University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT AND NURSES’ PRODUCTIVITY (HEALTHCARE DELIVERY): EVIDENCE FROM PUBLIC HOSPITALS IN GHANA BY RICHARD SAM-MENSAH (10600026) THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MPHIL HUMAN RESOURCE MANAGEMENT DEGREE JUNE, 2018 University of Ghana http://ugspace.ug.edu.gh DECLARATION I do hereby declare that this thesis is the result of my own research under supervision and has not been presented by anyone for any academic award in this or any other university. All references used in the work have been duly acknowledged. I bear sole responsibility for any shortcomings. ………………………………... …………………………… RICHARD SAM-MENSAH DATE (1000026) i University of Ghana http://ugspace.ug.edu.gh CERTIFICATION I hereby certify that this thesis was supervised in accordance with procedures laid down by the University. ……………………………. …………………………… Dr. OLIVIA ANKU-TSEDE DATE (SUPERVISOR) ii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I thank God Almighty for giving me the grace, favor, strength, wisdom, and protections for the successful completion of this thesis. I also express my heartfelt appreciation to my Supervisor Dr. Olivia Anku-Tsede for providing me with constructive comments, strategic suggestions, and feedback throughout this thesis. I am indeed grateful to him. I also express my profound gratitude to all the lecturers at the Department of Organisation and Human Resource Management of the University for their inputs during Departmental Seminar Sessions. In addition, I am most grateful to the officials of the Ghana Health Service for facilitating the data collection from the sampled hospitals. Furthermore, I am thankful to my Boss Mr. Kwame Owusu Boakye and Lecturers of UEW Business School, more especially, Mr. Isaac Nyarko Adu who gave me the needed assistance for this thesis. I am also highly indebted to the various nurses who took time from their heavy schedules to participate in the study. I also wish to express my sincere appreciation to my parents Mr. Albert Sam-Mensah Snr and Mrs. Joyce Sam-Mensah for their priceless support, love, and encouragement as well as all my siblings. I am particularly grateful to Mrs. Margaret Ansah and Ms. Nadia P. Ekyire for their immense supports throughout this course. I am also grateful to the numerous authors and researchers whose works I have benefited from in doing this thesis. Thank you all and may God richly bless us all. iii University of Ghana http://ugspace.ug.edu.gh DEDICATION I dedicate this work to the glory of God Almighty And To my Lovely and caring parents as well as my wonderful siblings and friends iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS Content Page DECLARATION i ACKNOWLEDGEMENT iii DEDICATION iv TABLE OF CONTENTS v LIST OF TABLES viii LIST OF FIGURES x ABSTRACT x CHAPTER ONE: INTRODUCTION 1 1.0 Background to the Study 1 1.2 Problem Statement 10 1.3 Research Objectives 15 1.4 Research Questions 15 1.5 Purpose of the Study 16 1.6 Significance and Justification of Study 16 1.7 Organization of Study 17 1.8 Scope and Limitation of the Study 17 CHAPTER TWO: LITERATURE REVIEW 18 2.0 Introduction 18 2.1 What Is Occupational Health and Safety? 18 2.2 Global Occupational Health and Safety 21 2.3 Occupational Health and Safety and the Law 28 2.4. The Ghana Health Sector 30 v University of Ghana http://ugspace.ug.edu.gh 2.4 The Ghana Health Service 32 2.5 Theoretical Review 34 2.6 Empirical Review 37 2.6. The Concept of labor productivity 37 2.7 Conceptual Framework 63 CHAPTER THREE: METHODOLOGY 65 3.0 Introduction 65 3.1 Research Philosophy 65 3.2 Study Area 66 3.3 Research Approach 67 3.4 Research Design 69 3.5 Study Population 70 3.6 Sampling Procedure and Sample Size 71 3.7 Types and Sources of Data 73 3.8 Data Collection Instrument 73 3.9 Data Collection Procedure 77 3.10 Method for Data Analysis 78 CHAPTER FOUR: ANALYSIS, PRESENTATION AND INTERPRETATION 80 4.0 Introduction 80 4.1 Demographic Characteristics of Respondents 80 4.2 Measurement Model Evaluation 85 4.3 Structural Model Analysis 94 4.4 Discussions of the Research Findings 96 vi University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 104 5.0 Introduction 104 5.1 Summary of the Findings 104 5.2 Conclusion 107 5.3 Recommendations 112 5.4 Recommendations for Future Research 113 REFERENCES 115 APPENDICES 127 vii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table Page 1: Summary of Frequencies and Percentages of the Demographic Characteristics of Respondents 81 2: Summary of the Test for Normality 84 3: Model Fitness Indices 87 4: Measurement scale and model indicators 90 5: Fornell-Larcker Standard for Discriminant Validity 91 6: Heterotrait-Monotrait Ratio (HTMT) Standard for Discriminant Validity 92 7: Summary of Correlation Analysis of the Measured Variables 93 8: Path Coefficients along with their bootstrap values and ‗T‘ Values 94 viii University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure Page 1: Conceptual Framework 64 2: Initial Path Model 86 ix University of Ghana http://ugspace.ug.edu.gh ABSTRACT The issue of occupational health and safety (OHS) management is gaining significant attention among scholars in this millennium and there is the need for hospitals providing healthcare in developing countries to formulate policies and take the necessary actions that lead to creating a conducive work environment and improving productivity. This study, therefore, examined the effect of occupational health and safety on the service delivery of healthcare workers (nurses) in Ghana. The study also assessed which OHS dimension highly predicts healthcare delivery. The study adopted a quantitative research methodology. Nurses of selected public hospitals in Ghana were sampled. The proposed research model was tested empirically through a survey of 286 valid and usable questionnaires using partial least squares (PLS) and structural equation modelling (SEM) tool to analyze the data to address the hypothesized relationships. The study shows that OHS management positively predicts nurses‘ productivity (healthcare delivery). Additionally, the results indicate that OHS practice significantly improves performance. However, OHS induction and training proved to be a better predictor of business values than Safety regulations and safety inspections and audits. This study, therefore, concludes that OHS investment must not be seen as a cost center, but a tool which gives the organization certain direct benefits such as reduced staff absenteeism and sick-offs due to workplace injury, ability to meet deadlines and set targets, improved service quality and appealing corporate reputations. Therefore, with appropriate OHS management policy in place that promotes positive working environment to safeguard employees from sustaining injuries and illness at the public hospitals, nurses will be willing to perform and deliver good healthcare to patients. x University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.0 Background to the Study Recited by Takala (2005) in his opening statement, Decent work-safe work, the former UN Secretary-General, Mr. Kofi Annan in his words says; “All too often lives are shattered unnecessarily because of poor working conditions and inadequate safety systems… Let me encourage everyone to join the International Labour Organization in promoting safety and health at work. It is not only a sound economic policy, it is a basic human right” (Takala 2005: Pg1). Certainly, the ultimate aim of all production or manufacturing firm is to sustain the business by making a profit in spite of that organizations should not loose focus that each employee has the right to work in a safe and healthy work environment. The efficiency of workers of any company or firm sustains the economic viability of the firm. Consequently, the occupational health, safety and the well-being of these workers are vital pre-requisite for production and are of extreme significance for all social and economic development (WHO, 2000). Occupational health and safety (OHS) may be explained broadly to be a discipline of expectation, appreciation, estimation and regulation of risks emanating from work locations with the tendency of causing damage to the safety and well-being of employees, considering the potential impact on the neighbouring communities and the overall surroundings (Kumar, Goud & Joseph, 2014). Healthy and fit workers do not only profit the institution in which they have been employed but the entire society they live in. Thus, safeguarding people‘s lives and preventing workplace injuries can prolong the working existence of nationals and add to development and achievement of success. 1 University of Ghana http://ugspace.ug.edu.gh Safety is a basic fundamental human requirement in every aspect of our lives and is the state of being sheltered from a potential source of hazard or risk (Wehmeier, McIntosh, & Turnbull, 2005). It is one of the most crucial human desires, as suggested in the theory of needs pyramid by Abraham Maslow formulated in 1943, hence sensation of safety at work positions as a very imperative factor in employees‘ job satisfaction (Akpan, 2011). Creating an enabling environment for employees to feel physically and psychologically safe is the easiest demonstration of how much they are valued (Pilbeam & Corbridge, 2006).Workplace safety defines rules and procedures established to guarantee the safety and wellbeing of employees inside a workplace (Forst, Nickels, & Conroy, 2009). It comprises the identification of hazards and control in accordance with the nation-wide standard and on-going education and training of workers on well-being and safety. Accidents threaten the safety of workers and therefore typical of any living being, workers presume their institutions will put in place essential measures to guarantee that these workers, by close of work daily, arrive home safely yet occupational accidents and mortalities are increasingly outrageous. This makes the overall safety and well-being of employees a vital discipline for growth and the success of every organization. Records from United States of America show that over 4000 employees died as a result of job-related accidents and almost three million injuries and diseases to private industry employees as well as nearly 800,000 injuries to the public sector employees were witnessed in the year 2012 only, whilst in that same year, emergency job-related injuries treated in various health centres were projected to be 2.8 million causing 140,000 hospital admissions (National Institute for Occupational Safety and Health, [NIOSH], 2014). This brought a projected cost of $250 billion to the American community in respect of occupational mortalities and infirmities (NIOSH, 2014). 2 University of Ghana http://ugspace.ug.edu.gh Great Britain in the year 2010 and 2011, recorded 173,000 occupational related deaths and 111,164 job-related injuries which amounted to 13.4 billion pounds as a cost of workplace accidents to the UK society (Health and Safety Executive Annual Statistics Report, 2011/2012). Statistics again indicates that the Caribbean region and the Latin America experience close to thirty thousand mortalities annually and in Africa, 22.6 million occupational accidents occur within the sub-Saharan region which causes not less than three days absenteeism, leaving the rate of mortality per hundred thousand employees to be twenty-one and the rate of accident at about sixteen thousand (International Labour Office, 2012). Recently, a study by the International Labour Organisation (ILO), International Standards Authority (ISO) and the World Business Council for Sustainable Development (WBCSD) estimate occupational health and safety related deaths to be 2.34 million per annum in 2013 with a daily average of about 660,000 whilst it is projected that worldwide, 3,350,000 employees within the healthcare zone experiences injuries through the skin with an infected sharp-edged device annually (Pruss-Ustun, Rapiti, & Hutin, 2005). Generally, the International Labour Organization reports that over 6,300 deaths are recorded owing to work-related mishaps daily and annually, over 2.3 million, 317 million happens in the process of work each year; many of these leading to increased absence from work (ILO, 2014). The human cost of this day-to-day misfortune is enormous and the financial drain on inferior workplace health and safety management is valued at 4 percent of the world‘s GDP annually. Perceptions propose that, there are unfortunate demeanours in the direction of health and safety practices in occupations, as businesses are not by any stretch of the imagination worried about the assurance of workers' well-being and security (Ministry of Health Report, 2007) and much more dreadful, some managers 3 University of Ghana http://ugspace.ug.edu.gh don't understand that they have the lawful duty to ensure employees' well-being and security (Puplampu & Quartey, 2012). Occupational health hazards put healthcare workers at risk of increased morbidity and mortality. Loss of expert health workforces will undesirably affect healthcare services which are at present, suboptimal in developing countries such as Ghana. The increasing impacts of occupational injuries and diseases amongst health workers include economic loss, physical loss and psychological ailments such as stress and depression. These consequences tend to have an overall negative impact on not only the workers, but their families and the nation at large (Osungbemiro, Adejumo, Akinbodewa, & Adelosoye, 2016). The existing turbulent surroundings and setting in which some workers carry out their work demand that organizations scrutinize their practices (Robbins & Judge 2007). Therefore ensuring the safety of the workplace has become a global concern as it ensures a harmless condition of people throughout work and loss of life is avoided. It is therefore imperative for organizations to see to it that all activities and arrangements at the workplace are appropriately positioned to guard and preserve people‘s life from calamities, mishaps, and illnesses at the workplace. Majority of the sources of calamities found in workplaces are owing to insufficient encounters and expertise of employees, wrong choice and application of PPE, neglect of mechanisms, application of incorrect devices, hardware and apparatus, inadequate protection units on equipment, operating at elevations and employees informal attitude in the direction of safety (Hamid et al., 2008; Jin & Chen, 2013). Working at the hospital is an intrinsically stressful job with extended working hours, substantial or heavy workloads, difficult patients and incompatible demands. The 4 University of Ghana http://ugspace.ug.edu.gh physical and psychological demands of workers at the referral hospital make them more prone to outrageous rates of occupational infirmities and stress. The effects of these infirmities and stress are demonstrated as increased mistakes in surgical operations, high medical bills, delay or unpunctual to work, low production and output and increased sick leaves. In order to deliver significant high-class services to patients, boost morale and improve efficiency by decreasing time waste and different absenteeism rates, it is imperative to avoid occupational injuries and infirmities amid healthcare specialists. (Alamgir, Cvitkovich, Yu, & Yassi, 2007). Safeguarding effective healthcare delivery in emerging nations, with effective rudimentary medical care are problematic and the fact that these healthcare element seem not prioritized is terrible and challenging. It is obvious that contamination from bloodborne pathogen specifically HBV, HIV and hepatitis C virus (HCV) are dreadful risks that healthcare workers are exposed to due to the excessive pervasiveness of such virus and bacterium in majority of poverty-stricken territories globally (Simonsen, Kane, Lloyd, Zaffran, & Kane, 1999; Kane, Lloyd, Zaffran, Simonsen & Kane 1999). Ghana is found to be among the countries in the African sub-regions, predominantly in the West Africa whose work-related well-being and security practices might be different from the situation of other countries. Africa was perceived to have failed in achieving a majority of the millennium development goals (MDGs), mostly those associated with well-being and moderately to security (WHO, 2002). The motive driving such finding was due to the fact that most African countries usually overlook the essence of workplace safety issues in attaining the Millennium Development Goals (MDGs). It is a major worry to also specify that, in Sub-Saharan Africa (SSA), the average life expectancy of people within the region is low (Human Development 5 University of Ghana http://ugspace.ug.edu.gh Report, 2007). Consequently, tackling these issues and hence reaching the MDGs and several universally approved growth objectives in Africa will go a long way to safeguard the safety of human lives lost. Hence, one key intervention in the achievement of enhanced safety and health results for people within the African sub- region is the persistent enhancement of occupational health and safety services. In attempting to realize the benefits of workplace safety and well-being, ILO regard matters concerning occupational health and safety (OHS) as a necessity to the extent that about eighty (80) percent of its standards and tools are either entirely or partially linked to it (Alli, 2008). This notwithstanding, while developed nations have exhibited assurance in realizing a decreased number in industrial accidents, that of developing countries, mostly Sub-Saharan Africa (SSA) is different (Kheni, Dainty, & Gibb, 2008). Information available reveals high accidents and mortality rates in Sub- Saharan Africa, which brings about not less than three working days off-duty by employees (Lajini, 2014). Workers in Ghana are exposed to work-related accidents daily and the occurrence of these accidents and other safety-related problems in the majority of the African nations is as a result of little concentration on or compliance with issues of safety and well-being by both the business and government. Many world-wide and nongovernmental organizations regularly inquire as to why the greater part of the African nations are finding it difficult in an attempt to cultivate a viable wellbeing and secured work setting. One viewpoint to the distress above is that greater parts of the African nations have bad safety and well-being awareness and lifestyle (Regional Committee for Africa Report, 2004). Another cause may be that more importance is placed on maximizing output and success whiles undermining standards, policies, and procedures of well-being and security at workplaces. 6 University of Ghana http://ugspace.ug.edu.gh According to previous studies that assessed the barriers associated with implementing OHS policies in Ghana considering the prevailing enactments and their contributions to different zones, identified the inadequacy of all-inclusive complete state occupational health and safety blueprint as the major barrier in implementing OHS practices in Ghana (GHS, 2007; Puplampo & Quartey, 2012). Additionally, futile OHS education, training and inspection; inadequate capital and subsidies for OHS research; observing and intensifying OHS abilities and potentials, and a lower rate of ILO customs modifications have also been specified by Puplampo and Quartey (2012) to be among the crucial obstacles hindering the implementation of OHS practices in Ghana. Kheni, Dainty and Gibb (2008) also pointed out unproductive systems and structures of institutions accountable for health and safety measures, insufficient government aid for governing entities and lack of knowledgeable experts, constrained economic resources and recognition given to occupational health and safety as crucial obstacles hindering the implementation of OHS in Ghana. To support this assertion, Dadzie (2013) in his study conducted on the viewpoints of professionals on safety and health contingencies in the Labour Act identified a number of issues disturbing the observance to the safety and health enactment in Ghana‘s Labour Act including deficiency in employee health and safety training, poor hazard and risk management, poor approach of workforces towards safety and health, insufficient safety and health experts and policies, scarce systems for data gathering, inadequate safety and health education within organisations, problems in communication, charge of delivering and sustaining worksite safety and well-being and gaps in reporting mishaps . Generally, the charges of many workplace mishaps and injuries to employees, their household and managers are on the rise. To the whole nation, the charges involved in workplace mishaps and infirmities can be projected as costly as four percent of the 7 University of Ghana http://ugspace.ug.edu.gh GDP of a country. According to Norman, Carpenter, Scott, Brune, and Sly (2014) in Ghana, an aggregate amount of GH₵ 5,368,203 was compensated to workers in a period of three consecutive years (2008—2010) from the public and private sectors together. In 2008 only, there was a collective payment of GH₵ 2,225,817.00 comprising of GH₵ 1, 331, 054.00 and GH₵ 894,763.00 in private and public sectors respectively. The year 2009 also incurred an amount of GH₵1,120,779.00 remunerated in the private sector only with no payment from the public sector and lastly in 2010 payment of GH₵ 2,021,607 was made in respect of compensation comprising of GH₵1,025,243 in the private sector and GH₵ 996,364 for the public sector. Workplace accidents, illness, injuries, and diseases are known to cost Ghana close to seven percent of Gross Domestic Product (Adei & Kunfaa, 2007) and it is required of employers via the Ghana Workmen‘s compensation Act 1987 (PNDC 187) to effect payment of all medical expenses regarding any workplace-related accident and also compensate for the accident victims. Certainly, no one seems to know the actual cost of work-related accidents and illnesses are owing to the fact that a host of ancillary charges exist which is hard to compute in addition to very apparent first-hand charges (Neequaye & Okwabi, 2012). In an effort to reduce workplace fatalities, policies, legislation, and institutional frameworks have been framed at the international, nationwide and industry levels to regulate workplace activities and ensure the safety of employees at work. But in Ghana, the legal and institutional frameworks governing well-being and security of workers have little influence on the attitude of management of organizations (Gibb & Bust, 2006; LaDou, 2003). Interestingly, governing structures, frameworks and institutes of numerous emerging nations including Ghana are borrowed from advanced nation-state with very little revisions or updating of such regulations or 8 University of Ghana http://ugspace.ug.edu.gh restructuring of the institutions to replicate their present level of growth and cultural backgrounds. Therefore, despite the existence of these regulations, in Ghana where the majority of the working population are involved in dominant industries like agriculture, mining, construction and logging, occupational health and safety has not attained a higher status in the country‘s sustainable economic expansion programme (Amponsah-Tawiah, 2013). The efficacy of workplace wellbeing and safety administration in these nations may, therefore, be questioned. For instance unlike the developed countries, where laws have been formulated to protect workers at work (Harnois & Gabriel, 2000), the legal and institutional frameworks for workplace safety and health administration in developing countries are far less extensive and comprehensive (Kheni & Braimah, 2014) and in the case of Ghana, the already prevailing OHS legislation is scrappy and limited in coverage (Mustapha, Marsh, & Harrison, 2016). Despite the fact that as per the Factories, Offices and Shops Act of 1970, every one of the partners in particular, the nation, the business manager and their workers have some obligations, duties and commitments in lessening work- related dangers, a definitive duty of wellbeing practice lays on the laborer/worker who specifically encounters the impacts of work-related risks. Employees must take after built up security methods and practice safety to guarantee their own particular security and great wellbeing and in addition those of their associates. This has become a major concern for stakeholders particularly those in the healthcare sector as it results in outrageous occupational mishaps and fatalities which decreases employee morale and commitment. Clark (2005) saw that the expenses of unfortunate and dangerous working environments have been all around recorded and are computed in terms of absenteeism. Great worker morale and commitment reduces absenteeism and turnover and gives the organization a good image and reputation. Great worker enthusiasm and 9 University of Ghana http://ugspace.ug.edu.gh devotion are linked with exorbitant safety accomplishment. As per Alazab (2003), in view of the investigations of the unified kingdom's Health and Safety Executive, discovered that organizations that advanced employees‘ contribution to safety and wellbeing matters regularly witnessed a decrease in mishaps and wounds and there was positive change in dangers mindfulness and efficiency Again, due to issues of less reporting and improper classification, several accidents, injuries, illnesses, process loss and damage in properties that occur at different workstations in an organization are not in the known due to the absence of appropriate organizational culture and values. This calls for businesses to respond to the growing concern of workplace accidents and deaths as a phenomenon. This research, therefore, seeks to investigate the influence of occupational health and safety management policies and healthcare delivery in the health sector of Ghana. 1.2 Problem Statement The administration of employee wellbeing and safety at the worksite remains among necessities of human distress. It aims at an adaptation of the working environment to workers for the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations (Armstrong, 2001). The economic, human and social repercussions of workplace injuries, mishaps and illnesses as well as crucial industry-related tragedies have long been an issue of distress at the organizational level, the national and international levels due to the fact that industrial or occupational accidents and injuries do not only affect the mental health and productivity of the victim worker, but also have financial implications for the injured worker and the employing authorities (Asumeng & Osae-Larbi, 2015; Minji & Joseph, 2012). 