a week.

___________________________________________

1.13 On average, how many additional hours do you work per week above your
contracted hours?

242
 COMMUNICATION ABOUT HEALTH AND SAFETY

To what extent do you agree or disagree with the following statements about
communication in your current department / unit / ward? Please circle one number on
each line.

Strongly Disagree Neither Agree Strongly

Disagree agree nor Agree
disagree

1. Health and safety issues that may affect 1 2 3 4 5

me are well communicated.

2. I know the person who represents me in 1 2 3 4 5

the Health and Safety Committee.

3. Staff will freely speak up if they see 1 2 3 4 5

something that may negatively affect
health and safety at work.

4. Staff have the freedom to question the 1 2 3 4 5

decisions or actions of those with more
authority.

5. Staff are afraid to ask questions when 1 2 3 4 5

something that does not seem right has
happen.

6. Problems often occur in the exchange 1 2 3 4 5

of information across hospital
departments / units.

7. Important health and safety information 1 2 3 4 5

is often lost during shift changes.

243
 COMPETENCE & TRAINING IN HEALTH AND SAFETY

To what extent do you agree or disagree with the following statements about competence
and training in your current department / unit / ward? Please circle one number on
each line.

Strongly Disagree Neither Agree Strongly

Disagree agree Agree
nor
disagree

1. I am clear about my responsibility for 1 2 3 4 5

health and safety.

2. I understand the health and safety 1 2 3 4 5

procedures for my job.

3. I understand the health and safety 1 2 3 4 5

risks in my job.

4. My training has covered the risks I 1 2 3 4 5

face in my job.

5. I am always certain what to do to 1 2 3 4 5

ensure high standards of health and
safety in my work.

6. I am involved in health and safety 1 2 3 4 5

initiatives at work such as health and
safety committee.

244
 REPORTING ON HEALTH AND SAFETY MATTERS

To what extent do you agree or disagree with the following statements about reporting in your
current department / unit / ward? Please circle one number on each line.

Strongly Disagree Neither Agree Strongly

Disagree agree Agree
nor
disagree

1. All health and safety incidents are 1 2 3 4 5

reported here.

2. I am encouraged to report health and 1 2 3 4 5

safety incidents.

3. I think that reporting incidents makes 1 2 3 4 5

a difference to safety here.

4. People are willing to report incidents 1 2 3 4 5

here.

5. All errors/near misses are reported 1 2 3 4 5

here.

6. I am encouraged to report errors/near 1 2 3 4 5

misses.

7. I think it is a waste of time reporting 1 2 3 4 5

errors/near misses because nothing
gets done about it.

8. People are willing to report 1 2 3 4 5

errors/near misses here.

245
 WORK DUTIES AND HEALTH AND SAFETY

To what extent do you agree or disagree with the following statements about work duties
in your current department / unit / ward? Please circle one number on each line.

Strongly Disagree Neither Agree Strongly

Disagree agree nor Agree
disagree

1. Health and safety issues are never 1 2 3 4 5

sacrificed to get more works done.

2. We have enough staff to handle the 1 2 3 4 5

workload.

3. Staff work longer hours than what is 1 2 3 4 5

considered to be best for their health
and safety.

4. We use more staff for health and safety 1 2 3 4 5

issues in the hospital.

5. We work in “crisis mode” when trying 1 2 3 4 5

to do too much, too quickly.

6. If I didn’t take a risk now and again, I 1 2 3 4 5

wouldn’t get my work done.

7. I am able to take scheduled rest breaks 1 2 3 4 5

and still get my work done.

8. I am satisfied with my current work 1 2 3 4 5

schedule.

9. There is pressure from other hospital 1 2 3 4 5

departments / units to get more work
done.

246
 SAFETY SATISFACTION

How satisfied are you with the following aspects of the safety system? Please circle one
number on each line.

Highly Dissatisfied Neither Satisfied Highly

Dissatisfied satisfied nor Satisfied
dissatisfied

1. Disposable personal protective 1 2 3 4 5

equipment (e.g. gloves, masks).

2. Uniforms and aprons. 1 2 3 4 5

3. Lead coats (for x-ray). 1 2 3 4 5

4. Personal alarms. 1 2 3 4 5

5. Police presence. 1 2 3 4 5

6. Security guard presence. 1 2 3 4 5

7. Controlled entry to 1 2 3 4 5
department/unit/ ward.

8. Hospital safety induction. 1 2 3 4 5

9. Department/unit/ward safety 1 2 3 4 5
induction.

10. Safety audits/inspections. 1 2 3 4 5

11. Hospital Health and Safety 1 2 3 4 5

Committee.

12. Department/unit/ward Health and 1 2 3 4 5

Safety Committee.

13. Workplace design. 1 2 3 4 5

247
 Highly Dissatisfied Neither Satisfied Highly
Dissatisfied satisfied nor Satisfied
dissatisfied

14. Housekeeping/cleaning. 1 2 3 4 5

15. Competency of co-workers. 1 2 3 4 5

16. Occurrence/incidence reporting 1 2 3 4 5

system.

17. Investigation and follow-up 1 2 3 4 5

measures after injuries and
accidents have taken place.

248
 SENIOR HOSPITAL MANAGERS

To what extent do you agree or disagree with the following statements about Senior Managers of this
Hospital (i.e. the Chief Executive and his team)? Please circle one number on each line.

Strongly Disagree Neither Agree Strongly

Disagree agree nor Agree
disagree

1. I know who the Senior Managers are. 1 2 3 4 5

2. Senior Managers seem interested in 1 2 3 4 5

health and safety only after an adverse
event happens.

3. The actions of Senior Managers show 1 2 3 4 5

that health and safety is a top priority.

4. Senior Managers seem interested in 1 2 3 4 5

worker safety only after an adverse event
happens.

5. The actions of Senior Managers show 1 2 3 4 5

that worker safety is a top priority.

6. Senior Managers have set out a clear vision 1 2 3 4 5

for health and safety in this hospital.

7. I receive no communication about health and 1 2 3 4 5

safety in any form from Senior Managers.

8. Senior Managers put their budget before 1 2 3 4 5

safety.

9. I trust Senior Managers. 1 2 3 4 5

10. Senior Managers genuinely care about the 1 2 3 4 5

health and safety of people at this hospital.

249
 Strongly Disagree Neither Agree Strongly
Disagree agree nor Agree
disagree

11. I know who is in charge of the Hospital’s 1 2 3 4 5

Health and Safety Committee.

12. The hospital’s procedures are only there to 1 2 3 4 5

cover the backs of Senior Managers.

13. I trust Senior Managers to act on safety 1 2 3 4 5

concerns.

250
 ERRORS AND INCIDENTS
(KESILAPAN DAN INSIDEN)
To what extent do you agree or disagree with the following statements about errors and
incidents in your current department / unit / ward? Please circle one number on each
line.
(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai
kesilapan dan insiden di jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor
pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree agree Agree
nor
disagree

1. We are informed about errors/mistakes 1 2 3 4 5

that happen in this department/unit/
ward.

2. In this department/unit/ward, we 1 2 3 4 5
discuss ways to prevent errors/mistakes
from happening again.

3. We are given feedback about changes 1 2 3 4 5

put into place based on event/incident
reports.

4. Staff feel mistakes are held against 1 2 3 4 5

them.

5. When an event is reported, it feels like 1 2 3 4 5

the person is being written up, not the
problem.

6. Mistakes have led to positive changes 1 2 3 4 5

here.

7. Staff worry that mistakes they make are 1 2 3 4 5

kept in their personnel file.

251
For the following questions, please circle the response which best describes the answer for each
question.

8. In the last month, how many incidents None 1-2 3-5 6 - 10 More than 10
did you see that inadvertently harmed
STAFF?

9. In the last month, how many errors or

near misses did you see that could have None 1-2 3-5 6 - 10 More than 10
harmed STAFF?

10. During the last year how many times have you been injured or felt unwell as a result of the
following problems at work?
(Sepanjang tahun lepas, berapa kali anda mendapat kecederaan atau merasa kurang sihat
akibat masalah berikut di tempat kerja seperti berikut:

a. Moving and handling. None 1-2 3-5 6 - 10 More than 10

b. Needlestick and sharp injuries. None 1-2 3-5 6 - 10 More than 10

c. Slips, trips or falls. None 1-2 3-5 6 - 10 More than 10

d. Exposure to dangerous substances None 1-2 3-5 6 - 10 More than 10

(including radiation.)

e. Work related stress. None 1-2 3-5 6 - 10 More than 10

252
 SUPERVISOR AND HEALTH AND SAFETY ISSUES

To what extent do you agree or disagree with the following statements about your
Supervisor? Please circle one number on each line.
Please answer with respect to the person to whom you directly report.

Strongly Disagree Neither Agree Strongly

Disagree agree Agree
nor
disagree

1. My supervisor says a good word when 1 2 3 4 5

he/she sees a job done according to
established safety procedures.

2. My supervisor is well qualified. 1 2 3 4 5

3. I trust my supervisor. 1 2 3 4 5

4. I never have to wonder whether my 1 2 3 4 5

supervisor will stick to his/her word.

5. My supervisor seems interested in 1 2 3 4 5

health and safety only after an adverse
event happens.

6. My supervisor is very concerned 1 2 3 4 5

about my welfare.

7. My supervisor seriously considers 1 2 3 4 5

staff suggestions for improving health
and safety for workers.

8. I feel very confident about my 1 2 3 4 5

supervisor’s skills.

9. The actions of my supervisor show 1 2 3 4 5

that worker safety is a top priority.

10. My needs and desires are very 1 2 3 4 5

important to my supervisor.

253
 Strongly Disagree Neither Agree Strongly
Disagree agree nor Agree
disagree

11. Sound principles seem to guide my 1 2 3 4 5

supervisor’s behaviour.

12. My supervisor is very capable of 1 2 3 4 5

performing his/her job.

13. I trust my supervisor to act on 1 2 3 4 5

workers’ health and safety concerns.

14. Whenever pressure builds up, my 1 2 3 4 5

supervisor wants us to work faster,
even if it means taking shortcuts.

15. My supervisor would not knowingly 1 2 3 4 5

do anything to hurt me.

16. The actions of my supervisor show 1 2 3 4 5

that health and safety is a top priority.

17. My supervisor tries hard to be fair in 1 2 3 4 5

dealings with others.

18. My supervisor is known to be 1 2 3 4 5

successful at the things he/she tries to
do.

19. I trust my supervisor to act on health 1 2 3 4 5

and safety concerns.

20. My supervisor will go out of his/her 1 2 3 4 5

way to help me.

21. My supervisor’s actions and 1 2 3 4 5

behaviours are not very consistent.

254
 Strongly Disagree Neither Agree Strongly
Disagree agree nor Agree
disagree

22. My supervisor knows about the work 1 2 3 4 5

that needs to be done.

23. My supervisor overlooks health and 1 2 3 4 5

safety problems that happen over and
over.

24. My supervisor has specialized 1 2 3 4 5

capabilities that can increase our
performance.

25. My supervisor has a strong sense of 1 2 3 4 5

justice.

26. My supervisor really looks out for what 1 2 3 4 5

is important to me.

27. My supervisor seems interested in 1 2 3 4 5

workers’ safety only after an adverse
event happens.

28. I like my supervisor’s values. 1 2 3 4 5

255
 SAFETY RULES

To what extent do you agree or disagree with the following statements about safety rules
in your current department / unit / ward? Please circle one number on each line.

Strongly Disagree Neither Agree Strongly

Disagree agree Agree
nor
disagree

1. The written safety rules and 1 2 3 4 5

instructions are easy for people to
understand and implement.

2. The rules are too strict and I can work 1 2 3 4 5

better without them.

3. The rules always describe the safest 1 2 3 4 5

way of working.

256
 SUPERVISOR’S LEADERSHIP STYLE

Judge how frequently each statement fits your Supervisor. Please circle one number on
each line.
Please answer with respect to the person to whom you directly report.

My Supervisor …… Not at all Once in Sometimes Fairly Frequently

a while often if not
always

1. Provides me with assistance in exchange 0 1 2 3 4

for my efforts.

2. Instills pride in me for being associated 0 1 2 3 4

with him/her.

3. Discusses in specific terms who is 0 1 2 3 4

responsible for achieving performance
targets.

4. Talks enthusiastically about what needs 0 1 2 3 4

to be accomplished.

5. Specifies the importance of having a 0 1 2 3 4

strong sense of purpose.

6. Spends time teaching and coaching. 0 1 2 3 4

7. Makes it very clear what one can expect 0 1 2 3 4

to receive when performance goals are
achieved.

8. Acts in ways that build my respect. 0 1 2 3 4

9. Articulates a compelling vision of the 0 1 2 3 4

future.

10. Gets me to look at problems from many 0 1 2 3 4

different angles.

257
 My Supervisor …… Not at all Once in Sometimes Fairly Frequently
a while often if not
always

11. Helps me to develop my strengths. 0 1 2 3 4

12. Suggests new ways of looking at how to 0 1 2 3 4

complete assignments.

13. Emphasizes the importance of having a 0 1 2 3 4

collective sense of mission.

14. Expresses satisfaction when I meet 0 1 2 3 4

expectations.

258
1. Please use the space below to make any comments on occupational health and safety
practices at your workplace.

Please place your completed questionnaire in the envelope provided and return to: XXX

YOUR PARTICIPATION IN THIS SURVEY IS VERY MUCH APPRECIATED.

THANK YOU.

259
 Appendix 5

HEALTH AND SAFETY SURVEY (REVISED FOR FINAL SURVEY)

Please be informed that I, Nor Azimah Chew Abdullah, am currently pursuing my doctoral study in the
field of health and safety at Curtin University of Technology, Australia. For this purpose, I am conducting
a survey to solicit views of employees in medical services on safety culture at workplace, specifically
those that being practiced at various public hospitals in Malaysia.

The questionnaire is anonymous and your participation is completely voluntary and you are free to
withdraw at any time. You can be assured that your answers will remain strictly confidential and no
names will be published.

Your individual participation is vital to the success of this survey and also critical to the completion of my
doctoral study. Please return your completed questionnaire in a self -addressed envelope provided,
possibly not later than 15 September 2007.

Should there be any clarifications needed, please contact Nor Azimah Chew Abdullah at Faculty of
Human and Social Development, Universiti Utara Malaysia, 06010 Sintok, Kedah or at 04-9283863/017-
5465620.

Please be acknowledged that your views and opinions on the matter would be highly appreciated. Thank
you for participating.

KAJIAN MENGENAI KESIHATAN DAN KESELAMATAN

Sila maklum bahawa saya, Nor Azimah Chew Abdullah, sedang melanjutkan pengajian di peringkat
ijazah doktor falsafah dalam bidang kesihatan dan keselamatan pekerjaan di Curtin University of
Technology, Australia. Bagi tujuan itu, kini saya menjalankan satu kajian bertujuan mendapat pandangan
staf dalam perkhidmatan perubatan tentang budaya keselamatan pekerjaan, khususnya yang diamalkan
oleh hospital kerajaan di Malaysia.

Soal-selidik ini tidak memerlukan identiti responden secara spesifik dan anda berhak untuk menarik diri
pada bila-bila masa. Nama dan identiti responden tidak akan dinyatakan dalam analisis kajian ini.

