CHEMICAL ENGINEERING TRANSACTIONS VOL. 111, 2024 A publication of The Italian Association of Chemical Engineering Online at www.cetjournal.it Guest Editors: Valerio Cozzani, Bruno Fabiano, Genserik Reniers Copyright © 2024, AIDIC Servizi S.r.l. ISBN 979-12-81206-11-3; ISSN 2283-9216 Promoting Behavioural Safety in Gas Manufacturing: Adaptation of the B-Safe Training Program Giulia Paganin*a, Federico Fraboni b, Marco De Angelis b, Marco Mariani b, Sofia Morandini b, Salvatore Zappalà b, Dina Guglielmi a, Luca Pietrantoni b aDepartment of Educational Science, University of Bologna, Via Filippo Re, 6, 40126 Bologna, Italy bDepartment of Psychology, University of Bologna, Viale Carlo Berti Pichat, 5, 40127 Bologna, Italy giulia.paganin2@unibo.it In the industrial gas manufacturing sector, stringent safety protocols and proactive safety promotion are crucial to prevent hazardous incidents protect employees, customers, and the environment from the potential risks of handling and transporting these gases. Train The Trainer (TTT) programmes can be tailored to the organisation’s needs and cover various topics, such as handling hazardous materials, emergency response procedures, equipment use and ergonomics, and managing emergency response procedures. The B-SAFE project, designed based on the ‘Communities of Practice’ theoretical framework and adopting the TTT approach, aims to provide workers with tools and resources to increase work safety and reduce accidents by acting on underlying cognitive behaviour and processes. The present case study aims to present the Italian adaptation of the B-SAFE training programme, incorporating specific revisions resulting from previous research. Twenty-five Health, Safety and Environment (HSE) top and middle managers from a leading gas manufacturing firm participated in the five-module training. At the conclusion of each B-SAFE module, they filled out a short questionnaire to report their satisfaction with the training methods and content. The answers were analysed to gather feedback on the course. In general, participants found the course to be useful, satisfying, fun and easy. 1. Introduction In recent decades, the issue of safety in the workplace remains a significant challenge (Paolucci et al., 2020). As the ILO reports, every 15 seconds, at least one worker dies from a workplace accident or occupational disease (Pega et al., 2022). A report released by the National Institute for Insurance against Accidents at Work (INAIL) reveals that, from January to September 2023, there were 430,829 accident reports in Italy and 761 fatalities. Homecare has become a topic of attention within the occupational safety domain, as it is particularly vulnerable to occupational accidents and injuries (Hansell et al., 2018). Homecare operators routinely navigate a labyrinth of chemical hazards, each posing unique risks to their safety and wellbeing. In this context, ensuring the chemical safety of operators, especially during the handling and delivery of oxygen and other medical gases, is crucial. Homecare workers face risks related to safety, including exposure to accidents involving chemicals. The sector is, in fact, inherently high-risk due to the transportation of highly flammable substances like oxygen, which, in the event of a leak, can lead to significant fire hazards (Chen, 2016). However, the spectrum of chemical risks extends beyond this singular focus. For instance, homecare operators are frequently exposed to aggressive cleaning agents and disinfectants (Goodyear et al., 2018). The handling of medications, particularly those with potent or chemotherapeutic properties, presents another layer of risk, necessitating careful management to prevent accidental exposure. Moreover, volatile organic compounds (VOCs), further complicate the chemical risk landscape (Su et al., 2018). 1.1 Role of Human Factors in Homecare Safety The importance of addressing Human Factors for preventing or reducing accidents in the homecare sector is a critical aspect of occupational safety. Human factors in the homecare sector encompass a broad range of psychological, cognitive, and social elements that significantly influence worker behaviour and safety. Errors, a DOI: 10.3303/CET24111037 Paper Received: 8 February 2024; Revised: 6 June 2024; Accepted: 28 June 2024 Please cite this article as: Paganin G., Fraboni F., De Angelis M., Mariani M., Morandini S., Zappalà S., Guglielmi D., Pietrantoni L., 2024, Promoting Behavioural Safety in Gas Manufacturing: Adaptation of the B-safe Training Program, Chemical Engineering Transactions, 111, 217-222 DOI:10.3303/CET24111037 217 central focus in human factors research, often result from complex interactions between individual capabilities, task demands, and environmental factors (Reason, 2000; Hollnagel, 2008; Rasmussen, 1990). For instance, time pressure and fatigue are common factors leading to lapses in attention and judgment, thereby increasing the likelihood of accidents (Reason, 2000). In addition to physical stressors, the emotional and psychological strain on homecare workers