10 University of Ghana http://ugspace.ug.edu.gh Moreover, the safety and health of workers at the work setting are critical to the worker himself, their families, employers and the entire nation (Asumeng & Osae- Larbi, 2015) and is a major contributor to the burden of occupational illness in most countries. A number of accidents that occurs at the workplace are mostly caused by mediocrity, unconcerned behaviour and absence of self-discipline by employees. Effective and efficient interventions are expected to emerge through a long-term policy to decrease infirmities and seriousness of injuries imposed on healthcare employees (Puerto & Gilkey, 2014). Worldwide, extant literature has shown that occupational health and safety occupies a pivotal position in enhancing employee productivity (Wanjau, 2013). In view of the aforementioned, the need for organizations to ensure adherence to OHS policies and procedures at their workplace as a basic right of employees and a strategic human relations management concern cannot be over-emphasized (Logasakthi & Rajagopal, 2013). Globally, Healthcare workforce is one of the largest workforces consisting of over 12 percent of the working population (Goniewicz et al; 2012) and about 70 percent of this workforce of health facilities in Ghana are nurses that exercise a lot of power and use most of the scarce resources (GHS, 2006). Healthcare workers carry out their duties in an environment considered as one of the most hazardous occupational settings. Personnel in this workforce are responsible for providing quality health care services, even though their workplaces (hospitals, clinics, and laboratories) are increasingly unsafe (Manyele et al, 2008). Adding to the normal work-related exposures, healthcare workers face different hazards as a result of the activities involved in their work. Evidence from the Africa sub-region indicates that these healthcare specialists are often introduced to various kinds of dangers at the workplace such as physical, biological, chemical and psychosocial (Nsubuga & 11 University of Ghana http://ugspace.ug.edu.gh Jaakkola, 2005; Tinubu, Mbada, Oyeyemi, & Fabunmi, 2010). They are always in connection with patients that expose them to contagions and thus require appropriate defensive actions to lessen their chance of acquiring sickness or affliction. Most healthcare workers in addition to the risk of contamination with blood-borne virus and bacterium through needle stick also stand the chance of the side reaction of medicine used for after vulnerability treatment and prevention as well as the mental worry and the dilemma of becoming liable to contamination (O‘Gorman, Lin, Stankovich, & Broadley 2013; Bhardwa,j Sow, Devi, Ng, Mandal, & Cho 2014). Ghana‘s health sector is known as a sector that utilizes chemicals, drugs and huge revolutionary appliances in carrying out work. Additionally, it is a sector that its territory is vulnerable to infirmities and afflictions considering the movement of patients‘, tools and chemicals used in providing quality health care services. This makes it imperative for these health institutions to formulate and institute OHS policies and strategies that provide precautions and defense for their employees against occupational fatalities, but the legislation governing health and safety of workers is rarely applied to healthcare workers or the health sector, resulting in a hazardous and risky work setting. The nonexistence of explicit strategies has downgraded the health zone to a delicate operational environment and aggressive drawback (Komollo, 2010). It would not be an exaggeration to contend that just like the high-risk zones such as construction, mining, and aviation; one cannot underestimate the occupational health and safety matters within the hospitals. In Ghana, owing to the problem of inadequate all-inclusive and stakeholder concentrated OHS laws, the safety and health of healthcare nurses cannot be guaranteed (Gyensare et al., 2017). Eminently, notwithstanding that most of the occupational related accidents and fatalities which come at various costs are avoidable via contemporary occupational health and 12 University of Ghana http://ugspace.ug.edu.gh security approaches; they are neglected and unnecessarily proliferated (Anku-Tsede, 2016). Identifying factors relating to occupational hazards among healthcare workers is essential in formulating occupational health and safety policies and systems that will improve the productivity and overall wellbeing of healthcare workers (Osungbemiro et al; 2016). Consequently, it becomes proactive and essential to embark on empirical research to investigate the nexus between occupational health and safety and the delivery of healthcare among nurses. Over the world and in Ghana, several occupational health and safety (OHS) researches have cut across diverse industries across the globe. Researches in the area have however been much focused in high risk and hazardous industries such as the oil and gas extraction (Anku-Tsede, 2016; Mason, 2015), construction (Brace et al., 2009; Zeng et al.,2008), mining (Amponsah-Tawiah & Mensah 2016), (Amponsah- Tawiah et al.,2016), waste management (Battaglia Passetti, & Frey,2015), Timber and wood processing (Adei & Kunfaa, 2007; Mitchual, Donkoh, & Bih, 2015) and manufacturing industries (Nowier Alidrisi, Al-Darrab, & Zytoon, 2013; Zubar, Visagavel, Raja, & Mohan, 2014). Perhaps very little or no studies, however, have been done on occupational health and safety especially with respect to the Policies in the health sector. Meanwhile extant literature has it that one of the territories mostly disregarded by management, particularly in the underdeveloped nations is the arrangement of a safe workplace for employees (Akpan, 2011). Intending to this menace, more consideration is been attracted to the level of destruction and loss suffered by workers and in numerous cases the valuation of expenses related to this destruction and infirmities. The degree of the impacts of wellbeing and security on labor efficiency crosswise over industries in Ghana still stays uncertain since accessible works essentially examine the effect on individual sectors and businesses. 13 University of Ghana http://ugspace.ug.edu.gh For example, Danso, Badu, and Ahadzie (2010) looked at the effect of hazardous conditions of work on employees within the Kumasi construction industries assessing the number of infirmities that happens. Moreover, various researches such as (Mock, Frangakis, Davidson, Ropka, Pickett, Poniatowski, & Cohen, 2005; Ametepe, 2011 & Annan, 2011) are either as cost figuring or reportage without detailed investigations. To guarantee the health and safety of employees, the degree of these hazardous and undesirable conditions on work profitability additionally should be known. This study thusly endeavors to connect this hole by giving a detailed knowledge of the impact of health and safety on workers' efficiency in Ghana. Regardless of to a great degree the negative impacts of occupational stress on the health of employees and labour productivity, and numerous actions employed to safeguard the safety and health of workforces at both the micro and macro business levels, many organizations, including the healthcare institutions has not established any tangible measures to solve these OHS-related problems that adversely affect productivity of employees and organizational performance (Reinhold, Järvis, & Tint, 2015; Masi, & Cagno, 2015). Also, there is still slight attention regarding work- related health and safety matters in healthcare centers, as this is evidenced by numerous workplace safety and health dangers, risk, and infections in Ghana (Puplampu & Quartey, 2012). So also, it is effortlessly seen that there is the absence of successful intercessions from qualitative and quantitative research activities. Endorsing safety and health operations at the workplace such as OHS policies, OHS inspections, OHS education and research demands a wider dais. It is therefore imperative to explore the occupational health and safety practices encountered by healthcare specialist in public hospitals and the various policies and legislations which 14 University of Ghana http://ugspace.ug.edu.gh ensure employee safety at work. Besides, there has not been cognizant foundation of a linkage amid occupational health and safety policies and practices and its adverse effect on labor productivity. It is in the light of these problems that this research seeks to bring to the fore and provide some intuition into the implication of workplace safety and health on the overall performance of healthcare institutions. 1.3 Research Objectives The main intention of the study was to explore the influence of occupational safety and wellbeing on the service delivery of healthcare workers (nurses) in Ghana. In line with this, the study specifically sought to: i. To determine whether OHS policies and regulations will significantly predicts nurses‘ delivery of healthcare in Ghanaian Hospitals. ii. To investigate whether workplace safety inspections will significantly predicts the delivery of healthcare in Ghanaian Hospitals. iii. To ascertain whether OHS induction and training will significantly predicts the delivery of healthcare in Ghanaian Hospitals. iv. To examine which of the OHS dimensions will predict healthcare delivery of nurses most in Ghanaian Hospitals. 1.4 Research Questions The following set of questions directed the researcher in this study: i. Do OHS policies and regulations predict healthcare delivery of nurses in Ghanaian Hospitals? ii. What is the effect of conducting workplace safety inspections and audits on the healthcare delivery of nurses in Ghanaian Hospitals? 15 University of Ghana http://ugspace.ug.edu.gh iii. What is the effect of conducting OHS induction and training on the healthcare delivery of nurses in Ghanaian Hospitals? iv. Which OHS variable will highly predict healthcare delivery of nurses in Ghanaian Hospitals? 1.5 Purpose of the Study Majority of organizations with the goal of achieving greater efficiency end up burdening employees with excess workload to be able to meet time limits and set targets, and this might have psychological and physical effects on the employees‘ productivity which may bring about something as opposed to what these organizations need to accomplish. The motive of this study is give an insight on the effect of occupational safety and health on the productivity of Ghanaian nurses. 1.6 Significance and Justification of Study The legitimization of this investigation rests on expectation to feature the indispensable commitment of health and safety to the efficiency of the labor force by means of the projection of the minor impacts of safety and wellbeing on nurses‘ health conveyance ability. Subsequently, it means to move far from the projection of the quantum of frequencies of damage, the measure of remuneration paid and the misfortune in beneficial hours; an idea which serves as the basis for the majority of OHS research works. The essence of this study is to give the premise to the detailing of a viable safety and health policy which tends to particular health and safety needs that will eventually help the work efficiency in all associations in Ghana, most particularly those in the service sectors. This investigation could likewise fill in as a kind of perspective material for both health and safety policymakers and understudies in scholarly research. This investigation will be utilized by top managers as a 16 University of Ghana http://ugspace.ug.edu.gh contribution for the assessment of their current safety strategy, policy, techniques, and practice by gaining insight into the effect of occupational safety and wellbeing on the efficiency of institutions. Furthermore, it provides a proposal for the distressed policy formulators to look at the effect of OHS on organizations performance. 1.7 Organization of Study The study was arranged in chapters one to five; the first chapter concentrates on the general overview of the study, comprising of the research background, research problem, study objectives, significance and justification of the study, research questions and hypothesis, the study organization and scope. The second chapter entails the review of empirical literature related to the subject under study. The third chapter looks at the methodology section of the study, it discusses the various methods and techniques employed to obtain data for this research work, the target population, and sample size. Presentation of results, analysis of the data gathered and discussions constitute the Chapter four and finally, the fifth chapter consists of the summary of findings, conclusion and possible recommendations to promote health and safety at the workplace. 1.8 Scope and Limitation of the Study This research was conducted within some carefully chosen public hospitals in the Central Region of Ghana. The study was limited to only four major hospitals in the region due to time constraints. Also, only nurses working in these four hospitals in the Central region participated in the study. Therefore generalization of this study result to the nurses working in private hospitals and even for those working in other public hospitals in and out of the region would be very challenging. Majority of the nurses in the selected hospitals have unstable duty schedules especially the night shift. 17 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.0 Introduction To make any significant and reasonable deductions from the information disclosed by the investigation, it is imperative to take a more intensive glance is made at comparative studies conducted on occupational health and safety with respect to employee service delivery and productivity and review some studies relevant to the study. This is aimed at enabling the researcher to to describe, summarize, evaluate and clarify the literature to make comparison, confirmation, and variances to be uncovered. It should provide a theoretical ground for the research and assist the researcher to discover the essence of his/her own study. It set the basis and assists in finding an important conceptual framework and suitable methodologies. This chapter reviews the related literature on effects of occupational health and safety on employee productivity and service delivery from various books and journals, discussed the theoretical framework and the conceptual framework to show the associations that exist between both the independent and dependent variables under study. The chapter also brings out the critique of the literature reviewed and the knowledge gaps that exist. 2.1 What Is Occupational Health and Safety? Occupational health and safety (OHS) is defined by the International Labour Organization (ILO) as ―the science of the anticipation, recognition, evaluation and control of hazards arising in or from the workplace that could impair the health and well-being of workers taking into account the possible impact on the surrounding communities and the general environment‖ (ILO, 2008, vii). Amponsah-Tawiah and Dartey-Baah (2011) claim that occupational health and safety captures the mental and 18 University of Ghana http://ugspace.ug.edu.gh physical wellbeing of the employee in connection with his work. Again, Muchemedzi and Charamba (2006) also define occupational health ―as a science concerned with health in its relation to work or working environment‖. According to Oxenburgh, Marlow, & Oxenburgh, (2004), the wellbeing and security of all workers are confidently associated with the organization's profitability in all work settings. Occupational health and safety from the literature Abddllah, Spickett, Rumchev, & Dhaliwal (2009) can be portrayed ―as a sound condition of the body and psyche of individuals from ailment resulting from the materials, procedures or techniques utilized as a part of the working environment, whiles occupational safety is the insurance of individuals from physical damage‖. In the perspectives of Mathis and Jackson (2004), work related wellbeing alludes to a general condition of physical, mental, and passionate prosperity of an employee. Cascio and Wayne, (1986) characterize safety hazards as those aspects of the workplace with the ability of rapid and at times savage harm to an employee; for example, damage of hearing, vision, or physique, grazes, injuries, wounds, fragmented bones, blisters and electric stun. Normally, occupational health and safety is generally evaluated by means of bad consequences such as infirmities and diseases emanating from the workplace, however these measures come with some drawbacks, for example, limited or lower occurrences of accidents and harm does not automatically translate into the fact that there is the existence of sufficient safety mechanisms and controls (Health and Safety Executives, 2006). In most organizations, the focus and interest are primarily on bad outcomes, hence occupational health and safety strategies and operations are not completely executed so far as there are no alarming and extreme accidents and 19 University of Ghana http://ugspace.ug.edu.gh injuries. Consequently, dangers to employees‘ security are no longer eradicated promptly since disaster-prone zones are not identified and dealt with prior to accidents (Katsuro, Gadzirayi, Taruwona & Mupararano, 2010). For the purpose of this study, the researcher adopted the occupational health and safety definition by the International Labor Organisation (ILO, 2008) which defines OHS as ―the science of the anticipation, recognition, evaluation and control of hazards arising in or from the workplace that could impair the health and well-being of workers taking into account the possible impact on the surrounding communities and the general environment‖. This definition was appropriate for the study in the sense that, the nature of jobs performed by nurses is risky considering the chemicals, drugs and sharp instruments used in providing healthcare as well as the movement of patients and the vulnerability to infections. In lieu of this, the healthcare sector, particularly hospitals need to anticipate and recognize the occurrence of hazards, so as to institute proactive measures to evaluate and control mishaps and infirmities emanating from the general work environment that has the potential of impairing the safety and well-being of nurses and other stakeholders. Accordingly, this definition provided the insight and guided the researcher on how, where, when and whom to gather data and analyse to achieve the main purpose of this study towards the implementation of OHS policies and practices (e.g. safety inspections and audits, safety induction and training) in the health sector. 20 University of Ghana http://ugspace.ug.edu.gh 2.2.0 Global Occupational Health and Safety The health of employees worldwide is of utmost importance to many international organizations and regulatory bodies. Therefore, many international bodies are in existence that sees to encourage occupational health and safety of workers in all aspect of their work setting. The very key ones are the World Health Organisation (WHO) and the International Labour Organisation (ILO). Indeed, issues concerning occupational health and safety have also been of utmost importance to the United Nations Conference on Environment and Development (UNCED). The International Labour Organization (ILO) being an associate of the United Nations organizations pursues to endorse and enforce safe and decent work within all nations worldwide. Since 1919, the Global Work Association has affirmed and distributed very nearly 190 labor conventions, which are explanations of lawfully restricting worldwide arrangements identified with different issues concerning work and workers. Hogstedt and Pieris (2000) distinguished the significant goal of the ILO in connection to occupational health, safety and wellbeing as empowering nations stretch out social insurance to all gatherings in humanity and to enhance conditions of work, safety and wellbeing at work through its "In Focus Program" which entails conditions of work. The goal of the Safe Work Program of the ILO as distinguished by Hogstedt and Pieris (2000) is to make overall attention to the measurements and results of business- related mishaps, wounds and ailments, likewise to advance the goal of essential primary security for all representatives incongruity with worldwide work standards lastly, to upgrade the limit of member countries and industry to plan and actualize viable preventive and defensive measures and programs that guarantee well-being and accidents free workplace. 21 University of Ghana http://ugspace.ug.edu.gh This notwithstanding, the ILO accommodates the selection of a national occupational health and safety policy. The ILO Occupational Health Services Convention 1985 (No. 161) and Recommendation (No. 171), likewise accommodate the establishment of work-related health administrations which will add to the usage of the occupational health and safety policy that advances the well-being and security of workers. Additionally, there exist within the ILO, the International Safety and Health Information Center (CIS) in Geneva, Switzerland, bodies in charge of the viable foundation and execution of occupational safety and wellbeing. The CIS has the primary commitment to the gathering and broadcasting of information on the anticipation and prevention of work-related mishaps and illnesses (OHS Convention, 1985). 2.2.1 Occupational Health and Safety in Africa The attitude of many African nations towards issues of occupational health and safety is seen in the little attention given to OHS issues by industries, individual employees and the governments at large. Numerous global and non-legislative associations find it troublesome to understand why many countries on the African continent are in a fix as to how OHS can be encouraged in the work environments. A report by the Regional Committee for Africa (2004) has stated that countries in Africa have limited commitment to OHS. Quite contradictory, greater attention and efforts are geared towards increased profits and production in most African economies at the expense of workplace safety policies (Meredith, 1986; Puplampo & Quartey, 2012). The African continent is gradually phasing away from the period of agriculture to industrialization and this could be accredited to the production, participation, and contributions from the private sector. Nevertheless, in the light of these developments of several industries, it is important for African leaders to commit large resources in the 22 University of Ghana http://ugspace.ug.edu.gh development of OHS, thus, productivity would, in any case, increase if the health and safety of employees are a top class priority. This is justified by Puplampu (2012) who suggests that, even though many countries in Africa are faced with major financial difficulties, the creation of a safe continent for foreign direct investments will help in making the continent competitive. The ILO, (2005a) and World Economic Forum (2002) has also suggested that most aggressive nations or landmasses are likewise the most secure. In an attempt to give a strategy structure to empowering OHS in Africa, a worldwide gathering was held in Benin in 2005 to evaluate the province of OHS practices in Africa of which it was revealed that the majority of nations in Africa have poor OHS assessment mechanisms, scanty OHS policy particularly Ghana whilst some others have set-ups in place for OHS. This calls for the necessity of OHS commitment and sacrifices in the area of health and safety training and education, OHS research, OHS policy formulation, execution and promotion of OHS in the Africa sub-regions. Findings by Katsuro et al. (2010) revealed that administrators of many food factories do not regard workplace health and safety as an imperative condition for improved efficiency. Also, a study by Osungbemiro et al. (2016) reported that greater number of state health workers in Nigeria had high work-related danger chance, poor consistency to work-related well-being measures in spite of high familiarity with OHS. Again, Annan et al., (2015) in their investigation of ―a call for action to improve occupational health and safety in Ghana and a critical look at the existing legal requirement and legislation‖ deduced in their examination that the huge number enterprises in Ghana have added to the elevated hazard in work environment risks. They further contended on the absence of national strategy and body in charge of checking and guaranteeing OHS necessities and rules. Although these benefits exist in the extant literature for the 23 University of Ghana http://ugspace.ug.edu.gh perusal of policymakers‘ on the African continent, the issue of health and safety has been relegated to the background. OHS issues are constantly relinquished for different issues which they see as essential. In this perspective, Nuwayhid, (2004) inferred that work-related wellbeing and security stays abandoned in emerging nations in Africa owing to contending nationwide issues and problems in areas such as poverty eradication, large-scale unemployment, and the struggle to meet up with growing economic competition from the developed world. In spite of the above difficulties in compelling OHS interest in some African nations, various OHS activities justify though. Nigeria, notwithstanding their occupational health and safety problems, was the principal African nation to have the first class on occupational safety and health for less advanced nations in Africa convened in Lagos in 1968 (Omokhodion, 2009). Some developing African nations are thinking about occupational health and safety framework; OHS training and education; joint efforts in OHS surveys; OHS clinical and research facility administrations; and OHS legitimate strategy instruments as some of the means for enhancing OHS practices (Rantanen, 2004) Additionally, Adebiyi and Charles-Owaba (2009) uncovered that some Nigerian ventures and sectors are currently seeking after a few OHS activities, for example, OHS training, OHS initiatives, OHS motivating forces, OHS mishaps examination and the delivery of individual defensive gear (PPE). They proposed that scholastics, industrial health and safety professionals should assist to set achievable and viable safety and health goals to aid in overseeing the affairs of wellbeing and security perils in African nations. The use of Information Communication Technologies (ICT) advances to OHS practices was seen to have risen in some African nations (Backtalk, 2000). In the year 2000, there was a WHO/ILO joint attempt on occupational safety and health in Africa with numerous associates, for 24 University of Ghana http://ugspace.ug.edu.gh example, USA, EU, WHO, and ICOH to share ideas on occupational health and safety; and building capacity with respect to workplace health and safety; and planning policies and enactments for workers health and safety in Africa. Recently, genuinely huge institutional and lawful improvements (Ladou, 2003) have been distinguished in a couple of African nations. The above exhibits the state of OHS in African nations which might be run of the mill in Ghana. 