Penyertaaan anda amat penting terhadap kejayaaan kajian ini dan ianya kritikal bagi melengkapkan
pengajian ijazah doktor falsafah saya. Pohon kembalikan soal-selidik yang telah lengkap dengan
menggunakan sampul beralamat sendiri yang disertakan secepat yang mungkin, pada/sebelum 15
September 2007.

Sekiranya anda memerlukan sebarang penjelasan, sila hubungi Nor Azimah Chew Abdullah di Fakulti
Pembangunan Sosial dan Manusia, Universiti Utara Malaysia, 06010 Sintok, Kedah atau di talian 017-
5465620 atau e-mail: [email protected].

Pandangan dan buah fikiran anda dalam kajian ini amatlah dihargai. Penyertaan anda diucapkan jutaan
terima kasih.

260
 BACKGROUND DETAILS (MAKLUMAT LATAR BELAKANG)

This section is about some of your background details. This will enable me to compare the views of
different groups of staff, and it will help in the analysis of the survey results.

(Bahagian ini adalah mengenai maklumat latar belakang anda. Ini membolehkan saya membuat
perbandingan mengenai pandangan pelbagai kumpulan staf dan membantu analisis dapatan kajian)

1. About you (Berkenaan diri anda)

1.1 Gender (Jantina):

Male (Lelaki) Female (Perempuan)

1.2 Age (Umur):

Less than 20 years 20 – 24 years 25 – 29 years
(Kurang drpd 20 tahun) (20 – 24 tahun) (25 – 29 tahun)

30 – 34 years 35 – 39 years 40 years and above

(30 – 34 tahun) (35 – 39 tahun) (40 tahun dan ke atas)

1.3 Ethnicity (Bangsa)

Malay (Melayu) Chinese (Cina) Indian (India)

Others (Lain-lain): ___________ (Please specify) (Sila nyatakan)

1.4 Highest level of education (Tahap pendidikan tertinggi)

Std 6 (Darjah 6) SRP/PMR/LCE SPM/MCE

STPM/STP/HSC Diploma Degree (Ijazah)

Others (Lain-lain): __________________ (Please specify) (Sila nyatakan)

261
1.5 Your salary scale per month (Tangga gaji jawatan anda setiap bulan) :

Below (Kurang) RM500 RM500 – RM1,500

RM1,501 – RM2,500 RM2,501 – RM3,500

RM3,501 – RM4,500 RM4,501 and Above

( dan Lebih)

1.6 Do you manage other people as part of your job?

( Apakah mengurus orang lain sebahagian daripada tugas jawatan anda ?)

Yes (Ya) No (Tidak)

1.7. Indicate your present department/unit.

(Nyatakan jabatan/unit anda berkhidmat sekarang.)

1.8. Indicate your present job position (Nyatakan pekerjaan anda sekarang)

Administrator Physician Radiographer

(Pentadbir) (Doktor) (Jururadiografi)

Ambulance/Paramedic Pharmacists Technicians

(Ambulans/Paramedik) (Ahli Farmasi) (Juruteknik)

Supporting staff (e.g. clerk) Nurse Dietician

(Staf sokongan) (Jururawat) (Pakar Diet)

Respiratory Therapist Physician (specialist)

(Ahli Terapi Respiratori) (Doktor Pakar)

Others (please state): ___________________

(Lain-lain – sila nyatakan)

262
1.9. Length of your service at this hospital. (Tempoh perkhidmatan anda di hospital

ini.)

________ years (tahun) _________ months (bulan)

(Please fill) (Sila isikan)

1.10. Indicate the length of your service at present department/unit/ward.

(Nyatakan tempoh perkhidmatan anda di jabatan/unit/wad sekarang.)

________ years (tahun) _________ months (bulan)

(Please fill) (Sila isikan)

1.11 Indicate whether your job requires you to follow shift work arrangements.
(Nyatakan sama ada jawatan anda memerlukan anda bekerja mengikut syif.)

Yes (Ya) No (Tidak)

1.12 Indicate number of hours you are required to work in a week.

(Nyatakan jumlah jam yang ditetapkan anda perlu bekerja dalam seminggu.)

___________________________________________

1.13 On average, how many additional hours do you work per week above your
contracted hours?
(Secara purata, berapa jam anda perlu bekerja sebagai tambahan kepada waktu
bekerja biasa dalam seminggu?)

263
 1. COMMUNICATION ABOUT HEALTH AND SAFETY
(KOMUNIKASI MENGENAI KESIHATAN DAN KESELAMATAN)

To what extent do you agree or disagree with the following statements about communication in
your current department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai
komunikasi di jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

1. Health and safety issues that may affect me 1 2 3 4 5

are well communicated.
(Isu-isu kesihatan dan keselamatan yang
mungkin memberi kesan terhadap saya
dikomunikasikan dengan baik)

2. Staff will freely speak up if they see 1 2 3 4 5

something that may negatively affect health
and safety at work.
(Staf bebas bersuara jika mereka melihat
sesuatu yang negatif yang mungkin
mengancam kesihatan dan keselamatan di
tempat kerja)

3. Staff have the freedom to question the 1 2 3 4 5

decisions or actions about health and safety
of those with more authority.
(Staf bebas menyoal keputusan atau
tindakan mengenai kesihatan dan
keselamatan yang dibuat oleh pihak
berautoriti)

4. Staff are afraid to ask questions about 1 2 3 4 5

health and safety when something that does
not seem right has happened.
(Staf berasa takut untuk bertanya soalan
mengenai kesihatan dan keselamatan
apabila terdapat sesuatu yang tidak betul
telah berlaku)

264
 Strongly Disagree Neither Agree Strongly
Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

5. Problems often occur in the exchange of 1 2 3 4 5

information about health and safety across
hospital departments / units.
(Masalah selalu timbul semasa pertukaran
maklumat kesihatan dan keselamatan
merentasi jabatan/unit di hospital)

6. Important health and safety information is 1 2 3 4 5

often lost during shift changes.
(Maklumat penting mengenai kesihatan dan
keselamatan kerap tidak sampai kepada
pekerja semasa pertukaran syif)

7. I receive no communication about health 1 2 3 4 5

and safety in any form from top
management.
(Saya tidak menerima sebarang maklumat
mengenai kesihatan dan keselamatan
daripada pengurusan atasan)

265
 2. WORKER PARTICIPATION/CONSULTATION
(PENYERTAAN PEKERJA/PERUNDINGAN)

To what extent do you agree or disagree with the following statements about joint consultation in
health and safety in your current department / unit / ward? Please circle one number on each
line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai
perundingan kesihatan dan keselamatan di jabatan/unit/wad anda sekarang? Sila bulatkan satu
nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

1. I know the person who represents me in the 1 2 3 4 5

Health and Safety Committee.
(Saya kenal orang yang mewakili saya
dalam Jawatankuasa Kesihatan dan
Keselamatan)

2. I am involved in health and safety 1 2 3 4 5

initiatives at work such as health and safety
committee.
(Saya terlibat dalam inisiatif kesihatan dan
keselamatan di tempat kerja seperti
jawatankuasa kesihatan dan keselamatan
pekerjaan)

3. I am clear about my responsibilities for 1 2 3 4 5

health and safety.
(Saya memahami tanggungjawab saya
terhadap kesihatan dan keselamatan
pekerjaan)

266
 3. COMPETENCE & TRAINING IN HEALTH AND SAFETY
(KECEKAPAN & LATIHAN DALAM KESIHATAN & KESELAMATAN)

To what extent do you agree or disagree with the following statements about competence and
training in your current department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai kecekapan
dan latihan di jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree (Setuju) Agree
(Sangat setuju) nor (Sangat
tidak disagree setuju)
setuju) (Neutral)

1. I understand the health and safety 1 2 3 4 5

requirements for my job.
(Saya memahami prosedur kesihatan
dan keselamatan dalam pekerjaan saya)

2. I understand the health and safety risks in 1 2 3 4 5

my job.
(Saya memahami risiko kesihatan dan
keselamatan dalam pekerjaan saya)

3. My training has covered the health and 1 2 3 4 5

safety risks I face in my job.
(Latihan saya meliputi risiko kesihatan
dan keselamatan yang saya hadapi dalam
pekerjaan saya)

4. I am always certain what to do to ensure 1 2 3 4 5

high standards of health and safety in my
work.
(Saya pasti apa yang harus dilakukan
untuk menentukan piawaian kesihatan
dan keselamatan yang tinggi bagi
pekerjaan saya)

267
 4. REPORTING ON HEALTH AND SAFETY MATTERS
(PELAPORAN MENGENAI HAL KESIHATAN DAN KESELAMATAN)

To what extent do you agree or disagree with the following statements about reporting in your current
department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai pelaporan di
jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree (Setuju) Agree
(Sangat setuju) nor (Sangat
tidak disagree setuju)
setuju) (Neutral)

1. All health and safety incidents are 1 2 3 4 5

reported here.
(Semua insiden kesihatan dan
keselamatan yang berlaku di sini
dilaporkan)

2. I am encouraged to report health and 1 2 3 4 5

safety incidents.
(Saya digalakkan untuk melaporkan
insiden kesihatan dan keselamatan)

3. I think that reporting health and safety 1 2 3 4 5

incidents makes a difference to safety
here.
(Saya fikir dengan membuat laporan
tentang insiden yang berlaku akan
menambahbaik amalan keselamatan
pekerjaan di sini)

4. People are willing to report health and 1 2 3 4 5

safety incidents here.
(Pekerja di sini bersedia membuat
laporan terhadap semua insiden yang
berlaku)

5. I think it is a waste of time reporting 1 2 3 4 5

health and safety errors/near misses
because nothing gets done about it.
(Saya rasa melaporkan
kesilapan/kemalangan nyaris adalah
suatu yang membuang masa kerana tiada
tindakan terhadap laporan tersebut)

268
 5. WORK DUTIES WITH HEALTH AND SAFETY
(TUGASAN DAN KESIHATAN & KESELAMATAN)

To what extent do you agree or disagree with the following statements about work duties in your
current department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai tugasan di
jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

1. Health and safety issues are never 1 2 3 4 5

sacrificed to get more work done.
(Isu kesihatan dan keselamatan tidak
pernah diabaikan semata-mata untuk
meningkatkan pelaksanaan tugas)

2. We have enough staff to handle the 1 2 3 4 5

workload.
(Kami mempunyai pekerja yang mencukupi
untuk mengendalikan bebanan kerja)

3. Staff work longer hours than what is 1 2 3 4 5

considered to be best for their health and
safety.
(Pekerja yang bekerja melampaui jumlah
jam yang sepatutnya boleh menjejaskan
aspek kesihatan dan keselamatan mereka)

4. We work in “crisis mode” when trying to 1 2 3 4 5

do too much, too quickly.
(Kami bekerja dalam “keadaan
kegawatan”, bila mana cuba melaksanakan
terlalu banyak tugasan dalam masa yang
singkat)

269
 Strongly Disagree Neither Agree Strongly
Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

5. If I didn’t take a risk now and again, I 1 2 3 4 5

wouldn’t get my work done.
(Sekiranya saya tidak berani mengambil
risiko yang ada di hadapan saya sekarang
dan pada masa akan datang, pasti tugasan
saya tidak dapat diselesaikan)

6. I am able to take scheduled rest breaks and 1 2 3 4 5

still get my work done.
(Saya boleh berehat dalam waktu yang
ditetapkan dan masih mampu
menyelesaikan tugas saya.)

7. I am satisfied with my current work 1 2 3 4 5

schedule.
(Saya berpuashati dengan penjadualan kerja
saya sekarang)

8. There is pressure from other hospital 1 2 3 4 5

departments / units to get more work
done.
(Terdapat tekanan daripada jabatan/unit
lain untuk menyelesaikan kerja yang lebih
banyak)

270
 6. SAFETY SATISFACTION
(KEPUASAN DALAM ASPEK SISTEM KESELAMATAN)

How satisfied are you with the following aspects of the safety system? Please circle one number
on each line. Do not give a response on item that is not applicable.

(Kepuasan anda terhadap aspek sistem keselamatan yang berikut? Sila bulatkan satu nombor pada
setiap barisan. Anda tidak perlu memberi respons kepada item yang tidak berkaitan.)

Highly Dissatisfied Neither Satisfied Highly

Dissatisfied (Tidak satisfied nor (Berpuashati) Satisfied
(Sangat tidak berpuashati) dissatisfied (Sangat
berpuashati) (Tidak pasti) berpuashati)

1. Disposable personal protective 1 2 3 4 5

equipment (e.g. gloves, masks).
[Peralatan perlindungan diri pakai
buang (contoh, sarung tangan,
topeng)]

2. Uniforms and aprons. 1 2 3 4 5

(Pakaian seragam dan apron)

3. Lead coats (for x-ray). 1 2 3 4 5

[Jaket bersalut plumbum (untuk
sinar-x)]

4. Personal alarms. 1 2 3 4 5
(Penggera peribadi.)

5. Police presence. 1 2 3 4 5
(Kehadiran polis)

6. Security guard presence. 1 2 3 4 5

(Kehadiran pengawal keselamatan)

7. Controlled entry to department/unit/ 1 2 3 4 5

ward.
(Kawalan kemasukan ke
jabatan/unit/wad)

8. Hospital safety induction. 1 2 3 4 5

(Induksi keselamatan di hospital)

271
 Highly Dissatisfied Neither Satisfied Highly
Dissatisfied (Tidak satisfied nor (Berpuashati) Satisfied
(Sangat tidak berpuashati) dissatisfied (Sangat
berpuashati) (Tidak pasti) berpuashati)

9. Department/unit/ward safety 1 2 3 4 5
induction.
(Induksi keselamatan di
jabatan/unit/wad)

10. Safety audits/inspections. 1 2 3 4 5

(Pemeriksaan/audit keselamatan)

11. Hospital Health and Safety 1 2 3 4 5

Committee.
(Jawatankuasa Kesihatan dan
Keselamatan Hospital)

12. Department/unit/ward Health and 1 2 3 4 5

Safety Committee.
(Jawatankuasa Kesihatan dan
Keselamatan Jabatan/Unit/Wad)

13. Workplace design. 1 2 3 4 5

(Rekabentuk tempat kerja)

14. Housekeeping/cleaning. 1 2 3 4 5
(Kemasan/kebersihan)

15. Competency of co-workers. 1 2 3 4 5

(Kecekapan rakan sekerja)

16. Occurrence/incidence reporting 1 2 3 4 5

system.
(Sistem pelaporan insiden/kejadian)

17. Investigation and follow-up 1 2 3 4 5

measures after injuries and
accidents have taken place.
(Penyiasatan dan tindakan susulan
selepas berlakunya kecederaan dan
kemalangan)

272
 7. SENIOR HOSPITAL MANAGERS
(PENGURUS ATASAN HOSPITAL)

To what extent do you agree or disagree with the following statements about Senior Managers of this
Hospital (i.e. the Hospital Director and his team)? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai Pengurus atasan di
hospital ini (contoh, Pengarah Hospital dan pegawai-pegawainya? Sila bulatkan satu nombor pada setiap
barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

1. I know who the Senior Managers are. 1 2 3 4 5

(Saya kenal Pengurus atasan di sini)

2. Senior Managers seem interested in health 1 2 3 4 5

and safety only after an adverse event
happens.
(Pengurus atasan nampak berminat dalam
kesihatan dan keselamatan hanya selepas
sesuatu kejadian buruk berlaku)

