Trainer and trainee agency across the work-training continuum in health care: a Safety-II-oriented approach

Occupational Health and Safety (OHS) is a crucial field, especially in complex sectors like healthcare (Cervai and Polo, 2015; Eklof and Ahlborg, 2016; Sa’diyah, 2024; Sharma et al., 2023). Historically, OHS operated as a technical domain targeting the elimination of physical, chemical and biological hazards (Flynn et al., 2022), guided by a biomedical cause-and-effect model (Schulte et al., 2022). In 1948, the World Health Organization (WHO) promoted a biopsychosocial approach on health that integrates social and psychological dimensions alongside biological determinants (Engel, 1960; Flynn et al., 2022; Franklin and Gkiouleka, 2021). Today, this perspective and its systemic orientation have become increasingly relevant within organisations (McDonald et al., 2019; Schmitt et al., 2025; Schulte et al., 2022), also highlighting the role of safety culture – shared values and practices through which organisation’s members perceive, prioritise and act upon safety (Reason, 1997, p. 194) – in safety promotion.

Recent studies also highlight growing attention to the agentic interaction between workers and their context, recognising the role of lived experience in managing complexity (Homann et al., 2022; Le Coze, 2022). Workers are interpreted as agentic, autonomous experts who adapt their routines to real-world complexity, using experience to manage variability and ensure successful outcomes (Homann et al., 2022). This shift challenges traditional OHS assumptions, recasting human error not as a primary cause of accidents but as a retrospective social judgement (Dekker, 2002; Reason, 2000; Schulte et al., 2022). This approach centres on sensemaking – how people interpret their social reality to act (Weick, 1995) – and acknowledges workers as experts of their work, who create situated routines to resolve goal conflicts, sometimes deviating from rules (Dekker, 2018; Dekker and Pitzer, 2016). This perspective is supported by the Safety-II approach, which emphasises learning from everyday practice rather than from adverse events, as opposed to the Safety-I approach, which defines safety as the absence of incidents managed through rules and procedures (Dekker and Pitzer, 2016; Hollnagel, 2014; Patriarca, Leonhardt and Licu, 2022).

Within Safety-II, everyday work is central (Hollnagel, 2014), as it provides opportunities to identify weak signals that allow for the anticipation of future incidents (Patriarca et al., 2022). A weak signal refers to subtle cues, often detected by frontline workers, that may precede adverse events (Schoemaker and Day, 2009). For instance, a home-care request lacking a patient’s medical history may signal a communication gap between the referring entity and frontline staff, exposing them to risks like patient aggression (Carman, 2020). It is argued that the identification of weak signals allows for intervention before incidents occur (Brizon and Wybo, 2009; Patriarca et al., 2022), thereby promoting resilience within organisations (Pillay, 2016; Weick and Sutcliffe, 2001).

OHS training practices have traditionally been anchored in a top-down Safety-I logic focused on workers’ compliance with procedures designed to control known hazards, often to satisfy legal requirements (Konijn et al., 2018; Robson et al., 2012). However, several authors highlighted the need to move towards a Safety II-oriented training (Bartman et al., 2021; Liu and Li, 2022; Peñaloza et al., 2019) capable of facilitating dialogue and eliciting practitioners’ experiential knowledge to generate new insights like weak signals (Bartman et al., 2021; Nicolaidou et al., 2021, 2022). To this end, OHS trainers’ pedagogical choices and facilitation practices play a decisive role in shaping how workers internalise and apply safety principles within complex work environments (Curcuruto et al., 2024; Sorrentino and Stabile, 2024).