2.2.2 Contextual dimension: OHS Regulation in Ghana Ghana as a country has several key OHS issues escalating in its economy. One of the major issues of OHS relates to dealing with OHS challenges and it is self-evident that like numerous African nations, Ghana cannot currently be proud of any all-inclusive nation-wide OHS policy. That is, distinctive from some advanced nations in territories of Asia, Europe and America where comprehensive health and safety laws are ordered to ensure protected and restorative conditions of work for people working (Harnois & Gabriel, 2000), that of Ghana is totally different, no national body, policy nor processes exist to control the administration of workplace health and safety in Ghana (Asumeng et al., 2015; Gyensare et al., 2017), OHS issues in Ghana are regulated by the Labour Act, 2003 (Act 651); Ghana Health Service and Teaching Hospitals Act, 1996 (Act 525), Workmen‘s Compensation Act, 1999 (Act 526), Factories, Offices and Shops Act, 1970 (Act 328) and various industry precise enactments which make arrangements for wellbeing and security at work, with the exception of these legislations, there exist no comprehensive act governing and safeguarding the imposition of work and safety principles at work (Gyensare et al., 2017). This as a challenge was detected by Ghana Health Service (2007) which testified that, Ghana‘s challenge of integrating OHS practices into its nation-wide expansion 25 University of Ghana http://ugspace.ug.edu.gh program is obviously alleviated by lack of national OHS policy. A matter of policy framework is universally regarded as a major limitation of African countries in the sense that policies do not function. Many of the enactments on OHS in Ghana is rudimentary which makes it difficult to be enforced across board thereby neglecting agriculture and majority of the informal sectors Clark (2005). Nonetheless, a couple of statutes advises the execution of occupational health and safety. These are the Mining Regulations 1970 LI 665 and Factories, Offices and Shops Act 1970, Act 328 which have driven OHS execution in the manufacturing, shipping, and mining segments. Different statutes that have a direction on OHS are the Workmen‘s Compensation Law 1987, Environmental Protection Agency Act 490, 1994, the Ghana Health Service and Teaching Hospital Act 526, 1999 and the Ghana Labour Act of 2003, Act 651 of which considering the year of enactment some of them are even obsolete. Annan (2010) posits that even though these statutes and other fragmented safety plans are in existence, they have not been successfully implemented. Also, the Ministry of Health Report (2007) found some OHS problems in Ghana. These comprise weak OHS infrastructures, untrained and insufficient OHS experts, and absence of appropriate checking and reconnaissance for work-related health and safety illnesses and wounds. In help, Muchiri (2003) reinforced these issue situations by demonstrating that, poor OHS foundation and subsidizing, inadequate quantity of eligible safety and health professionals and the general absence of satisfactory data are among the primary downsides to a viable OHS practices. A study by Kheni, 2008, on health and security measures within construction small and medium enterprises came out with crucial OHS matters which included scanty HR experts, insufficient government reinforcement for governing bodies and incompetent institutional 26 University of Ghana http://ugspace.ug.edu.gh structure accountable for health and safety excellence. Adding to this, education on health and safety is considered to be among the difficulties of work-related safety and health practices (Ministry of Health Report, 2007). Additional vital OHS concern is the workers' perpetual introduction to dangers, sicknesses, and risks associated with the workplace. In the light of all these discrepancies, studies have stressed that, the security atmosphere circumstance in Ghanaian enterprises is extremely appalling and goes further to say that, the citizenry would just get the opportunity to rise up to it when there is a serious calamity or mischance, which is predominantly fire related (Anang, 2008). And this has been vindicated by a dramatic increase in fire flare-ups in both public and private organizations without significant mediations. For example Ghana's greatest market (Kumasi Central Market) was crushed by flame which was evaluated to have annihilated over 400 market stalls, and also remarkable quantum of goods and cash (Ghana News Agency, 2009), the public institutions such as the Lands Commission and Ministry of Foreign Affairs which were signed into fiery remains with destroying impacts and not mentioning the recent June 3, 2015 Fire Disaster at a Goil Petrol Station through which over 150 lives were lost and dozens injured (http://:www.myjoyonline.com, accessed on 4/06/2015). Organizations blatantly ignore safety policies and procedures and introduce their workers to a wide range of hazards, hence violating their ―duty of care‖ to the workers. This clarifies why the couple of OHS approaches, statutes and controls do not work. A study by Avotri and Walters (1999) demonstrated that sanitation issues seem to be bothered by the absence of open running water, and in addition, insufficient toilet facilities have the most noteworthy propensity of causing malaria and diarrhea, musculoskeletal pain, parchedness, and migraines. As a business and quickly 27 University of Ghana http://ugspace.ug.edu.gh developing economy, clamour incited hearing misfortune is distinguished as a standout amongst the most predominant occupational health and safety danger and risks in the development enterprises with harming consequences for construction workers health (Amedofu, 2002). These discoveries were factually upheld. For instance, it was accounted for that the construction industry recorded 902 accidents cases including 56 deadly accidents and 846 non-fatal accidents in 2000 (Danso, 2005). In addition, an investigation by Agbenorku et al. (2010) found that employees are presented to higher volumes of injuries, illnesses, and hazard, particularly in the mining and printing enterprises. The Labour Department Report (2000) showed that OHS hazard, risks, and mischances in the construction and mining sites are exceptionally deadly and alarming. In a similar light, Ackerson and Awuah (2010) found that ranchers are likewise presented to work-related and water-related wellbeing dangers, threats and sicknesses comprising schistosomiasis, cholera, nematode contaminations, malaria, cerebral pains, dermatological, visual, cardiovascular, and other respiratory issues. These, in any case, require both legislative and industrial consideration. Finally, there are no specific benchmarks against which the operations of services are to be assessed. There is no association between the level of risk workers are exposed to and the compensation they are to benefit coupled with no specific explanation on the mechanisms of funding for OHS as to whether it pertains to either or both the public or private sectors of the country. 2.3 Occupational Health and Safety and the Law Ghana's Occupational health and safety enactment have been acquired from an English lawful and institutional structure when Ghana was an English reliance. The 28 University of Ghana http://ugspace.ug.edu.gh health and security of specialists in the mining and wood processing ventures of Ghana preceding independence was ensured by the Factories Ordinance 1952. This remained the primary work-related health and safety enactment in use until its nullification by the Factories, Offices and Shops Act 1970. Directions made under this statute which stayed implemented include: the Factories (Woodworking) Regulations, 1959; the Food Factories (Welfare) Regulations, 1959; and the Factories (Docks Safety) Regulations, 1960 Ghana's enactments on occupational health and safety are impacted by the global work association (ILO). Main ILO customs concerning safety and health in all occupations which have been approved by Ghana incorporate: Underground Work (Women) Convention 1935 (No. 45); Radiation Protection Convention 1960 (No. 115); Guarding of Machinery Convention 1963 (No. 119) and Hygiene (Commerce and Offices) Convention 1964. However, out of the several OHS related ILO conventions, only 10 ratifications have been done by the government of Ghana (Conventions 45, 81, 89, 90, 103, 115, 119, 120, 147 and 148) leaving some key OHS resolutions including; (Conventions 155, 161, 170, 174, 176 and 187) (ILO 2012 & Anku-Tsede 2016). The safety and wellbeing of workers in Ghana are safeguarded by the Ghana Labor Act (Act 651, 2003). It puts the wellbeing of workers under administrators and business owners' supervision by expressing that ―it is the duty of an employer to ensure that every worker employed by him/her works under satisfactory, safe and healthy conditions‖. The Labour Act, 2003 (Act 651) in Section 122 (b) provides that ―There shall be carried out labor inspection to provide technical information and advice to employers and 29 University of Ghana http://ugspace.ug.edu.gh workers concerning the most effective means of complying with provisions of this Act‖. (Ghana Labour Act, 2003, p. 45) Labour inspection under the law among others, seeks to identify and enforce breaches to Health and Safety regulations under Section 118 of the Labour Act, 2003 (Act 651) and other legislation. For example, Act 651, part III section 9 (c) of 2003, states that ―An employer shall take all practicable steps to ensure that the worker is free from the risk of personal injury or damage to his or her health during or in the course of the worker‘s employment or while lawfully on the employer‘s premises‖. (Ghana Labour Act, 2003, p.10) Act 651 part III section11 (f) also states that ―Workers have a duty to take all reasonable care for the safety and health of fellow workers‖. (Ghana Labour Act, 2003, p.11) This places responsibility on both employers and employees to uphold the health and safety of the workforce and the work environment (Britwum, Enu-Kwesi, & Akorsu, 2006) as employers are expected by the Ghana Labour Act 2003, Act 651 to guarantee their workers are not lay bare to circumstances likely to usher them to business-related accidents and damages whiles workers are equally expected to demonstrate their commitment of care in ensuring that they fill in as indicated by the organizations' standard working strategies which must consolidate health and safety prerequisites. 2.4. The Ghana Health Sector The Ministry of Health (MOH) controls the health system in Ghana. According to the MOH, in Ghana there exist four structures of health care systems; these are the state- controlled, private profit-oriented, private non-profit-oriented and the traditional 30 University of Ghana http://ugspace.ug.edu.gh structure. Administratively, the MOH has its headquarters in Accra, the nation‘s capital with other offices in the regional capitals, district assemblies, and sub-districts. The Ministry of Health categorizes healthcare delivery at various levels; they have a community health post, health centers and clinics, the district/municipal hospital, the regional and tertiary hospital (MOH, 1995). The medium-term goal of the ministry is ―to ensure a healthy and productive population that continues to reproduce itself safely‖ with a vision of having a healthy population for national development‘‘ (MOH, 2017). The main functions of the Ministry are as follows; ―Formulate health policy‖, ―Set standards for the delivery of health care in the country‖, ―Provide strategic direction for health delivery services‖, ―Monitor and evaluate the health service delivery by the Ghana Health Service (GHS) and the Teaching Hospitals, other Agencies, Development Partners and the Private sector‖, ―Develop policies for the practice of Traditional and Alternative Medicine in the country‖, ―Source funding for service delivery through Government of Ghana, Health Insurance and international community‖, ―Allocate resources to all health care delivery agencies under the Ministry‖, ―Provide framework for the development and management of the human resources for health and make proposals for the review and enactment of health legislation‖ (MOH, 2017). Policy implementation of MOH is channel through the public, private and traditional sectors. The Ghana Health Service (GHS), Teaching Hospitals Board (THB) and the Quasi-Government Institution Hospitals (QGIH) are the national implementing organs for the ministry (Abor, Abeka Nkrumah & Abor, 2008). To achieve these goals, public administration of Ghana's health sector has experienced real policy amendments. These evolutions have achieved a rebuilding of institutional courses of action in the health sector. They have additionally isolated the 31 University of Ghana http://ugspace.ug.edu.gh strategy making, service delivery, financing, and governing functions of the Ministry of Health (MOH) and assigned them to moderately independent organizations which incorporate the Ghana Health Service (GHS), the National Health Insurance Authority (NHIA), teaching hospitals and numerous administrative bodies. Administration of human resources for health is as yet unified inside MOH and GHS structures; the same is valid for mission health establishments that rely upon MOH for their human resources. A large portion of the fundamental general health operations in this segment is overseen via the Public Health and Family Health Divisions of GHS with a significant overspreading of obligations (Saleh, 2013). The private health sector provides approximately 40 percent of total health care services in Ghana (Abekah-Nkrumah, 2006). The key providers of private healthcare are the Mission-Based Providers (MBP) which are the Christian and Moslem hospitals. The private health sector also comprises of the private medical and dental practitioners. The private health sector is regulated by the Private Hospitals and Maternity Homes Board (PHMHB) (Abor, Abeka-Nkrumah & Abor, 2008). Faith-Based Healers (FH), Alternative Medicine (AM) and Traditional Medical Providers (TMP) are the agencies responsible for carrying out the traditional healthcare systems in Ghana. A directorate at the Ministry of Health regulates the activities of these agencies (Abor, Abeka Nkrumah & Abor, 2008). 2.4.1 The Ghana Health Service The Ghana Health Service (GHS) is a Ghanaian government agency founded in 1996 as expected by the 1992 constitution under Act 525 of 1996 as part of the Health Sector Reforms of Ghana. The GHS is an independent Executive Agency accountable for the execution of nation-wide policies under the jurisdiction of the Minister of 32 University of Ghana http://ugspace.ug.edu.gh Health via the Ghana Health Service (GHS, 2017). Administratively, GHS has 11 directorates including office of the Director-General, Family Health, Health Administration and Support Services, Human Resources, Internal Audit etc. and is organised in three (3) levels: National Level, Regional Level and District Level whilst functionally GHS is organised in five (5) levels: National Level, Regional Level, District Level, Sub-district Level and Community Level (GHS, 2017). Notwithstanding the fact that the GHS is a Ghanaian government body, its employees, however, do not form part of the civil service of Ghana. The sovereignty of the GHS was structured with the sole aim of empowering staffs to have a more prominent level of administrative adaptability to do their command superior to anything it would be on the off chance that they remained entirely inside the civil service. However, the Teaching Hospitals, Private and Mission Hospitals are not part of the GHS (Ghana Health Service, 2017). The sole mandate of GHS is to ―provide and prudently manage comprehensive and accessible health service in Ghana with special emphasis on primary health care at regional, district and sub-district levels in accordance with approved national policies‖ (GHS, 2017). The staff members of GHS comprises of health personnel in the employment of the MOH immediately before the coming into force of the GHS ACT 525 and all those employed by GHS or seconded to it after the coming into force of GHS (GHS, 2017). These staff compositions are ―medical officers, dental surgeons, pharmacists, Expatriate staff (Doctors and Technicians), professional nurses, enrolled nurses (health assistants), community health nurses, registered nurses, medical assistants, allied health professionals and non-clinical and clinical staff‖ with nurses been the majority of the staff workforce. 33 University of Ghana http://ugspace.ug.edu.gh 2.4.2 Healthcare workers According to the (ILO 2010:4), healthcare workers (HCWs) are persons engaged with direct patient care in public or private healthcare settings. In this study, HCWs refer to all general nurses employed at the central regional public hospitals. 2.4.3 Categories of Nurses in Ghana The various categories of nurses in Ghana are as follows; general nurses, nurse educators, community health nurses, the government registered midwives, peri- operative nurses, ophthalmic nurses, psychiatric nurses and critical care nurses. However, a general nurse can work in an inpatient department (ward) or an outpatient department (OPD) in a health facility (Cudjoe, 2015). 2.5 Theoretical Review Various theories have been developed in an attempt to explain how organizations can harness the work environment in order to improve employee productivity. The theories that are relevant to the study are reviewed. They include the theory of work adjustment and expectancy theory. 2.5.1 The Work Adjustment Theory The theory of Work Adjustment (TWA; Dawis and Lofquist, 1984) created out of the University of Minnesota's work modification project, 20-year exploration program aimed at studying how professional recovery customers acclimated to work. The theory of work adjustment depicts the relationship of the individual to his or her workplace. Work is conceptualized as a cooperation between an individual and a workplace. The workplace requires that specific errands be performed, and the individual brings abilities and skills to undertake these errands or tasks. In return, the individual requires a reward for work execution and certain favored conditions, for 34 University of Ghana http://ugspace.ug.edu.gh example, a protected and agreeable work environment. The work surrounding and the individual must keep on meeting each other's necessities for the cooperation to be kept up (Clark, 2006). According to the theory, the work environment is assessed in terms of the opportunities it has to offer employees as motivational incentives, that is, its capacity to fulfill an individual‘s identified needs, values and interests. The theory also deals with a satisfactory performance which covers the employee‘s efficiency and productivity. It also touches on employees‘ ability to get along with co-workers and willingness to follow company policies. Further, the theory takes into account the length of time an individual and work environment interact (Gellar, 2003). The implication of this theory is that if the work environment is not conducive in all aspects including OHS, the employees which are the nurses develop counterproductive and withdrawal behavior within the hospitals. These behaviors include absenteeism, lateness, being upset and unhappy and voluntary turnover. These behaviors are an indicator of reduced commitment to work and hence low productivity (Williams & Purdy, 2005). 2.5.2 Expectancy Theory Expectancy theory, established by Victor Vroom in the 1960s, clarifies worker inspiration, especially in accordance with workers impression of circumstances. These judgments thus influence how they carry on in light of these circumstances. The theory asserts that people have distinctive goals and objectives and can be persuaded in the event that they trust that there exists a constructive affiliation between hard work and performance, ideal implementation or execution of assignment will realize appealing prize, reward will satisfy an imperative need, and the yearning to achieve 35 University of Ghana http://ugspace.ug.edu.gh the need is adequately solid to make the hard work valuable. The motivation of behavior selection is determined by the desirability of the outcome (Benardi, 1997). Vroom (1960) understood that a worker's performance is contingent on individual constituents, such as identity, aptitudes, knowledge, experience, and capabilities. He held the view that execution is a component of aptitude and inspiration. Expertise identifies with capabilities both intrinsic and gained. Inspiration contains exertion consumed by an individual and the information of what is relied upon by the incentive to be inferred because of the exertion and the quality of the connection between exertion and the reward (Wright and Kehoe, 2008). As per the expectancy theory, to accomplish a greater state of workplace inspiration, three conditions must be met all the while. To start with, the reward for a worker‘s performance must be seen as significant. Second, the reward employees get must be equivalent or a reasonable trade for their execution of the errand. Third, there must be the extensive probability of a worker getting the reward, once the undertaking is performed or objective accomplished. Remarkably all the three conditions must be met to keep up an extreme great level of employee inspiration (Gyekye, 2005). With regard to OHS, to enhance safe work motivation, employees need to believe that if they exert more effort, the safety goals shall be achieved and rewarded. Moreover, the employee must be assured that they will receive their valuable and just reward soon after achieving the safety goals. In any case, a worker's dangerous conduct is unequivocally impacted by the person's view of hazard or the anticipation for damage, together with the apparent probability of how genuine of damage that could be managed in a given circumstance (Robins & Walker, 2000). 36 University of Ghana http://ugspace.ug.edu.gh The implication of the theory to this work is that Expectancy theory has some critical consequences on OHS inspiration. When outlining work processes or choosing hazard control systems, one must be vigilant and take reasonable care to guarantee that disincentives work safety are not presented. For instance, where playing it safe prompts uneasiness or is tedious, laborers will be enticed to ignore safe and healthy work practices and take the risk. On their part, Williams and Purdy (2005) are of the view that motivational methods must be compelling where OHS conduct is under volitional control of employees and care must be taken to guarantee that impetuses to work securely are not exceeded by motivators to take the risk. 2.6 Empirical Review 2.6.1 The Concept of labor productivity The term labor productivity is the added value of creation or efficiency that every employee produces (Mostafa, 2003). In this way worker productivity is identical to the valuation of creation separated by work input. Typically worker productivity is utilized as a measure of effectiveness in each sort of firm since it is substantially less demanding to locate its numerical gauges when contrasted with different determinants of efficiency (Mostafa, 2003). Efficiency is a significant worry for any sort of organization. Productivity speaks to the viability and proficient way an organization can change over its assets into attractive services and marketable products. The word productivity has been begotten by a few gathering of researchers' from the eighteenth century. Mali (1978) considers efficiency to be "the measure of how assets are united in associations and used for achieving an arrangement of results‖. Profitability is achieving the most outrageous quantity of execution with the least utilization of 37 University of Ghana http://ugspace.ug.edu.gh advantages. The term ―employee productivity‖ is ordinarily used to imply the volume of stock and ventures delivered or contributed per worker inside some specific unit of time (year, month, week, day or hour). Productivity is viewed as the intensity of workers, that is, limit of the laborer to turnout used characteristics (merchandise and ventures) which can be typical at a given state, method and association (Lambert, 2000; Nwachukwu, 1987). For example, Davis, (1955), explained ―productivity as a change in the product obtained for the resources used‖. The International Labour Organization (ILO, 1995) alternatively described ―productivity as a comparison between how much one puts into projects in terms of manpower, material, machinery or tools and the result one gets out of the project‖. The Japanese National Production Centre described ―productivity as an attitude of the mind, it is a mentality of progress, of constant improvement of that which exists. It is the certainty of being able to do better today than yesterday and less well than tomorrow. It is the will to improve the present situation, no matter how good it may seem, no matter how good it may really be. It is a constant adaptation of economic and social life to changing conditions; it is the continual effort to apply new techniques to new methods; it is faith in human progress." In spite of the endless meanings of profitability, one thing emerges ―a comparison of outputs to inputs‖ (Kuykendall, 2007). Many organizations are occupied with the benefit they make, subsequently, as indicated by Mostafa, (2003) productivity ought to have been the most ideal method for estimating the capability of any sort of business yet this isn't the situation. This is because of the means of benefits are abundantly impacted by outside components, for example, change in desire or higher prices; hence benefit may increase and decrease. 38 University of Ghana http://ugspace.ug.edu.gh Regardless of the reality that an entire arrangement of strategies for estimating efficiency; either multi-factor or fractional profitability proportions in a firm are much best since they introduce some merits, Single factor profitability measure, for example, work efficiency may incredibly be helpful to organizations since firms may deliver labour-intensive items or might need to contrast its accomplishment and that of different firms with comparative methods of task. A work efficiency measure may likewise be utilized to estimate work necessities and capital venture needs when the development of yield is to be arranged. In addition, in mutual haggling, work efficiency may help in getting ready assessments of the effect of a wage settlement on costs. Work profitability fills in as a wellspring of an upper hand in any sort of economy. An outrageous state of work profitability as the increment in learning and aptitudes will build yield or the nature of yield and if, at a speedier rate, advantages will be accomplished through the worth added to items and services (Kuykendall, 2007). Work efficiency, as indicated by the USAID, (2005), is known to be controlled by numerous determinants among which are; human capital, capital usage, advancement, firm qualities and administration, rivalry and receptiveness to exchange, and industry condition. Human capital is the most remarkable determinant of work efficiency since in it includes the expertise, information, and soundness of the individual required to have authority over alternate elements of productivity. Wellbeing, as indicated by Grossman, significantly affects one's abilities and learning, consequently, wellbeing significantly affects one's level of efficiency through its effect on human capital. 