3. The actions of Senior Managers show that 1 2 3 4 5

health and safety is a top priority.
(Tindakan Pengurus atasan menunjukkan
kesihatan dan keselamatan merupakan suatu
prioriti utama)

4. Senior Managers put their budget before 1 2 3 4 5

safety.
(Pengurus atasan tidak mengambilkira isu
keselamatan dalam belanjawan mereka)

273
 Strongly Disagree Neither Agree Strongly
Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

5. Senior Managers genuinely care about the 1 2 3 4 5

health and safety of people at this hospital.
(Pengurus atasan benar-benar mengambil
berat mengenai kesihatan dan keselamatan
orang ramai di hospital ini)

6. The hospital’s procedures are only there to 1 2 3 4 5

cover the backs of Senior Managers.
(Prosedur hospital hanya untuk melindungi
Pengurus atasan sahaja)

7. I trust Senior Managers to act on safety 1 2 3 4 5

concerns.
(Saya percaya Pengurus atasan
mementingkan isu keselamatan)

274
 8. HEALTH & SAFETY GOALS & OBJECTIVES
(MATLAMAT & OBJEKTIF KESIHATAN & KESELAMATAN)

To what extent do you agree or disagree with the following statements about health and safety
goals/objectives in your hospital? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai
matlamat/objektif kesihatan & keselamatan di hospital ini. Sila bulatkan satu nombor pada
setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

1. Top management have set out a clear vision for 1 2 3 4 5

health and safety in this hospital.
(Pengurusan atasan menetapkan visi yang jelas
mengenai kesihatan dan keselamatan di
hospital ini)

2. Top management discusses in specific terms 1 2 3 4 5

who is responsible for achieving performance
targets in health and safety.
(Pengurusan atasan membincangkan secara
khusus tanggungjawab untuk mencapai sasaran
prestasi kesihatan dan keselamatan)

3. Top management emphasizes the importance 1 2 3 4 5

of having a collective sense of mission for
health and safety.
(Pengurusan atasan menekankan tentang
mustahaknya mempunyai kesepaduan misi
untuk kesihatan dan keselamatan)

4. Top management articulates a compelling 1 2 3 4 5

vision of the future for health and safety.
(Pengurusan atasan menzahirkan wawasan
masa hadapan untuk kesihatan dan
keselamatan yang menyakinkan)

5. Top management makes it very clear what one 1 2 3 4 5

can expect to receive when performance goals
for health and safety are achieved.
(Pengurusan atasan menjelaskan ganjaran yang
boleh diharapkan apabila matlamat prestasi
untuk kesihatan dan keselamatan dicapai)

275
 9. ERRORS AND INCIDENTS
(KESILAPAN DAN INSIDEN)

To what extent do you agree or disagree with the following statements about errors and incidents
in your current department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai kesilapan
dan insiden di jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree (Setuju) Agree
(Sangat setuju) nor (Sangat
tidak disagree setuju)
setuju) (Neutral)

1. We are informed about errors/mistakes 1 2 3 4 5

that happen in this department/unit/ ward.
(Kami dimaklumkan mengenai kesilapan
yang berlaku di jabatan/unit/wad)

2. In this department/unit/ward, we discuss 1 2 3 4 5

ways to prevent errors/mistakes from
happening again.
(Di jabatan/unit/wad ini, kami berbincang
cara untuk mencegah kesilapan daripada
berlaku lagi)

3. We are given feedback about changes put 1 2 3 4 5

into place based on event/incident
reports.
(Kami mendapat maklumbalas mengenai
perubahan yang bakal dilakukan
berdasarkan laporan insiden)

4. Staff feel mistakes are held against them. 1 2 3 4 5

(Staf merasakan mereka sering
dipersalahkan apabila berlaku kesilapan)

276
 Strongly Disagree Neither Agree Strongly
Disagree (Tidak agree (Setuju) Agree
(Sangat setuju) nor (Sangat
tidak disagree setuju)
setuju) (Neutral)

5. When an event is reported, it feels like 1 2 3 4 5

the person is being written up, not the
problem.
(Apabila suatu kejadian dilaporkan,
dirasakan seolah-olah orang yang
melaporkan itu yang diperhalusi, bukan
masalah yang dilaporkan itu)

6. Mistakes have led to positive changes 1 2 3 4 5

here.
(Kesilapan telah mendorong kepada
perubahan positif di sini)

7. Staff worry that mistakes they make are 1 2 3 4 5

kept in their personnel file.
(Staf bimbang kesilapan yang mereka
lakukan akan dicatatkan dalam fail
peribadi mereka)

277
For the following questions, please circle the response which best describes the answer for each
question.
(Untuk soalan berikut, sila bulatkan respons yang benar-benar menjawab soalan yang diberikan.)

8. In the last month, how many incidents did None 1-2 3-5 6 - 10 More than 10
you see that inadvertently harmed staff? (Tiada) (Lebih
(Dalam bulan lepas, berapa kali anda daripada 10)
perhatikan insiden berlaku yang secara
tidak disedari telah mengancam
keselamatan staf?)

9. In the last month, how many errors or near None 1-2 3-5 6 - 10 More than 10
misses did you see that could have harmed (Tiada) (Lebih
staff? daripada 10)
(Dalam bulan lepas, berapa kali anda
perhatikan berlaku kesilapan atau
kemalangan nyaris yang boleh
mencederakan staf?)

10. During the last year how many times have you been injured or felt unwell as a result of the
following problems at work?
(Sepanjang tahun lepas, berapa kali anda mendapat kecederaan atau merasa kurang sihat akibat
masalah berikut di tempat kerja seperti berikut:)

a. Moving and handling. None 1-2 3-5 6 - 10 More than 10

(Pergerakan dan pengendalian) (Tiada) (Lebih daripada 10)

b. Needlestick and sharp injuries. None 1-2 3-5 6 - 10 More than 10

(Tertusuk jarum dan benda tajam) (Tiada) (Lebih daripada 10)

c. Slips, trips or falls. None 1-2 3-5 6 - 10 More than 10

(Tergelincir, tersandung atau terjatuh) (Tiada) (Lebih daripada 10)

d. Exposure to dangerous substances None 1-2 3-5 6 - 10 More than 10

(including radiation.) (Tiada) (Lebih daripada 10)
(Pendedahan kepada bahan berbahaya
– termasuk radiasi)

e. Work related stress. None 1-2 3-5 6 - 10 More than 10

(Tekanan kerja) (Tiada) (Lebih daripada 10)

278
 10. SUPERVISOR AND HEALTH AND SAFETY ISSUES
(PENYELIA DAN ISU-ISU KESIHATAN & KESELAMATAN)

To what extent do you agree or disagree with the following statements about your Supervisor?
Please circle one number on each line.
Please answer with respect to the person to whom you directly report.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai Penyelia
anda? Sila bulatkan satu nombor pada setiap barisan.
Sila jawab berdasarkan penyelia yang anda lapor diri secara terus)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree (Setuju) Agree
(Sangat tidak setuju) nor (Sangat
setuju) disagree setuju)
(Neutral)

1. My supervisor says a good word when 1 2 3 4 5

he/she sees a job done according to
established safety procedures.
(Penyelia saya memberi pujian apabila
beliau melihat sesuatu kerja dilakukan
berdasarkan prosedur keselamatan)

2. My supervisor is well qualified in health 1 2 3 4 5

and safety.
(Penyelia saya adalah seorang yang
berkelayakan dalam kesihatan dan
keselamatan)

3. My supervisor seems interested in health 1 2 3 4 5

and safety only after an adverse event
happens.
(Penyelia saya nampak berminat dalam
kesihatan dan keselamatan hanya selepas
sesuatu kejadian buruk berlaku)

4. My supervisor seriously considers staff 1 2 3 4 5

suggestions for improving health and
safety for workers.
(Penyelia saya mempertimbangkan secara
serius cadangan staf untuk
menambahbaik kesihatan dan
keselamatan pekerja)

279
 Strongly Disagree Neither Agree Strongly
Disagree (Tidak agree nor (Setuju) Agree
(Sangat setuju) disagree (Sangat
tidak (Neutral) setuju)
setuju)

5. I feel very confident about my 1 2 3 4 5

supervisor’s skills to deal with health and
safety issues.
(Saya sangat berkeyakinan terhadap
kemahiran penyelia saya untuk menangani
isu kesihatan dan keselamatan)

6. Whenever pressure builds up, my 1 2 3 4 5

supervisor wants us to work faster, even if
it means taking shortcuts.
(Dalam keadaan desakan kerja yang
memuncak, penyelia saya mengkehendaki
kami bekerja pantas, dan jika perlu,
mengambil jalan pintas)

7. The actions of my supervisor show that 1 2 3 4 5

health and safety is a top priority.
(Tindakan penyelia saya menunjukkan
kesihatan dan keselamatan merupakan
suatu prioriti utama)

8. My supervisor is known to be successful 1 2 3 4 5

at the things he/she tries to do.
(Penyelia saya sentiasa melakar kejayaan
dalam perkara yang dilakukan)

9. I trust my supervisor to act on health and 1 2 3 4 5

safety concerns.
(Saya percaya penyelia saya tidak
mengabaikan isu kesihatan)

10. My supervisor knows about the work that 1 2 3 4 5

needs to be done.
(Penyelia saya mengetahui tugas-tugas
yang perlu dilaksanakan)

11. My supervisor overlooks health and safety 1 2 3 4 5

problems that happen over and over.
(Penyelia saya sentiasa terlepas pandang
terhadap masalah kesihatan dan
keselamatan pekerjaan yang berlaku
berulangkali)

280
 11. SAFETY RULES
(PERATURAN KESELAMATAN)

To what extent do you agree or disagree with the following statements about safety rules in your
current department / unit / ward? Please circle one number on each line.

(Setakat mana anda bersetuju atau tidak bersetuju dengan pernyataan berikut mengenai peraturan
keselamatan di jabatan/unit/wad anda sekarang? Sila bulatkan satu nombor pada setiap barisan)

Strongly Disagree Neither Agree Strongly

Disagree (Tidak agree (Setuju) Agree
(Sangat setuju) nor (Sangat
tidak disagree setuju)
setuju) (Neutral)

1. The written safety rules and instructions 1 2 3 4 5

are easy for people to understand and
implement.
(Peraturan dan arahan bertulis tentang
keselamatan pekerjaan akan mudah
difahami dan dilaksanakan oleh pekerja)

2. The rules are too strict and I can work 1 2 3 4 5

better without them.
(Peraturan terlalu rigid dan tegas dan
saya lebih selesa bekerja tanpanya)

3. The rules always describe the safest way 1 2 3 4 5

of working.
(Peraturan lazimnya menjelaskan cara
bekerja yang paling selamat)

281
 12. SUPERVISOR’S LEADERSHIP STYLE
(GAYA KEPIMPINAN PENYELIA)

Judge how frequently each statement fits your Supervisor. Please circle one number on each line.
Please answer with respect to the person to whom you directly report.

(Nilai berapa kerap setiap pernyataan menepati Penyelia anda. Sila bulatkan satu nombor pada
setiap barisan. Sila jawab berdasarkan penyelia yang anda lapor diri secara terus)

My Supervisor …… Not at all Once in Sometimes Fairly Frequently

(Penyelia saya …….) (Tidak a while (Kadang- often if not
langsung) (Sekali- kala) (Agak always
sekala) kerap) (Sangat
kerap)

1. Provides me with assistance in exchange for 0 1 2 3 4

my efforts.
(Membantu saya sejajar dengan usaha yang
saya pamerkan.)

2. Instills pride in me for being associated with 0 1 2 3 4

him/her.
(Menanamkan kebanggaan dalam diri saya
kerana dikaitkan dengan beliau.)

3. Talks enthusiastically about what needs to 0 1 2 3 4

be accomplished.
(Giat berbincang tentang tugasan yang perlu
dilaksanakan.)

4. Specifies the importance of having a strong 0 1 2 3 4

sense of purpose.
(Menegaskan betapa pentingnya
mempunyai sifat keinginan yang kuat untuk
menjayakan sesuatu perkara yang
dilakukan.)

5. Spends time teaching and coaching. 0 1 2 3 4

(Meluangkan masa mengajar dan melatih.)

6. Acts in ways that build my respect. 0 1 2 3 4

(Melaksanakan tugas dan
tanggungjawabnya dengan sedemikian cara,
yang menyebabkan rasa hormat saya
terhadapnya terus meningkat.)

282
 My Supervisor …… Not at all Once in Sometimes Fairly Frequently
(Penyelia saya …….) (Tidak a while (Kadang- often if not
langsung) (Sekali- kala) (Agak always
sekala) kerap) (Sangat
kerap)

7. Gets me to look at problems from many 0 1 2 3 4

different angles.
(Mendorong saya menggunakan pendekatan
pelbagai sudut dalam menyelesaikan
permasalahan kerja.)

8. Helps me to develop my strengths. 0 1 2 3 4

(Membantu membentuk kekuatan saya.)

9. Suggests new ways of looking at how to 0 1 2 3 4

complete assignments.
(Menyarankan kaedah baru dalam
menyempurnakan tugasan.)

10. Has a strong sense of justice. 0 1 2 3 4

(Memiliki sifat keadilan yang kental.)

283
1. Please use the space below to make any comments on occupational health and safety practices at
your workplace.
(Sila gunakan ruang di bawah untuk sebarang komen berkaitan amalan kesihatan dan
keselamatan pekerjaan di tempat kerja anda.)

Please place your completed questionnaire in the envelope provided

(Sila masukkan soal-selidik yang telah dilengkapkan ke dalam sampul surat yang diberi)

YOUR PARTICIPATION IN THIS SURVEY IS VERY MUCH APPRECIATED.

THANK YOU.

284
 Appendix 6

Letter of Support from the Director General of Health Malaysia

285
English Translation

APPROVAL APPLICATION TO CONDUCT SURVEY AT HOSPITAL UNDER

MINISTRY OF HEALTH, MALAYSIA

The above-mentioned subject is referred.

2. I have received your application to do a survey at the PhD level entitled “Occupational
Health and Safety Management Systems and Their Impact to Malaysian Public Hospitals”. After
reading your proposal, I have no objection to let you conduct the survey.

3. With regards to that, I hope the complete study will be given to the Ministry of Health,
Malaysia before you do any publication or presentation.

Thank you.

(TAN SRI DATUK DR. HJ. MOHD ISMAIL MERICAN)

Director General of Health Malaysia

c.c.: - Deputy Director General of Health (Medical)

- Director of Health Kedah
- Director of Health Kelantan
- Director of Health Terengganu
- Director of Health Perlis

286
 Appendix 7

INFORMATION SHEET

OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT SYSTEM:

IMPLEMENTATION IN THE MALAYSIAN HOSPITALS

You are being invited to take part in this research project. Please read this information sheet
carefully before deciding whether or not to participate. Thank you if you decide to participate. If
you decide not to take part there will be no disadvantage to you of any kind and thank you for
considering my request.

Please be informed that I, Nor Azimah Chew Abdullah, am currently pursuing my doctoral study
in the field of health and safety at Curtin University of Technology, Australia. For this purpose, I
am now conducting a survey to solicit views of employees in medical services on safety culture
at workplace, specifically those that being practiced at various public hospitals in Malaysia.

