What, if anything, does a “near miss” have to do with health and safety?

“Well, no one died, so what’s the problem?”  I have heard lines like this before and I heard it again yesterday.  What irks me is that the people saying (or reported to have said) these words are often in supervisory or managerial positions.  Some even have a title or function that includes “safety and health”.  The truth is, the absence of injury is not a true measure of workplace health and safety.   And how a “near miss” is reported and reviewed reveals much about the safety culture of a workplace.

I instruct classes and seminars with learners and talk about safety with a lot of workers.  When I ask about their health and safety experiences, they often relate incidents like the following—serious incidents but without injury: 

•  The ladder I was on began to slide sideways and I had to jump off.     
•  The patient suddenly lost balance and collapsed on top of me.
•   The student I was helping impulsively started the drill press while my eye was next the bit aligning the project.    
• As I pulled out the top drawer, the file cabinet began to fall forward… I was just able to step out of the way before it went crashing to the floor.        
• Someone had sprayed a lubricant in the hallway and I nearly slipped and fell when I stepped in it.
• The metal plate broke loose from the winch and missed my toes by a fraction of an inch.

The workplaces above are varied:  a paint job on a residential site, a clinic, an industrial education shop in a school, an office, a hallway in a public building, a fabrication shop.  From an outcome perspective, there were no injuries, no lost days due to accidents, no need for doctor’s visits or alternate duties.  Yet, most of us would recognize that what separated the worker from injury in each case was a matter of luck (or millimetres) and not safety. 

Regardless of the workplace, each of the above incidents is a wake-up call, an opportunity to review the “near miss” to see if there are improvements or changes that might prevent a repeat of the incident.  Each case is worthy of an incident report and an investigation by the site safety committee. 

Safety is a function of the safeguards, barriers and defenses that protect workers from harm due to the hazards inherent in all workplaces.  Every near miss reveals active or latent defects in the barriers, safeguards and defenses that protect workers from harm.  Design, supervision, training, safe work procedures are some of the safeguards, barriers and defenses I’m talking about; an effective investigation will reveal the possible defects that had to align in order for the near miss to occur. 

If you are looking for a leading indicator of your workplace health and safety program, focus on incident or “near miss” reports.  How many are we getting?  Are they being investigated and discussed at the Joint Health and Safety Committee?  Are means of preventing future incidents being considered?  If incidents are not being reported, don’t assume they aren’t occurring.  And if incident reports are met with a “no one died” or “that’s just part of the job” sort of response, you’ll know a true concern for health and safety is not part of the culture of your workplace.  

How do leading indicators fit into the planning and implementation of health and safety plans?

I’ve had a lot more questions about leading indicators and how they fit into the planning and implementation of health and safety plans, and so, I thought a further example and simple graphic organizer may help.

A few years ago, I was speaking with the head of the safety and wellness program for a large US manufacturing firm. The company has factories in several states. I asked her how she knew her programs were working. Her responses gave me a practical insight how leading indicators fit into that process. 

 

Central to her approach, was a sound theory of behavioural change and a clear logic model of the factors that lead to injuries.

Occupational injuries and illnesses, near misses, and individual health issues like obesity, diabetes, and hearing loss are usually multi-causal. The physical plant, equipment design, training, and behaviours such as the adherence to safe work procedures, were very important but underlying these are attitudes. She pointed out that behaviours such as violating safe-work procedures had a feedback effect: the more violations of safe-worker procedures that occur and tolerated or ignored, the more they will occur. Before she could change the behaviours that opened employees to injury, she needed a model of what drives behaviour and a way to integrate that into planning and implementation of health, safety and wellness. 

 

From a planning perspective, the “theory of reasoned action” and its revised version, the “theory of planned behaviour,” suggest that attitudes and beliefs determine much of voluntary behaviour. Changing behaviour must rely on changing attitudes and beliefs. This is consistent with concepts such as “bounded rationality” and safety culture. Workers and managers act rationally and if safety and health are demonstrably important to supervisors and upper management, that will get translated to the shop floor.

 

My US contact described her approach to eliminating eye injuries in their plants. Her model included many components. She and her staff looked at design (including guards), considered awareness sessions, worked to have supervisors insist on and reinforce compliance with wearing eye protection, as well as consistently modelling the behaviour will likely contribute to your goal.

 

Her final planning step was to decide the inputs, resource, activities, and products her plan would encounter (and to seek budgetary approval where required).

 

Remember, her goal was to eliminate eye injuries. Counting the number of workers who suffer eye injuries is a trailing indicator. She developed several possible leading indicators including the percentage of staff participating in awareness sessions and observational data on violations detected by her safety officers. She also made the inspection of guards and shields routine with a plant manager report on guards filed monthly.

 

I hope this example helps. Leading indicators are a powerful prevention tool that may make your prevention program more effective.

How do you develop leading indicators for occupational safety and health?

Most of us are familiar with the concepts of “lagging” (sometimes referred to as “trailing”) and “leading” indicators from the world of economics. GDP and “average duration of unemployment claims” tell us about where we have been and, therefore, are generally considered lagging indicators of the relative health of the economy. Housing starts and permits are great examples of leading indicators. If these are rising, the demand for labour and supplies to build the new housing units is likely to rise in the near future. As the housing units are completed, demand for consumer goods like furnishings to fill them is also likely to rise.



The power of leading indicators is obvious to those gauging current conditions and making plans. If housing starts are rising, retailers of furniture and appliances are more likely to increase orders and hire new staff; manufacturers are likely increase production and inventories in anticipation of rising demand.