OHS trainers occupy a key position in shaping organisational performance, as they determine learning goals, content and oversee post-training activities (Freitas and Silva, 2017). Their role is critical in knowledge translation (Khamarko et al., 2012) and in supporting trainees through complex, real-world problem-solving (Mollo et al., 2019). OHS trainers can be internal professionals used by the organisation who usually have a deep, organisation-specific knowledge, or external, often consultants (Freitas and Silva, 2017). Both aim to protect workers from hazards, also ensuring a continuity through retraining (Freitas and Silva, 2017). They are expected to act as facilitators of self-directed adult learning (Knowles, 1978), capable of shaping attitudes and nurturing a positive safety culture (Casey et al., 2021; Freitas and Silva, 2017). Therefore, effectively implementing innovative, Safety-II-oriented programmes requires OHS trainers’ sensitivity and competence in recognising and working with weak signals, anticipation and adaptation.

Increasing organisational complexity, intensified by crises like the COVID-19 pandemic, has reinforced the need to integrate Safety-II and resilience-based approaches in the health-care sector (Ashari, 2022; Ellis et al., 2023; Hollnagel, 2014; Milios, 2017; Pillay, 2016). In this study, we focus on the Italian context, and the regulatory boundaries, i.e. Decreto Legislativo 9 aprile (2008), which could be implemented by trainers and organisations in a compliance-based curriculum that could overlook the adaptive competencies health-care professionals – such as nurses, physicians and medical assistants – have. However, although the Italian legislation defines the mandatory topics to be covered, the specific content (e.g. examples or theoretical safety-related perspectives) and teaching methodologies are left to the trainers’ discretion to interpret these requirements through different paradigms.

Within this context, this study aims to explore how Italian OHS trainers are prepared to incorporate the Safety-II approach into their practice, navigating this inherent tension. The research question is the following:

OHS training is framed as a primary tool for safety management, especially in high-risk sectors (Freitas and Silva, 2017; Liu and Li, 2022; Pham, Lingard and Zhang, 2023; Ricci et al., 2016; Robson et al., 2012). Its traditional foundation rests on the assumption that accidents are primarily caused by unsafe worker attitudes or behaviours (Endroyo, Yuwono and Mardapi, 2015; Laberge, MacEachen and Calvet, 2014). Consequently, the primary goal of training is to modify human behaviour by increasing worker knowledge, skills and safety attitudes (Liu and Li, 2022; Mollo et al., 2019; Robson et al., 2012).

Within OHS training, the focus on technical knowledge, skills and competencies plays a crucial role. Knowledge is the outcome of the assimilation of information, comprising facts, principles, theories and practices which can be theoretical and/or factual. Skills refer to the ability to apply knowledge to complete tasks and solve problems, while competence represents the proven ability to use knowledge and skills with responsibility and autonomy (European Parliament and Council, 2008). Rooted in cognitive-behavioural paradigms, OHS training aims to shape workers’ attitudes and actions by transmitting correct and standardised procedures for safe task execution (Laberge, MacEachen and Calvet, 2014; Mollo et al., 2019; Palka and Hąbek, 2017), such as teaching proper patient lifting techniques to prevent the musculoskeletal disorders for health-care professionals (Che Huei et al., 2020). Furthermore, increasing attention has been paid to non-technical skills (NTS), defined as the cognitive, social and personal capacities that enable individuals and teams to maintain safe and effective performance under pressure (Ellis et al., 2023; Liu and Li, 2022). Flin and O’Connor (2008) identified seven key NTS relevant for OHS contexts – situational awareness, decision-making, communication, teamwork, leadership, stress management and fatigue management – forming a foundation for resilience-based approaches (Bagarotto, 2021).

Beyond individual competencies, another major area of OHS education concerns the enhancement of safety culture (Liu and Li, 2022) and safety climate, namely, workers’ perceptions of the importance of safety at work (Neal, Griffin and Hart, 2000). According to Christian et al. (2009), safety climate affects safety outcomes (behaviours like compliance and participation) indirectly through psychological mediators such as safety knowledge and safety motivation. However, training interventions targeting safety climate typically aim to increase safety knowledge and strengthen compliance, reduce dangerous deviations and promote collective awareness of safety regulations (Liu and Li, 2022; Ricci, Panari and Pelosi, 2022). Finally, empowerment represents a further goal, supporting the development of safety citizenship’s behaviours and safety voice (Noort, Reader and Gillespie, 2019) – i.e. proactive actions such as speaking up about hazards and contributing ideas for safer practices (Konijn et al., 2018; Robson et al., 2012). A central question in OHS training is how to ensure training transfer – i.e. the extent to which acquired knowledge and skills are applied in the workplace and retained over time (Burke and Hutchins, 2007; Freitas and Silva, 2017; Pham, Lingard and Zhang, 2023). The debate on training effectiveness often revolves around the “model of training” (Endroyo, Yuwono and Mardapi, 2015, p. 83), distinguishing between traditional approaches centred on top-down theoretical instruction and participatory models grounded in real-world scenarios and collaborative problem-solving.