Should you agree to take part in this project, you will be asked to answer a survey questionnaire.
The questionnaire is anonymous and your participation is completely voluntary. Individual
responses will only be seen by the researcher. It will eventually be no specific names of
individual respondents to be mentioned in the final analysis of the survey. You may withdraw
from participation in the project at any time and without any disadvantage to yourself of any
kind. Results of this project may be published but any data included will in no way be linked to
any specific participant.

You are most welcome to request a copy of the results of the project should you wish. The data
collected will be securely stored in such a way that only the researcher will be able to gain access
to it. At the end of the project any personal information will be destroyed immediately except
that, as required by the university’s research policy, any raw data on which the results of the
project depend will be retained in secure storage for five years, after which it will be destroyed.

Should there be any clarifications needed, please contact Nor Azimah Chew Abdullah at Faculty
of Human and Social Development, Universiti Utara Malaysia, 06010 Sintok, Kedah or at 04-
9283863/017-5465620.

Please be acknowledged that your views and opinions on the matter would be highly appreciated.
Thank you for participating.

287
 Appendix 8

CONSENT FORM

I, __________________________________________________________________
Given names Surname

have read the information explaining the study entitled “Occupational health and safety
management system: Implementation in the Malaysian Hospitals”

I, _______________________________________________________________
(full name of participant)

agree to participate in the study.

I understand I may withdraw from the study at any stage and withdrawal will not interfere with
routine care.

I agree that research data gathered from the results of the study may be published, provided that
names are not used.

Signature ______________________________

Dated _________________ day of ____________________ 20

I, ______________________________ have explained the above to the signatories,

(Investigator’s full name)

who stated that he/she understood the same.

Signature _____________________________

288
 Appendix 9

Approval from the Human Research Ethics Committee at Curtin University of Technology

289
 Appendix 10

Study’s Total of Return

Table 4.2: Total of return from Hospital Sultanah Bahiyah, Alor Setar, Kedah according to post

Post Population Sample Total of %

Return
Doctor 348 45 5 1.51
Nurse 1,186 157 73 22.05
Officer (management) 16 2 2 0.60
Supporting staff (management) 633 84 31 9.37
Officer (medical) 66 9 9 2.72
Supporting staff (medical) 259 34 34 10.27
Total 2,508 331 154 46.52

Table 4.3: Total of return from Hospital Tuanku Fauziah, Kangar, Perlis according to post

Post Population Sample Total of %

Return
Doctor 126 29 13 4.38
Nurse 605 134 100 33.67
Officer (management) 24 6 5 1.68
Supporting staff (management) 131 30 28 9.43
Officer (medical) 53 12 6 2.02
Supporting staff (medical) 388 86 55 18.51
Total 1,327 297 207 69.69

Table 4.4: Total of return from Hospital Pulau Pinang, Georgetown, Pulau Pinang according to
post

Post Population Sample Total of %

Return
Doctor 432 48 0 0
Nurse 1287 144 9 2.64
Officer (management) 15 3 1 0.29
Supporting staff (management) 877 98 43 12.61
Officer (medical) 61 7 0 0
Supporting staff (medical) 366 41 4 1.17
Total 3,038 341 57 16.71
290
 Table 4.5: Overall total of return according to post

Post Population Sample Total of %

Return
Doctor 906 122 18 1.86
Nurse 3,078 435 182 18.78
Officer (management) 55 11 11 1.14
Supporting staff 1,641 212 96 9.91
(management)
Officer (medical) 180 28 21 2.17
Supporting staff (medical) 1,013 161 90 9.29
Total 6,873 969 418 43.15

291
 Appendix 11

The Demography of Respondents

Table 4.14: Demographic Information

Age in Years (n = 418)

Age Group Frequency
(Percent)
< 20 4 (1.0)
20 – 24 42 (10.0)
25 – 29 101 (24.2)
30 – 34 66 (15.8)
35 – 39 51 (12.2)
40 & > 154 (36.8)

Gender (n = 418)
Gender Frequency
(Percent)
Male 89 (21.3)
Female 329 (78.7)

Race (n = 418)
Race Frequency
(Percent)
Malay 357 (85.4)
Chinese 35 (8.4)
Indian 17 (4.0)
Siamese 5 (1.2)
Punjabi 2 (0.5)
Bidayuh 2 (0.5)

Education Level (n = 418)

Education Level Frequency
(Percent)
Year 6 3 (0.7)
Lower Certificate of Education (LCE) 19 (4.5)
Malaysian Certificate of Education (MCE) 147 (35.2)
Higher School Certificate (HSC) 37 (8.9)
Diploma 161 (38.5)
Bachelor Degree 45 (10.8)
Certificate 2 (0.5)
Master 4 (0.9)

292
 Table 4.14: Demographic Information

Job Position (n = 418)

Job position Frequency (Percent)
Physician 18 (4.3)
Nurse 182 (43.5)
Management Officer 8 (1.9)
Support Staff (Management) 102 (24.4)
Medical Officer 15 (3.6)
Support staff (Medical) 93 (22.2)

Years in Service (n = 418)

Tenure (year) Frequency (Percent)
<1 43 (10.3)
1–5 154 (36.8)
6 – 10 60 (14.4)
11 – 15 47 (11.2)
16 - 20 31 (7.4)
21 & > 83 (19.9)

Table 4.15: Work Duration/Mode

Number of Working Hours Per Week

(n = 418)
Hours per week Frequency (Percent)
21 - 40 220 (52.6)
41 - 60 185 (44.3)
> 60 13 (3.1)

Shift work arrangement (n = 418)

Shift work Frequency (Percent)
Yes 214 (51.2)
No 204 (48.8)

293
 Appendix 12

Safety Experts’ Feedback and the Pilot Survey

Table 4.16: Safety experts’ judgments: Deletion and addition of items in the revised
questionnaire

Factor Number of Description Number

items in of items
original scale in revised
scale
Safety 7 1 item added into this factor: 7
communication 1. Item taken from “Management
commitment” factor:

• “I received no communication
about health and safety in any form
from top management”

Deleted 1 item from this factor:

2. Item moved to “safety
responsibility” factor:

• “I know the person who represents

me in the Health and Safety
Committee”

Training & 6 Deleted 2 items from this factor: 4

competence 1. Items moved to “safety
responsibility” factor:

• “I am clear about my responsibility

for health and safety”
• “I am involved in health and safety
initiatives at work such as health
and safety committee”

294
 Factor Number of Description Number
items in of items
original scale in revised
scale
Health & Safety 8 Deleted 3 items from this factor: 5
reporting • “People are willing to report health
and safety errors/near misses here”
• “I am encouraged to report health
and safety errors/near misses”
• “People are willing to report health
and safety errors/near misses here”

(Justification: Incidents are accidents

and near misses)

Safety rules 3 Maintain the whole items 3

Safety satisfaction 17 Maintain the whole items 17

Errors and incidents 14 Maintain the whole items 14

Work duties 9 Deleted 1 item from this factor: 8

• “We use more staff for health and

safety issues in the hospital”

Safety responsibility - 3 items added into this factor: 3

1. 2 items taken from “training and
competence” factor
• “I am involved in health and
safety initiatives at work such as
health and safety committee
• “I am clear about my
responsibilities for health and
safety”

2. 1 item taken from “safety

communication” factor
• “I know the person who represents
me in the health and safety
committee”

295
 Factor Number of Description Number of
items in items in
original revised
scale scale
Role of 28 Deleted 17 items from this factor: 11
supervisor in 1. Item moved to “Supervisor’s leadership style”
health and safety factor:

• “My supervisor has a strong sense of justice”

2. Dropped 16 items from this factor:

• “I trust my supervisor”
• “I never have to wonder whether my supervisor
will stick to his/her word”
• “My supervisor is very concerned about my
welfare”
• “The actions of my supervisor show that
worker safety is a top priority”
• “My needs and desires are very important to
my supervisor”
• “Sound principles seem to guide my
supervisor’s behaviour”
• “My supervisor is very capable of performing
his/her job”
• “I trust my supervisor to act on workers’ health
and safety concerns”
• “My supervisor would not knowingly do
anything to hurt me”
• “My supervisor tries hard to be fair in dealings
with others”
• “My supervisor will go out of his/her way to
help me”
• “My supervisor’s actions and behaviours are
not very consistent”
• “My supervisor has specialized capabilities that
can increase our performance”
• “My supervisor really looks out for what is
important to me”
• “My supervisor seems interested in workers’
safety only after an adverse event happens”
• “I like my supervisor’s values”

(Justification: the item has almost similar meaning

as item in the same factor, the term worker safety
is included in health and safety” and some items
are too general)

296
 Factor Number of Description Number
items in of items
original scale in revised
scale
Management 13 Deleted 6 items from this factor: 7
commitment
1. Item moved to “Safety
communication” factor:
• “I receive no communication
about health and safety in any
form from top management”

2. Item moved to “Health and Safety

goals” factor:

• “Top management has set out a

clear vision for health and safety
in this hospital”

3. Dropped 4 items from this factor:

• “Senior Managers seem interested
in worker safety only after an
adverse event happens”
• “The actions of Senior Managers
show that worker safety is a top
priority”
• “I trust Senior Managers”
• “I know who is in charge of the
Hospital’s Health and Safety
Committee”

(Justification: the item has almost

similar meaning as item in the same
factor, the term worker safety is
included in health and safety” and
some items are too general)

297
 Factor Number of Description Number
items in of items
original scale in revised
scale
Supervisor’s 14 1 item added into this factor: 10
leadership style 1. Item taken from “role of
supervisor” factor:

• “My supervisor has a strong sense

of justice”

Deleted 5 items from this factor:

1. 4 item moved to “health and safety
goals” factor:

• “Discusses in specific terms who is

responsible for achieving
performance targets”
• “Makes clear what one can expect
to receive when performance goals
are achieved”
• “Articulates a compelling vision of
the future”
• “Emphasizes the importance of
having a collective sense of
mission”

2. Dropped 1 item from this factor:

• “Expresses satisfaction when I meet

expectations”

298
 Factor Number of Description Number
items in of items
original scale in revised
scale
Health & safety - 5 items added into this factor: 5
goals 1. 4 items taken from “supervisor’s
leadership style” factor

• “My supervisor discusses in specific

terms who is responsible for
achieving performance targets in
health and safety”
• “Top management emphasizes the
importance of having a collective
sense of mission for health and
safety”
• “Top management articulates a
compelling vision of the future for
health and safe”
• “My supervisor makes clear what
one can expect to receive when
performance goals for health and
safety are achieved”

2. 1 item taken from “management

safety commitment” factor
• “Top management has set out a
clear vision for health and safety
in this hospital”

TOTAL 119 94

299
 Appendix 13

Normality test for all variables

Table 4.8: Normality test for dependent variable: Safety satisfaction and feedback (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Significance Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) distribution transformation
satisfy1 -1.062 0.119 -8.892 2.171 0.238 9.113 0.328 0.000 >3, -ve skewed Ref & Ln -1.711
satisfy2 -0.893 0.119 -7.484 1.788 0.238 7.506 0.340 0.000 >3, -ve skewed Ref, sqrt & back -1.759
satisfy3 -0.545 0.119 -4.565 0.773 0.238 3.244 0.256 0.000 >3, -ve skewed Ref, sqrt -0.447
satisfy4 -0.264 0.119 -2.215 0.539 0.238 2.264 0.272 0.000 >2, -ve skewed Ref, sqrt -2.804*
satisfy5 -0.284 0.119 -2.376 -0.014 0.238 -0.058 0.214 0.000 >2, -ve skewed Ref, sqrt -1.850
satisfy6 -0.566 0.119 -4.739 -0.260 0.238 -1.090 0.251 0.000 >3, -ve skewed Ref, sqrt & back -1.135
satisfy7 -0.329 0.119 -2.755 -0.738 0.238 -3.097 0.236 0.000 >2, -ve skewed Ref, sqrt -0.477
satisfy8 -0.459 0.119 -3.845 -0.111 0.238 -0.465 0.256 0.000 >3, -ve skewed Ref, sqrt -0.117
satisfy9 -0.584 0.119 -4.895 -0.083 0.238 -0.348 0.293 0.000 >3, -ve skewed Ref, sqrt & back -1.313
satisfy10 -0.570 0.119 -4.778 -0.115 0.238 -0.482 0.281 0.000 >3, -ve skewed Ref, sqrt & back -1.290
satisfy11 -0.693 0.119 -5.809 0.461 0.238 1.933 0.292 0.000 >3, -ve skewed Ref, sqrt & back -1.662
satisfy12 -0.744 0.119 -6.236 0.640 0.238 2.686 0.291 0.000 >3, -ve skewed Ref, sqrt & back -1.998
satisfy13 -0.607 0.119 -5.088 -0.487 0.238 -2.044 0.304 0.000 >3, -ve skewed Ref, sqrt & back -2.013*
satisfy14 -1.153 0.119 -9.657 1.387 0.238 5.821 0.390 0.000 >3, -ve skewed Ref & Ln -0.947
satisfy15 -1.111 0.119 -9.305 1.808 0.238 7.591 0.376 0.000 >3, -ve skewed Ref & Ln -2.074*
satisfy16 -0.739 0.119 -6.188 0.385 0.238 1.615 0.345 0.000 >3, -ve skewed Ref, sqrt & back -2.027*
satisfy17 -0.939 0.119 -7.866 0.634 0.238 2.663 0.329 0.000 >3, -ve skewed Ref & Ln -1.233
Note: *z-score after transformation for skewness is >2 but < 3

300
 Table 4.9: Normality test for dependent variable: Safety Incidents/accidents (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Signifi- Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) cance distribution transformation
incident1 -1.086 0.119 -9.093 0.721 0.238 3.026 0.367 0.000 >3, -ve skewed Ref, Ln & back -1.381
incident2 -1.230 0.119 -10.305 2.180 0.238 9.154 0.391 0.000 >3, -ve skewed Ref & Ln -1.570
incident3 -0.894 0.119 -7.488 0.848 0.238 3.558 0.353 0.000 >3, -ve skewed Ref & Ln -2.088*
incident4 0.429 0.119 3.591 -0.365 0.238 -1.532 0.264 0.000 >3, +ve skewed Sqrt & back 0.114
o.k. - -
0.198 0.000
incident5 0.094 0.119 0.789 -0.608 0.238 -2.554
incident6 -0.989 0.119 -8.281 1.700 0.238 7.138 0.343 0.000 >3, -ve skewed Ref & Ln -2.600*
incident7 0.500 0.119 4.190 -0.269 0.238 -1.129 0.262 0.000 >3, +ve skewed sqrt 0.398
incident8 1.688 0.119 14.139 2.679 0.238 11.247 0.406 0.000 >3, +ve skewed Inv & back 7.337#
incident9 1.969 0.119 16.496 4.715 0.238 19.792 0.419 0.000 >3, +ve skewed Inv & back 8.224#
incident10a 1.609 0.119 13.477 2.422 0.238 10.170 0.385 0.000 >3, +ve skewed Inv & back 6.084#
incident10b 2.458 0.119 20.587 6.455 0.238 27.097 0.469 0.000 >3, +ve skewed Inv & back 13.016#
incident10c 1.824 0.119 15.282 3.006 0.238 12.619 0.439 0.000 >3, +ve skewed Inv & back 9.491#
>3, +ve skewed Inv & back 5.609#
0.355 0.000
incident10d 1.603 0.119 13.428 1.605 0.238 6.737
>3, +ve skewed sqrt 1.219
0.216 0.000
incident10e 0.511 0.119 4.280 -0.706 0.238 -2.964
Note: *z-score after transformation for skewness is >2 but < 3
#z-score after transformation for skewness is >3 and is non normal