In workers’ compensation and OH&S, traditional measures tend to be lagging indicators. Injury rates, injury counts, and “days injury free” are, at best, lagging indicators of safety—they may tell us something about where we were but little (if anything) about where we are going. These measures are heavily weighted to the past and may mask serious safety and health risks in the current workplace. Developing leading indicators at the operational, sectoral and even jurisdictional levels helps focus resources and attention where it is most needed and provides early signals of the effectiveness of current programs or initiatives.


To design a leading indicator, you need a logic model, a framework that takes into account the near-term, mid-term and long-term objectives that will lead you to your goal.


Suppose your goal is a safer, healthier workplace and you have an objective of reducing strain injuries in your manufacturing plant. You might want to start by identifying the factors that lead to these injuries. Ergonomics is an obvious factor but you could get more granular or more general in your consideration. Loads, repetitions, and workstation design might be factors at the individual level while work procedures, the pace of work, and safety culture might be important factors at the operational or corporate levels.


Now that you have a model of how the injuries occur, you can think about interventions at the causative level that will contribute to greater prevention. Perhaps you have been convinced as I have that safety culture is vitally important and you have initiatives to improve safety culture in your operation. Annual external audits or random quarterly surveys could help you determine both the current climate and trend over time. If your model is correct, improvements in your safety culture will lead to outcomes like improved adherence to safe work procedures, more safety-oriented content in supervisor-worker interactions, more rapid time from hazard identification to removal—all of which have been proven to reduce injuries and make workplaces safer and healthier.


Other examples of leading indicator metrics for the objective of reducing strain injuries I’ve come across in industry include:

• % of workstation ergonomic evaluations completed

• % of employees/supervisors trained in ergonomics

• % of ergonomic action items addressed

• % of employees engaged in fitness and wellness program


Developing a logic model and selecting a leading indicator forces you to understand your business, how injuries occur and what research tells us will prevent them. That understanding is critical for good management as well as OH&S.



Don’t bother developing logic models, selecting leading indicators, and continually measuring indicators if you think it will be easy. Making the time and effort is hard but worthwhile.



My favourite quote on this topic makes the point very well:

"Measurement is the first step that leads to control and eventually to improvement.

If you can't measure something, you can't understand it.

If you can't understand it, you can't control it.

If you can't control it, you can't improve it.”


- H. James Harrington (Author, columnist, a Fellow of the British Quality Control Organization and the American Society for Quality Control).

Can you rewire your safety culture?

I was invited to deliver the keynote presentation at the “Make It Safe” conference a few days ago. The event was hosted by the FIOSA-MIOSA Safety Alliance of BC, the Canadian Manufacturers & Exporters of BC, and WorkSafeBC.




The FIOSA — MIOSA Safety Alliance of BC, is a not-for-profit industry organization that seeks to address challenges and opportunities specific to food & beverage processing and manufacturing and to set industry standards for health and safety.



The industries represented in the room were ideal for my topic, “Rewiring your Safety Culture.” Most participants had great safety backgrounds, but my goal was to take their thinking about safety beyond the lagging indicators such as injury free days, injury counts, and reportable injury frequency rates. The manufacturing sector has made huge strides in improving safety and health but to take the industry to the next level of safety will mean rewiring the way we think about safety and how we measure our progress.



Manufacturing has been the focus of much research on safety culture. The rich research in this sector provided me with examples from oil refineries, commercial bakeries, electronics manufacturing, and metal fabrication to illustrate my point.



I also happen to like James Reason’s work on human factors because I find it connects with audiences. Briefly, his “Swiss Cheese” model is widely used and easy to visualize. Reason conceptualizes the barriers, safeguards and defences (like training, supervision, safe work procedures, and equipment design) that protect workers as being imperfect with holes of varying sizes and location representing active and latent gaps in the protection. Workers can only get hurt when the hazard in the work environment follows a trajectory through the holes to harm the worker.



Adding “Six Sigma” (an innovation born in the manufacturing sector) to Reason's model allowed the audience to visualize my argument for a rewired safety culture. They agreed that active defects in training, supervision, adherence to safe work procedures can be eliminated or reduced by applying the Six Sigma methodology.



Taking Reason’s model, I argued for a re-conceptualization of the holes as “defects” in the barriers, safeguards, and defences that would protect workers from harm. Six Sigma methodologies are all about reducing variation and improving processes to ensure defects fall below the 3.4 million per million level. Through improvements in training, supervision, and adherence to safe work procedures, we can reduce the number, and size, of defects in these defences and reduce the probability of harm to workers. As defects approach Six Sigma levels, injuries to workers will approach zero. Selecting leading indicators consistent with the approach completes a rewired approach to safety and safety culture.



In this competitive world, the one big question audiences ask about rewiring their thinking about safety and changing their safety culture, relates to costs. The good news is that most of this rewired thinking about safety is not expensive. Small investments and equipment can have a big effect. The big change is in mindset; the big benefit is in saved lives, lowered costs, and improved productivity.



Because my job for much of the last thirty years has involved environmental scanning, I collect stories and examples from other jurisdictions. One of my current favourites from the manufacturing world is for Simms Fishing Products. WorkSafeMT has highlighted this small manufacturing firm in a video available on YouTube that makes the point: it is possible — and worth it — to rewire your safety culture.



Take a look at the video and take the next step: start rewiring!