Kolb (1984), a central author in experiential learning theory, proposed a learning cycle building on Lewin’s (1951) group dynamic research. The cycle comprises four stages: concrete experience, reflection on that experience, conceptualisation and experimentation in new situations (Kolb, 1984, p. 21). For Kolb (1984), learning is a recursive process in which knowledge emerges through the analysis of a “concrete” and “immediate” experience (p. 9) that, through a process of inquiry, is transformed into learning. Learners therefore integrate their subjective dimension (comprising personal lived experiences and feelings) with instructional tools (referred to as “technology”, p. 11), such as simulations or trainer-designed cases, which stimulate reflection.

In health care, two key experiential learning methods enhance safety in clinical practice: simulation and supervision. Simulation uses realistic scenarios to develop skills and promote reflection, especially through debriefing (Cheng et al., 2014). Supervision provides guided oversight through either direct observation or reflective debriefing after patient contact (Snowdon et al., 2016). Supervisors can identify gaps in safety performance and frame experience as a learning resource to align competencies with workplace demands (Kolb, 1984).

A 2012 review found that training could modify worker behaviours but could not demonstrate an impact on health outcomes (Robson et al., 2012); a subsequent meta-analysis provided a clearer picture: methods involving direct engagement, active teaching and, critically, hands-on practice demonstrated the greatest effectiveness on behavioural and health outcomes (Ricci et al., 2016). This evidence supports a pedagogical shift towards approaches grounded in situated action and social interaction (Laberge, MacEachen and Calvet, 2014).

The effectiveness of training depends significantly on the trainer (Freitas and Silva, 2017). The role of OHS trainers is a largely unexplored area in academic literature (Freitas and Silva, 2017; Khamarko et al., 2012). Few studies describe them as pivotal figures who can shape organisational outcomes by defining learning objectives, content and follow-up activities (Freitas and Silva, 2017). This is true for both classroom and on-the-job training, where the trainer’s technical expertise, teaching ability and relational skills are paramount, especially when guiding a learner through complex problem-solving in a real-world setting (Mollo et al., 2019).

The role extends far beyond being a subject-matter expert. Trainers must be effective facilitators of knowledge translation (KT), the process through which trainees apply new skills in their clinical practice (Khamarko et al., 2012). This requires a combination of technical mastery and strong communication skills, as being competent in a job does not automatically translate into an ability to teach it effectively to others (Mollo et al., 2019).

Research in the health-care sector highlights concrete KT strategies, such as actively familiarising themselves with trainees’ work environments, tailoring content to specific needs, engaging organisational stakeholders to secure buy-in and providing crucial post-training support to help trainees overcome implementation barriers (Khamarko et al., 2012). This proactive engagement also helps build trust and respect, which are key to a positive safety culture (Mollo et al., 2019). However, for this process to be effective, trainers themselves must feel a sense of responsibility and believe in their own competencies (Freitas and Silva, 2017; Freitas, Silva and Santos, 2017), which in turn requires strong organisational support in sustaining learning objectives and providing the trainer with the necessary resources (Freitas et al., 2017). Consequently, trainers are also key agents of change, responsible for championing innovations (Mollo et al., 2019).

Given this critical and multifaceted role, investing in their development through Train-the-Trainer (TTT) programmes represents a strategic priority. This is particularly relevant in complex environments such as health care (Fraboni et al., 2024), where early recognition and interpretation of weak signals can prevent incidents and support adaptive, learning-oriented safety practices.