301
 Table 4.10: Normality test for independent variables: Safety communication, safety involvement, training and competence, and safety
reporting (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Significance Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) distribution transformation
comm1 -0.875 0.119 -7.325 1.251 0.238 5.253 0.356 0.000 >3, -ve skewed Ref, sqrt & back -2.146*
comm2 -0.925 0.119 -7.746 0.836 0.238 3.509 0.305 0.000 >3, -ve skewed Ref & Ln -0.612
comm3 -0.622 0.119 -5.214 0.215 0.238 0.903 0.303 0.000 >3, -ve skewed Ref, sqrt & back -0.984
comm4 -0.533 0.119 -4.461 -0.564 0.238 -2.370 0.292 0.000 >3, -ve skewed Ref, sqrt & back -1.150
comm5 0.214 0.119 1.795 -0.642 0.238 -2.694 0.219 0.000 o.k. - -
comm6 -0.046 0.119 -0.385 -0.857 0.238 -3.598 0.207 0.000 o.k. - -
comm7 -0.723 0.119 -6.054 0.087 0.238 0.367 0.305 0.000 >3, -ve skewed Ref, sqrt & back -2.049*

consul1 -0.503 0.119 -4.211 -0.727 0.238 -3.052 0.274 0.000 >3, -ve skewed Ref, sqrt & back -1.668
consul2 0.036 0.119 0.300 -0.936 0.238 -3.929 0.219 0.000 o.k. - -
consul3 -1.012 0.119 -8.479 2.068 0.238 8.682 0.339 0.000 >3, -ve skewed Ref, sqrt & back -2.542*

training1 -1.012 0.119 -8.477 2.470 0.238 10.369 0.358 0.000 >3,-ve skewed Ref, sqrt & back -2.140*
training2 -0.748 0.119 -6.266 2.411 0.238 10.121 0.340 0.000 >3,-ve skewed Ref, sqrt & back -0.133
training3 -0.928 0.119 -7.771 0.529 0.238 2.222 0.350 0.000 >3,-ve skewed Ref & Ln -1.479
training4 -0.887 0.119 -7.433 1.016 0.238 4.265 0.337 0.000 >3,-ve skewed Ref, sqrt & back -2.535*

report1 -1.087 0.119 -9.101 1.715 0.238 7.200 0.358 0.000 >3,-ve skewed Ref & Ln -1.824
report2 -1.075 0.119 -9.001 1.984 0.238 8.331 0.351 0.000 >3,-ve skewed Ref & Ln -1.935
report3 -1.087 0.119 -9.106 2.586 0.238 10.857 0.289 0.000 >3,-ve skewed Ref & Ln -0.630
report4 -0.719 0.119 -6.019 0.552 0.238 2.315 0.308 0.000 >3,-ve skewed Ref, sqrt & back -1.455
report5 -0.961 0.119 -8.053 1.102 0.238 4.628 0.308 0.000 >3,-ve skewed Ref & Ln -1.422
Note: *z-score after transformation for skewness is >2 but < 3

302
 Table 4.11: Normality test for independent variables: work pressure and management commitment (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Significance Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) distribution transformation
duty1 -0.875 0.119 -7.330 0.593 0.238 2.491 0.348 0.000 >3, -ve skewed Ref & Ln -2.167*
duty2 0.444 0.119 3.719 -0.553 0.238 -2.323 0.265 0.000 >3, +ve skewed sqrt 0.283
duty3 0.927 0.119 7.764 0.689 0.238 2.891 0.306 0.000 >3, +ve skewed Ln & back 0.451
duty4 0.439 0.119 3.681 -0.585 0.238 -2.454 0.277 0.000 >3, +ve skewed sqrt 0.306
duty5 0.801 0.119 6.708 0.590 0.238 2.479 0.344 0.000 >3, +ve skewed sqrt 2.150*
duty6 -0.885 0.119 -7.410 0.088 0.238 0.369 0.343 0.000 >3, -ve skewed Ref & Ln -0.597
duty7 -0.610 0.119 -5.113 -0.111 0.238 -0.465 0.310 0.000 >3, -ve skewed Ref, sqrt & back -1.377
duty8 0.086 0.119 0.720 -0.775 0.238 -3.254 0.203 0.000 o.k. - -

manager1 -1.063 0.119 -8.908 2.366 0.238 9.933 0.336 0.000 >3, -ve skewed Ref & Ln -1.892
manager2 0.236 0.119 1.973 -0.701 0.238 -2.944 0.234 0.000 o.k. - -
manager3 -0.653 0.119 -5.470 1.068 0.238 4.483 0.312 0.000 >3, -ve skewed Ref, sqrt & back -0.516
manager4 -0.073 0.119 -0.610 -0.059 0.238 -0.247 0.238 0.000 o. k. - -
manager5 -0.887 0.119 -7.428 0.715 0.238 3.003 0.327 0.000 >3,-ve skewed Ref & Ln -1.747
manager6 -0.506 0.119 -4.241 -0.001 0.238 -0.003 0.262 0.000 >3,-ve skewed Ref, sqrt & back -0.191
manager7 -0.816 0.119 -6.837 1.352 0.238 5.677 0.327 0.000 >3,-ve skewed Ref, sqrt & back -1.740
Note: *z-score after transformation for skewness is >2 but < 3

303
 Table 4.12: Normality test for independent variables: safety objectives, the role of the supervisor and safety rules (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Significance Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) distribution transformation
goal1 -0.952 0.119 -7.976 1.441 0.238 6.048 0.361 0.000 >3, -ve skewed Ref, sqrt & back -2.770*
goal2 -0.705 0.119 -5.903 0.396 0.238 1.664 0.325 0.000 >3, -ve skewed Ref, sqrt & back -1.775
goal3 -0.842 0.119 -7.050 0.888 0.238 3.728 0.346 0.000 >3, -ve skewed Ref, sqrt & back -2.489*
goal4 -0.746 0.119 -6.247 0.763 0.238 3.202 0.327 0.000 >3, -ve skewed Ref, sqrt & back -1.986
goal5 -0.387 0.119 -3.244 -0.188 0.238 -0.788 0.225 0.000 >3, -ve skewed Ref, sqrt & back -0.103

superv1 -0.695 0.119 -5.825 0.474 0.238 1.989 0.268 0.000 >3, -ve skewed Ref, sqrt & back -1.762
superv2 -0.697 0.119 -5.839 0.677 0.238 2.840 0.289 0.000 >3, -ve skewed Ref, sqrt & back -1.408
superv3 0.013 0.119 0.106 -0.707 0.238 -2.966 0.195 0.000 o.k. - -
superv4 -0.966 0.119 -8.095 1.113 0.238 4.675 0.321 0.000 >3, -ve skewed Ref & Ln -1.508
superv5 -0.815 0.119 -6.828 0.663 0.238 2.785 0.320 0.000 >3, -ve skewed Ref & Ln -1.784
superv6 -0.285 0.119 -2.388 -0.557 0.238 -2.337 0.242 0.000 >2, -ve skewed Ref & sqrt -0.884
superv7 -1.004 0.119 -8.412 1.198 0.238 5.030 0.336 0.000 >3,-ve skewed Ref & Ln -0.770
superv8 -0.722 0.119 -6.044 0.438 0.238 1.840 0.285 0.000 >3,-ve skewed Ref & Ln -1.286
superv9 -1.145 0.119 -9.593 2.180 0.238 9.154 0.362 0.000 >3,-ve skewed Ref & Ln -1.699
superv10 -1.167 0.119 -9.771 2.131 0.238 8.945 0.380 0.000 >3,-ve skewed Ref & Ln -1.726
superv11 -0.321 0.119 -2.690 -0.075 0.238 -0.317 0.227 0.000 >2, -ve skewed Ref & sqrt -1.386

rule1 -0.880 0.119 -7.372 1.223 0.238 5.135 0.356 0.000 >3,-ve skewed Ref, sqrt & back -2.217*
rule2 0.263 0.119 2.207 -0.381 0.238 -1.599 0.205 0.000 >2,+ve skewed Sqrt & back 1.312
rule3 -1.149 0.119 -9.622 2.338 0.238 9.816 0.364 0.000 >3,-ve skewed Ref & Ln -2.574*

Note: *z-score after transformation for skewness is >2 but < 3

304
 Table 4.13: Normality test for independent variable: leadership style (N = 418)

Variable Skewness Kurtosis Test of normality Applicable remedies

Kilmogorov-Smirnov
Statistic Std. z-score Statistic Std. z-score Statistic Significance Description of Transformation z-score after
Error (< 2/< 3) Error (< 7) distribution transformation
style1 -0.380 0.119 -3.187 -0.277 0.238 -1.162 0.211 0.000 >3, -ve skewed Ref & sqrt -0.604
style2 -0.042 0.119 -0.353 -1.083 0.238 -4.546 0.220 0.000 o.k. - -
style3 -0.405 0.119 -3.391 -0.529 0.238 -2.221 0.245 0.000 >3, -ve skewed Ref & sqrt -0.114
style4 -0.567 0.119 -4.752 -0.020 0.238 -0.083 0.252 0.000 >3, -ve skewed Ref, sqrt & back -0.592
style5 -0.223 0.119 -1.865 -0.754 0.238 -3.164 0.193 0.000 o.k. - -
style6 -0.600 0.119 -5.027 -0.350 0.238 -1.468 0.251 0.000 >3, -ve skewed Ref, sqrt & back -1.401
style7 -0.415 0.119 -3.472 -0.476 0.238 -1.998 0.222 0.000 >3, -ve skewed Ref, sqrt & back -0.109
style8 -0.339 0.119 -2.838 -0.693 0.238 -2.910 0.198 0.000 >2, -ve skewed Ref & sqrt -0.361
style9 -0.306 0.119 -2.559 -0.595 0.238 -2.499 0.202 0.000 >2, -ve skewed Ref & sqrt -0.790
style10 -0.355 0.119 -2.973 -0.612 0.238 -2.568 0.201 0.000 >2, -ve skewed Ref & sqrt -0.560

305
 Appendix 14
Exploratory Factor Analysis for Dependent Variables and Independent Variables

Table 4.18: Factor analysis for the items in the dependent variables (N = 418)
Item Item Factor
Code Factor 1: Safety Satisfaction & Feedback Loading

SS12 How satisfied are you with the following aspects of the safety system?
0.765
Department/unit/ward Health and Safety Committee
SS9 How satisfied are you with the following aspects of the safety system?
0.761
Department/unit/ward safety induction
SS11 How satisfied are you with the following aspects of the safety system?
0.753
Hospital Health and Safety Committee
SS10 How satisfied are you with the following aspects of the safety system?
0.741
Safety audits/inspections
SS8 How satisfied are you with the following aspects of the safety system?
0.689
Hospital safety induction
SS6 How satisfied are you with the following aspects of the safety system?
Security guard presence 0.674
SS16 How satisfied are you with the following aspects of the safety system?
Occurrence/incidence reporting system 0.662
SS5 How satisfied are you with the following aspects of the safety system?
Police presence 0.647
SS17 How satisfied are you with the following aspects of the safety system?
0.626
Investigation and follow-up measures after injuries and accidents have taken place
SS7 How satisfied are you with the following aspects of the safety system?
0.604
Controlled entry to department/unit/ ward
SI2 In this department/unit/ward, we discuss ways to prevent errors/mistakes from
0.503
happening again
SS13 How satisfied are you with the following aspects of the safety system?
0.495
Workplace design
SS14 How satisfied are you with the following aspects of the safety system?
0.487
Housekeeping/cleaning
SI3 We are given feedback about changes put into place based on event/incident reports
0.473
SS3 How satisfied are you with the following aspects of the safety system?
0.471
Lead coats (for x-ray)
SS2 How satisfied are you with the following aspects of the safety system?
0.469
Uniforms and aprons
SS15 How satisfied are you with the following aspects of the safety system?
0.469
Competency of co-workers
SS1 How satisfied are you with the following aspects of the safety system?
0.458
Disposable personal protective equipments (e.g. gloves, masks)
SS4 How satisfied are you with the following aspects of the safety system?
0.448
Personal alarms
SI1 We are informed about errors/mistakes that happen in this department/unit/ ward 0.412
SI6 Mistakes have led to positive changes here 0.383
Percentage of variance explained 23.65
Cronbach’s Alpha (21 items) 0.910

306
Item Item
Code Factor
Factor 2: Safety Incident/Accident Loading

SI9 In the last month, how many errors or near misses did you see that could
have harmed staff? 0.722

SI8 In the last month, how many incidents did you see that inadvertently
harmed staff? 0.698

SI10a During the last year how many times have you been injured or felt unwell
as a result of the following problems at work?
0.692
Moving and handling

SI10c During the last year how many times have you been injured or felt unwell
as a result of the following problems at work?
0.653
Slips, trips or falls

SI10b During the last year how many times have you been injured or felt unwell
as a result of the following problems at work?
0.635
Needlestick and sharps injuries

SI10e During the last year how many times have you been injured or felt unwell
as a result of the following problems at work?
0.466
Work related stress

SI10d During the last year how many times have you been injured or felt unwell
as a result of the following problems at work?
0.385
Exposure to dangerous substances (including radiation)

Percentage of variance explained

9.02
Cronbach’s Alpha (7 items)
0.762

307
 Table 4.19: Factor analysis for the items in the independent variables (N = 418)

Item Item
Code Factor
Factor 1: Role of Supervisor Loading

superv10 My supervisor knows about the work that needs to be done 0.805
superv2 My supervisor is well qualified in health and safety 0.753
superv5 I feel very confident about my supervisor’s skills to deal with health and
0.724
safety issues
superv8 My supervisor is known to be successful at the things he/she tries to do 0.661
superv4 My supervisor seriously considers staff suggestions for improving health
0.644
and safety for workers
superv9 I trust my supervisor to act on health and safety concerns 0.561
superv7 The actions of my supervisor show that health and safety is a top priority 0.557
superv1 My supervisor says a good word when he/she sees a job done according to
0.421
established safety procedures
Percentage of variance explained 33.79
Cronbach’s Alpha (8 items) 0.913

Factor 2: Supervisor’s Leadership Style

Style8 My supervisor helps me to develop my strengths -0.862

Style7 My supervisor gets me to look at problems from many different angles -0.824
Style3 My supervisor talks enthusiastically about what needs to be accomplished -0.803
Style4 My supervisor specifies the importance of having a strong sense of
-0.794
purpose
Style5 My supervisor spends time teaching and coaching -0.786
Style9 My supervisor suggests new ways of looking at how to complete
-0.761
assignments
Style1 My supervisor provides me with assistance in exchange for my efforts -0.756
Style6 My supervisor acts in ways that build my respect -0.704
Style10 My supervisor has a strong sense of justice -0.670
Style2 My supervisor instills pride in me for being associated with him/her -0.639
Percentage of variance explained 8.23
Cronbach’s Alpha (10 items) 0.945