39 University of Ghana http://ugspace.ug.edu.gh 2.6.2 OHS managements and Nurses’ Healthcare Delivery Occupational health and safety do come with some influence on the efficiency of nurses. OHS has gotten much consideration from researchers not long ago globally and has assumed great essence in industries. Workplace susceptibility of Healthcare workers consequently undermines the excellent healthcare delivery in emerging nations, particularly among Medical Doctors, Nurses, and Nursing Assistants. Wilson and Rosenfeld (2004) affirmed that a well-coordinated administration of health, safety and efficiency are emerging as an employment essential for improving the cumulative valuation of human resource assumptions. These projects are contingent on the combined administration of HR benefits and programmes that laborers achieve when they are overwhelmingly defeated, hurt or modifying work/life matters. They encompass medical coverage, inability, and worker‘s pay, workers support, sick leave payments, and work-related well-being programs. The act of good and viable OHS administration by firms should display better job execution and citizenship conduct which by the day's end amplifies efficiency. The utilization of OHS administration frameworks for each division in a firm can offer workers with a precise acknowledged code arrangement of guidelines or methods about the protected machine operation, different gadgets, and suitable practices. Accidents are known to arise from unsafe conditions of equipment or materials (Koopman et al, 2011). They assert that accidents and injuries end up in permanent disability bringing pain and anguish to the individual worker and his family at large. The injured worker may be deprived of his pocket and his normal active life. Therefore employers‘ participation to warrant the existence of occupational health and safety policies is of necessity (Koopman et al, 2011). When these occupational health 40 University of Ghana http://ugspace.ug.edu.gh and safety programs are established, there is the likelihood that nurses in the hospitals will ensure maximum participation to preserve their lives. Adverse OHS practices are thought to influence a person's mental and physical wellbeing, and the firm‘s productivity, in an unfavourable way (WHO, 2003). OHS influences individuals through various means. Negative OHS practices may add to different kinds of endless medical issues and furthermore influence a person's insusceptible framework adversely (WHO, 2003). Work environment wellbeing and security of healthcare workers can cause a few manifestations, for example, a sleeping disorder, which can bring about a decrease in nurses' execution. The experience with OHS issues can likewise cause bizarre and broken conduct at work and add to poor physical and emotional wellness. In Ghana, a research finding found nurses to have the highest workload ahead of paramedics, support staff and even medical doctors (Asamani, Amertil & Chebere, 2015). This outcome was in relation to the demanding nature of nurses‘ work such as work interruptions, procedures, and processes involved in treating patients, as well as facing work-related uncertainties. The achievement of corporate institution, which decides its survival and development, depends to a greater degree on the efficiency of its employees and as such it is pertinent to consider the extent to which OHS factors within the work environment influences the organizational productivity of employees. 2.6.3 OHS Policies and Regulations and Nurses’ Healthcare Delivery Operating standards of OHS are normally set in legislation. Legal reasons for OHS practices relate to the Safety awareness programs, preventive, corrective and compensatory impacts of laws that ensure employee's health and security. Wellbeing and security strategy and systems are a subset of productive safety and health administration structure. Generally, workplace health and safety frameworks establish 41 University of Ghana http://ugspace.ug.edu.gh the readiness of management to give employees, a healthy and safe work environment (Christian, Bradley, Wallace, & Burke, 2009). OHS Policies and Regulations aim at reducing work-related injury and diseases by changing workplaces and work practices. Many countries have come up with legislation to ensure comprehensive OHS protection for all workers and in respect to all workplaces. OHS act and their associated regulations serve to secure the health and safety of workers and to improve the work surroundings. It seeks to find out the extent to which organizations have distinct frameworks and arrangements for risk relay and disclosure, the utilization of individual defensive gear and comprehensive security systems established within the organization. The safety of the Ghanaian healthcare workforce is mainly regulated by the health sector‘s OHS strategy framework. This strategy and specialized rules apply principally to all workers inside the wellbeing division (government, semi- government, private and additionally NGO's), potential workers of the health segment and clients, patients and guests to all wellbeing offices and Health establishments including students attach. The policy is set out to achieve the following objectives;  ―Achieve and maintain the overall well-being, quality of life and work performance of health sector staff in order to minimize the impact of work on their physical and mental health  Promote a safe and healthy work environment, work practices and procedures for all staff of the health sector in order to minimize work-related injuries and illnesses.  Promote a culture of safe and healthy attitudes and practices  Provide a safe work environment, work practices and procedures for all health sector workers in order to minimize work-related injuries and illnesses. 42 University of Ghana http://ugspace.ug.edu.gh  Ensure that health and safety management in the workplace constitutes a core management function of health sector institutions that is on-going and promotes a culture of co-operation between the major stakeholders (government, employers and their employees) in the spirit of tripartitism.  Put in place and continually review structures and remedies that totally remove or mitigate risks posed by workplace hazards.  Promote the incorporation of OHS educational programmes aimed at reducing workplace hazards and risks into the work plans of health facilities.  Facilitate compliance with OHS policy and legislation by contractors and suppliers to all health facilities.  Educate contractors, suppliers and the general public about health and safety programmes and protocols of the health sector and how they can comply with them.  Institute measures aimed at ensuring adequate financing of occupational health services‖. Noe et al. (2008) Stress the fact that safety awareness programs go beyond compliance with OSHA and attempt to instill symbolic and substantive changes in the organization‘s emphasis on specific types of injuries or disabilities. A safety and health awareness programs have three elements: recognizing and conveying perils, fortifying safe practices, and advancing security universally. To distinguish and convey dangers', workers, supervisors and other proficient sources need to sit and consider probable issues identified with wellbeing and security. To promote the security of employees globally, associations likewise need to deliberate how best to guarantee the wellbeing of individuals paying little heed to the country in which they work. Social contrasts may make this surprisingly troublesome. Armstrong (2006) 43 University of Ghana http://ugspace.ug.edu.gh recommended steps to increase the efficacy of security messages; keeping away from negatives-productive security intentional exposure should hold constructive messages, not alarms of unappealing aftereffects of activity, introduction of message effectively addressing the message to the appropriate individuals at dangerous points, utilization of eye-catching system deliberately attracted pictures may just be associated with what they are, not for the message they are attempting to pass on, augment pressure message ought to be straightforward, clear and particular, message must be convincing, they should address main problems and be seen as being conveyed by individuals (i.e. Directors) who put stock in what they say and are accomplishing something in regards to it. The best message should call for positive activities that can be accomplished by the collectors and will offer them an unmistakable advantage. Dessler (2005) emphasizes those positive reinforcements as a way of communicating programs that are important in improving safety at workplace. He says researchers introduced one program in a wholesale bakery. An analysis of the safety-related conditions existing in the plant before the study suggested a number of areas that needed improvement. For example, new hires received no training on safety but the manager kept on communicating about health and safety verbally and pictorial these impacted positively on employees. In addition, managers kept on recognizing employee‘s efforts on safety. Safety in the plant subsequently improved markedly. Luis et al (2007) suggested that managers should convey security principles and arrangements and uphold them. OSHA commits workers to stick to security rules, and in great projects directors' will utilize the disciplinary framework to punish perilous work practices. They utilize impetuses, prizes, and uplifting feedback to empower safe conduct. They compensate worker objections or proposals about wellbeing and security. 44 University of Ghana http://ugspace.ug.edu.gh Numerous empirical studies have been conducted to investigate the nexus amid OHS policies and regulations and worker safety behaviors and organizational outcomes in different locations globally. For instance, in Spain, (Fernández-Muñiz, Montes-Peón, & Vázquez-Ordás, 2009) in their study among 455 Spanish firms established a positive association amid OHS administration and firm delivery. Their findings revealed that organizational outcomes such as safety performance, competitiveness performance, and economic-financial performance are positively influenced by safety management and provided evidence of the compatibility between employee protection and corporate competitiveness. OHS administration has additionally been accounted for as a prime factor of a firm's notoriety and identity among its partners (EU-OHSA, 2010). In assessing the level of knowledge concerning workplace hazards among nurses in health facilities, (Amosu, Degun, Atulomah, Olanrewju, & Aderibigbe, 2011) conducted a study among different categories of nurses in both public and private health facilities in Nigeria which consisted of 1,200 respondents in 12 different health facilities. Using a validated structured questionnaire, the study revealed that 96.2% of the nurses were conscious of the fact that the nursing profession is susceptible to workplace risks and dangers and that the most remarkable means to circumvent these workplace associated dangers is to keep away from uplifting patients and huge equipment. The study also revealed that the most distinguished and famous factor that makes nurses liable to hazard is prolonged standing and other frequent ones such as back injury, neck and back pain as confirmed by majority of the nurses and suggested that nursing professionals develop conscious and collaborative attempts to reduce preventable dangers in their course of operation to avoid jeopardizing their health. 45 University of Ghana http://ugspace.ug.edu.gh Considering the influence of occupational health and safety policy on the efficiency of healthcare workers, Lim (2012) indicated that, a clear consciousness and discernment of employees about the policies, guidelines and systems governing the place of their work activities as well as the operating apparatus, aids to do work in a successful, effectual and coherent manner which results in improved employee delivery. Alli (2001) is additionally shared by Lamm, Massey, and Perry (2007) who perceives that a reasonable and precise work-related safety and health framework assumes an imperative part in decreasing mishaps and wounds at work. To support this claim, Wachter and Yorio (2014) posit that enhanced accidents reduction at the workplace comes as a result of investment in security administration structures by organizations. A clear and precise OHS policy is known to contribute significantly to reducing accidents and infirmities at work (Alli, 2001). Steckel's work in 2002 demonstrates an evidence of health effects on productivity. He discovered that health is a factor which decisively affects the productivity of an employee with the value of association between 0.82 and 0.88 between GDP. Moreover, as per Steckel, imbalances in per- capita wage within nations could be clarified by the disparities in the status of health among nations. From his observational inter-country examination; nations with superior health index (low morbidity rate, favorable life expectancy etc) had better per-capita income. Another study by Kirombo (2015), affirms that health and safety regulations are necessary in a workplace environment to ensure worker‘s safety and wellbeing so as to maintain and improve productivity and quality of work. Further empirical study by Dwomoh, Owusu, and Addo, (2013) to examine the impact of safety policies on employees‘ performance in the timber industry of Ghana using a case study approach also revealed that health and safety measures formulated by the company have a positive association with the performance of employees even 46 University of Ghana http://ugspace.ug.edu.gh though the association is weak. The authors were of the view that organizations need to concentrate and focus more on their health and safety standards. Companies need to give careful consideration to their wellbeing and security measures since separated from the way that in different wards it is upheld by law and is compulsory, it is delegated as extant requirement for which other motivational components intended to enhance workers performance and productivity spins. For example, nurses' view and opinion of the absence of health and safety administration strategy in the public hospitals is probably going to trigger dissatisfaction, faintness, and dormancy and finally reduce their performance and productivity. Therefore, posit that promoting health and safety at the workplace tend to have an undeviating favorable effect on workers' delivery and increases the productivity and performance of the company whether micro or macro (Grenslade & Paddock, 2007; Hudson , 2012) . To them, great work-related well-being and security administration operations would aid in cultivating a positive work environment culture which helps prevent the negative consequences that emanate from the workplace hazards and thus enhance the performance of all employees. Hudson, (2012) is of the view that, it likewise gives space for high worker execution that empowers inventiveness and development. In Ghana, a study by (Amponsah-Tawiah, Ntow & Mensah, 2016) found a contrary association between employees‘ intention to quit and occupational safety and health administration in the mining section of Ghana and demonstrated that safety leadership is critical in the management of workplace safety and decreasing turnover intentions of employees. Again in the mining industry, (Amponsah-Tawiah & Mensah, (2016), in examining the association and influence of workplace safety and health on workers‘ commitment to the organization, using a cross-sectional research design 47 University of Ghana http://ugspace.ug.edu.gh reported a positive and significant correlation between occupational health and safety management and affective, normative and continuance commitment. They were of the view that, management within the Ghanaian mining industry needs to acknowledge the fact that employees who are fit and feel secured in their operations cultivate emotional connection and are more likely committed. They asserted that workers expect management to have their wellbeing and safety needs at heart by investing in employee safety and formulate better and sound OHS policies. In line with previous studies (e.g. Amosu, et al., 2011; Dwomoh, Owusu, & Addo, 2013; Kirombo, 2015; Amponsah-Tawiah, Ntow & Mensah, 2016), the researcher proposed the following hypothesis. H1: OHS policies and regulations significantly predict healthcare delivery of nurses in Ghanaian Hospitals. 2.6.4 OHS Audits and Inspection and Nurses’ Healthcare Delivery According to Obese (2010), the purpose of workplace inspections is to ensure that any potential or actual dangers in the workplace are found and corrected before they cause accidents and injuries to employees and others. On his part, Donald (2007) is of the view that involving employees at all levels of the organization in safety inspections gives them the authority to make observations, give feedback, and then use the behavioral-based information to target areas of safety improvement. According to Grenslade and Paddock (2007), promoting workplace safety inspections is the way to maximize the productivity and performance of employees in any company and is the only way to prevent the negative effects and possible tragedies that come from hazards in the workplace. Terjeck (2010), cites productivity as the top beneficiary of effective workplace safety inspections. 48 University of Ghana http://ugspace.ug.edu.gh In Ghana, there is a regulation on the safety of factories (Factories, Offices and Shops Act 1970, Act 328). Inspections are carried out on factories, for instance on drains, pollution and any areas that are lacking in terms of the act. During an inspection, the inspector looks out for health hazards which the employer may or may not be aware of. The Factories, Offices and Shops Act 1970 require that factories should register and renew their licenses periodically. This is done to ensure that a working environment is safe. It spells out that for the implementation of this act, there shall be an inspector who will shall exercise the power to; (a) ―enter, inspect and examine, by day or by night, a factory and every part thereof, when he has reasonable cause to believe that any person is employed therein, and to enter, inspect and examine by day any place which he has reasonable cause to believe, to be a factory, office or shop, and any part of any building of which a factory, office or shop forms part and in which he has reasonable cause to believe that explosive or highly inflammable materials are stored or used; (b) take with him a police officer if he has reasonable cause to expect obstruction in the execution of his duty; (c) require the production of the registers, certificates, notices, and documents kept in pursuance of this Act and to inspect, examine and copy any of them; (d) make or cause to be made such examination and inquiry as may be necessary to ascertain whether the provisions of this Act and of the enactments in force relating to public health are complied with so far as respects a factory, office or shop and any persons employed therein; 49 University of Ghana http://ugspace.ug.edu.gh (e) require any person who he finds in a factory, office or shop to give such information as it is in his power to give as to who is the occupier of the factory, office or shop; (f) examine or cause to be examined any person, either alone or in the presence of any other person, as he thinks fit, with respect to matters under this Act; (g) in the case of an Inspector who is a registered medical practitioner, to carry out such medical examinations as may be necessary for the purposes of his duties under this Act; and (h) exercise such other powers as may be necessary for carrying this Act into effect.‖ (2) The occupier of each industrial facility, office or shop, his specialists and hirelings, will give the methods required by an Inspector as essential for a section, assessment, examination, request, the taking of tests, or generally for the activity of his forces under this Act in connection to that manufacturing plant, office or shop. Dessler (2005) affirms that conducting wellbeing and security reviews are not surrogates for expelling risks. Regular reviews or inspections of all premises for possible security and medical problems, using checklist as inspires should be set up. Examine all mishaps and near misses. Have a structure established for allowing all workers to advise managers and supervisors about hazards. Make use of workers safety and security boards to conduct the investigation. Advisory group exercises consolidate security abundancy, conforming to security audits disclosures, and proposing systems for upgrading health and security performance. As indicated by Armstrong (2006) safety reviews and inspections are intended to inspect a particular territory of the organization's operational division or assembling 50 University of Ghana http://ugspace.ug.edu.gh process keeping in mind the end goal to find and characterize any flaws in the framework, equipment, plant or machines or any operational blunders that may be the source of mishaps. Safety inspection must be done frequently by the line managers and supervisors with the exhortation and help of safety and health counselors. Noe et al (2008) contends that OHSA inspections are led by exceptionally trained operators of the Department of Labour called compliance officers. Empirical studies have examined the nexus between safety inspections and organisational outcomes. For example, Mitchual et al., (2015), in a cross-sectional survey to assess the safety practices and injuries in Ghana also found out that even though employees of the wood processing industry rarely report of eye irritation, arm, and leg amputation, neck pains, hearing damage, poor vision and skin irritation, however, they often report of minor sicknesses such as migraine, respiratory infections, minor cuts and back pains. They suggested that management of sawmill need to put in more effort to put into effect safety practices, particularly the utilization of individual defensive gear (PPE), to decrease workplace dangers and wounds related to the wood handling organizations. As indicated by McCunney (2001), the essential helpful effect of work-related well-being and security on productivity is diminished non-attendance. He exhibits that the wellbeing dangers and disappointment of workers to partake in wellness and safety advancement programs are related to outrageous levels of worker absenteeism. Also in Uganda, a study by Ndejjo, Musinguzi, Yu, Buregyeya, Musoke, Wang, and Ssempebwa, (2015), in assessing OHS hazards encountered by healthcare workers and their alleviating measures found out that healthcare workers experience numerous hazards in their places of work which adversely impacts service delivery. They found some associating factors to comprise of healthcare workers disregarding all essential 51 University of Ghana http://ugspace.ug.edu.gh protective apparatus, overtime working and work-related pressures. The study suggested that some intermediations, particularly, PPEs, job stress and inadequate adherence to alleviation measures should be designed to alleviate the hazards. Supporting the view above, Akinyele (2010), assessed the influence of work environment on future worker‘s productivity in the Nigerian oil and gas industry and showed that components outer and inner to the workplace impact productivity. This outcome was because 42.63 percent of the employees recognize that poor security conditions obstructed their capacity to convey. He concluded that the type of work setting in which workers operate determines performance in that; conducive work environment stimulates creativity of employees and bad working conditions contribute to low productivity of employees. De Koster, Stam, and Balk, (2011) found a positive nexus between OHS and productivity and indicated that concentrating on the security of employees supported in decreasing misfortunes at work and improvement in productivity and profitability. In appreprehension of the part played by effective OHS administration in connection to work fulfillment of workers who work in associations inclined to dangers, such as, before said, numerous researchers and policy formulators have directed their concentration toward OHS management practices as a field of study. An investigation led by (Kumar, Goud & Joseph, 2014) on the connection between OHS practices and job satisfaction of workers in Indian clinics. The discoveries demonstrate a critical positive connection between OHS practices and job satisfaction. Different researchers (Cudjoe, 2011; Masi & Cagno, 2015) likewise examined the connection between OHS administration practices and job satisfaction of workers in hospitals in Ghana. The discoveries propose that OHS practices prompt job satisfaction. 52 University of Ghana http://ugspace.ug.edu.gh To concur with the assertions above, the evidence given by the Australian National Commission for Health and Safety (2002) on the advantage of advancing health and security in organisations demonstrated that when workers are given safe workplace using viable OHS administration frameworks, it decreases workers absenteeism and this has the first-hand impact on increment of efficiency which the final product will be increment in productivity for the association. Taking a gander at a report by Safe Work Victoria (2006) on wellbeing and security of different associations, they share the comparative perspective of the documentation given by the Australian National Commission to Health and Safety. To them, in associations where wellbeing and security arrangements are exceptionally advanced, workers feel esteemed in light of the fact that they are kept from peril at work. This gives chances to workers to perform extremely well at work to accomplish organizational success. Hudson (2012) likewise observes wellbeing and security improvement in the work environment to have a direct positive effect on workers performance. He clarifies that great work- related OHS administration practices would create a favourable way of life at the workplace and this upgrades the delivery of the overall workforce. According to him, it likewise gives space for the high performance of workers that empowers inventiveness and advancement. In support of prior literature (e.g. Cudjoe, 2011; Masi & Cagno, 2015; Kumar, Goud & Joseph, 2014) the researcher hypothesised that H2: Conducting workplace safety inspections and audits significantly improves the healthcare delivery of nurses in Ghanaian Hospitals. 