plays a significant role in their overall well-being. Negative interactions with patients and caregivers can act as catalysts for stress. A study by Karakaya et al. (2023) revealed that homecare workers experience heightened stress levels, social isolation, and adverse societal perceptions, suggesting that external factors may also impact stress levels. Psychosocial factors, including stress and job dissatisfaction, can detrimentally affect cognitive function and decision-making, leading to increased accident risks (Karakaya, 2023). These findings emphasise the necessity of addressing not only the tangible physical demands of the role but also the emotional and organisational challenges these professionals face. Consequently, it is imperative to adopt a holistic approach in evaluating and addressing the myriad factors influencing the health and safety of homecare workers. Developing a safety-conscious work culture, where safety protocols are respected and openly discussed, is another critical aspect of integrating human factors into safety management (Burke & Hutchins, 2007). Tailoring interventions targeting individual differences can help address context-specific vulnerabilities and needs. Homecare organisations have implemented policies and processes and personnel training programmes to handle safety-related issues. These results highlight the importance of addressing not only the job's physical demands but also the emotional and organisational challenges these professionals face. Therefore, it is crucial to take a comprehensive approach to assessing and addressing the various factors affecting homecare workers' health and safety. 1.2 Practical Training to Reduce Human Errors Effective training and skill development in homecare organisations are crucial for minimising hazards and ensuring the safe execution of tasks (Quinlan et al., 2015), including chemical hazards (Robson et al., 2012). Training could encompass practical demonstrations and usage of medical equipment, handling of hazardous materials, and emergency response protocols (Rydenfält et al., 2020). Regular and updated training sessions are vital to keep healthcare professionals abreast of new safety regulations and to maintain their skill proficiency. The Train-The-Trainer (TTT) technique, where a limited group of people receive training to train other collaborators later on, has been shown to be an practical approach for improving safety, particularly in industries with specific safety regulations and in large organisations (Pearce et al., 2012; Triplett et al., 2020). These programs aim to enhance safety awareness and instill a sense of collective responsibility towards maintaining a safe working environment (Ree & Wiig, 2019; Sartori et al., 2023). As delineated by Yarber et al. (2015), TTT programs harness the expertise of a selected group of employees to disseminate safety knowledge and best practices across an organisation effectively. Moreover, in TTT programs, involving managers has proven to boost the effectiveness of these initiatives. The participation of managers in these programs is linked to higher levels of competence and confidence among trainees (Munera et al., 2017). By engaging in peer-to- peer training, employees contribute actively to this culture. The versatility of TTT programs allows them to be customised to meet an organisation’s specific needs, covering a wide array of topics such as hazardous materials handling and equipment usage (Pearce et al., 2012). The efficacy of TTT programs was substantiated in various contexts. Yarber et al. (2015) demonstrated the cost-effectiveness of TTT programs in broadly disseminating evidence-based public health principles, highlighting their adaptability to address local concerns. Similarly, Nakamura et al. (2014) revealed the effectiveness of TTT in fostering skill development and work practices by providing customised training tailored to specific audience needs. Summerside et al. (2018) also found that TTT programs effectively nurture technical and non-technical skills in interprofessional teams, further emphasising this training approach’s versatility and broad applicability. Considering the homecare sector’s unique aspects and the need for TTT programs for safety improvement in this area, this paper presents the content and the participants’ evaluation of an adapted TTT program specifically tailored to the organisational needs. 