308
 Item Item Factor
Code Loading
Factor 3: Training and Competence

Train2 I understand the health and safety risks in my job 0.768

Train1 I understand the health and safety requirements for my job 0.766
Train4 I am always certain what to do to ensure high standards of health and
0.718
safety in my work
Train3 My training has covered the health and safety risks I face in my job 0.660
consul3 I am clear about my responsibilities for health and safety 0.620
consul2 I am involved in health and safety initiatives at work such as health and
0.365
safety committee
Percentage of variance explained 5.43
Cronbach’s Alpha (6 items) 0.823

Factor 4: Health and safety objectives

Goal4 Top management articulates a compelling vision of the future for health
0.813
and safety
Goal2 Top management discusses in specific terms who is responsible for
0.770
achieving performance targets in health and safety
Goal3 Top management emphasizes the importance of having a collective sense
0.654
of mission for health and safety
Goal5 Top management makes clear what one can expect to receive when
0.629
performance goals for health and safety are achieve
Goal1 Top management have set out a clear vision for health and safety in this
0.527
hospital
Percentage of variance explained 2.71
Cronbach’s Alpha (5 items) 0.877

Factor 5: Management Commitment

manager6 The hospital’s procedures are only there to cover the backs of Senior
0.503
Managers
manager7 I trust Senior Managers to act on safety concerns
0.481
manager5 Senior Managers genuinely care about the health and safety of people at
0.477
this hospital
comm7 I receive no communication about health and safety in any form from top
0.392
management
manager3 The actions of Senior Managers show that health and safety is a top
0.321
priority
Percentage of variance explained 2.59
Cronbach’s Alpha (5 items) 0.740

309
 Item Item Factor
Code Loading
Factor 6: Safety Reporting

report4 People are willing to report health and safety incidents here 0.755
report1 All health and safety incidents are reported here 0.636
report3 I think that reporting health and safety incidents makes a difference to
0.478
safety here
report2 I am encouraged to report health and safety incidents 0.402
duty1 Health and safety issues are never sacrificed to get more work done 0.311
Percentage of variance explained 1.65
Cronbach’s Alpha (5 items) 0.764

310
 Appendix 15

Concurrent Validity

Table 4.21: Interscale Correlations of the independent variables and two outcome
variables: Safety satisfaction and feedback and Safety incidents/accidents (n = 418)

Variables RS LS TC SO MC SR SSF SI
Role of
Supervisor (RS) 1

Leadership Style
(LS)
.648** 1

Training &
Competence (TC) .440** .338** 1

Safety Objectives
(SO) .635** .433** .439** 1

Management
Commitment
.563** .418** .389** .583** 1
(MC)

Safety Reporting
(SR)
.423** .330** .569** .417** .441** 1

Safety
Satisfaction &
.542** .389** .456** .634** .559** .505** 1
Feedback (SSF)

Safety
Incident/Accident -.156** -.004 -.073 -.175** -.225** -.106* -.123* 1
(SI)
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

311
 Appendix 16

Confirmatory Factor Analysis (CFA)

Table 4.22: Acceptable cutoff values for fit indices

Fit indices Recommended Values

Absolute fit indices:

Chi-square (χ2) -
χ2 p-level > 0.05
Goodness-of-Fit Index (GFI) > 0.90 or 0.95
Root Mean Square Error of Approximation < 0.05 to 0.08
(RMSEA)
Root mean square residual (RMSR) < 0.05
Population Gamma Index (PGI) > 0.95

Incremental/comparative fit indices:

Adjusted GFI (AGFI) > 0.90

Adjusted PGI (APGI) > 0.95
Normed fit index (NFI) > 0.90 or 0.95
Comparative fit index (CFI) > 0.90 or 0.95
Tucker-Lewis Index (TLI) or Non-normed fit > 0.90
index (NNFI)

Parsimonious fit indices:

Parsimonious NFI (PNFI) Closer to 1 (the higher the

better)

Parsimonious GFI (PGFI) Closer to 1 (the higher the

better)

chi-square/degrees-of-freedom ratio (cmindf) < 2.00 or 3.00

Akaike information criterion (AIC) Small values

312
Safety Satisfaction and Feedback

Table 4.23: Item parceling for safety satisfaction and feedback

Dimension Variable Items

Safety Satisfaction and sspar1 SS1, SS5, SS9, SS13, SS17
Feedback
sspar 2 SS2, SS6, SS10, SS14

sspar 3 SS3, SS7, SS11, SS15

sspar 4 SS4, SS8, SS12, SS16

feedpar SI1, SI2, SI3, SI6

The Supervisor’s Leadership Style

Table 4.26: Item parceling for a supervisor’s leadership style

Dimension Variable Items

Supervisor’s Leadership STYLE1 S1, S6
Style
STYLE2 S2, S7

STYLE3 S3, S8

STYLE4 S4, S9

STYLE5 S5, S10

313
The Role of the Supervisor

Table 4.28: Item parceling for the role of the supervisor

Dimension Variable Items

The Role of the Supervisor PARSUPER1 superv1, superv7

PARSUPER 2 superv2, superv8

PARSUPER 3 superv4, superv9

PARSUPER 4 superv5, superv10

Structural Model of the Instrument

Table 4.36: Standardized Factor loading of variables

Standardized Regression Weights

Estimate
Safety incident/accident The supervisor’s leadership style 0.185

Safety incident/accident The role of the supervisor -0.132

Safety incident/accident Training and competence 0.038

Safety incident/accident Health and safety objectives -0.067

Safety incident/accident Management commitment -0.195

Safety incident/accident Safety reporting -0.019

Safety satisfaction and The supervisor’s leadership style 0.010

feedback
Safety satisfaction and The role of the supervisor 0.098
feedback
Safety satisfaction and Training and competence 0.078
feedback
Safety satisfaction and Health and safety objectives 0.347
feedback
Safety satisfaction and Management commitment 0.183
feedback
Safety satisfaction and Safety reporting 0.190
feedback

314
 Appendix 17

Relationships between variables using crosstab with chi-square analysis

i. Stage 1 analysis

a. Gender, level of education and safety satisfaction and feedback

Table 4.38: Analysis between level of education and safety satisfaction and
feedback with gender as the control variable

Gender Variable Safety satisfaction and feedback Total Chi- p-

Neither square value
satisfied nor
Dissatisfied dissatisfied Satisfied
Male Education School 26 4.034 0.401
12 5 43
level Level (47%) (df=4)
Certificate
4 16 7 27
& Diploma
University
4 13 2 19
Degree
Total
20 55 14 89
Female Education School 116 7.894 0.096
15 32 163
level Level (50%) (df=4)
Certificate
21 95 20 136
& Diploma
University
7 21 2 30
Degree
Total
43 232 54 329
Note: Male: 3 cells (33.3%) have expected count less than 5. The minimum expected count is
2.99.
Female: 2 cells (22.2%) have expected count less than 5. The minimum expected count is
3.92.

315
 b. Gender, level of education and training and competence

Table 4.39: Analysis between level of education and training and competence with
gender as the control variable

Gender Variable Training & competence Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Education School Level 23 0.800 0.938
5 15 43
level (50%) (df=4)
Certificate &
2 13 12 27
Diploma
University
2 10 7 19
Degree
Total
9 46 34 89
Female Education School Level 13.392 0.010
16 84 63 163
level (df=4)
Certificate & 88
4 44 136
Diploma (46%)
University
5 19 6 30
Degree
Total
25 191 113 329
Note: Male: 3 cells (33.3%) have expected count less than 5. The minimum expected count is
1.92.
Female: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
2.28.

316
 c. Gender, level of education and health and safety objectives

Table 4.40: Analysis between level of education and health and safety objectives with
gender as the control variable

Gender Variable Health & safety objectives Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Education School Level 9.214 0.056
10 16 17 (49%) 43
level (df=4)
Certificate &
0 17 (40%) 10 27
Diploma
University
2 9 8 19
Degree
Total
12 42 35 89
Female Education School Level 11.385 0.023
15 80 (45%) 68 163
level (df=4)
Certificate &
20 78 38 136
Diploma
University
4 21 5 30
Degree
Total
39 179 111 329
Note: Male: 2 cells (22.2%) have expected count less than 5. The minimum expected count is
2.56.
Female: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
3.56.

317
 d. Gender, level of education and the role of the supervisor

Table 4.41: Analysis between level of education and the role of the supervisor with
gender as the control variable

Gender Variable The role of the supervisor Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Education School Level 3.036 0.552
11 22 (42%) 10 43
level (df=4)
Certificate &
4 18 5 27
Diploma
University
2 12 5 19
Degree
Total 17
52 20 89
Female Education School Level 6.244 0.182
20 90 (48%) 53 163
level (df=4)
Certificate &
24 77 35 136
Diploma
University
6 20 4 30
Degree
Total
50 187 92 329
Note: Male: 2 cells (22.2%) have expected count less than 5. The minimum expected count is
3.63.
Female: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
4.56.

318
 e. Gender, level of education and management commitment

Table 4.42: Analysis between level of education and management commitment with
gender as the control variable

Gender Variable Management commitment Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Education School Level 3.105 0.540
11 22 (49%) 10 43
level (df=4)
Certificate &
3 14 10 27
Diploma
University
5 9 5 19
Degree
Total
19 45 25 89
Female Education School Level 7.205 0.125
20 77 66 163
level (df=4)
Certificate &
13 84 (48%) 39 136
Diploma
University
5 15 10 30
Degree
Total
38 176 115 329
Note: Male: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
4.06.
Female: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
3.47.

319
 f. Gender, level of education and safety reporting

Table 4.43: Analysis between level of education and safety reporting with gender as the
control variable

Gender Variable Safety reporting Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Education School Level 7.839 0.098
9 16 18 (42%) 43
level (df=4)
Certificate &
1 9 17 27
Diploma
University
1 10 8 19
Degree
Total 11
35 43 89
Female Education School Level 105 8.269 0.082
6 52 163
level (54%) (df=4)
Certificate &
3 57 76 136
Diploma
University
1 17 12 30
Degree
Total
10 126 193 329
Note: Male: 2 cells (22.2%) have expected count less than 5. The minimum expected count is
2.35.
Female: 3 cells (33.3%) have expected count less than 5. The minimum expected count is
0.91.

320
 g. Gender, level of education and the supervisor’s leadership style

Table 4.44: Analysis between level of education and the supervisor’s leadership style
with gender as the control variable

Gender Variable The supervisor’s leadership style Total Chi- p-

Not at Sometimes Frequently square value
all
Male Education School Level 28 20.492 0.000
11 4 43
level (72%) (df=4)
Certificate &
4 21 2 27
Diploma
University
7 9 3 19
Degree
Total
41 9 89
39
Female Education School Level 1.232 0.873
55 91 (52%) 17 163
level (df=4)
Certificate &
51 71 14 136
Diploma
University
13 14 3 30
Degree
Total
119 176 34 329
Note: Male: 3 cells (33.3%) have expected count less than 5. The minimum expected count is
1.92.
Female: 1 cells (11.1%) have expected count less than 5. The minimum expected count is
3.10.

321
h. Gender, level of education and accidents

Table 4.45: Analysis between level of education and accidents with gender as the control
variable

Gender Variable Accidents Total Chi- p-value

None Yes square
Male Education School 0.482 0.786
24 (45%) 19 43
level Level (df=2)
Certificate
17 10 27
& Diploma
University
12 7 19
Degree
Total 53
36 89
Female Education School 106 6.711 0.035
57 163
level Level (52%) (df=2)
Certificate
84 52 136
& Diploma
University
12 18 30
Degree
Total
202 127 329
Note: Male: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
7.69.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
11.58.

322
i. Gender, level of education and injuries

Table 4.46: Analysis between level of education and injuries with gender as the control
variable

Gender Variable Injuries Total Chi- p-value

None Yes square
Male Education School 0.283 0.868
12 31 (47%) 43
level Level (df=2)
Certificate
6 21 27
& Diploma
University
5 14 19
Degree
Total
23 66 89
Female Education School 128 1.462 0.481
35 163
level Level (48%) (df=2)
Certificate
22 114 136
& Diploma
University
5 25 30
Degree
Total
62 267 329
Note: Male: 1 cells (16.7%) have expected count less than 5. The minimum expected count is
4.91.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
5.65.

323
 ii. Stage 2 analysis

a. Gender, length of employment and safety satisfaction and feedback

Table 4.47: Analysis between length of employment and safety satisfaction and
feedback with gender as the control variable

Gender Variable Safety satisfaction and feedback Total Chi- p-

Neither square value
satisfied nor
Dissatisfied dissatisfied Satisfied
Male Length of Less than 5.297 0.506
employment or equal to 2 12 4 18 (df=6)
2 years
2.1 - 6
7 19 (35%) 2 28
years
6.1 - 15
3 11 4 18
years
15.1 years
8 13 4 25
and above
Total
20 55 14 89
Female Length of Less than 2.718 0.843
employment or equal to 8 56 12 76 (df=6)
2 years
2.1 - 6
11 54 12 77
years
6.1 - 15
12 56 10 78
years
15.1 years
12 66 (28%) 20 98
and above
Total
43 232 54 329
Note: Male: 6 cells (50.0%) have expected count less than 5. The minimum expected count is
2.83.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
9.93.

324
 b. Gender, length of employment and training and competence

Table 4.48: Analysis between length of employment and training and competence with
gender as the control variable

Gender Variable Training & competence Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Length of Less than 16.740 0.010
employment or equal to 5 9 4 18 (df=6)
2 years
2.1 - 6
0 17 (37%) 11 28
years
6.1 - 15
0 12 6 18
years
15.1 years
4 8 13 25
and above
Total
9 46 34 89
Female Length of Less than 10.372 0.110
employment or equal to 7 53 (28%) 16 76 (df=6)
2 years
2.1 - 6
7 41 29 77
years
6.1 - 15
3 47 28 78
years
15.1 years
8 50 40 98
and above
Total
25 191 113 329
Note: Male: 4 cells (33.3%) have expected count less than 5. The minimum expected count is
1.82.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
5.78.

325
 c. Gender, length of employment and the role of the supervisor

Table 4.49: Analysis between length of employment and the role of the supervisor with
gender as the control variable

Gender Variable The role of the supervisor Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Length of Less than 2.100 0.910
employment or equal to 4 11 3 18 (df=6)
2 years
2.1 - 6
4 18 (35%) 6 28
years
6.1 - 15
3 11 4 18
years
15.1 years
6 12 7 25
and above
Total
17 52 20 89
Female Length of Less than 4.584 0.598
employment or equal to 10 49 17 76 (df=6)
2 years
2.1 - 6
13 41 23 77
years
6.1 - 15
9 47 22 78
years
15.1 years
18 50 (27%) 30 98
and above
Total
50 187 92 329
Note: Male: 5 cells (41.7%) have expected count less than 5. The minimum expected count is
3.44.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
11.55.

326
 d. Gender, length of employment and health and safety objectives

Table 4.50: Analysis between length of employment and health and safety objectives
with gender as the control variable

Gender Variable Health and safety objectives Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Length of Less than 14.200 0.027
employment or equal to 0 12 6 18 (df=6)
2 years
2.1 - 6
3 17 (40%) 8 28
years
6.1 - 15
2 7 9 18
years
15.1 years
7 6 12 25
and above
Total
12 42 35 89
Female Length of Less than 16.196 0.013
employment or equal to 5 51 (29%) 20 76 (df=6)
2 years
2.1 - 6
14 30 33 77
years
6.1 - 15
7 49 22 78
years
15.1 years
13 49 36 98
and above
Total
39 179 111 329
Note: Male: 4 cells (33.3%) have expected count less than 5. The minimum expected count is
2.43.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
9.01.