2.6.5 OHS Induction and Training and Nurses’ Healthcare Delivery The burden of workplace injuries, illnesses, and fatalities in society are large and one common approach to alleviate such adverse results is occupational health and safety (OHS) training (Schulte, 2005). Certainly, training is commonly regarded as a 53 University of Ghana http://ugspace.ug.edu.gh significant component of OHS programs. However, definitive information on the effectiveness of OHS training is still developing. Training according to Cole (2008) is any learning activity which is directed towards the acquisition of specific knowledge and skills for the purposes of a task. Examples of training needs are the need to have efficiency in safety in the operation of particular machines or equipment; the need for an effective sales force: and the need for competent management in the organization. OHS training alludes to planned endeavors to help the learning of OHS-particular abilities (Noe, 2000). Such training regularly comprises of the guideline in danger acknowledgment and control, safe work operations, appropriate utilization of individual defensive gear, and crisis methods and preventive activities. It might likewise direct laborers on where to discover extra data about potential perils. Armstrong (2006) defines health and safety training as a key piece of the safeguard program. It should start as part of the induction course. It ought to likewise occur following an exchange of worker to another station or change in a working technique. Health and security training illuminates the guidelines and gives data on potential risks and how to maintain a strategic distance from them. additional refresher training ought to be given an extraordinary courses lay on to manage new parts of wellbeing and security or regions in which security issues have developed. Dessler (2005) asserts that training is another way of reducing unsafe and unhealthy acts, especially for new employees and new equipment. They should be instructed in safe practices and procedures, warn them of potential hazards, and work on developing a safety- conscious attitude. Materna Harrington, Scholz, Payne, Stubbs, Hipkins, Merideth, Kisech, Lomax, Coyle, and Uratsu, (2002) in their study among painting contractors and their employees about lead safety in San Francisco, USA, found out that positive variations can be attained via widespread training and support in technical know-how. 54 University of Ghana http://ugspace.ug.edu.gh It is vital that workers understand health and safety practices, rules & regulations and procedures. OSHA has published booklets on training requirements and teaching safety in the workplace. In Ghana, The Factories, Offices and Shops Act 1970 (ACT 328) emphasizes on training and supervision and provides that; No person shall be employed at any machine or in any process liable to cause bodily injury, unless ―(a) He has been fully instructed as to the dangers likely to arise in connection therewith and the precautions to be observed; and (b) He has received sufficient training in work at the machine or in the process, or is under adequate supervision by a person who has a thorough knowledge and experience of the machine or process.‖ OHS training is considered as an indispensable strategic tool for effective individual and organizational safety performance and its importance should not be underestimated. Agbola (2012) posits that OHS induction aims at building up a favorable attitude towards safety measures and precautions while OHS training is concerned with providing immediate job knowledge, skills and methods of work and creating awareness on the hazards likely to be encountered in the course of work. The process also enables understanding the causes of accidents and how they may be prevented, the importance of good house-keeping and handling materials safely. Training is an excellent way for employees to learn new skills and knowledge and to reinforce good work practices. This can result in a change in workplace behavior. Investing in effective employee training will increase skills, knowledge, productivity, and morale as well as reduce workplace incidents (Gyekye, 2005). Tsui and Gomez- Mejia, (1988) express that a means to urge worker security is to include all workers in 55 University of Ghana http://ugspace.ug.edu.gh different circumstances in safety training. Safety training should be possible in different ways. This includes;  Regular sessions with directors, supervisor, and workers frequently are facilitated by members HR staff.  Showing recordings, transmissions and web-based assets all are means employed to lead safety or security training. To fortify safety training, ceaseless correspondence to create security cognizance is vital. Only sending safety notices aren‘t sufficient. Producing pamphlets, changing security posters, ceaselessly refreshing bulletin boards and publishing information in noticeable areas likewise are recommended.(Tsui and Gomez-Mejia.1988) Literature has it that many several types of OHS problems are troubling Ghana, of which one paramount issue has to do with dealing with OHS problems (Annan et al., 2015). However enhancing worker profitability and work-related wellbeing and security (OHS) have been an imperative field of enthusiasm of industry particularly in emerging nations (Kaynak, Toklu & Toklu 2016). A study conducted by (Katsuro, Gadzirayi, Taruwona & Mupararano, 2010), to investigate OHS problems on productivity in the Zimbabwean commercial food industry found out that occupational health and safety related problems have a negative impact on employees‘ productivity. The study targeted production supervisor, shop floor workers, and industrial clinic nurses and argued that high incidents of mishaps do occur at the workplace and employees cultivate negative behaviours and low morale towards work which adversely affect work performance. The researchers 56 University of Ghana http://ugspace.ug.edu.gh recommended that the food industry firms upgrade their OHS via training programmes and make use of contemporary apparatus. In the healthcare sector, research has demonstrated that vulnerability to bloodborne bacterium which now and then are the outcomes of percutaneous wounds experienced through needle and other sharp devices represents a danger of transmission of HIV, hepatitis B and different virus to wellbeing specialists (Prüss‐Üstün, Rapiti, & Hutin, 2005; Kessler, McGuinn, Spec, Christensen, Baragi, & Hershow, 2011 ). Likewise, (Kassa, Selenic, Lahuerta, Gaolathe, Liu, Letang & Bock, 2016) investigated workplace vulnerability to bloodborne virus among 1,624 healthcare workers in Botswana. The researchers identified that more than half of the workforce saw themselves as standing a high chance of being introduced to the bloodborne virus. Subsequently, when these wellbeing and security issues are not appropriately tended to, it might almost certainly influence the job fulfilment of nurses, which perpetually will maximize their turnover expectation or demand to move into different parts in the healthcare segment. Productivity and efficiency is therefore of real importance to the individual worker of irrespective of status, to the affiliation whether business or not and to the nations' economy for the most part and subsequently in like manner, to the upliftment of the welfare of the inhabitants and the diminishing if not total disposal of mass dejection (Yesufu, 2000; Akinyele, 2007). Similarly, occupational health and safety is known to affect the quality and adequacy of work of mental health experts (Rossler, 2012). Thusly, a solid work environment is a prime factor for job satisfaction and a high standard of emotional wellness. Work- related health and safety has been accounted for to influence job performance and employee turnover intentions among nurses in hospitals. A study by Gyensare et al., 57 University of Ghana http://ugspace.ug.edu.gh (2017) to assess the relationships that exist within OHS, the engagement of nurses and their intentions to quit within the mental hospitals in Ghana revealed nurses engagement in Ghanaian hospitals were predicted by safety procedure, safety leadership, and safety equipment. They found out that safety leadership was the most significant predictor of nurses‘ engagement and suggested that the health sector of Ghana requires the need for enhanced efficiency, quality and effective administration of occupational health and safety; hence, it is essential to note that formulating OHS administrative policies only cannot solve the health and safety problems within the hospitals. They further argued that the positive relationship between OHS and employee engagement depicts that encouraging an OHS strategy will vitalize nurses to perform their best in increasing the productivity of the hospital. Steege, Boiano & Sweeney (2014), conducted a study on NIOSH health and safety practices survey of healthcare workers assessing employee training and awareness of employer safety procedures. They reported low safe handling training and low procedures for reducing vulnerability and concluded that training and establishing techniques for decreasing submission to chemical hazards is an evidence of management and employee awareness of safety. Furthermore, Aluko, Adebayo, Adebisi, Ewegbemi, Abidoye, & Popoola, (2016) also studied the knowledge, attitudes, and perceptions of occupational hazards and safety practices in Nigerian healthcare workers by examining the occupational hazards and safety practices of healthcare workers in a descriptive cross-sectional survey of 290 respondents. The outcome of the study showed that most of the registered nurses had knowledge about the dangers of healthcare facilities. They recognized used recapping needles as a risky practice and effective washing of hand before and after each clinical process as a means of preventing cross contaminations. Majority of the respondents 58 University of Ghana http://ugspace.ug.edu.gh perceived they were at elevated risk of occupational hazards and about half of them frequently observed standard safety procedures. They concluded that the outrageous altitude of knowledge showed by respondents was at fluctuation with training, consequently, measures targeted at advancing security operations and, reducing vulnerability to risks, for example, arrangement of security apparatus, pre-situation and regular preparing of staff on health and safety operations and sufficient support of staff potential and ability through drills across healthcare facilities ought to be systematized and made compulsory. An investigation by Ward et al. (2008) strengthens the idea of several researchers who perceive firms reaping direct advantages in advancing work-related health and security. To them when workers within an organization feels that management is anxious about their safety and wellbeing, it gives an indication of favourable safety and health management framework and therefore, brings about more secure work operations and furthermore have positive effect on worker results (such as, work inspiration, work inclusion, safe atmosphere, commitment, work fulfilment, psychological well-being and prosperity). Positive or more remarkable records of these results buttress the capacity of the worker to deliver exceptionally well at work for the institution to accomplish its objectives. Numerous precursors have been tested in order to gain an understanding of safety performance in various workplaces. For instance, previous researches (Hayes, Perander, Smecko, & Trask, 1998 and Lee & Dalal, 2016) examined how important organizational safety climate and culture were in predicting the safety performance of workers in organizations. Griffin & Neal (2000) also in their model considered safety knowledge and safety motivation as proximal factors which are positively related to safety behavior of workers. Adebiyi and Charles-Owaba (2009) in their study about the manufacturing sector realized that most manufacturing industries have established 59 University of Ghana http://ugspace.ug.edu.gh health and safety strategies like training, guarding, consciousness, motivations, misfortunes inquiry and the delivery personal protective equipment (PPE) to reduce accidents at the workplace and improve performance. Safety measures avoid mishaps which are appalling to the workers and the business. Where these are given, worker efficiency is substantially outrageous in such zones than in others where security is missing due to the fact that workers carry out work without fear and with confidences safety precautionary measures are guaranteed. They deliver their best without strain and this increases the efficiency of work and lifts worker assurance. As argued by Hopkins (2003), enhancing the working conditions for workers may boost output and overall excellence. Safety and health of employees as a social obligation pulls and maintains high caliber workers, create a decent notoriety, maximize investor worth and diminishes administrative oversights (Tencati et al., 2004; Cowe et al., 2003; Swift and Zadek, 2002). This makes it a clarion call for firms to emphasis on OHS induction and training of employees for quality employee delivery. As indicated by McCunney (2001), the essential useful effect of work-related wellbeing and security on profitability is a decreased rate of absenteeism. Literature has it that a few specialists encounter back, neck, leg or arm torment uneasiness. Fernandez-Muniz et al., (2009) further contended that the demand to secure the upper hand and enhance monetary budgetary returns must compel organizations to expend resources in operations of worker safety and health. There is currently a recognition that more secure and better workplaces change over into extended gainfulness, more work fulfilment, and more grounded essential concern outcomes. There are four factors that clarify the connection amongst profitability and workers‘ general wellbeing and security (Brandt-Rauf et al., 2001): 60 University of Ghana http://ugspace.ug.edu.gh a. ―The requirement for more imaginative approaches to diminish the high rates of workplace damage and sickness. b. The strain to lessen the social and financial expenses of damage and sickness, especially remuneration costs. c. The need to enhance work profitability without workers expecting to work longer hours as well as taking on extra work. d. The need to offer great working conditions as an allure to enlist and maintain talented workers in a tight work showcase.‖ In line with the foregoing discourse (e.g. Rossler, 2012; Katsuro, Gadzirayi, Taruwona & Mupararano, 2010; Sweeney, 2014; Kaynak, Toklu & Toklu 2016), the researcher formulated the following hypothesis. H3: Conducting OHS induction and training significantly enhance healthcare delivery of nurses in Ghanaian Hospitals. 2.6.6 OHS Induction and Training, OHS Policies and Regulations, OHS Inspections and audits and Nurses’ Healthcare Delivery Occupational health and safety consist of several dimensions which influences employee and organizational outcomes at different levels. On the extent to which productivity is affected by OHS practices, Morwabe and Atambo, (2016) investigated the influence of OHS practices on employee productivity in a tea development agency concentrating on three OHS predictors. It was discovered that the productivity of employees is predicted mostly by OHS induction and training, safety inspections of the workplace and OHS regulations respectively. Despite the presence of some literature on OHS management (Morwabe & Atambo, 2016), little attention has been 61 University of Ghana http://ugspace.ug.edu.gh given to the extent to which occupational health and safety interacts with nurses‘ healthcare delivery. However, it is imperative to note that the insignificant quantity of empirical studies relating OHS to healthcare delivery implies limited knowledge in the area and this makes it justifiable for more studies investigating which OHS dimension highly predicts the delivery of healthcare of nurses in the hospitals in sub- Saharan Africa. Against this backdrop the researcher hypothesised that H4: OHS induction and training will significantly predict healthcare delivery of nurses more than OHS policies and regulations and workplace safety inspections and audits in Ghanaian Hospitals 62 University of Ghana http://ugspace.ug.edu.gh 2.7 Conceptual Framework The conceptual framework of this study is built on both theoretical and empirical literature reviewed and the interrelationship between variables in the context of the problem investigated. The independent variables in the study include - OHS policies & regulations, workplace safety inspections and OHS induction and training while the dependent variable is the Nurses healthcare delivery. This study aims to add to knowledge by explaining three OHS facets: Safety Policies and Regulation (SPR), Workplace Safety Inspections (WSI) and Safety Induction and Training (SIT). Included in this research model, these facets are proposed to examine the association between healthcare delivery and OHS practices and its effects. 63 University of Ghana http://ugspace.ug.edu.gh The framework can be conceptualised as; INDEPENDENT VARIABLES DEPENDENT VARIABLE OHS POLICIES AND REGULATIONS H1 NURSES WORKPLACE HEALTHCARE SAFETY DELIVERY I N S P E C T I O N S H2 AND AUDITS OHS H3 INDUCTION AND TRAINING Figure 1: Conceptual Framework Source: Field Data (2018) 64 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 3.0 Introduction McNabb (2013) defines research methodology as the approach the researcher uses to obtain important data with respect to the topic under investigation. What's more, research methodology can be comprehended as a science of learning how research is efficiently carried out. Keeping in mind the end goal to utilize reasonable solutions for an issue, researchers are requiring to plan and utilize appropriate methodologies. This chapter displays an outline of the methods and tools employed in gathering and analysing the data about the occupational health and safety of workers of public hospitals in the central region of Ghana, i.e. what was done and how it was done. It comprises of research philosophy, the setting, research approach, research design, study population, sample size and sampling strategy as well as ethical considerations. The data sources, procedure for data collection, instrumentation, methods of data analysis, validity and reliability have also been explained. This study is to provide the impact analysis of OHS policies and practices and its effect on the productivity of nurses in the public hospitals in Ghana. 3.1 Research Philosophy Every research is influenced by the world view of the researcher (Guba & Lincoln, 1994); known as the research philosophy or paradigm (Silverman, 2013). A paradigm or research philosophy is the overall conceptual framework in which researchers may conduct their studies (Sobh & Perry, 2006). Some of the major research paradigms include; Positivism, interpretivism and realism (Creswell & Plano-Clark, 2011). These paradigms are defined based on three assumptions; Ontology, epistemology and methodology. 65 University of Ghana http://ugspace.ug.edu.gh Interpretivism philosophy maintains that various substances exist and are liable to human encounters and interpretation (Jernigan, 2010). It will likely fathom the significance of an occurrence as opposed to sum up or foresee results from information (Cranton, 2001). Realists on the other hand, recognize contrasts between this present reality and their specific perspective of it and attempt to develop different perspectives of this reality as far as which ones are relative in time and place (Riege, 2003). Positivist believes there is a single, objective and tangible reality. Knowledge generated is objective, free of time influences, and is context independent. Researchers formulate research questions and hypotheses and then test them empirically, sometimes in carefully controlled circumstances (Beverland & Lindgreen, 2006). Quantitative methods such as survey and experiments (Sobh & Perry, 2006) are employed in positivism paradigm. This study adopted the positivist paradigm since it is the most aligned or consistent research paradigm with this study. The adoption of the positivist paradigm allowed the researcher to formulate research objectives and questions and employed questionnaires to collect large data from respondents to answer the research questions. Also, this study did not seek to understand deeper meaning of a phenomenon or generalize propositions to conceptual frameworks as it pertains to the other alternative paradigms. 3.2 Study Area The Central Region is one of the ten administrative regions of Ghana and was the former administrative centre of the Gold Coast. The region has a population of about 2,201,863 and occupies a total land area of 9,826 sq. km, which makes it the eighth largest among the regions in terms of land size. It has a population density of 224.1 66 University of Ghana http://ugspace.ug.edu.gh people per sq. km. It shares common boundaries with Western region on the west, Ashanti and Eastern regions on the north, the Greater Accra Region on the East and on the south by the Gulf of Guinea. With regards to the economy, the labour force participation rate for population aged 15 - 64 is almost 71.2%. With a growth rate of 3.1% the population is estimated to increase to 5.5 million by 2040. The study was limited to the two major public hospitals within the study area. These hospitals are the Cape Coast Teaching Hospital and the Trauma and Specialist Hospital. These are largest and major referral hospitals in the region. They are specialist hospital and a secondary referral centre. These hospitals has a very high client turn-over operating 24 hours a day, 7 days a week all year round providing services to the general public within the region and beyond. 3.3 Research Approach A research design is the ground breaking strategy for the investigation spreading over from the technique for data gathering through the technique for data analysis. According Dawson (2002), a research design is the conceptual framework inside which study would be directed. Generally, research design provides guidance and rules that prompts significant sites and materials and the accumulation and examination of this data foremost to the study (Zikmund, 2000). Generally, three main types of research methodology or approach exist which comprises of qualitative, quantitative, and the mixed methods. Qualitative research is normally employed to pick up a apprehension of fundamental reasons, conclusions, and inspirations. It additionally gives bits of knowledge into the issue or creates thoughts or theories for potential quantitative research. It is likewise used to reveal drifts in thought and feelings, and jump extensively into the issue with a small sample 67 University of Ghana http://ugspace.ug.edu.gh size (Wyse, 2011). The qualitative approach was not employed by the researcher, since the focus of this study was not to gain in-depth opinion on a small number of nurses. In addition, it is time consuming and relatively costly. Quantitative research is another method where researchers follow the positivist approach to create knowledge and to realize the nature of reality. Quantitative research involves the collection of factual data that is measured and quantified (Armstrong, 2009). The various approaches involved in collecting the data are questionnaires or surveys, and experiment‖ (Armstrong, 2009, p. 181). The next research method is the mixed method. The researchers who utilize the mixed methods follow the realist paradigm. Malina, Norreklit and Selto (2011), are of the view that mixed methods research puts together qualitative and quantitative approach simultaneously in order to come out with a stronger outcome. However, the mixed method was not adopted because it can be time consuming and expensive. The study was quantitative in nature because the researcher sought to find out the relationship between certain OHS variables within the institutions selected for the study. In line with this, the quantitative research method was embraced by the researcher. Quantitative research is described by Aliaga and Gunderson (2000), as explaining phenomena by gathering numerical data that are analyzed based on mathematical methods especially in statistics. The objective for this type of research was to measure the incidence of various views and opinions in a chosen sample and to obtain conclusive findings therefore the use of this research technique enabled the researcher to use questionnaire to collect data from larger number of participants for analysis. Yauch and Stendel (2003) suggests that quantitative research design oucomes are free of the researchers as it involves thorough techniques and procedures that restrains the impact of the researcher, consequently delineating the genuine 68 University of Ghana http://ugspace.ug.edu.gh situation of the phenomenon understudy. Dudwick, Kuehnast, Jones and Woolcock (2006) contend that discoveries are more exact and dependable because of its thorough nature and can be summed up to speak to the perspective of the whole population. They additionally recommend that quantitative research design is frequently reasonable for studies with extensive number substances. Additionally, Choy (2014) maintains that quantitative research has got two major advantages. The first is that it can be completed and assessed rapidly as reactions can be organized inside a brief time frame contrasted with qualitative research. Secondly, if the data gathered is thoroughly and honestly gathered, it turns out to be more dependable to use for examination and generalization. In reality the above defenses framed the reason for the researcher‘s decision of a quantitative research approach. 3.4 Research Design The study adopted the descriptive research design that includes gathering data that portray occasions and afterward composes, classifies, delineates, and depicts the data collection (Glass and Hopkins, 1984). Miller (1991) defines descriptive research as the process of gathering data with a definite end goal to provide solutions to questions regarding the current state of the subject under study. To meet the objective of this study, descriptive survey design was used. According to Creswell (1994), descriptive survey design entails collecting information or data regarding the present existing situation or phenomenon and to answer questions relating to the present state of the phenomenon under study (Miller's 1991). Saunders (2009) says that descriptive research depicts an exact profile of people, occasions or circumstances. The strategy includes direct investigation, examination, and depiction of a specific phenomenon, as free as could be allowed, aiming at extreme instinctive presentation (Mugenda and Mugenda, 2003). The inspiration driving using this technique is to depict the 69 University of Ghana http://ugspace.ug.edu.gh possibility of a condition, as it exists at the period of the investigation and to explore the impact of a particular phenomenon. This design offers to the researcher a profile of portrayed significant parts of the phenomena of enthusiasm from an individual, organizational and industry-oriented point of view. It presents information in a significant shape that causes the researcher to comprehend the features of a group in an offered circumstance, to contemplate viewpoints in a given circumstance, offer thoughts for further research and settles on certain straightforward choices. 