1.3 Objective of the Study This paper aims to outline the key components and detail the overall satisfaction reported by participants regarding the Italian implementation of the TTT program, focuses on workplace safety in homecare respiratory therapy services, focusing on liquid gas production and delivery and involves analysing safety events from the past four years to identify training needs. The development of the program is extensively described in a previous work by Fraboni et al. (2023). Briefly, the program development process involved categorising and analysing safety events and contributing factors, ensuring data accuracy and consistency. The TTT program includes five modules addressing human factors issues. Table 1 presents an overview of the activities in each module. It was translated and adapted to the Italian context. Participants will then train their collaborators on the content of the 218 modules. The program, which leverages a team of Health, Safety, and Environment (HSE) managers to disseminate crucial safety information and best practices, comprises five key training modules. The Italian adaptation of the TTT program, initially implemented to address these diverse hazards, offers a framework for understanding and mitigating the unique risks associated with chemical safety in the homecare sector. Table 1. List and description of the activities in each of the 5 modules Mod. Activity Title Activity Description 1 Case Study 1 Identify Human Factors related issue in a real accident case study How workers behave? Identify common behaviours in everyday activities that could lead to accidents (e.g. violations) Challenges for attention List what challenges participants’ attention focus during one selected routine activity Case Study 2 Identify attentional related issue in a real accident case study Are you distraction prone? Complete a quiz with questions aimed to identifying if and how participants are “distraction prone” Strategies for reducing distractions Identify two strategies that can be used to avoid distractions during everyday operations at work, then identify pros and cons of the selected strategies 2 Describe an Event Identify a safety related event in which fatigue contributed to the increased risk. List antecedents to fatigue, consequences, and strategies to mitigate its effects Fatigue Checklist Complete a checklist for identifying self-observables behavioral cues of fatigue Case Study 3 Identify fatigue-related risk factors in a real accident case study Chronotype and Fatigue Complete a quiz to identity individual chronotype and related vulnerabilities to fatigue Role Playing: Fatigue Role playing a situation in which fatigue created a risk but it was effectively managed 3 Work “inside the box” Schedule a typical workday activity and identify sub-tasks related to the specific activities using a box-shaped timesheet. Case Study 4 Identify cognitive biases influencing decision-making strategies in a real accident case study Managing Priorities Assign priorities, using the “ABC” method, to the tasks identified in the first activity of the module. Managing Contingencies Order the selected activities in a matrix of importance and urgencies, thinking how activities should be prioritized if a contingency happened Writing in “behaviour mode" Improve the list of activities writing down the actions or behaviors needed to carry out the tasks. 4 Case Study 5 Identify antecedents and consequences of customers aggression in a real accident case study De-Escalation techniques Present a real-life situation at work in which they had to manage aggressive using de-escalation techniques Cognitive re-structuring and mindfulness Participate to a brief mindfulness session and re-formulate their thoughts on real- life aggressions experienced ad work 5 Identify the type of Human Error Identify the type of human error according to the taxonomy presented. Case Study 6 Identify factors contributing to human errors in a real accident case study Case Study 7 Identify antecedents to violations from procedure in a real accident case study Elaborating Feedbacks using the STAR model Elaborate a feedback to a collaborator, thinking about a real event, using the STAR model 2. Method Our case study examines the safety procedures of a multinational corporation providing home care services in European countries. Services include creating medical oxygen, distributing it to clinics and patients’ homes, managing in-home care, and technical assistance with oxygen cylinder maintenance. The TTT program was structured into five modules, employing frontal teaching with slide presentations, supplemented by ad-hoc explanatory videos for straightforward concept delivery. Additionally, the course incorporated interactive 219 exercises and activities, including case study analysis and role-playing, to enhance engagement and practical understanding. At the conclusion of each training session, the tutors distributed a link to a brief questionnaire aimed at evaluating the suitability of the covered module. Furthermore, participants were asked to give feedback on the proposed activities, suggesting changes that were gradually incorporated by the tutors, directly editing the material that was shared. 2.1 Participants A total of 24 employees (16 males and 8 females) from Italy were trained according to the TTT methodology, with the objective of further training their collaborators. Regarding the organizational roles of participants, the course was attended by 7 Operation Coordinators, 5 Planning Coordinators, 4 Production Managers, 3 QHSE Coordinators, 1 QHSE manager, 1 QHSE Specialist, 2 Technical Managers, and 1 Training Supervisor. 