Monday, June 25, 2012

When did you last witness safety trumping other considerations?

In popular culture, the opening sentence of a bad novel begins with the clichĂ© phrase, “It was a dark and stormy night…”. Returning late last week from Washington, DC and a NIOSH workshop on the use of workers’ compensation data for occupational safety and health, I was stuck in Toronto-Pearson International Airport at dusk as the clouds darkened ominously. Through the boarding lounge window, I could see a wall of rain sweeping towards the terminal. On the top of every jetway, white strobes began flashing in unison. Over the handheld communicator a ground agent was carrying, I heard the announcement: the tarmac and apron were being cleared for safety reasons: lightning strikes from the dark storm clouds approaching YYZ.

The safety equation on this dark and stormy night was particularly evident. The inbound plane at our gate was a mere five meters from the jetway with a full manifest of passengers. At other gates, flights had been loaded and doors closed. Planes were still landing but backing up, still burning fuel, and clock time for aircrews. Connections were being missed, overtime incurred, and schedules overturned. Despite all these costs, all activity on the field stopped for the protection of ground crews.

Our lounge was full of passengers for Vancouver, BC or carrying on to Sydney, Australia. In almost perfect unison, thousands of people in Terminal 1 pulled smartphones and began checking connections and informing friends, families and colleagues of the indeterminent delay.

Here was an actual example of safety trumping other considerations. You can’t fuel an aircraft, load it with baggage and cargo, or push it back from the gate without workers and the risk of injury to a worker during a lightning storm is significant; an average of 57 people are killed each year in the US due to lighting strikes. Canada has shorter lightning seasons than in the US, yet lightening kills 9 or 10 people and injures between 100 and 150 people each year. Safety is about managing risks and managing the risks in this case means stopping airside operations.

How did people in my very crowded waiting lounge react? Most took the delay in stride. I heard one passenger actual say to the gate agent, “Worker safety should come first.”
After a couple of hours with intermittent starts and stops due to the storm, operations got going again. There was a huge backlog of flights. Our Air Canada flight 033 was fully loaded and had to wait 45 minutes after the doors closed before a crew was available for pushback.

Yes, we arrived home three or four hours later than planned… but we were safe and so were the crews that served us along the way.

There is nothing inherently safe about air travel. What makes it safe is a culture that values safety at every point, in the air and on the ground. Wouldn’t the world be a better place if we could day the same thing about every industry?

“There is nothing inherently safe about [building a bridge, lifting a patient, felling a tree…] what makes it safe is a culture that values safety.”

Monday, June 11, 2012

"what does the research tell us about...?"

Three times in the last week, I received calls or emails that contained a question that began, “What does the research tell us about…?” Each question related to a current issue in workers’ compensation and prevention. One wanted to know which prevention strategies have the best evidence as being effective. Another was interested in the degree to which financial “secondary gain” might be a factor in claim duration. Another asked about the elevated risk victims of a certain common occupation disease claims might have for other serious illnesses (with the implication of compensability).

These are all good questions. Each has real-world implications for policy, case management and prevention. In some cases, there are solid answers from the published literature; in others, the question is unanswered or there is too little information to provide a clear answer at this time.

Behind each question lie important assumptions:
1. Valid, peer reviewed research matters to policy makers and practitioners

2. Scientific hypothesis testing and data analysis in properly designed and ethically applied research provides better information for decision making than conjecture

3. Research that has been subject to scrutiny and review by other researchers is defensible as a basis for decision making

4. The synthesize of the many pieces of research necessary to arrive at valid answers to such questions has taken place.

There is often a fifth assumption: research is “costless”. It is “free” in that most research policy makers need will eventually be published in peer-reviewed journals. However, I get the impression that anyone asking a policy analyst the questions above assumes the information is “out there” and will only take a little scratching about to summarize in a briefing note.

I know that most policy makers and practitioners would never say research is costless if they gave it any thought, but I am certain not one of the people asking me these important questions could put a dollar figure on a given piece of research. Even if they could, (I know I couldn’t), I doubt they would take into account the costs beyond the dollars involved. Every scientist, Master’s student and Ph.D. candidate who applies their intellectual resources to research questions in workers’ compensation, prevention and rehabilitation is foregoing other research topics—an opportunity cost that can have huge implications.

I had the pleasure of welcoming nearly 200 researchers, students and policy makers to the Canadian Association for Research on Work and Health (CARWH) to their conference in Vancouver a few days ago. WorkSafeBC has funded research and researchers for more than 40 years and was proud to be the host organization for this event. WSIB Ontario, WCB Nova Scotia, and IWH Ontario also directly supported this event. Many other organizations were represented through the research presented that was the product of their financial support (the IRSST in Quebec and WCB Manitoba among them). Far from being “free riders”, these organizations understand that research is not costless and have made a commitment to paying a share of that cost. It is not the “price of admission” but it is an admission that there is a price worth paying for answers that will make a difference in workers’ compensation and prevention.

Along with guests from the US, Australia, New Zealand and the United Kingdom, I had the opportunity to meet with researchers, ask questions and discuss areas for further research. The abstracts for this event are still available online. Just skimming through the titles speaks volumes about the new answers to important questions researchers are now investigating.

So, what does the research tell us about these important questions? A lot more than a blog post can do justice. Next time you find your self asking (or being asked) a question that begins this way, ask what you and your organization are doing to support research, researchers and the sharing of data that will make a difference.