3.5 Study Population The population of a study can be depicted as the amount of all units of the event to be investigated that exists in the zone of examination (Kumekpor, 2002). Population according to (Babbie, 2008 & Nachmias and Nachmias, 1996) is the sum total of all elements that corresponds to some defined set of specifications, from which the sample is actually selected. Mugenda and Mugenda (2003), also posits that target population is that aspect of the population to which a researcher intends to generalize the results of the study. In this study the target population comprised of all nurses working in the major public hospitals within the central region of Ghana. However, the foremost selected criterion for the hospitals was that it should be of regional hospital status in Ghana. Therefore the accessible population for this study was limited to two (2) major public hospitals in the study area. These hospitals are the Cape Coast Teaching Hospital and the Trauma and Specialist Hospital, Winneba. This population is made up of nurses of both sexes with different educational qualification levels but restricted to registered nurses and of general nurse category. 70 University of Ghana http://ugspace.ug.edu.gh 3.5.1 Eligibility Criteria The eligibility criteria for selecting respondents for this study were; 1. Participants should be nurses in active service in the hospitals mentioned. 2. Participants must be of a general nurse status. 3. Participants must give voluntary informed consent to participate in the study 3.6 Sampling Procedure and Sample Size Sampling is the process of selecting a portion of cases and analysing them in order to gain understanding and make deductions and inferences about the whole set (Koul, 2009). As indicated by Cohen (2003), researchers most often do not get access to the entire population to obtain information due to certain factors such as expense, time and accessibility. Therefore it is of essence to solicit information from a minor group or subset of the aggregate population in a way that the knowledge obtained is illustrative of the whole population under examination. A two-phased sampling was used, whereby the public hospitals and the general nurses located in the central region were selected to participate in the study, by means of purposive sampling followed by the stratified and convenience sampling of participants in the targeted hospitals, as described hereunder: The researcher adopted both purposive and stratified convenience sampling techniques. Purposive sampling is ―a type of non-probability sampling in which the units to be observed are selected on the basis of the researcher‘s judgment about which ones will be the most useful or representative‖ (Babbie, 2008, p.204). Stratified sampling involves grouping of the units composing a population into homogeneous groups or strata before sampling (Babbie, 2008). 71 University of Ghana http://ugspace.ug.edu.gh In this study, the researcher purposively sampled the two (2) major hospitals for the study. Purposive sampling was used in choosing the hospitals because they are known to be the major notable public hospitals in the central region with Trauma and Specialist Hospital of status being the Central regional hospital whiles the Cape Coast hospital remains the only Teaching Hospital within the region. Again the stratified and convenience sampling allowed the researcher to categorize the nurses into different strata based on their nature of work and units of operation, that is, Psychiatric nurses, general nurses, midwives, community nurses, enrolled nurses, nurse anaesthetists, ophthalmic nurses, and public health nurses. This division was fundamental by reason of the way that the make-up of work being performed and levels of vulnerability to dangers among these nurses are unique. The benefit of stratified random sampling is that it guarantees consideration, in the sample of subgroups, which generally were discarded completely by other sampling techniques on account of their little numbers in the population. Stratified design was chosen because it results in more reliable and detailed information (KIM, 2009). And subsequently, convenience sampling was used in choosing the respondents to partake in the study owing to the fact that the nurses have different work schedules. Mugenda and Mugenda (2003) recommend that in descriptive studies, 10 percent and above of the reachable population stand ample for the study. Gay (1992) recommends 20% of the target population in a social study. The researcher used 30% since the higher the percentage the closer the characteristics of the sample population are to the target population. The study used a sample size of 300 nurses. 72 University of Ghana http://ugspace.ug.edu.gh 3.7 Types and Sources of Data Two main types of data exist in research: Primary and secondary research data. Primary data is the original data observed or collected from first-hand experience specifically for the purpose of your research. Some methods used in obtaining primary data include interview, observation and questionnaire (Francis, 2008). Secondary research on the other hand, is a form of data already gathered and processed and are accessed and reanalysed often for a different purpose by another (Babbie, 2008). The study used both primary and secondary data. The researcher used questionnaires in obtaining the primary data. Respondents were asked to respond to questions assessing their views on OHS in relation to their productivity (Healthcare delivery). The secondary data also comprised of information about the study area, profile of the public hospitals and number of staff obtained from GHS and human resource department of selected hospitals. This study conducted primary analysis. The primary research analysis aided the researcher to investigate the effect of OHS implementation on healthcare delivery via the administration of questionnaires using nurses in the selected hospitals. Furthermore, the use of primary analysis ensured that the study did not use a secondary data that could have a questionable quality (Babbie, 2008). 3.8 Data Collection Instrument The study used questionnaire in the collection of primary data. Questionnaire according to Kumekpor, 2002, is a blueprint which comprises several questions concerning a specific subject, problem, phenomenon or a belief to be examined by the researcher. The researcher adopted structured questionnaires and closed ended questions which were developed on the basis of the objectives of the study to be scored on a likert scale aimed at enabling the researcher in making deductions or 73 University of Ghana http://ugspace.ug.edu.gh inferences between occupational health safety and nurses‘ productivity. The choice of the questionnaire was because it was faster, well suited for literate and educated people and efficient method enabling the researcher to reach and gather data from a large sample within a short period of time (Combo & Tromp, 2006; Twumasi, 1986). According to Kothari (2008), since the questions were presented in a paper format, questionnaires do not give room for interview bias as the answers are in respondent own words and judgements. Also respondents have enough time to give well thought out responses. The questionnaire also had the added advantage of being less expensive as a data collection instrument (Serakan, 2006). The variables in the second to fifth scales were rated on a 5-point scale, where 1= very low, 2= low, 3= medium, 4= high and 5= very high. The structured survey questionnaire was a modification of (Morwabe & Atambo 2016) OHS scale. The structured survey questionnaire had five sections which were labelled as Demography, OHS Policies & Regulations, Workplace Safety Inspections, OHS Induction and Training and Nurses or employee Productivity. Section A obtained data on the demographic features of the respondents which covered seven (7) questions. The first question was on gender of respondents. The second was on respondents‘ age groups followed by marital status of the respondents. Question 4 collected data on the level of education achieved by the respondents in relation to five intervals; from secondary to post graduate. The fifth question assembled data about the duration of service in relation to five intervals; from below 1 year to above 15 years. Question 6 obtained data on number of working hours in relation to five intervals; from less than 5 hours to over 12 hours. Section 2 of the questionnaire measured OHS Policies & Regulations with a 9-item scale by (Morwabe & Atambo 2016) with little modifications (α=.87). Sample of the 74 University of Ghana http://ugspace.ug.edu.gh items are: The hospital has safety and health policy in place; Nurses awareness of legal rights concerning OHS; I know the content of the safety and health policy. It is also available near to my work place or in book form? Section 3 measured Workplace Safety Inspections and Audits with a 7-item scale by (Morwabe & Atambo 2016) with some little modifications (α=.84). Sample of the items are: Safety audits and inspections carried out as planned; Timely inspections to detect faults in systems/equipment/machine; Timely remedial action taken wherever there is an accident or dangerous occurrence. Section 4 measured OHS Induction and Training with a 7-item scale by (Morwabe & Atambo 2016) with some little modifications (α=.87). Sample of the items are: Training and/or inducting newly recruited staff on OHS before officially allocated duties; Conducting OHS training/refresher courses/seminars regularly; Provision of training on the use of new equipment or technology. The last section, Section 5 also measured the influence on Nurses or employee productivity. To achieve this, the researcher developed a 7-item scale by the modifications of (Morwabe & Atambo, 2016; Nyoh, 2015) scale (α=.84). Sample of the items are: Improves my performance in healthcare delivery (output); Reduces absenteeism and sick-offs due to workplace injury; Improves on my efficiency and effectiveness in healthcare delivery. 3.8.1 Study Variables The dependent variable used in this study was Employee productivity whiles the independent variables were OHS policies and regulations, workplace safety inspections and OHS induction and training. Earlier proven measures of each of the study variables were used, thus structured survey instruments were adapted and used 75 University of Ghana http://ugspace.ug.edu.gh in gathering quantitative data. Ideally, the Cronbach‗s alpha coefficient of a scale should be 0.7 and above (Pallant, 2001). The scale used by the researcher for this study was adopted from (Morwabe & Atambo 2016) with a Cronbach‗s alpha coefficient of OHS policies and regulation (0.813), Workplace Safety Inspections (0.732) and OHS Induction and Training (0.774) and modified to suit the context of the recent study. These scales were adopted for the study in that the items had direct relation with the objectives of the study and hence were appropriate scales to address the research objectives. 3.8.2 Validity and Reliability A scale must command validity in order for it to be used with confidence. According to Wilson (1993), validity is when an instrument measures what it is designed to measure. One common way of assessing content validity is through expert opinion. However, in this study, face and content validity were assured with the aid of expert opinions. The instrument was made available to my supervisor and other scholars in the field to utilize their master knowledge to evaluate the understandability, reasonableness of the questions, ensuring the questions were easily readable and appropriate in measuring the construct as well as the extent of coverage. In addition, confirmatory factor analysis was done to evaluate the construct validity of the data collection instrument in order to determine the item that loads well onto their corresponding construct. Both convergent and discriminant validity were assessed. Reliability is realized when a measuring instrument offers a stable and unvarying outcomes or data on repeated usage in different situations and contexts. This is usually assessed by internal consistency frequently measured using Cronbachs alpha value of the scale (Hair et al., 2006; Malholtra, 2007). Cronbach‘s alpha can be coined 76 University of Ghana http://ugspace.ug.edu.gh as a measure of the mutual connections between the distinguished items utilized to capture the construct (Ghauri & Gronhaug, 2005). Normally a Cronbachs alpha value of 0.70 or above is considered acceptable. However, Hair, Ringle and Sarstedt, (2011) recommends that composite reliability is more suitable and a better measure of internal consistency than Cronbach‘s alpha since unlike Cronbach‘s alpha, it did not assume that all indicators were equally reliable and also the composite reliability is not as dependent on the number of items as the Cronbach‘s alpha. Based on these underlying reasons, both the Cronbach‘s alpha values obtained during the pre-testing and composite reliability values assessed by the confirmatory factor analysis were all used to measure internal consistency. (Bagozzi and Yi, 1988; Hair,Sarstedt,Ringle & Mena, 2012) recommends composite reliability value threshold of 0.70 or higher. 3.8.3 Pilot Study The researcher carried out a pilot study with fifteen (15) respondents to ascertain the reliability adopted and modified measuring scale and also to guarantee the correction of errors in the questionnaires before embarking on the main survey. However, the respondents used in the pilot survey were not included in the main survey and some minor mistakes identified in the questionnaires were duly corrected before the main study. The reliability analysis of the scales tested using Cronbach‘s alpha values, revealed that all the variables used in the study had Cronbach‘s alpha values of above 0.70 which is the acceptable benchmark according to (Nunnally and Bernstein, 1994). 3.9 Data Collection Procedure The researcher obtained a letter of introduction from the Department of Organization and Human Resource Management (OHRM) of the University of Ghana Business School (UGBS), Legon and submitted to the selected hospitals and the Ghana Health 77 University of Ghana http://ugspace.ug.edu.gh Service Regional Directorate, central region. The investigation relied on essential primary data with the use of questionnaire, which was administered by giving introduction and clarification for chose respondent about the motivation behind the examiner with aid from supervisors. Questionnaires were disseminated to the sampled population by the researcher for filling by the respondents. The questionnaires are streamlined however much as could reasonably be expected so all respondents have an obvious significance of every one of the inquiry. 3.10 Method for Data Analysis The finalized questionnaires were first and foremost checked for accuracy, fullness, consistency and uniformity. Data coding was done to scan for errors and omissions (Kaewsonth and Harding, 1992) with the aid of the Statistical Package for Social Sciences (SPSS) version 20. The coded data was then analyzed using procedures within Structural Equation Modeling (SEM). Both descriptive (for example, frequency tables) and inferential statistics, (for example, regression analysis) were utilized for the analysis of data. The researcher utilized descriptive statistics to analyse the demographic data of respondents. Descriptive statistics as per Pallant (2011) demonstrates the attributes of any study‘s sample via the delivery of summary statistics, for example, mean, median or standard deviation for continuous variables, or frequencies on what number of individuals gave every reaction for categorical variables. Furthermore, the study hypotheses were tested using Partial Least Squares Structural Equation Modelling (PLS-SEM). SEM is a second generation multivariate analytical tool which has been used in most research in recent years due to its capacity to 78 University of Ghana http://ugspace.ug.edu.gh measure latent variables and test associations between numerous latent variables concurrently (Hair et al., 2012). As a second generation multivariate analytical instrument, SEM deals with two major models; the structural model which comprises of the hypothesised associations between the dependent and independent latent variables also referred to as constructs; and secondly, the loadings of the items on their corresponding constructs included in the measurement model (Gefen, Straub, & Boudreau, 2000). Thus, conjoining these two models permits mistakes and errors of the observed variables as well as factors analysis to be included concurrently in testing the entire model for proposed hypothesised associations between constructs (Gefen et al., 2000). This ability makes SEM a better tool for analysis (Bollen, 1989) than other tools such as regression which only tests a layer of associations between dependent and independent variables separately (Gefen et al., 2000). Therefore, the researcher chooses SEM to analyse the data in this study. 79 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR ANALYSIS, PRESENTATION AND INTERPRETATION 4.0 Introduction This chapter outlines the results of the analysed data and presents the findings of the study which were organized with respect to the study objectives. It get under way with the demographic characteristics of the study respondents and then goes further with the preliminary analysis of the data gathered and also the testing of the hypotheses. The data was analysed using Partial Least Square Structural Equation Modeling (PLS-SEM), a second generation multivariate analytical tool (Hair et al., 2012; Ringle, Sarstedt, & Straub, 2012), with use of the software Smart-PLS 3 (Ringle et al., 2015; 2005; Wong, 2013). 4.1 Demographic Characteristics of Respondents A total of 286 out of 300 questionnaires administered were retrieved, deemed fit and used in analysing the data representing 95.3% response rate. Table 1 presents a summary of the demographic characteristics of the respondents. 80 University of Ghana http://ugspace.ug.edu.gh Table 1: Summary of Frequencies and Percentages of the Demographic Characteristics of Respondents Variables Frequency Percentage (%) Gender Male 106 37.1 Female 180 62.9 Total 286 100 Age 18-24 78 27.3 25-34 140 49.0 35-44 58 20.3 45-55 10 3.5 Total 286 100 Marital Status Single 134 46.9 Married 130 45.5 Separated/ Divorced 16 5.6 Widowed 6 2.1 Total 286 100 Educational Level Certificate 82 28.7 Diploma 164 57.3 First Degree 26 9.1 Professional 12 4.2 Post Graduate Degree 2 0.7 Total 286 100 Working Experience Below1Year 16 5.6 1-5 194 67.8 6-10 60 21.0 11-15 12 4.2 15 and above 4 1.4 Total 286 100 Job Status Supervisory 58 20.3 Non-Supervisory 228 79.7 Total 286 100 Source: Field Data (2018) 81 University of Ghana http://ugspace.ug.edu.gh Gender Distribution Based on the demographic features of the respondents, the study disclosed that most of the nurses were females 180 (62.9%), and males 106 (37.1%) indicating that nursing is a female dominated profession. Age Distribution Age is also one of the demographic factors attention is paid to in employment issues as it affects behaviours or perception of respondents at the workplace. It was therefore important that the researcher assesses the age bracket of the respondents to determine whether they were young, matured or old because the more youthful a man, the more he or she comprehends a given idea and the more dynamic that individual is. Data on the age of the respondents ranged from 18years to 55years and above. The age group was dominated by 25 - 34 years 140 (49%) followed by18 - 24years 78 (27.3%), 35 – 44years 58 (20.3%) and the age group with the least respondents was 45- 55years 10 (3.5%). It was therefore concluded that majority of the nurses were in their youthful age and mature to handle issues of occupational health and safety with regards to their healthcare delivery. It is also an indication to the hospital that a larger number of the nurses have over 25 years of service ahead and the averagely large number of nurses within the age brackets of 35 – 55years indicates that the hospital has highly experienced nurses who intends mentor the inexperienced ones (Akweenda, Cassim and Karodia 2016). Respondents Marital Status Marital status of the respondents were sought to establish whether the respondents were single, married, divorced, separated or widowed. Majority of the respondents 82 University of Ghana http://ugspace.ug.edu.gh 134 (46.9%) were single, followed by 130 (45.5%) who were married while 16 (5.6%) were separated. The remaining 6 (2.1%) were widowed. Educational Qualifications Regarding the nurses level of education, most of the respondents 164 (57.3%) holds Diploma in nursing followed by certificate holders 82 (28.7%), first degree 26 (9.1%), Professional 12 (4.2%) and the remaining 2 (0.7%) had post graduate degree. Years of Service Tenure of nurses in the hospitals was also considered important and investigated as this will tell the exposure and experience that the nurses has had in the hospital which may relate to the efficiency in nurses work environment. Most of the respondents have worked with the hospitals for 1-5years 194 (67.8%), followed by 6-10 years 60 (21%) working experience with the hospital, below 1year 16 (5.6%) whilst 12 (4.2%) have worked with the hospital between 11-15years and the remaining 4 (1.4%) also have worked for 15years and above. In Ghanaian nursing profession, a nurse is expected to at least spend 3 years in the profession to be considered to have good working knowledge of the nursing profession. This shows that majority of the nurses who responded to the research questionnaire have a good working knowledge of their profession. Job Position of Respondents The position held by the respondents in the hospitals was assessed and the researcher discovered that a greater number of the respondents 228 (79.7%) were in the non- supervisory category (subordinates) whilst minority 58 (20.3%) were supervisors. 83 University of Ghana http://ugspace.ug.edu.gh 4.2.0 Preliminary Analysis Preceding the structural equation modelling (SEM), preliminary data analysis was done in order to ensure the data is normally distributed as a prerequisite for using SEM to test the hypothesised relationships. Test for Normality Normality of data must be ensured to prevent cases of bloated figures of model fit measures as a prerequisite to SEM. The normality of the acquired data was identified utilizing the conclusive skewness and kurtosis values of each latent construct. For a data to be normally distributed, the absolute values of the skewness and kurtosis of the variables must fall within the recommended yardstick of -2 and +2 (Tabachnick & Fidell, 1996). SPSS was used in performing this analysis and table 2 displays the summary of the results. Table 2: Summary of the Test for Normality Variable Mean Std. Dev Skewness Kurtosis OHSIT. 3.6395 .55571 -.952 .287 OHSIA 3.3431 .56637 -.414 .288 OHSPR 2.9171 .47941 -.920 .287 NHD 3.5115 .58540 -.604 .287 Note: NHD = Nurses healthcare delivery OHSIT. = occupational health and safety induction and training OHSIA = occupational health and safety inspections and audits OHSPR = occupational health and safety regulations Source: Field Data (2018) The results from table 2 indicates that all the latent construct used in the study had absolute values of skewness and kurtosis to fall within the threshold of -2 and +2 which indicates a normal data distribution. 84 University of Ghana http://ugspace.ug.edu.gh 4.2.1 Measurement Model Evaluation This study investigates the effective healthcare delivery of nurses with respect to OHS practices. Partial Least Squares (PLS) based structural equation modelling was adopted for this empirical study. PLS is grounded on the principal component analysis as well as a blend of recurrent regression to be used in interpreting the alterations in the variables associated with the model (Chin, 1998). Forecasting all path coefficient and discrete constituents‘ loads as well as avoiding biases and uncertain threshold predictions remains a benefit of this model. On account of current developments, (Chin, Marcolin & Newsted, 2003) recommended that PLS is a constructive and effectual tool for analysis which reduces Type II error and test relations (Loureiro & Kastenholz, 2010). To evaluate the measurement model, the researcher conducted the Confirmatory Factor Analysis (CFA) to examine the validity of scales, and that the loadings of factors combined with the values of cronbach‘s alpha, composite reliability and average variance extracted were displayed in table 2. CFA is used as a tool which consents to theories (Schreiber, Nora, Stage, Barlow, & King, 2006); and is required to eliminate all errors in evaluating the factor structure of constructs (Hsu, 2010). Based on the item loadings, the original CFA was established in this study comprising of the latent constructs, namely; occupational health and safety regulations, safety inspections and audits, safety induction and training and nurses healthcare delivery which is denoted as OHS REG, OHS INP. & AUD, OHS IND. & TRNG. and NRS HC DLVRY in the CFA model. As Kenny (2016) suggested, at least two out of the observed variables should be maintained for each of the unobserved variable after deletion to enhance the model fit measures and considered as the mutual way according to Hair et al., (2012). 85 University of Ghana http://ugspace.ug.edu.gh The Smart PLS procedure was realistic, and the consequent relationships, coefficients and values of loadings are depicted in the path model in Figure 2. Figure 2: The CFA (Measurement) Model with Standardized Loadings Figure 2: Initial path model Source: Field Data (2018) 4.2.2 Test of Fitness of Model In order to evaluate how excellent the model fit the data, the model fitness test was conducted. Though numerous fit indices exist, researchers normally specify that a blend of some of these indices can be used in establishing the fitness of the model only if the acceptable threshold is met. The fit indices employed in this study were the Standardized Root Mean square Residual (SRMR) and Normed Fit Index (NFI). 