This study was conducted in 10 Italian public hospitals and involved 21 trainers. Public hospitals constitute the majority of health-care facilities in the country.

Participants were 11 internal trainers – 7 Health and Safety Manager (HSM) and 4 Health and Safety Assistant (HSA) ^[1] – and 10 external trainers. Their professional experience in OHS training ranged from 1 to 5 years (beginners) to intermediate level of experience (5–15 years) to over fifteen years (very experienced). Both HSMs and HSAs manage internal OHS training activities. They usually complete specific OHS Train-the-Trainer (TTT) programmes to qualify them as OHS trainers, covering topics established by Italian regulation, such as general and specific risks, roles and responsibilities and risk mitigation strategies. HSMs in this study held degrees in Biology or Engineering, while HSAs possessed specialised qualifications in Workplace Prevention Techniques. Unlike HSMs and HSAs, who have in-depth knowledge of the hospital context and frequent contact with health-care professionals, external trainers are freelance professionals invited to deliver specialised training modules. In this study, their degrees were usually in Work and Organisational Psychology. These trainers are often academics or consultants whose professional expertise aligns closely with the training topics.

We used semi-structured interviews to collect our empirical data. Through them, we explored how trainers conceptualised Safety-II principles, anticipation and weak signals within their training practice, as well as how they perceived the role and purpose of training itself. We explored whether weak signals emerged during training, in what ways they did so, and how participants elaborated them. We also investigated how trainers understood training and professional updating for workers, and how they viewed the role of everyday experience in learning processes. When these trainers were already familiar, the dialogue focused on how they interpreted and applied them in their own teaching; when the concepts were unfamiliar, they were first introduced through examples to clarify. For instance, we provided examples (such as the silence in a room, or the placement of ward doors that might cause confusion about the location of an emergency exit as weak signals), and then collaboratively explored them during the interview.

For this reason, interviews – conducted as peer-level conversations between the interviewer (this study’s first author) and the participating trainers – were highly dialogical, co-constructed, allowing for shared meanings to surface. Written informed consent was obtained from all participants prior to each interview. Each interview, lasting approximately one and a half hours, was conducted online via Microsoft Teams, recorded and later transcribed verbatim.

The reflexive thematic analysis method was adopted following the inductive approach proposed by Braun and Clarke (2021). NVivo (version 13, ©Lumivero) facilitated the inductive mapping of the data set, as well as the organisation of codes, themes and annotations essential for describing the emerging patterns.

Following the familiarisation phase, the analysis involved creating numerous first-level codes, which were then grouped by semantic similarity into broader themes. For example, codes referring to the trainees’ daily work were clustered under the label “Daily work”. This cluster was closely related to “Practical learning” and “Practical expertise”, which captured the need to value hands-on experience, and to “Open dialogues”, which referred to discussions about daily work. Ultimately, these interconnected categories were synthesised under the overarching theme of “The Training Gym”, representing training as a preparatory space for everyday practice.

The development of codes and themes was guided by the research objectives. This was an iterative process of constructing, deconstructing, and reconstructing themes, aimed at developing a nuanced and coherent “story” of the results.

All participants confirmed that no formal curriculum focused on the topic of Safety-II principles and weak signals has ever been delivered. One HSM and one HSA reported having previously heard about weak signals, as did six external trainers; however, everybody reported being sensitive about what weak signals are, even if they were not explicitly defined as such. Indeed, weak signals were often described as tacit or implicit experiences, “gut feelings”, or intuitions as discussed by trainees during the training sessions. Four themes resulted from the analytical process, as presented in Figure 1.