2.2 Measures The brief questionnaire aimed at evaluating the suitability of the covered module in terms of its content alignment, congruence with training objectives, compatibility with the trainees’ classroom management skils, and relevance to their specific work context, as well as the appropriateness in terms of duration and content. Additionally, participants were asked to evaluate, using a 5-point semantic differential scale, the perceived (a) usefulness of the module, (b) overall satisfaction, (c) enjoyment (referred to as 'fun'), and (d) level of difficulty. Finally, feedback was requested on any suggested changes to the various activities included in the module. The descriptive results will be presented in the following section. Table 2. Training evaluation Range Module 1 Module 2 Module 3 Module 4 Module 5 Module duration Adequate 95,5% 86,4% 77,3% 76,2% 100% Insufficient 4,5% 13,6% 18,2% 23,8% - Excessive - - 4,5% - - Activities Duration Adequate 86,4% 77,3% 72,7% 76,2% 95,7% Insufficient 13,6% 22,7% 22,7% 23,8% 4,3% Excessive - - 4,5% -- Number of slides Adequate 95,5% 86,4% 77,3% 90,5% 100% Insufficient - - - - Excessive 4,5% 13,6% 22,7% 9,5% Content of slides Clear and effective 72,7% 86,4% 63,6% 52,4% 95,7% Some Adjustment 27,3% 13,6% 31,8% 38,1% 4,3% Need to modify - - 4,5% 9,5% - In line with... Training objectives Yes 95,5% 90,9% 81,8% 85,7% 91,3% No 4,5% 9,1% 9,1% 14,3% 8,70% I don't Know - - 9,10% - - In line with... Classroom management skills Yes 90,9% 95,5% 68,2% 61,9% 87% No 4,5% 4,5% 18,2% 19% 4,3% I don't Know 4,50% - 13,60% 19% 8,70% In line with... Workplace Yes 90,9% 81,8% 72,7% 76,2% 91,3% No 9,10% 13,6% 13,6% 9,5% 8,7% I don't Know - 4,50% 13,60% 14,30% - 220 3. Results In general, the overall evaluations of the training course were positive. Regarding the total duration of the module, 92% of participants considered it adequate. In addition, the time available to carry out the activities (85%) and the number of slides (92%) was also assessed as adequate.The 83% of participants considered the content of the slides explicit and effective. Regarding the evaluation of the activities carried out in the modules, 89.1% of the participants felt that they were in line with the training objectives. Furthermore, 80.1% of the participants assessed the activities as appropriate for their classroom management skills. 82.7% of the participants also considered the proposed activities to be appropriate for their work context: in line with this, 86.4% of them stated that they wanted to keep all the activities of the modules unchanged. Analysing open- ended suggestions from participants, the main request was to add more concrete examples adaptable to the work context. Based on the feedback received, several amendments have been made to the training modules. Across all modules, there is a need to standardize acronyms and ensure consistency between training materials (i.e. slides and videos). References should be added to provide insights into key concepts. Additionally, trainers are advised to customize slides, potentially by reducing text and focusing on images. Terms used, especially in exercises, should be neutral and non-judgmental. As far as the overall evaluations of the course are concerned, on average, the modules were rated as useful (M=4.13; SD=1.15), satisfactory (M=4.11; SD=1.05), somewhat enjoyable (M=3.62; SD=1.29) and relatively easy (M=3.51; SD=1.37). See Table 2 for details on training evaluation. 4. Conclusions Workplace safety has emerged as a prominent and persistent challenge in recent decades. Within the distinctive context of homecare services, the chemical safety of operators engaged in the handling and delivering medical gases, notably oxygen, presents a unique array of challenges. Homecare organisations have responded to safety-related concerns by instituting comprehensive policies, procedural frameworks, and personnel training initiatives. The TTT technique has demonstrated efficacy in enhancing safety. Also, employees perceive a more significant commitment from their organization towards training and development when managers actively participate in these programs, increasing satisfaction with the training process and a stronger belief in the organization's commitment. Finally, a higher level of motivational involvement from participants is expected when managers lead by example. The influence of leadership behavior on employee motivation and performance has been well documented, underscoring the critical role that managerial involvement plays in the success of TTT programs. To date, there is a dearth of studies exploring Italian adaptations of TTT training courses for homecare workers. This paper addresses this gap by presenting participants' perceptions of the course's suitability. Overall, the evaluations of the training course have been positive. Over 90% of participants considered the total duration of the module as adequate, and more than 80% found the content of the slides to be clear and compelling. Furthermore, over 85% of the participants expressed satisfaction with the activities. 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