86 University of Ghana http://ugspace.ug.edu.gh Firstly, fitness of the measurement model was analysed and assessed in Smart PLS. Due to the sensitiveness of chi-square value to large samples, other fit indices for example, standardized root mean square residual and normed fit index were also considered to test model fitness to the data collected. Hu and Bentler (1999) recommended that SRMR values less than 0.08 is considered best fit and also an indication that the model is not mis-specified (Henseler et al., 2014). Bentler and Bonett (1980) asserted that, the NFI results in a value between 0 and 1, and that, the more closely the NFI value to 1, the better the fit. NFI values above 0.7 represent acceptable fit and this confirm the fitness of the measurement model (Dijkstra et al., 2015). The summary of the results are displayed in table 3 below. Table 3: Model Fitness Indices Fit Indices Thresholds Authors Final CFA Model <.08, excellent; .08- Hu and Bentler (1999) SRMR 0.075 .10, acceptable Henseler et al., (2014) >0.7, excellent; 0.7- Bentler and Bonett (1980) NFI 0.733 1, acceptable Dijkstra et al., (2015) Note: The boldened figures represent the fit results of the final CFA model for the current study SPMR = Standardized Root Mean Square Residual NFI = Normed Fit Index Source: Field Data (2018) Based on the sampled data of two hundred and eighty-six (286) respondents, the results of the CFA shows that the conceptualised model had a better fit to the data. The SRMR = 0.075 and NFI = 0.733. These indices demonstrate a superior model fit for the conceptualised model to the alternative models as shown in Table 3. 87 University of Ghana http://ugspace.ug.edu.gh 4.2.3 Validity and Reliability Reliability Reliability focuses on the duplication and consistency of the variables under study. To evaluate the adequacy and accuracy of the measurement model the researcher examined the internal consistency reliability of all items and the discriminant validity (Hulland, 1999). Reliability of the items was evaluated by examination of measurement loads inside the relating constructs. In the event that all scale loads estimating reflective construct approach or surpass 0.70, this demonstrates the construct represents more than half of the fluctuation in observed variables (Loureiro & Kastenholz, 2010).A review of Table 4 provides that NHD3, OHSR1, OHSR6, SITO5 and SITO7 values were close to 0.70 and therefore the said items were not excluded. Prior literature (Nunnally and Bernstein, 1994) suggests the use of Cronbach‘s alpha and composite reliability (CR) to measure internal consistency reliability of measurement model and recommended that the Cronbach‘s alpha reliability coefficient should be above the threshold value of .70. The researcher used both, focusing on composite reliability as more suitable for PLS-SEM rather than the conventional and familiar Cronbach‘s alpha values, since unlike Cronbach‘s alpha, CR does not consider the number of items being assessed and again does not assume that all indicators are equally reliable for different items in a sample (Hair, Ringle & Sarstedt, 2011). (Bagozzi and Yi, 1988; Hair et al.; 2012) suggest that the composite reliability value should be 0.70 or higher. As seen from Table 4, the Cronbach‘s alpha and composite reliability values for all the construct were above 0.70 demonstrating internal consistency reliability. 88 University of Ghana http://ugspace.ug.edu.gh Validity Testing for validity, the researcher assessed two types. Firstly, the convergent validity was assessed and secondly, discriminant validity was also assessed. Convergent validity is about how well the observed variables and items in the study relates. This is established by examining the composite reliability, factor loadings and average variance extracted (Gholami et al., 2013). As reported in table 4 above, each construct has achieved the loadings above 0.7, Composite reliability (CR) values of the constructs were all greater than 0.7 and average variance extracted (AVE) values were also above 0.5 meeting the threshold of 0.5 or above as recommended by Hair et al. (2014) The summary of the results are displayed in table 4 below. 89 University of Ghana http://ugspace.ug.edu.gh Table 4: Measurement scale and model indicators Average Factor Cronbach’s Composite Variance Loadings Alpha Reliability Extracted NHD1 0.794 Nurses‘ NHD2 0.727 Healthcare NHD3 0.671 0.839 0.881 0.554 Delivery NHD4 0.711 NHD5 0.761 NHD7 0.794 Occupational OHSR1 0.663 Health and OHSR2 0.792 Safety OHSR6 0.679 0.824 0.872 0.532 Regulations OHSR7 0.708 OHSR8 0.732 OHSR9 0.793 Safety SIAO1 0.714 Inspections and SIAO3 0.766 Audits SIAO6 0.763 0.739 0.835 0.558 SIAO7 0.744 SITO2 0.797 Safety SITO3 0.737 Induction and SITO4 0.742 0.816 0.867 0.522 Training SITO5 0.654 SITO6 0.722 SITO7 0.675 Source: Field Data (2018) 90 University of Ghana http://ugspace.ug.edu.gh 4.2.4 Fornell-Larcker Criterion for Discriminant Validity The discriminant validity (degree or level to which items measures definite concepts) was examined treading on heels of Fornell-Larcker standard by making comparisons of the square root of the AVEs with the correlations between constructs (see table 5). Table 5: Fornell-Larcker Standard for Discriminant Validity 1 2 3 4 1.NHD 0.744 2. OHSIT. 0.694 0.723 3.OHSIA 0.574 0.637 0.747 4.OHSPR 0.582 0.600 0.618 0.730 Note: NHD = Nurses healthcare delivery OHSIT. = occupational health and safety induction and training OHSIA = occupational health and safety inspections and audits OHSPR = occupational health and safety regulations. Source: Field Data (2018) Fornell and Larcker (1981) suggest that the value of the square root of the Average Variance Extracted (AVE) of each latent variable should be of higher value than other correlation values between latent variables. As displayed in Table 5, the AVEs square root (values in bolded) on the diagonal reported were of higher values than the corresponding column and row values, demonstrating the discriminant validity of the measures. For instance, the square root of the variable OHSIT was found to be 0.723 which exceeds the correlation values in the column of OHSIT (0.637and 0.600) and again bigger than those in the row of OHSIT (0.694). Similar observations were made for the other variables NHD, OHSIA, and OHSPR. The results indicate that discriminant validity is well established. 91 University of Ghana http://ugspace.ug.edu.gh 4.2.5 Heterotrait-Monotrait Ratio (HTMT) Standard for Discriminant Validity In assessing the discriminant validity of our constructs, we apply the Heterotrait- monotrait (HTMT) ratio of correlations which indicate an establishment of discriminant validity for HTMT value below 0.90 (Henseler et al. 2015). Discriminant validity refers to the extent to which measures of non-identical concepts are definite or discrete. Table 6: Heterotrait-Monotrait Ratio (HTMT) Standard for Discriminant Validity 1 2 3. 4 1.NHD 2. OHSIT. 0.826 3.OHSIA 0.707 0.808 4.OHSPR 0.680 0.722 0.768 Note: NHD = Nurses healthcare delivery OHSIT. = occupational health and safety induction and training OHSIA = occupational health and safety inspections and audits OHSPR = occupational health and safety regulations Source: Field Data (2018) The HTMT criterion in this study shows that discriminant validity is established. The highest correlation found is between occupational health and safety Induction and Training and Nurses Healthcare Delivery 0.826, which is within the conventional yardstick of 0.85 and below 0.90 (Henseler et al., 2015) as shown in Tables 6. Therefore, both the two types of validity in this study were established. 4.2.6 Correlation Analysis Variables In order to assess the appropriateness, the strength of the relationship as well as the direction between the variables and to examine the construct for multicollinearity, the researcher conducted the correlation analysis. 92 University of Ghana http://ugspace.ug.edu.gh Table 7: Summary of Correlation Analysis of the Measured Variables Mean Std. 1 2 3 4 5 6 7 Deviation 1. Gender 1.63 .484 1 .092 2. Age 2.00 .786 1 .119 ** 3. Educational .059 .253 1.91 .776 1 Level .316 .000 ** -.116 -.089 .161 4. OHSPR 3.6395 .55571 1 .050 .132 .006 - ** ** ** -.047 .252 .715 5. OHSIA 3.3431 .56637 .229 1 .432 .000 .000 .000 * * ** ** ** 6. OHS IND.& -.142 -.122 .198 .645 .734 2.9171 .47941 1 TRNG. .017 .039 .001 .000 .000 ** ** ** ** -.065 .033 .257 .580 .646 .719 7. NHD 3.5115 .58540 1 .277 .582 .000 .000 .000 .000 **. Correlation is significant at 0.01 levels (2-tailed). *. Correlation is significant at 0.05 levels (2-tailed). Note: NHD = Nurses healthcare delivery OHSIT. = occupational health and safety induction and training OHSIA = occupational health and safety inspections and audits OHSPR = occupational health and safety policies and regulations Source: Field Data (2018) The results of the correlation coefficient demonstrated that there was a significant and positive correlation between the independent variables and the dependent variable. Assessing the construct for multicollinearity, which is as a result of a powerful association between two or more predictor variables in a regression model, the researcher examined the correlation matrix among the predictors (Field, 2009; Hair et al. 2014). A correlation coefficient of value 0.90 or more signifies the presence of considerable multicollinearity. The outcome from table 4.2.5 of this study reported the highest inter-correlation coefficient among the predictors to be 0.734 indicating an absence of collinearity. 93 University of Ghana http://ugspace.ug.edu.gh 4.3 Structural Model Analysis After assessing the validity and reliability of the measurement, the structural model as depicted in Figure 1, representing the associations that exist between the constructs presupposed in the theoretical model was assessed. Figure 1 and Table 7 show the estimates for the full structural model. Figure 1 portrays the amount of variance 2 accounted for (R ) in the dependent variable. To define the precise paths effect level in the structural model, congruous with Chin (1998), bootstrapping was employed to generate the standard errors and t-statistics. A bootstrapping resampling technique (Efron and Tibshirani, 1993) of two hundred and eighty-six sample was used. Bootstrap speaks to a non-parametric approach for evaluating the exactness of the PLS benchmark. This enables us to evaluate the factual significance of the path coefficients. A five percent level of significance (p<0.05) was set as the measure of statistical conclusion. The significance level using the degree of the homogeneous factor estimates between the constructs specified in the aftermath t-value. Table 8 presents the results of the structural model. Table 8: Path Coefficients along with their bootstrap values and ‘T’ Values Original Sample Standard T Statistics Model Sample Mean Deviation P Values (|O/STDEV|) (O) (M) (STDEV) OHSIT. → NHD 0.481 0.481 0.055 8.716 0.000 OHSIA →NHD 0.140 0.142 0.057 2.435 0.015 OHSPR→NHD 0.207 0.207 0.058 3.582 0.000 Note: NHD = Nurses healthcare delivery OHSIT. = Occupational Health and safety induction and training OHSIA = Occupational Health and Safety inspections and audits OHSPR = occupational health and safety regulations Source: Field Data (2018) 94 University of Ghana http://ugspace.ug.edu.gh 2 The PLS-SEM results showed that the coefficient of determination R , is 0.534 for the NHD endogenous latent variable. This explains that the three latent variables, occupational health and safety regulations, occupational health and safety inspections and audits and occupational health and safety induction and training (OHSPR, OHSIA, and OHSIT) accounted for about 53% of the variance in Nurses healthcare delivery (NHD). Furthermore, in testing the associations of the structural model, the significance level was established at p<0.05 (2-tailed) (Hair et al., 2014) and the strength of the paths revealed the relationships between the variables. Hypothesis Testing H1: OHS policies and regulations significantly predict healthcare delivery of nurses. The first hypothesis tested OHS policies and regulations (OHSPR) as a predictor of Healthcare delivery. From the analysis, OHSPR had a significant and positive relationship on Nurses healthcare delivery with the original sample (β = 0.207), statistics (t = 3.582) and significant value (p < 0.000). This indicates that Nurses healthcare delivery is predicted directly and positively by OHSPR. Therefore hypotheses H1 was accepted. H2: Conducting workplace safety inspections and audits significantly improves the healthcare delivery of nurses. The second hypotheses tested workplace safety inspections and audits (OHSIA) as a predictor of Healthcare delivery. The relationship between safety inspections and audits and Nurses healthcare delivery was found to be significant with the original sample (β = 0.140), statistics (t = 2.435) and significant value (p < 0.015) which indicates that Nurses healthcare delivery is influenced directly and positively by safety inspections and audits. Therefore, hypotheses H2 was accepted. 95 University of Ghana http://ugspace.ug.edu.gh H3: OHS induction and training significantly enhances healthcare delivery of nurses. The third hypotheses tested safety induction and training (OHSIT) as a predictor of Healthcare delivery. The relationship between Safety induction and training (OHSIT) and Nurses healthcare delivery was also found to be significant with the original sample (β = 0.481), statistics (t = 8.716) and significant value (p < 0.000) which indicates that OHS induction and training directly and positively influences Nurses healthcare delivery. Therefore, hypotheses H3 was accepted. H4: OHS induction and training will significantly predict healthcare delivery of nurses more than OHS policies and regulations and workplace safety inspections and audits. The last hypotheses tested which OHS variable is the highest predictor of healthcare delivery. The above findings showed that unit increase of OHSIT leads to 0.481 increase in Nurses healthcare delivery, which is the highest impact, followed by OHSPR in which a unit increase led to 0.207 increase in Nurses healthcare delivery in public hospitals and a unit increase in inspections and audits for OHS results in 0.140 increase in Nurses healthcare delivery in the public hospitals. This indicates that among the three OHS predictors of effective healthcare delivery, safety induction and training is the most significant construct in predicting Healthcare delivery. Therefore, hypotheses H4 was accepted. 4.5 Discussions of the Research Findings This study focused on examining the effect of occupational health and safety on the service delivery of healthcare workers (nurses) in Ghana. The study specifically looked at the extent to which occupational health and safety policies and regulations (OHSPR), occupational health and safety inspections and audit (OHSIA) and 96 University of Ghana http://ugspace.ug.edu.gh occupational health and safety induction and training (OHSIT) influences employee productivity in health care delivery. The results and findings of the data analysis are discussed in line with previous studies within the framework of the theory of work adjustment. The first objective of the study was to determine whether OHS policies and regulations have a significant effect on the healthcare delivery of nurses in Ghanaian Hospitals. The results of the study revealed that OHS policies and regulations had a statistically significant and positive effect on nurses‘ healthcare delivery. This finding is due to the fact that the hospital has a health and safety policy in operation whereby nurses are supposed to be guided by safety rules and procedures at all times. This permits the nurses in the course of performing their duties, to be directed, tutored, mentored and motivated by their supervisors in ensuring safety. The existence of these safety policies and procedures makes nurses and employees in general conscious of the potential hazards in the work itself and the safe way to go about it. The development of health and safety policy that incorporates the association's responsibility to security and formally communicates targets, for example, the standards and rules to follow in circumstances of wellbeing and security at work are key and critical for a good occupational health and safety administration to reduce workplace accidents and improve organizational performance. This significant positive effect of OHS policies and regulations on the delivery of healthcare among nurses within public hospitals is consistent with the findings of previous researchers (Morwabe & Atambo 2016; Logasakthi & Rajagopal 2013) which established that OHSPR influence employee productivity to a moderate extent and further argued that the different welfare arrangements by the employer will have instantaneous influence health, physical and mental efficiency vigilance, morale and 97 University of Ghana http://ugspace.ug.edu.gh general efficiency of the employee, hence contributing to higher efficiency. This positive effect of OHS policies and regulations on the healthcare delivery of nurses‘, implied that when employees know and understand the content of the safety policies and regulations governing the workplace, they tend to perceive the work environment as conducive and makes them feel that management have them at heart. This is an indication of positive occupational health and safety management and this translate into safety behaviors and safer working practices for employees. These positive employee outcomes buttress the ability of employees to give out their best in performing their job. This corroborates the idea that institutions which highly promote health and safety policies, makes employees feel appreciated and cherished because they are exposed to less risk or danger-free work settings. These workers tend to understand the health and safety rules, work procedures as well as their working tools, which assist them to perform in an efficient and effective manner and consequently, improved performance of employees and organizational success (Safe Work Victoria 2006; Lim, 2012). Again, the existence of OHS policies and regulations creates a conducive work environment that ensures the safety and wellbeing of workers resulting in the quality of work and enhanced worker‘s productivity (Kirombo, 2015). The finding again is supported by the findings of similar studies (Danish, Ramzan & Ahmad, 2013; Kaynak et al., 2016; Taiwo, 2010; May & Schwoerer, 1994) with job performance as the outcome variable and argued that safety and health rules were significant and positively related to job performance. Furthermore, in line with Gyapong, Garshong, Akazili, Aikins, Agyepong, and Nyonator (2007) claim, employees can only fall victim if they are not conscious of the possible danger that is hidden because the worker‗s idea and knowledge about potential threats to life are inherently a means of accident prevention. 98 University of Ghana http://ugspace.ug.edu.gh This results, however, contradicted the findings of few studies that found negative and no effect between organizational health and safety policies, rules and procedures and nurses safety behavior (Silaparasetti, Srinivasara & Khan, 2017; Glendon & Litherland, 2001; Lu & Yang, 2011). This may be due to the fact that nurses may not see the mere existence of policies and procedures to be meaningful and may therefore not see the usefulness of these safety rules and procedures. Earlier research done in the Australian mining sector by (Hu, Griffin & Bertuleit 2016) indicated that if employees do not witness the mileage and significance of safety rules and procedure within the organization, there is the likelihood to report non-compliance. Thus it is very imperative for hospitals to identify plans to ensure safety policies and procedures are meaningful and their essence is made known to all nurses (Hu et al., 2016) for better performance and improved safety behaviors owing to the fact that precise workplace health and safety policy and procedures play a significant part in decreasing work accidents and injuries (Lamm, Massey & Perry, 2007). Also, these contradictions of the current results with their findings may also be attributed to context and cultural differences and different regulatory regimes or framework that governs OHS in these countries. The second objective of the study sought to investigate whether workplace safety inspections have a significant effect on the healthcare delivery of nurses in Ghanaian Hospitals. Hypotheses H2 was tested to address this research objective. The results of the study again discovered that workplace safety inspections and audits had a statistically significant and positive effect on nurses‘ healthcare delivery. This implies that whenever workplace safety inspections and audits are improved by one percent (1%) it will lead to 14% improvement in nurses‘ healthcare delivery in public hospitals, holding all other things equal. This significant outcome conforms to the 99 University of Ghana http://ugspace.ug.edu.gh literature (Donald, 2007; Morwabe & Atambo 2016), who found out that workplace safety inspections influence employees‘ productivity. They share the view that getting employees involved at all levels of the organization in safety inspections gives them the mandate to monitor or make surveillance, provide feedback, and then utilize the behavioral-based information to mark safety improvement areas. Donald (2007) explains further that the inspections also signify the provision of safer work surroundings and to commit employees to their job, hence improved productivity. The findings also agree with those of Grenslade and Paddock (2007), whose findings state that promoting workplace safety inspections is the means through which performance and productivity of employees in any company can be maximised, be it huge or small, and is the sole medium to get rid of the negative impacts and potential tragedies that emanate from workplace hazards. This finding could mean that as organizations conduct safety inspections and audits within the work setting, it translates into an improvement of the workplace which results in the conducive work environment and improved productivity of the employees. It also creates a positive impression in the minds of employees and boosts their performance leading to better service delivery and productivity. This is contradicted by the findings of (Nel, Werner, Haasbroek, Poisat, Sono, and Schultz, 2008; Jamal, 2011; Akweenda et al., 2016) in their study of occupational stress who contends that there is an inverse relationship between job stress and employee performance. They argued that occupational stress has negative aftereffects on the safety behavior and work outcomes of nurses and can create mental problems for nurses. It is concluded that once occupational stressors are predictors of female managers‘ ill-health in the work setting, organizations or firms should be conscious of 100 University of Ghana http://ugspace.ug.edu.gh these stressors for the purpose of safeguard against job performance of their female managers. The third objective of the study sought to ascertain whether conducting OHS induction and training significantly enhances healthcare delivery of nurses in Ghanaian Hospitals. Hypotheses H3 was tested to address this objective. The outcome of the study showed that OHS induction and training significantly enhanced nurses‘ healthcare delivery. This implies that when the safety induction and training of the hospital improve by one percent (1%) it will result in 48% enhancement in nurses‘ healthcare delivery in public hospitals, holding all other things equal. This supports the findings of (Donald & Cantre, 1994; Lu & Yang 2011; Vinodkumar & Bhasi, 2010; Vredenburgh, 2002) who also found the association between safety training and safety compliance and participation. (Kirombo 2015; Morwabe & Atambo 2016), also found out that induction and training provide awareness regarding health and safety policies, procedures and practices of the organization and enables employees to take safety measures thus ensuring their wellbeing, resulting into maintenance and improved productivity and quality of work. Again, this view supports the literature of other empirical studies (Zohar, 1980; Donald & Cantre, 1994; Mearns, Whitaker & Flin, 2003; Ali, Abdullah, & Subramaniam 2009; Vinodkumar & Bhasi, 2010; Boughaba, Hassane & Roukia, 2014; Keffane, 2014). This statistically significant positive effect of OHS on service delivery suggests that the nurses within the public hospitals in Ghana are conscientised on the need for an essence of safety at work and therefore incorporates the skills they acquire from the various safety training programs implemented by the hospital‘s management into their jobs. Therefore management of the hospital should pay much attention and invest in OHS training for staff as safety induction and training is a key factor in maintaining and changing 101 University of Ghana http://ugspace.ug.edu.gh employees‘ attitude and actions towards safety performance within organizations. (Mills 2007; Gyekye 2005), also asserts that investing in training projects that gives pertinent information to staff to encourage health and safety increases skills, knowledge, productivity and morale and reduces the level of risk that employees will face in carrying out their duties as well as workplace incidents, therefore, higher safety performance is attained with safety training (Hinze, Hallowell & Baud, 2013). This means that safety induction and training should be considered as an important organizational feature that distinguishes organization with successful safety program (Zohar, 1980), and a constructive way for employees to improve their expertise and knowledge of safety in institutions (Shea et al., 2016). Organizations can improve workers safety behavior by making them conscious of safety and health practices through OHS workshops, seminars, and training on the job among others (Mearns, Hope, Ford & Tetrick, 2010). These safety behaviors of employees will result in reduced staff absenteeism and sick-offs as a result of workplace injury, efficient and effective healthcare delivery, ability to meet deadlines and set targets, quality service delivery and increased organizational performance and general profitability. The findings also disputes the findings of a study by Taiwo, (2010), a study conducted within Nigeria‘s oil and gas sector to assess the influence of work setting on future worker‘s productivity realized that a numerous employment-related policies and structures such as OHS familiarization for fresh staff, training and development chances, work security among others are currently recognized as unfavorable to employees, hence negative effect for productivity. In assessing the fourth objective of the study which sought to examine which of the OHS dimensions will predict healthcare delivery of nurses most in Ghanaian Hospitals. Hypotheses H4 was tested to address this research objective. The outcome 102 University of Ghana http://ugspace.ug.edu.gh of the study revealed that among the three OHS predictors of effective healthcare delivery, safety induction and training is the most significant construct in predicting Healthcare delivery. This is evident in the findings in the sense that an improvement in OHS induction and training leads to 48.1% enhancement in Nurses healthcare delivery, which is the greatest predictor, followed by OHS policies and regulations in which a unit increase leads to 20.7% improvement in Nurses healthcare delivery in public hospitals and a unit increase in OHS inspections and audits results in a 14% increase in Nurses‘ healthcare delivery in the public hospitals. This is supported by the findings of (Kirombo 2015; Morwabe & Atambo 2016) who also found OHS training to be the highest predictor of employee productivity. This means that OHS training can empower employees and managers of companies and nurses and nurses‘ in-charge, of hospitals to become more energetic in taking safety decisions and ensuring safety at the workplace. The findings again could mean that the nurses‘ staffs are conscientized on the necessity of safety at work during safety training sections, and as such are able to transfer knowledge acquired from training to their work which might have influenced the attitudes of the nurses of these hospitals in the direction of occupational health and safety. These calls for management of hospitals to continuously conduct OHS training for their staff to enable them perform and also exert more effort into formulating better OHS policies and regulations and as well in conducting safety inspections and audits periodically at the work setting to enable the nurses and other staff deliver better services to patients. 