A consensus emerged among all trainers: training can no longer be a top-down transmission of skills, but must instead be a space for sharing daily work experiences. This is particularly crucial for workers with high experience. According to the prescriptive Italian regulations, all workers must complete 4 h of basic training on risk and hazard, followed by a specific module of 4–12 h based on risk level. Furthermore, at least 6-hour refresher training is required every five years. These timeframes establish only the minimum legal requirements, as the overarching regulatory obligation is to provide training that effectively responds to real-world needs. These needs encompass the specific hazards of the professional role and the continuous evolution of workplace risks. This structure is designed to ensure a common foundation of safety-related knowledge, while also providing periodic opportunities to update competencies in response to evolving workplace risks and needs. Reflecting this, both internal and external trainers described their role as bringing value to simple formal requirements. They positioned themselves as active contributors, enriching the training offer with their own professional and personal experience to better respond to both participants’ needs and the specific organisational context.

Internal trainers noted that while these repeated modules are intended to maintain awareness, training in practice often remains a formal exercise, failing to leverage the richness of healthcare professionals’ experiential knowledge. It is precisely through the trainers’ active reinterpretation that these mandated sessions can acquire a deeper, more meaningful purpose:

The training space is thus transformed into an experimental “gym” (External trainer, expert), a reflective environment where participants can deconstruct their everyday practices to prepare for real-world complexities. In the high-variability context of hospitals, this provides a protected space for co-constructing knowledge from personal experience. The pedagogical objective therefore shifts from top-down instructions to bottom-up facilitated inquiry. This collective exploration moves beyond past events to consider potential alternative outcomes, aiming to interpret and pre-empt the latent drivers of error, such as emotional responses, limited experience or fragmented reasoning.

In this perspective, the trainer and trainees are recognised as complementary experts. The trainer’s role is to create a context in which trainees can reinterpret their “experiential mental maps” (External trainer, expert) and enrich them with new frameworks for understanding reality; by leveraging the participants’ deep contextual knowledge, the trainer’s goal is to help them leave with a “revised social map” (External trainer, expert) and greater confidence.

The training gym thus plays a crucial role in bridging the gap between formal procedures and the highly variable nature of hospital work, where workers develop adaptive, tacit skills that protocols cannot capture and competencies traditional training programmes rarely consider. External trainers recognised that their role often does not involve creating new competencies from the ground up, but rather making the tacit and adaptive skills already possessed by workers explicit and open to reflection. As one external trainer noted, “the training’s value lies in helping participants elaborate on and give structure to what they already have” (External trainer, expert). In their words, the potential of such training can only be realised under one fundamental condition: it must be a space of freedom and psychological safety. This is especially vital given that in hospitals, structured opportunities for sharing are rare due to heavy workloads, fear of exposure, and a weak reporting culture. In this context:

For training to be effective, participants must feel free to discuss what actually happens, beyond rules and protocols, without fear of judgment. Trainers emphasised that adopting a “no-blame approach” (External trainer, expert) is essential to create the conditions for participants to analyse and discuss their real-world challenges openly.

Theme 2 marks the evolution from the reflective “gym” to a “Foresight Field”, shifting the focus from past experiences to future preparedness. Cultivating this preparedness, as one external trainer articulated, involves acting “with a cool head” and learning to “stay with fear” (External trainer, expert) without losing clarity, skills rooted in deep self-awareness and emotional regulation.

Echoing this, all trainers asserted that true contextual awareness transcends procedural knowledge, demanding a systemic understanding of how work is done. The capacity to recognise and interpret weak signals thus emerges as a pivotal skill. While these signals are ignored by conventional training, they surface organically and with transformative power within this reinterpreted pedagogical space:

Discussing weak signals in the classroom enables training to act as an “organisational sensor” (External trainer, expert), revealing underlying dynamics and critical issues. All trainers, however, identified a widespread limitation: many professionals struggle to recognise these signals, not due to inattentiveness, but because they lack the cognitive frameworks and conceptual tools needed to organise and interpret what they perceive. To address this gap, training should operate across multiple levels. It needs to enhance workers’ meta-reflective and situational analysis skills, enabling them to critically examine their actions and interpret weak signals within context. At the same time, it should involve employers, cultivating attentiveness to signals emerging from the workforce and ensuring that information “from below” (Internal trainer, HSM, expert), i.e. the operational level, reaches top management to prompt timely interventions.