327
 e. Gender, length of employment and management commitment

Table 4.51: Analysis between length of employment and management commitment with
gender as the control variable

Gender Variable Management commitment Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Length of Less than 14.614 0.023
employment or equal to 3 8 7 18 (df=6)
2 years
2.1 - 6
7 15 (33%) 6 28
years
6.1 - 15
1 15 2 18
years
15.1 years
8 7 10 25
and above
Total
19 45 25 89
Female Length of Less than 5.730 0.454
employment or equal to 6 45 25 76 (df=6)
2 years
2.1 - 6
12 44 21 77
years
6.1 - 15
8 40 30 78
years
15.1 years
12 47 (27%) 39 98
and above
Total
38 176 115 329
Note: Male: 2 cells (16.7%) have expected count less than 5. The minimum expected count is
3.84.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
8.78.

328
 f. Gender, length of employment and safety reporting

Table 4.52: Analysis between length of employment and safety reporting with gender as
the control variable

Gender Variable Safety reporting Total Chi- p-

Disagree Neither Agree square value
agree/disagree
Male Length of Less than 5.892 0.435
employment or equal to 2 9 7 18 (df=6)
2 years
2.1 - 6 14
4 10 28
years (33%)
6.1 - 15
0 9 9 18
years
15.1 years
5 7 13 25
and above
Total
11 35 43 89
Female Length of Less than 6.509 0.369
employment or equal to 3 36 37 76 (df=6)
2 years
2.1 - 6
1 24 52 77
years
6.1 - 15
3 31 44 78
years
15.1 years 60
3 35 98
and above (31%)
Total
10 126 193 329
Note: Male: 4 cells (33.3%) have expected count less than 5. The minimum expected count is
2.22.
Female: 4 cells (33.3%) have expected count less than 5. The minimum expected count is
2.31.

329
 g. Gender, length of employment and the supervisor’s leadership style

Table 4.53: Analysis between length of employment and the supervisor’s leadership style
with gender as the control variable

Gender Variable The supervisor’s leadership style Total Chi- p-

Not at Sometimes Frequently square value
all
Male Length of Less than 8.132 0.229
employment or equal to 6 9 3 18 (df=6)
2 years
2.1 - 6 16
11 1 28
years (41%)
6.1 - 15
4 11 3 18
years
15.1 years
13 10 2 25
and above
Total
39 41 9 89
Female Length of Less than 1.735 0.942
employment or equal to 28 42 6 76 (df=6)
2 years
2.1 - 6
27 42 8 77
years
6.1 - 15
26 44 8 78
years
15.1 years
38 48 (27%) 12 98
and above
Total
119 176 34 329
Note: Male: 4 cells (33.3%) have expected count less than 5. The minimum expected count is
1.82.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
7.85.

330
 h. Gender, length of employment and accidents

Table 4.54: Analysis between length of employment and accidents with gender as the
control variable

Gender Variable Accidents Total Chi- p-

None Yes square value
Male Length of Less than or 1.819 0.611
employment equal to 2 12 6 18 (df=3)
years
28
14 14
2.1 - 6 years
18
12 6
6.1 - 15 years
15.1 years
15 (28%) 10 25
and above
Total
53 36 89
Female Length of Less than or 6.106 0.107
employment equal to 2 40 36 76 (df=3)
years
77
45 32
2.1 - 6 years
78
48 30
6.1 - 15 years
15.1 years
69 (34%) 29 98
and above
Total
202 127 329
Note: Male: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
7.28.
Female: 0 cells (0.0%) have expected count less than 5. The minimum expected count is
29.34.

331
 i. Gender, length of employment and injuries

Table 4.55: Analysis between length of employment and injuries with gender as the
control variable

Gender Variable Injuries Total Chi- p-

None Yes square value
Male Length of Less than or 4.349 0.226
employment equal to 2 8 10 18 (df=3)
years
28
5 23 (35%)
2.1 - 6 years
18
4 14
6.1 - 15 years
15.1 years
6 19 25
and above
Total
23 66 89
Female Length of Less than or 9.325 0.025
employment equal to 2 19 57 76 (df=3)
years
77
7 70
2.1 - 6 years
78
12 66
6.1 - 15 years
15.1 years
24 74 (28%) 98
and above
Total
62 267 329
Note: Male: 2 cells (25.0%) have expected count less than 5. The minimum expected count is
4.65.
Female: 0 cells (.0%) have expected count less than 5. The minimum expected count is
14.32.

332
 iii. Chi-Square Analysis Summary

Table 4.56: Relationship between levels of education, nine dimensions of health and
safety management, and gender

OBJECTIVE LEVEL OF EDUCATION

1 Variables Gender Education Total Scale p-value
to investigate Safety satisfaction Male School 26 (47%) neutral Non-
the perception & feedback level significant
of hospital Female School 116 (50%) neutral p = 0.096
employees level
regarding the Training and Male School 23 (50%) neutral Non-
different competence level significant
elements of Female Cert. & 88 (46%) neutral p = 0.010
OHS diploma
management Health and safety Male School 17 (49%) agree p = 0.056
objective level
Female School 80 (45%) neutral p = 0.023
level
The role of the Male School 22 (42%) neutral Non-
supervisor level significant
Female School 90 (48%) neutral Non-
level significant
Management Male School 22 (49%) neutral Non-
commitment level significant
Female Cert. & 84 (48%) neutral Non-
diploma significant
Safety reporting Male School 18 (42%) agree p = 0.098
level
Female Cert. & 105 (54%) agree p = 0.082
diploma
Leadership style Male School 28 (72%) Not at all p = 0.000
level
Female School 91 (52%) sometimes Non-
level significant
Accidents Male School 24 (45%) none Non-
level significant
Female School 106 (52%) none p = 0.035
level
Injuries Male School 31 (47%) yes Non-
level significant
Female School 128 (48%) yes Non-
level significant
*p-value significant = reject Ho
Ho = there is no relationships/differences between the two variables

333
 Table 4.57: Relationship between length of employment, nine dimensions of health and
safety management, and gender

OBJECTIVE LENGTH OF EMPLOYMENT

1 Variables Gender Length of Total Scale p-value
employment
Safety Male 2.1 – 6 yrs 19 (35%) neutral Non-
to investigate satisfaction & significant
the perception feedback Female 15.1 & 66 (28%) neutral Non-
of hospital above significant
employees Training and Male 2.1 – 6 yrs 17 (37%) neutral p = 0.010
regarding the competence
different Female Less than or 53(28%) neutral Non-
elements of equal 2 years significant
OHS Health and Male 2.1 – 6 yrs 17 (40%) neutral p = 0.027
management safety
objective Female Less than or 51 (29%) neutral p = 0.013
equal 2 years
The role of the Male 2.1 – 6 yrs 18 (35%) neutral Non-
supervisor significant
Female 15.1 & 50 (27%) neutral Non-
above significant
Management Male 2.1 – 6 yrs 15 (33%) neutral p = 0.023
commitment
Female 15.1 & 47 (27%) neutral Non-
above significant
Safety Male 2.1 – 6 yrs 14 (33%) agree Non-
reporting significant
Female 15.1 & 60 (31%) agree Non-
above significant
Leadership Male 2.1 – 6 yrs 16 (41%) Not at all Non-
style significant
Female 15.1 & 48 (27%) sometimes Non-
above significant
Accidents Male 15.1 & 15 (28%) none Non-
above significant
Female 15.1 & 69 (34%) none Non-
above significant
Injuries Male 2.1 – 6 yrs 23 (35%) yes Non-
significant
Female 15.1 & 74 (28%) yes p = 0.025
above
*p-value significant = reject Ho
Ho = there is no relationships/differences between the two variables

334
 Appendix 18

Logistic Regression

i. Safety satisfaction and feedback

Table 4.58: Logistic regression: Enter method for predicting the dependent variable:
safety satisfaction & feedback

Dependent Model Enter method

variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Variables
gender: female
0.501 0.142 1.650 0.846 – 3.216
Goodness of fit
Safety Omnibus Tests age: 25 – 39
satisfaction of Model -0.356 0.450 0.700 0.278 – 1.765
years
& feedback Coefficients age: 40 years
Chi-square = 0.247 0.665 1.280 0.419 – 3.911
& above
139.657, df = ethnicity:
18, p-value = 0.370 0.457 1.447 0.546 – 3.837
Chinese
0.000 ethnicity: Indian
Hosmer and 0.396 0.541 1.486 0.417 – 5.295
Lemeshow ethnicity:
Test -0.415 0.598 0.660 0.142 – 3.082
Others
Chi-square = *education
8.086, df = 8, level: School 0.030
p-value = level
0.425 education level:
Cert. & -0.480 0.102 0.619 0.348 – 1.100
Diploma
education level:
University -1.358 0.016 0.257 0.085 - 0.776
degree
Job position:
non-medical -0.399 0.236 0.671 0.347 – 1.298

*Reference value

335
Dependent Model Enter method
variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Goodness of fit Variables
Omnibus Tests Length of
of Model employment: -0.003 0.993 0.997 0.453 – 2.192
Safety Coefficients 2.1 - 6 years
satisfaction Chi-square = Length of
& feedback 139.657, df = employment: -0.023 0.955 0.977 0.433 – 2.206
18, p-value = 6.1 - 15 years
0.000 Length of
Hosmer and employment:
Lemeshow -0.386 0.435 0.680 0.258 – 1.792
15.1 years &
Test above
Chi-square = The role of the
8.086, df = 8, 0.350 0.360 1.419 0.671 - 3.003
supervisor
p-value =
0.425 Leadership style 0.031 0.877 1.032 0.696 – 1.530

Training &
0.204 0.487 1.226 0.690 – 2.178
competence
Health & safety
1.627 0.000 5.089 2.533 - 10.226
objective
Management
0.682 0.032 1.978 1.062 - 3.682
commitment
Safety reporting
0.513 0.097 1.671 0.912 – 3.061
Constant
-13.316

336
 Table 4.59: Logistic regression: Forward method for predicting the dependent variable:
safety satisfaction & feedback

Dependent Model Forward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Safety of Model *education level:
0.013
satisfaction Coefficients school level
& feedback Chi-square = education level:
127.259, df = 5, -0.378 0.144 0.686 0.413 - 1.138
Cert. & Diploma
p-value = 0.000 education level:
-1.496 0.005 0.224 0.079 - 0.639
University degree
Hosmer and Health & safety
Lemeshow Test 1.669 0.000 5.306 2.812 - 10.012
objective
Chi-square = Management
15.907, df = 8, 0.826 0.005 2.284 1.275 – 4.092
commitment
p-value = 0.044 Safety reporting
0.713 0.010 2.041 1.186 – 3.512
Constant
-12.523
*Reference value

Table 4.60: Logistic regression: Backward method for predicting the dependent variable:
safety satisfaction & feedback

Dependent Model Backward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Safety of Model gender: female
0.540 0.102 1.716 0.898- 3.278
satisfaction Coefficients
& feedback Chi-square = *education level:
130.019, df = 6, 0.028
school level
p-value = 0.000 education level:
-0.376 0.147 0.686 0.413 – 1.141
Cert. & Diploma
Hosmer and education level:
Lemeshow Test -1.340 0.013 0.262 0.091 - 0.753
University degree
Chi-square = Health & safety
8.532, df = 8, p- 1.736 0.000 5.673 2.974 - 10.824
objective
value = 0.383 Management
0.798 0.008 2.222 1.235 - 3.998
commitment
Safety reporting
0.707 0.012 2.028 1.172 – 3.511
Constant
-13.097
*Reference value

337
 Table 4.61: Logistic regression: Final model for predicting the dependent variable:
safety satisfaction and feedback

Dependent Model Enter method – Final model

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Safety of Model
satisfaction Coefficients *education
& feedback Chi-square = level: school 0.013
127.259, df = level
5, p-value = education level:
0.000 Cert. & -0.378 0.144 0.686 0.413 - 1.138
Diploma
Hosmer and education level:
Lemeshow University -1.496 0.005 0.224 0.079 - 0.639
Test degree
Chi-square = Health & safety
1.669 0.000 5.306 2.812 - 10.012
15.907, df = 8, objective
p-value = Management
0.826 0.005 2.284 1.275 – 4.092
0.044 commitment
Safety reporting
0.713 0.010 2.041 1.186 - 3.512
Constant
-12.523
*Reference value

338
 ii. Safety incidents/accidents: accidents

Table 4.62: Logistic regression: Enter method for predicting the dependent variable:
accidents

Dependent Model Enter method

variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Variables
gender: female
0.113 0.671 1.120 0.665 - 1.887
Goodness of fit
Accidents Omnibus Tests age: 25 – 39
of Model -0.168 0.655 0.846 0.405 – 1.764
years
Coefficients age: 40 years
Chi-square = -0.383 0.409 0.682 0.274 – 1.693
& above
36.604, df = ethnicity:
18, p-value = 0.046 0.909 1.047 0.476 – 2.304
Chinese
0.006 ethnicity:
-0.401 0.482 0.669 0.219 – 2.051
Indian
Hosmer and ethnicity:
Lemeshow -0.813 0.333 0.444 0.086 – 2.301
Others
Test education level:
Chi-square = Cert. & -0.011 0.964 0.989 0.605 – 1.616
6.810, df = 8, Diploma
p-value = education level:
0.557 University 0.441 0.223 1.554 0.765 – 3.155
Degree
Job position:
Non-medical 0.248 0.356 1.281 0.757 – 2.169
Length of
employment: -0.017 0.958 0.984 0.528 – 1.831
2.1 - 6 years
Length of
employment: -0.097 0.775 0.907 0.465 – 1.771
6.1 - 15 years
Length of
employment:
-0.292 0.470 0.747 0.338 – 1.650
15.1 years &
above

339
Dependent Model Enter method
variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Variables
Goodness of fit The role of the
-0.631 0.025 0.532 0.307 - 0.923
Omnibus Tests supervisor
Accidents of Model
Coefficients Leadership 0.389 0.020 1.476 1.063 – 2.049
Chi-square = style
36.604, df = Training &
18, p-value = 0.268 0.262 1.308 0.818 – 2.089
competence
0.006 Health & safety
0.298 0.218 1.347 0.838 – 2.164
objective
Hosmer and Management
Lemeshow -0.676 0.006 0.509 0.313 - 0.826
commitment
Test
Chi-square = Safety reporting -0.368 0.128 0.692 0.431 – 1.112
6.810, df = 8,
p-value =
0.557 Constant 2.474

340
 Table 4.63: Logistic regression: Forward method for predicting the dependent variable:
accidents

Dependent Model Forward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Accidents of Model Management
-0.703 0.000 0.495 0.349 – 0.702
Coefficients commitment
Chi-square =
16.360, df = 1,
p-value =
0.000

Hosmer and Constant

2.030
Lemeshow
Test
Chi-square =
13.089, df = 6,
p-value =
0.042

Table 4.64: Logistic regression: Backward method for predicting the dependent variable:
accidents