103 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 5.0 Introduction This chapter of the study presents the summary of the research findings in relation to the research questions and objectives. In addition, it discusses the conclusion of the study and recommendations for management and future researchers. 5.1 Summary of the Findings Organizational accidents and damages cause a great quantum of employees‘ lives and damages to properties each and every year. Work-related injuries and accidents are the major concern for nurses in various hospitals, given the risky nature of hospitals environment (Nixon et al., 2015). Nurses frequently encounter daily hazards which include: physical, biological, and chemical hazards (Nixon et al., 2015). As a result of these challenges, organizations are increasingly required to aid in combatting these challenges by formulating and implementing effective OHS policies. In the light of this, the study sought to provide an understanding of the effect of OHS on the service delivery of Ghanaian nurses in the public hospitals. This study was guided by Dawis & Lofquist, (1984) theory of Work Adjustment and Victor Vroom (1960) Expectancy theory. In addressing the study objectives, the researcher adopted a quantitative methodology. Two (2) major hospitals within the central region of Ghana namely, Cape coast Teaching hospital and Trauma and Specialist Hospital, Winneba were purposively sampled for the study. The study population comprised of registered general nurses of these hospitals who were sampled using stratified and convenience sampling. 286 respondents were sampled for this study and a structured questionnaire was the main 104 University of Ghana http://ugspace.ug.edu.gh instrument used in collecting the data. The study made use of both primary and secondary data where quantitative data was secured via a survey which was analyzed using Partial Least Square Structural Equation Modelling (PLS-SEM) using Smart PLS 3. Concerning the demographic facts of the respondents in the survey, it was realized that over 60 percent of the nurses were females. With respect to the age distribution, it was realized that majority of the respondents were youthful; where most of them fell between the ages of 18 and 34. Furthermore, with reference to the educational qualifications, it was disclosed that a greater number of the respondent had obtained a diploma in nursing, with some of them going further to obtain the first degree. Finally, with respect to the number of years, it is realized that a large part of the respondent has been working for the hospitals for a period of 1to 5 years. The research findings from the data analyzed are summarized according to the research questions. Research question one: How do OHS policies and regulations influence the healthcare delivery of nurses in Ghanaian Hospitals? In answering this question, path coefficient together with their bootstrap values analysis was conducted to find out if OHS policies and regulations influence nurses healthcare delivery in public hospitals in Ghana. The result of the correlation coefficient showed that OHS policies and regulations and the healthcare delivery of nurses are significant and positively related. This means that when policies and regulations governing OHS in the hospitals are intensified, a service delivery of nurses also increases. Further analysis using the bootstrap values and paths coefficient indicates that OHS Regulation indeed predicts healthcare delivery of nurses (β = 105 University of Ghana http://ugspace.ug.edu.gh 0.207,p < 0.000) and explains 20.7% of the variations in healthcare delivery. This is accounted for through the path loadings of the following aspects of OHS policies and regulations namely; OHSR1= 0.663, OHSR2=0.792, OHSR6=0.679, OHSR7=0.708, OHSR8=0.732 and OHSR9= 0.793. Among these above-highlighted aspects, OHSR9 has the most influence whilst OHSR1 has the least. Research Question Two: How do workplace safety inspections and audits influence the healthcare delivery of nurses in Ghanaian Hospitals? In answering this question, path coefficient together with their bootstrap values and ‗T‘ value analysis were conducted to find out if workplace safety inspections and audits influence nurses‘ healthcare delivery in public hospitals in Ghana. The outcome of the correlation coefficient showed a significant positive relationship between workplace safety inspections and audits and the healthcare delivery of nurses. This means that when there is an improvement in workplace safety inspections and audits in the hospitals, service delivery of nurses also improves. Further analysis using the bootstrap values and paths coefficient indicates that workplace safety inspections and audits strongly predicts healthcare delivery of nurses (β = 0.140,p < 0.015) and explains 14% of the variations in healthcare delivery. This is accounted for through the path loadings of the following aspects of workplace safety inspections and audits namely; SIAO1= 0.714, SIAO3= 0.766, SIAO 6= 0.763 and SIAO 7=0.744. Among these above-highlighted aspects, SIAO 3 has the most influence whilst SIAO 1 has the least. Research Question Three: How do OHS induction and training influence the healthcare delivery of nurses in Ghanaian Hospitals? 106 University of Ghana http://ugspace.ug.edu.gh In answering this question, path coefficient together with their bootstrap values and ‗T‘ values and correlation analysis were conducted to find out if OHS induction and training influence nurses‘ healthcare delivery in public hospitals in Ghana. The result of the correlation coefficient revealed that the relationship between OHS induction and training and the healthcare delivery of nurses was positive and significant. This indicates that when there is an improvement in OHS induction and training in the hospitals, service delivery of nurses also improves. Further analysis using the bootstrap values and paths coefficient indicates that workplace safety inspections and audits strongly predicts healthcare delivery of nurses (β = 0.481, p < 0.000) and explains 48.1% of the variations in healthcare delivery. This is accounted for through the path loadings of the following aspects of OHS induction and training namely; SITO 2= 0.797, SITO 3= 0.737, SITO 4= 0.742, SITO 5= 0.654, SITO 6= 0.722 and SITO 7=0.675. Among these above-highlighted aspects, SITO 2 has the most influence whilst SITO 5 has the least. The last research question which sought to identify which among the OHS variables will be the highest predictor of healthcare delivery was also answered by comparing the variations in healthcare delivery explained by the three OHS predictors. From the findings, it was revealed that OHS induction and training was the highest predictor among the three followed by OHS policies and regulations and workplace safety inspections and audits respectively given their structural coefficient. In this regard, all hypotheses for the study were confirmed. 5.2 Conclusion The issue of Occupational health and safety has gained much attention among scholars and researchers over the years due to the increased rate of accidents at the 107 University of Ghana http://ugspace.ug.edu.gh workplace and therefore its importance cannot be overemphasized for all organizations for growth and success. As a result, there is a call for national policy and industry-specific regulations to control issues of health and safety at the workplace to guarantee that the environment of work is free as much as possible from undesirable elements. This has motivated the researcher to contribute to knowledge by examining how OHS practices influence the delivery of healthcare of public hospital nurses in Ghana. This study sought to investigate the effect of occupational health and safety policies and regulations on the service delivery of nurses in the Ghanaian health sector focusing on public hospitals. The results and findings showed that all the dimensions of OHS statistically, significantly predict healthcare delivery positively. This statistical computations combined with the collected data certifies the conceptual model developed out of the literature that as OHS practices are increased in organizations through investment in safety policies and regulations, safety inspections and audits and safety induction and training, it comes along with some immediate advantages as nurses become committed and fulfilled with the occupation they are connected with, staff absenteeism and sick-offs due to workplace injury is reduced, inability to meet deadlines and set targets and also the physical and mental trauma which occurs as a result of the dread of perilous workplace is diminished. All these immediate advantages have a positive effect on workers' execution which the final product is an increment in profitability for the association. The aspect of OHS policies and regulations which influences healthcare delivery most include; adequate provision of first aid kits and medical facilities at the workplace, workplace-specific policies for hazard communication, adequate provision and enforcement of the use of PPEs at the workplace and adequate provision of drinking 108 University of Ghana http://ugspace.ug.edu.gh water and sanitary facilities at the workplace. On the other hand, the aspect with less influence includes; safety and health policy in operation and conducive work environment. Additionally, carrying out safety inspections and audits as planned, timely inspections to detect faults in the hospital‘s systems/equipment/machines, arranging medical check-up at least once a year for staff and reviewing and updating safe work procedures regularly in the hospital were aspects of workplace safety inspections and audits which were found to influence healthcare delivery most. Also, some aspects of safety induction and training including; conducting occupational health and safety training/refresher courses/seminars at regular intervals, providing training about new procedures and equipment or technology for nurses, providing quality safety information throughout the organization by use of safety signage & posters and giving safety issues high priority during training programmes were found to influence nurses healthcare delivery most whilst organizing comprehensive occupational safety and health training, workshop and seminar periodically and covering the type of situations that confront nurses in their job in workplace health and safety training also moderately influence healthcare delivery in hospitals. The study concludes that, with the presence of OHS governing strategy that fosters a positive working environment to protect workers from experiencing sickness and wounds at the public hospitals, nurses will be willing to perform and deliver good healthcare to patients. Hence it is crucial that safety policies and guidelines need to formulated, strictly enforced and adhered to. Supervisors, with support from management, must ensure that people placed under their responsibility adhere to safe work policies and procedures. Constant revitalizing training to enhance abilities, expertise and worker education and training, as well as effective communication to all at the workplace concerning health 109 University of Ghana http://ugspace.ug.edu.gh and safety issues are crucial and will improve the understanding with respect to safety perspectives among employees and improve safety behaviours. Persistent OHS inspections, holding consciousness meetings, investigation of events and procedures for reporting must be seen as an essential component of management commitment. Implications for Practice This investigation features safety induction and training as the most paramount indicators of worker productivity or service delivery. Occupational health and safety assume a huge part in any work surroundings, hence, it is indispensable and crucial to specify that setting up OHS administration policy and framework alone can't solve the problems of wellbeing and security in the public hospitals in Ghana on the grounds that the need for improved efficiency, quality administration and viability of OHS administration is a requirement of the health sector (Battaglia, Passetti, & Frey, 2015). For example, the significant positive relationship between safety induction and training and nurses‘ healthcare delivery depicts that stimulating an OHS framework through legitimate inspections and training will rejuvenate and empower the nurses to perform to the best of their abilities towards accomplishing the hospitals‘ objectives. Effective execution of OHS administration practices, for example, hazard communication policy, provision of workplace drinking water and sanitary facilities, PPEs, first aid kits and emergency facilities, timely inspections and audits, medical check-up and comprehensive occupational health and safety training might result in higher employee efficiency. In this regard, (Anitha, 2014) stressed that higher profitability genuinely prevails when the safety and well-being of employees are the highest need of an organizations‘ management. In light of the expectancy theory, employees will enhance their abilities and commitment to the organization, when management assumes responsibility and give recognition to the wellbeing and 110 University of Ghana http://ugspace.ug.edu.gh security of workers. Thus, the administration of public hospitals in Ghana should give careful consideration to safety induction and training on well-being and security issues of their nurses. Moreover, the understanding of OHS administration and service delivery in public hospitals is paramount for the reason that the nurses‘ readiness to perform diligently has both immediate and incidental cost and efficiency consequence. Fostering a decent OHS strategy is a critical method to maximize workers insight of the institution‘s perspective to deal with security and well-being cultivates a conviction of being secured, relief and sense of belonging in the minds of workers and hence this converts into employee satisfaction (Sembe, & Ayuo, 2017) and ultimately improve efficiency. This infers occupational damage rates, unforeseen happenings and disasters can be brought to the barest minimum with a decent occupational health and safety administration. Additionally, most mishaps and infirmities at the public hospitals are a result of the introduction to hazard and failure in equipment and chemical use. These, to a great extent, do influence service delivery, profitability, and ability to retain and manage talents in the public hospitals. Effective safety inspections and training in the administration of safety and health will elevate the nurses‘ service delivery. In this way, the management of public hospitals and other numerous organizations ought to connect a great deal of significance to OHS management practices and to embark on behaviors and practices that advance the security and prosperity of its employees. Majority of institutional sacrifices in terms of finance, training, physical resources and time should often be geared towards safeguarding the effective implementation of OHS management practices. Management should emphasis on the creation and execution of an approach that sharpens and takes into consideration arrangement of 111 University of Ghana http://ugspace.ug.edu.gh adequate welfare administrations, for example, drinking water facilities, sanitary facilities, legal rights concerning OHS administrations and conducive workplace in order to enhance work fulfillment levels of the workers in their workplaces. The investigation additionally prescribes to organizations to put more emphasis on and to fund the use of extravagant OHS practices and plans. The arrangement of composed crisis design, medical aid offices in their work settings, testing of crisis methodology, and nearness of trained experts on tragedy management, clearing systems, exhibition of contacts for emergencies and show of departure techniques, workers training on the utilization of crisis apparatus within the work settings will emphatically impact work fulfilment levels and will thus enhance productivity. 5.3 Recommendations The following recommendations are made for consideration and for implementation based on the research findings: Even though there are some policy documents regulating OHS such as the Ghana Labour Act, Factories Shop and Offices Act and the Ghana health service and Teaching hospital Act in existence, industry-specific policies need to be developed and implemented. Various stakeholders within industries need to formulate and develop a comprehensive OHS policy to encourage their members. From the study, it was clear that all three dimensions contribute to service delivery of nurses and therefore the public hospitals should continue to invest in the various aspects of the three OHS dimensions especially OHS induction and training which according to the findings is the highest predictor of nurses service delivery. Therefore the study recommends that public hospitals should invest more in identifying the OHS training needs of nurses and to always guarantee regular training of the nurses to 112 University of Ghana http://ugspace.ug.edu.gh equip them with the requisite expertise, knowledge and right attitudes that will propel employees to work efficiently and effectively to achieve their targets, therefore, improving their services. Management should ensure that there is adequate provision of quality safety information throughout the organization by use of safety signage and posters and also ensure that staff is trained with respect to new procedures, equipment, technology and more especially chemicals and vaccines used by the nurses in their operations. The study recommends that the public hospitals should carry out timely inspections to detect faults in systems, equipment and machines as delay in the same hinders continuity and adversely affects service delivery. The study again recommends that the hospitals should continue to embrace and keep improving on the aspects which were found to contribute most to employee service delivery and also devise new strategies to improve on the other aspects that have less impact on the service delivery of nurses. 5.4 Recommendations for Future Research The direction for future researchers should concentrate on this line of research examining other possible dimensions of occupational health and safety. Further studies could look at OHS and other employee outcomes with responses from not only the nurses but other healthcare workers such as physicians, surgeons, administrators and laboratory technicians as this study focused on the service delivery of nurses. Again the study obtained the primary data through the use of self- administered questionnaires and analyzed them quantitatively, future studies could also explore the impact of OHS in different sectors in Ghana as well as sub-Saharan Africa considering the moderating role of some potential variables by obtaining data through interviews, surveys among others and analyze them qualitatively. Finally, this 113 University of Ghana http://ugspace.ug.edu.gh study analyzed how OHS variables influence the healthcare delivery of nurses. However, other empirical studies show that OHS affect other variables like employee engagement, turnover intentions, and organizational commitment. 114 University of Ghana http://ugspace.ug.edu.gh REFERENCES Abddllah, N. A. C., Spickett, J. T., Rumchev, K. B. & Dhaliwal, S. (2009), Assessing employees‘ perception on health and safety management in public hospitals. International Review of Business Research Papers, 5(4) Adei, D., & Kunfaa, E. Y. (2007). 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I therefore humbly request that you participate in this study. However, kindly note that participation is completely voluntary, and any information provided herein shall be treated anonymously, confidentially and for academic purposes only. The study will go a long way to inform human resource practitioners and consultants on the management of occupational health and safety (OHS) in organizations. All questions and comments regarding this research should be directed to the researcher. Richard Sam-Mensah (0246337287) Email: samrichie.rsm@gmail.com. Thank you for your willingness to respond to this questionnaire and your co- operation. SECTION A: DEMOGRAPHIC DATA Please kindly answer the following by ticking (√) the appropriate answer of your choice. 1. Gender: Male [ ] Female [ ] 2. Age: 18-24years[ ] 25-34years[ ] 35-44years[ ] 45-55years[ ] Over 55years[ ] 127 University of Ghana http://ugspace.ug.edu.gh 3. Marital Status: Single[ ] Married[ ] Separated/divorced[ ] Widowed[ ] 4. Educational level: Certificate [ ] Diploma[ ] First Degree [ ] Professional [ ] Post Graduate degree [ ] 5. Number of years spent in the nursing profession: Less than a year [ ] 1-5 years [ ] 6-10 years [ ] 11-15 years [ ] 15years and above [ ] 6. Current job status/position: Supervisory[ ] Non-supervisory[ ] Other (specify) ……..….. 7. Department of work: …………………………………………………. Instructions: Use the following scale in responding to all the statements in the different sections: Very Low = 1 Low = 2 Medium = 3 High = 4 Very High = 5 There are no wrong answers. It is important that you complete all the items on the scales. SECTION B: The following statements concern you and the occupational health and safety policies and regulations of your organization. Kindly answer the following by circling the appropriate answer of your choice. 1 This hospital has safety and health policy in operation. 1 2 3 4 5 2 There are workplace specific policies for hazard 1 2 3 4 5 communication in this hospital 3 I know the content of the health and safety policy of this 1 2 3 4 5 hospital. 4 The health and safety policy of this hospital is available near 1 2 3 4 5 to my work place or in book form. 5 This hospital has made me aware of my legal rights 1 2 3 4 5 concerning Occupational Health and Safety 128 University of Ghana http://ugspace.ug.edu.gh 6 This hospital‘s work environment is conducive for me. 1 2 3 4 5 7 There is adequate provision of drinking water and sanitary 1 2 3 4 5 facilities at the workplace. 8 There is adequate provision and enforcement of the use of 1 2 3 4 5 personal protective equipment at the workplace 9 There is adequate provision of first aid kits and medical 1 2 3 4 5 facilities at the workplace. SECTION C: The following statements concern you and the safety inspections and audits of your organization. Kindly answer the following by circling the appropriate answer of your choice. 1 Safety audits and inspections are carried out as planned in 1 2 3 4 5 this hospital. 2 This hospital involves employees during safety inspections 1 2 3 4 5 and audits. 3 There is timely inspection to detect faults in 1 2 3 4 5 systems/equipment/machine in this hospital. 4 Timely remedial actions are taken wherever and whenever 1 2 3 4 5 there is an accident or dangerous occurrence in this hospital. 5 Supervisors always ensure that staff wears the necessary 1 2 3 4 5 protective devices while working in this hospital. 6 This hospital arranges medical check-up at least once a year 1 2 3 4 5 for staff. 7 Our hospital reviews and updates our safe work procedures 1 2 3 4 5 regularly. 129 University of Ghana http://ugspace.ug.edu.gh SECTION D: The following statements concern you and the safety induction and training of your organization. Kindly answer the following by circling the appropriate answer of your choice. 1 Newly recruited staff are trained and/or inducted on Occupational Health and Safety before officially allocated 1 2 3 4 5 duties in this hospital. 2 This hospital conducts Occupational Health and Safety 1 2 3 4 5 training/refresher courses/seminars at regular intervals. 3 This hospital provides training about new procedures and 1 2 3 4 5 equipment or technology for employees. 4 This hospital provides quality safety information throughout 1 2 3 4 5 the organization by use of safety signage & posters. 5 This hospital organizes comprehensive Occupational Safety 1 2 3 4 5 and Health training, work shop and seminar periodically 6 Safety issues are given a high priority during training 1 2 3 4 5 programs in this hospital. 7 Workplace health and safety training covers the type of 1 2 3 4 5 situations that nurses face in their job. 130 University of Ghana http://ugspace.ug.edu.gh SECTION E: Kindly answer the following by circling the appropriate answer of your choice. 1 Occupational Health and Safety measures of this 1 2 3 4 5 hospital improve service quality (Healthcare delivery) of the hospital. 2 Occupational Health and Safety measures of this 1 2 3 4 5 hospital improve my performance in healthcare delivery (output). 3 Occupational Health and Safety measures of the 1 2 3 4 5 hospital reduce staff absenteeism and sick-offs due to workplace injury. 4 Occupational Health and Safety measures of this 1 2 3 4 5 hospital improve on my efficiency and effectiveness in healthcare delivery. 5 Occupational Health and Safety measures of this 1 2 3 4 5 hospital help increase organizational performance and general profitability. 6 Occupational Health and Safety measures of this 1 2 3 4 5 hospital enable me to meet deadlines and set targets. 7 Occupational Health and Safety measures of this 1 2 3 4 5 hospital improve time management at the workplace. 131 University of Ghana http://ugspace.ug.edu.gh University of Ghana http://ugspace.ug.edu.gh University of Ghana http://ugspace.ug.edu.gh