Both internal and external trainers identified realistic scenario simulations as a prime tool for developing these skills, valuing them for safely heightening awareness and allowing participants to practise managing the unexpected. They also highlighted collaborative methods like case studies and reflective practices such as journaling to help internalise conscious frameworks for action. Yet, despite this consensus on effective methods, trainers confirmed a critical gap: the complete absence of any structured programme dedicated to developing the general competence of weak signal detection.

All trainers agree: non-technical skills (NTS) are increasingly central in training programmes, especially in complex contexts like hospitals. The Italian regulation is primarily focused on technical safety, even if it does not preclude the integration of NTS, such as communication in courses for safety supervisors. On the contrary, there is a growing recognition of their relevance. This is closely linked to the previous themes: the recognition of the operational context’s value and the understanding that a purely regulatory or bureaucratic approach cannot address the variability and unpredictability inherent in healthcare settings.

Internal trainers identified a critical imbalance in OHS training, arguing that it wrongly prioritises technical topics over foundational NTS. They championed communication as an essential, first-line safety tool and promoted situation awareness, a continuous attentiveness no technical expertise can substitute, as a core skill. They suggested training should focus on helping workers recognise and restore diminished awareness. Likewise, critical thinking was framed as a cultivated sensitivity required to counter the complacency of experience, which can lead to overlooking familiar weak signals.

Crucially, this focus on NTS does not diminish technical proficiency. Instead, trainers emphasised a holistic perspective, asserting that TS and NTS are “deeply linked” (External trainer, expert). This powerful critique of a divided skillset led many trainers to reject the conventional TS/NTS separation as simplistic. In its place, they proposed the unified notion of “situated professional competence” (External trainer, expert): a single, integrated construct where technical, relational and reflective skills are understood to be continuously and inseparably intertwined within the fluid, complex practices of daily work.

This perspective calls for a rethinking of training design. Trainers underscored the importance of highly contextualised programmes grounded in the observation of real work and professionals’ lived experiences:

All trainers argued for a systemic approach to safety that transcends a narrow, compliance-oriented perspective, which they deemed inadequate. They critiqued the common hospital practice of managing safety, quality and clinical risk in departmental silos, a structure that hinders a unified view. Training, in this context, becomes a unique arena for fostering this systemic understanding. As external trainers reported, it is here that participants identify organisational “blind spots” (External trainer, expert), revealing how safety issues are deeply embedded within the “everyday life of the facility” (External trainer, expert).

The inadequacy of a narrow approach, all trainers argued, lies in its failure to recognise the interdependence of all organisational domains. They illustrated this powerfully: a “clinical risk”, (Internal trainer, HSM, expert) like a patient infection, is simultaneously a worker safety issue due to the stress it creates for staff. This insight reframes organisational boundaries. For this reason, all trainers stressed that training must catalyse cross-functional dialogue, as it is this very interaction that generates the “extra information” (Internal trainer, HSM, expert) required to transform partial perceptions into meaningful weak signals:

This study contributes to the workplace safety-related learning literature by illuminating the nuanced and agentic process through which OHS trainers reflect on their practice within a highly prescriptive regulatory system, shaping the development of OHS training from a Safety-I to a Safety-II perspective. Our results uncover the extent to which trainers, positioned at the nexus of formal mandates and operational reality, act as crucial mediators who pragmatically expand the compliance-oriented framework (Bartman et al., 2021; Liu and Li, 2022; Peñaloza et al., 2019) through reinterpretation and adaptation in practice.

A major shift concerns the attempt to minimise the distance between theory – represented by Italian regulatory frameworks and guidance on known risks – and practice, namely, the everyday work contexts experienced by workers, particularly during refresher training for experienced staff. In this sense, the study places the health-care worker’s experience at its core (Le Coze, 2022), supporting the classical experiential learning model developed by Kolb (1984) while also extending it in important ways.