Dependent Model Backward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Accidents of Model The role of the
-0.514 0.037 0.598 0.368- 0.970
Coefficients supervisor
Chi-square = Leadership
22.696, df = 4, 0.369 0.022 1.447 1.055 – 1.985
style
p-value = Management
0.000 -0.643 0.003 0.526 0.344 – 0.803
commitment

Hosmer and
Lemeshow
Test Constant
Chi-square = 2.470
4.286, df = 8,
p-value =
0.830

341
 Table 4.65: Logistic regression: Final model for predicting the dependent variable:
accidents

Dependent Model Enter method – Final model

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Accidents of Model
Coefficients The role of the
-0.514 0.037 0.598 0.368- 0.970
Chi-square = supervisor
22.696, df = 3,
p-value = Leadership 0.369 0.022 1.447 1.055 – 1.985
0.000 style
Management
-0.643 0.003 0.526 0.344 – 0.803
Hosmer and commitment
Lemeshow
Test
Chi-square = Constant
2.470
9.086, df = 8,
p-value =
0.335

342
 iii. Safety incidents/accidents: Injuries

Table 4.66: Logistic regression: Enter method for predicting the dependent variable:
Injuries

Dependent Model Enter method

variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Variables
gender: female
0.553 0.073 1.738 0.949 - 3.184
Goodness of fit
Injuries Omnibus Tests age: 25 – 39
of Model -0.726 0.165 0.484 0.174 – 1.348
years
Coefficients age: 40 years &
Chi-square = -1.003 0.103 0.367 0.110 – 1.226
above
36.007, df = ethnicity:
18, p-value = 0.497 0.356 1.645 0.572 – 4.727
Chinese
0.007 ethnicity: Indian
0.399 0.562 1.491 0.387 – 5.743
Hosmer and ethnicity:
Lemeshow 1.089 0.316 2.972 0.354 – 24.977
Others
Test education level:
Chi-square = Certificate & 0.306 0.320 1.358 0.743 – 2.482
2.999, df = 8, Diploma
p-value = education level:
0.934 University 0.289 0.521 1.335 0.553 – 3.226
degree
Job position:
non-medical -0.262 0.414 0.770 0.411 – 1.442
*Length of
employment:
0.004
Less than or
equal to 2 years
Length of
employment: 1.438 0.001 4.211 1.869 – 9.488
2.1 - 6 years
Length of
employment: 0.952 0.020 2.591 1.161 – 5.780
6.1 - 15 years
Length of
employment:
0.717 0.120 2.049 0.830 – 5.056
15.1 years &
above
*Reference value

343
Dependent Model Enter method
variable characteristics
Predictors B p-value Odds Ratio 95% C. I.
Variables
The role of the
-0.680 0.059 0.506 0.250 – 1.027
Goodness of fit supervisor
Injuries Omnibus Tests
of Model Leadership 0.083 0.669 1.086 0.744 – 1.586
Coefficients style
Chi-square = Training &
36.007, df = -0.005 0.986 0.995 0.563 – 1.760
competence
18, p-value = Health & safety
0.007 0.188 0.533 1.207 0.668 – 2.180
objective
Management
Hosmer and -0.504 0.092 0.604 0.336 – 1.085
commitment
Lemeshow
Test Safety reporting 0.025 0.932 1.026 0.573 – 1.836
Chi-square =
2.999, df = 8,
p-value = Constant
0.934 4.080

344
 Table 4.67: Logistic regression: Forward method for predicting the dependent variable:
injuries

Dependent Model Forward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Injuries of Model *Length of
Coefficients employment:
0.022
Chi-square = Less than or
20.432, df = 4, equal to 2 years
p-value = Length of
0.000 employment: 1.071 0.005 2.920 1.370 – 6.221
2.1 - 6 years
Hosmer and Length of
Lemeshow employment: 0.699 0.052 2.011 0.994 – 4.070
Test 6.1 - 15 years
Chi-square = Length of
7.147, df = 8, employment:
p-value = 0.218 0.487 1.244 0.672– 2.302
15.1 years &
0.521 above
Management
-0.665 0.004 0.514 0.326 – 0.812
commitment

Constant 3.327

*Reference value

345
 Table 4.68: Logistic regression: Backward method for predicting the dependent variable:
injuries

Dependent Model Backward method

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Injuries of Model
Coefficients Gender: female 0.596 0.043 1.816 1.019 – 3.236
Chi-square =
27.224, df = 7, *Length of
p-value = employment:
0.000 0.012
Less than or
equal to 2 years
Hosmer and Length of
Lemeshow employment: 1.184 0.003 3.267 1.512 – 7.059
Test 2.1 - 6 years
Chi-square = Length of
16.039, df = 8, employment: 0.722 0.047 2.058 1.011 – 4.189
p-value = 6.1 - 15 years
0.042 Length of
employment:
0.227 0.474 1.255 0.674 – 2.338
15.1 years &
above
The role of the
-0.501 0.078 0.606 0.347 – 1.058
supervisor
Management
-0.443 0.103 0.642 0.377 – 1.094
commitment

Constant 3.834

*Reference value

346
 Table 4.69: Logistic regression: Final model for predicting the dependent variable:
injuries

Dependent Model Enter method – Final model

variable characteristics
Goodness of fit Predictors B p-value Odds Ratio 95% C. I.
Omnibus Tests Variables
Injuries of Model
Coefficients
Chi-square = Gender: female 0.596 0.043 1.816 1.019 – 3.236
27.224, df = 6,
p-value = *Length of
0.000 employment:
0.012
Less than or
Hosmer and equal to 2 years
Lemeshow Length of
Test employment: 1.184 0.003 3.267 1.512 – 7.059
Chi-square = 2.1 - 6 years
6.877, df = 8, Length of
p-value = employment: 0.722 0.047 2.058 1.011 – 4.189
0.550 6.1 - 15 years
Length of
employment:
0.227 0.474 1.255 0.674 – 2.338
15.1 years &
above
The role of the
-0.501 0.078 0.606 0.347 – 1.058
supervisor
Management
-0.443 0.103 0.642 0.377 – 1.094
commitment

Constant 3.834

*Reference value

347
Table 4.70: Summary of the logistic regression analysis

OBJECTIVE 2 Safety satisfaction & feedback

(first to last order)
to examine whether Enter method 1. Education level: university degree
the elements of OHS 2. Health and safety objectives
management are
3. Management commitment
viewed as supportive
4. Safety reporting
or preventive factors
Forward method 1. Education level: university degree
to the implementation
of OHS management 2. Health and safety objectives

system in Malaysian 3. Management commitment

public hospitals 4. Safety reporting

Backward method 1. Education level: university degree

2. Health and safety objectives
3. Management commitment
4. Safety reporting

Final model – 1. Education level: university degree

Enter method
2. Health and safety objectives
3. Management commitment
4. Safety reporting

348
 OBJECTIVE 2 Accidents
(first to last order)
to examine whether Enter method 1. The role of the supervisor
the elements of OHS 2. Leadership style
management are
3. Management commitment
viewed as supportive
or preventive factors Forward method 1. Management commitment
to the implementation
of OHS management Backward method 1. The role of the supervisor
system in Malaysian 2. Leadership style
public hospitals 3. Management commitment

Final model – 1. The role of the supervisor

Enter method
2. Leadership style
3. Management commitment

349
 OBJECTIVE 2 Injuries
(first to last order)
to examine whether the Enter method 1. Gender: female
elements of OHS 2. Length of employment: 2.1 – 6 years
management are
3. Length of employment: 6.1 – 15
viewed as supportive or years
preventive factors to 4. The role of the supervisor
the implementation of 5. Management commitment
OHS management
system in Malaysian Forward method 1. Length of employment: 2.1 – 6 years
public hospitals 2. Length of employment: 6.1 – 15
years
3. Management commitment

Backward method 1. Gender: female

2. Length of employment: 2.1 – 6 years
3. Length of employment: 6.1 – 15
years
4. The role of the supervisor

Final model – 1. Gender: female

Enter method
2. Length of employment: 2.1 – 6 years
3. Length of employment: 6.1 – 15
years
4. The role of the supervisor

350
 Appendix 19
Results of the Open-Ended Question

Table 4.73: Results of the open-ended question

No. Resp. Gender Length of Comments on OHS practices

# employment
1. 8 male 2.1 – 6 years need to change lead gowns. Need lead lines doors
and goggles. Need to have HIV cocktail. Need
monitoring of radiation. Need better gloves
2. 17 male 6.1 – 15 years to organize internal training regarding OSH. Create
partnership with Fire Brigade & Public Defense Dept
for exhibition and safety talk. Poster and brochure of
safety awareness
3. 18 female Less than or All hospital staff should be given awareness
equal to 2 years regarding OSH practices
4. 22 female 6.1 – 15 years Provide a safe, clean & broader working
environment. 2) Provide more staff so that job can be
shares and no feeling of stress 3) provide a
harmonious working environment by increasing
more good facilities
5. 23 female 15 years & 1) provide a safe working environment 2) Create a
above harmonious working condition to avoid stress
6. 29 female 2.1 – 6 years Overall OK

7. 36 male 2.1 – 6 years Overall OK

8. 37 female Less than or 1) Cooperation among staff is necessary 2)

equal to 2 years information about OSH should be shared to increase
performance and protection of staff
9. 45 female 6.1 – 15 years 1) Continuous teaching education must be done
every week for paramedic especially who deals
directly with patients. 2) The supervisor must
participate in brainstorming and considers staff
suggestions
10. 48 male 15 years & very good and updated
above
11. 49 male 2.1 – 6 years 1) Workstation design is not wide 2) Small store to
accommodate many things 3) Wide workstation is
only allocate for critical unit and dept.
12. 55 female 15 years & 1) PPE usage is practiced here 2) Usage of special
above chair for seated work

351
No. Resp. Gender Length of Comments on OHS practices
# employment
13. 57 female 15 years & 1) Long gloves not provided to be used for washing
above equipment as solution used to clean equipment is
dangerous to skin 2) Safety boot not provided to
work in unclean zone 3) Noisy place with vacuum
cleaner
14. 63 male 2.1 – 6 years to be honest, I'm not aware of any health and safety
measure, but I do know basic protective gear
attire/equipment & universal precaution
15. 78 female 15 years & 1) Dilute chemo drug is done in the ward and expose
above to staff and patients 2) safety of workers - big and
heavy oxygen cylinder is still being used in ward
where workers need to carry and push this cylinder
from store to patient. This cause backache
16. 80 male 15 years & 1) OSH practices is individual affairs & some not
above even aware of it 2) There is no total approach from
management in implementing safety system.
Implementation is the responsibility of each dept/unit
3) no compensation for staff who meet with accident
at workplace
17. 84 female Less than or The supervisor must provide good welfare and staff
equal to 2 years be made comfortable
18. 98 male 15 years & 1) Noisy workplace 2) Workstation not wide 3) Not
above comfortable and needs new building
19. 104 male 15 years & 1) Motivation and awareness from management is
above necessary 2) Courses from time to time is necessary
to upgrade knowledge of staff
20. 105 male 15 years & 1) OSH practices should be implemented in all
above working places as an on-going program continuously
and should be monitored monthly by an appointed
committee
21. 106 male 2.1 – 6 years Our dept is moving towards digital imaging to
eliminate staff exposure to chemicals in daily work
22. 189 female Less than or Lower category of staff has to follow the top
equal to 2 years management instruction even though at times we are
not satisfied. We are not given the right to say what
we want to say. Only our supervisor keeps on
motivating us to do our jobs efficiently.
23. 218 female 2.1 – 6 years Preparation of cytotoxic medicine is being done in
the treatment room and not in special room. This
practice is not complying with safety procedure and
staff is exposed to this risk.

352
No. Resp. Gender Length of Comments on OHS practices
# employment
24. 239 female 2.1 – 6 years Staff still exposed to chemotherapy

25. 242 male 2.1 – 6 years PPE not given to staff while performing work

26. 245 female 2.1 – 6 years Staff still exposed to chemotherapy

27. 264 male 15 years & OSH practices is satisfactory

above
28. 268 male 6.1 – 15 years preparation of chemo drugs is done in the clinic
setting for day-care cases. Should be constituted in a
proper set-up place for safety
29. 279 female Less than or lack of monitoring on staff vehicle safety
equal to 2 years
30. 283 male 15 years & we have good OSH practices in the workplace
above
31. 290 female 6.1 – 15 years organize workshop on OSH issues to increase staff
knowledge
32. 294 female 15 years & Conduct courses on OSH
above
33. 295 female 15 years & Conduct courses on OSH
above
34. 303 female Less than or Staff must be motivated and given awareness on the
equal to 2 years importance of OSH in the workplace. OSH
committee members must go from ward to ward to
give 5-10 minutes talk on OSH awareness.
35. 304 male Less than or cooperation among staff on OSH issues is important
equal to 2 years no matter among top management or lower level
employees
36. 314 female 15 years & training should be given from time to time to ensure
above everybody get information clearly and to avoid
making mistake
37. 317 female 2.1 – 6 years there's no safety when sending patient from ward to
the labour room at night as the distance is far
38. 318 female 6.1 – 15 years there's no safety when sending patient from ward to
the labour room at night as the distance is far
39. 319 female 2.1 – 6 years there's no safety when sending patient from ward to
the labour room at night as the distance is far
40. 329 male 15 years & most staff face stress caused by patients who do not
above want to queue for their turn; ego of patients, patients
who do not follow procedures. When reported to
Director or Head of Dept, staff was blamed for not
entertaining patients accordingly.

353
No. Resp. Gender Length of Comments on OHS practices
# employment
41. 357 male 15 years & management should concentrate on health, safety
above and welfare of staff especially lower category staff
42. 360 female 15 years & Overloaded works cause stress to staff. Action taken
above for complaints only after bad incident/accident had
happened.
43. 367 female Less than or Untidy arrangement of equipment in fixtures and
equal to 2 years narrow pathway affected our focus to work
efficiently
44. 383 female Less than or still at the level of below optimum
equal to 2 years
45. 393 female 6.1 – 15 years no special place to wash used equipments and to
throw patient’s blood
46. 395 female 15 years & the structure of the layout is not ideal, no isolation
above cubicles for ingestion patient, shortage of staff, too
many cables lying on the floor, wet floor due to
disconnecting pipes for dialysis, fire hazard due to
air-condition, no proper storage for equipment
47. 396 female 15 years & no proper place for washing instruments, ICU caught
above fire twice but no proper advice/plan been given to
nursing staff, wet floor, cables on the floor, structure
of workplace too congested, fire drills training
should be given on a rotation basis
48. 399 female 2.1 – 6 years safety and health rules should be displayed in every
unit, organize safety and health workshop from time
to time, changes in safety and health practices should
be informed as soon as possible
49. 414 female 15 years & I was never been brief on OSH practices
above

354
Theme

i. Continuous education and training on OSH

ii. Awareness training

iii. Personal protective equipment (PPE) not from good quality

iv. Hospital environment not conducive for working

v. Sharing of OSH information

vi. Workstation design not comfortable

vii. Ergonomics issues

viii. The role of the supervisor

ix. Effective safety communication

x. Exposure to dangerous substance without enough protection

xi. Cooperation among top management and employees

xii. Work stress

xiii. Improper disposal of waste

xiv. Safety rule not display

355