As in Kolb’s framework (1984), personal lived experience is the essential starting point for learning, which emerges through reflection and analysis. This is reflected in Theme 1, where training is described as a “psychosocial gym”, a space where individuals bring their own experiences and actively work on them, thereby generating learning. In this sense, learning remains subjective and grounded in the interpretation of experience. However, whereas Kolb (1984) acknowledges that learners enter training with prior ideas, his approach typically relies on structured, “here-and-now” (p. 10) experiences designed by the trainer (such as exercises, role plays and simulations) to trigger the learning process. In contrast, this study shows that experience is not primarily constructed within the training setting, but it emerges from everyday work (Le Coze, 2022) and enters the training environment spontaneously. Indeed, it may refer to events that occurred long before they become subject to discussion.

Moreover, experience may even refer to situations that have not yet taken place, as in Theme 2 – Foresight Field, where discussions around weak signals require “having an experience in the future”. This makes the application of the experiential training approach less predictable than in Kolb’s model, and demands greater flexibility from trainers. Critically, the training setting enables participants to mobilise tacit knowledge (Polanyi, 2009) and competencies that already exist and reshape them for everyday work (Le Coze, 2022). However, our results do not suggest that Kolb’s (1984) cycle is ineffective. Rather, Theme 2 shows that realistic simulations help develop anticipation and detection of weak signals, indicating that everyday experience complements, rather than replaces, Kolb’s approach.

As the connection between training and the operational context strengthens, OHS training becomes a space where individual experiences are shared and collectively elaborated, resembling a community of practice (Lave and Wenger, 1991), where workers reflect on operational problems and carry the resulting insights back into everyday practice. Compared with Knowles (1978), where the trainee’s lived experience is used to enrich the individual’s mental map and support personal development, our results highlight how everyday trainee agentic decision-making enters the classroom to be collectively deconstructed and re-elaborated, acting as a process of organisational sensemaking (Weick, 1995). To this end, the Training Gym (Theme 1) emerges as a reflective and diagnostic space for the organisation itself. By using the classroom to explore real-world situations, training extends beyond individual learning to an organisational role, acting as a diagnostic and a means of sensing weak signals and everyday issues (Themes 1 and 2). Furthermore, trainers expand the workforce’s capacity to act effectively within a complex system, going beyond “silos” thinking (Hollnagel, 2020, p. 4) (Theme 4).

With this work, we suggest that this context-embedded participatory training approach can support resilient organisations (Pillay, 2016; Weick and Sutcliffe, 2001), particularly in anticipation and proactivity (Theme 2), by acting as a form of “system tuning” (Hollnagel, 2021, p. 990). Hollnagel (2021) defines tuning as the adjustment of a system’s various functions so they operate in synergy. In this study, training becomes the key mechanism for this calibration, as it can help understand everyday practices to better organisational dynamics to improve safety. According to Knowles (1978), a learning need is a gap between existing and desired competences, with the trainer’s role being to support learners in identifying such gaps (p. 125). Similarly, Kolb (1984) describes the need of aligning individual competences with job needs (p. 7). This paper argues that trainers extend beyond this individual function to assume a role centred on facilitating organisational sensemaking and supporting systemic diagnosis. Our results highlight trainers’ agency and reposition their role beyond the transmission of codified knowledge – a view implicit in traditional behaviour-modification training models (Liu and Li, 2022; Robson et al., 2012). Here, both internal and external trainers act as “boundary spanners” (Ofstad and Bartel-Radic, 2024; Williams, 2011) who, through pedagogical strategies, help health-care workers “connect the dots” between their tasks and wider organisational dynamics (Theme 4 – Systemic Safety). In doing so, the trainer also contributes to the development of situated professional competences (Theme 3 – Situated Professional Competence), aimed at overcoming the academic distinction between technical and non-technical skills by providing structure to what workers already possess.

Trainers emerge as guides for problem-solving, facilitators of learning, and builders of organisational trust, in line with a still underexplored strand of literature (Freitas and Silva, 2017; Khamarko et al., 2012; Mollo et al., 2019). In their agentic trainer roles, they empower health-care workers as experts of their own work (Dekker, 2018), creating a psychologically safe environment where the tacit, lived experience of navigating complexity can be surfaced. They become the engine for a broader paradigmatic shift in OHS towards organisational learning models predicated on worker experience and the detection of weak signals (Nicolaidou et al., 2021; Patriarca et al., 2022). In this research, organisational learning is understood not as the incremental improvement of existing knowledge, but as a process of expansive learning (Engeström and Kerosuo, 2007), in which participants collectively examine internal contradictions in their activity to design and implement new models of action that fundamentally expand the object of their work (p. 338).

This suggests a compelling avenue for future research: exploring how the training environment can function as an alternative or complementary channel to formal reporting systems, particularly for the nebulous, hard-to-report phenomena of weak signals, which appear to gain clarity and substance through facilitated group dialogue (Brizon and Wybo, 2009).

Our results also sustain the shift from traditional Safety-I training content to a Safety-II-oriented approach (Hollnagel, 2014), especially reconsidering the traditional philosophy of safety, which attributes accidents mainly to unsafe worker attitudes or behaviours (Endroyo et al., 2015; Laberge et al., 2014) and position training as a corrective tool by increasing knowledge and skills (Liu and Li, 2022; Mollo et al., 2019; Robson et al., 2012).

In light of this research experience, this study proposes guidelines for a Train-the-Trainer (TTT) approach to design future programmes for OHS trainers, with the aim of developing the competencies needed to support a Safety-II transition, as detailed in the next section.

This Train-the-Trainer (TTT) programme is designed to target both internal and external OHS trainers. Although this TTT programme is the outcome of these results within health care, we believe that it could be also applied to other organisational contexts and settings. Trainers, indeed, support a Safety-II-oriented approach by reframing trainees/workers as sources of adaptive capacity and by embedding resilience-oriented learning within OHS training practices. The key competencies to be developed should include:

• Bridging regulation and practice. It concerns the ability to translate prescriptive OHS frameworks into meaningful representations of everyday work. Trainers should develop the capacity to promote experiential and reflective learning grounded in workers’ experience (Dekker, 2018), eliciting tacit knowledge and enabling participants to reinterpret their own work activities in light of safety principles.

• Designing collective learning environments. It focuses on configuring training as a community of practice (Lave and Wenger, 1991) and as a “training gym”, where individual experiences are shared, collectively analysed and transformed into organisational insights (Engeström and Kerosuo, 2007). Trainers are expected to facilitate open dialogue and enable the emergence and discussion of weak signals through interaction.

• Supporting organisational sensemaking. It is the ability to promote systemic thinking and collective interpretation of work practices (Weick, 1995). Trainers should be able to integrate multiple perspectives and promote the examination of interdependencies, trade-offs and goal conflicts inherent in health-care work (Hollnagel, 2014).

• Acting as organisational sensors and boundary spanners. It involves capturing and connecting weak signals and experiences to broader organisational dynamics, acting as boundary spanners (Ofstad and Bartel-Radic, 2024; Williams, 2011). Training could also be used as a complementary reporting system, particularly for subtle hard-to-report phenomena.

Developing these competencies should enable trainers to move beyond a Safety-I compliance-driven approach and contribute to building a more proactive and resilient safety culture, strengthening the role of frontline workers as early sensors of emerging risks.

The proposed TTT programme could be evaluated through a longitudinal mixed-methods approach consistent with Safety-II principles. Evaluation should assess not only knowledge acquisition but also changes in trainers’ practices and organisational learning.

At the individual level, it could examine trainers’ ability to connect regulation with everyday work, facilitate reflection and promote systemic thinking and weak signal awareness. At the process level, it should evaluate whether training sessions foster dialogue, psychological safety and organisational sensemaking. At the organisational level, it could explore improvements in communication, discussion of weak signals and integration between OHS and operational practice.

Effectiveness should be measured not only through accident reduction but also through the organisation’s capacity to anticipate, adapt, reflect and learn from everyday work.