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!

What were the rehabilitation and return-to-work highlights from the PIEF Conference?

I’ve recently returned from speaking at the Personal Injury Education Foundation (PIEF) conference in Brisbane, Queensland, Australia. PIEF has no exact counterpart in Canada or the United States. It was established in 2006 as a not-for-profit organization by a consortium of Australian and New Zealand accident compensation regulators, insurers, and claims management organisations. They wanted to create programs, initiatives and events focused to raise the common standard of knowledge, skills, and professionalism in the personal injury industry, which covers what North Americans would think of as workers’ compensation, transport accidents compensation, and other injury compensation programs.




My assignment as a keynote speaker was to give a North American perspective on rehabilitation and return to work. (In the interest of full blog disclosure, PIEF funded my travel and registration costs while WorkSafeBC funded salary and other expenses). Highlights for me included hearing the other presenters in the concurrent sessions, other keynote speakers in plenary sessions, and the discussions in the halls, meals, and social events.



The conference opened with a brief talk from an injured worker, Edward Bailey — an ex-pat Canadian who suffered severe back injuries and surgeries that left him unable to work in his 30-year career as a mechanic. He relayed how scary this was, how depressed he became and how the assistance he received to be a trainer and assessor as well as his additional work he does as a technical writer have made all the difference. He said the pain is still there but the rewards of his work allow him to carry on.



That theme of "work being important and good for you and your recovery" was echoed in many sessions. The employer representative who spoke next was Amy Sproule, the Health and Wellness coordinator for Carlton United Brewers — supplier or a quarter of Australia’s beer. She outlined their extensive program which includes on-site physiotherapists (PT) and access to Occupational Therapy (OT), physiatrists, and other allied professionals. She noted that some of the costs for referrals are picked up by WorkCover or by their benefits program but some are just absorbed as an HR cost. She acknowledge that onsite PT was expensive but said it was a visible commitment to early intervention, prevention and RTW — part of a culture they have and want to foster. She concluded that the program makes good business and good moral sense.



The next speaker was Jon Schubert, the president and CEO of the Insurance Corporation of British Columbia (ICBC). He gave a detailed talk focused on transport accidents but some of the research he presented certainly got a reaction from the delegates. For example, he showed how whiplash claims frequency were the lowest in Quebec, a province with a no fault system. He spoke about the Quebec taskforce on whiplash that is widely used for neck pain and the work he was involved in with Saskatchewan that has gone beyond that to focus on a functional model. Interestingly, following the research leads to some surprising outcomes. He noted that some interventions, such as early fitness programs, actually delay recoveries and others have no effect. It raises important questions about what should be funded. Are we doing harm by funding interventions that delay recover, increase disability, or have no effect?



The third keynote speaker in this two-day conference was Professor Sir Mansel Aylward CB, Chair, Public Health Wales and Director, Centre for Psychosocial and Disability Research, Cardiff, Wales. His talk was primarily based on the bio-psycho-social model but his message was clear: We have to change our current thinking and models of disability. He called this focus on outcomes, on health and work, “a moral obligation”. He noted that the bio-psycho-social model is now supplanted the standard medical model and has the published, peer-reviewed data with biochemical, neurotransmitter, and other evidence to back it up. “There is a limited correlation with illness, disability and the capacity for work,” he said — a statement that most in the field of vocational rehabilitation would agree with. He advocates return-to-work outcomes becoming an objective of primary care.



Other topics at the conference included how to define and measure client outcomes, the effects on health, psychological, and work status following compensable injury, and predicting common law claims. I took copious notes at this event and know I will be following up on much of what was presented.



Although the event is only held every two years, based on having attended two of the last three I have no hesitation in recommending the PIEF conference. The next one will be Auckland and will be held in conjunction with the International Forum on Disability Management (IFDM). ​

Is there only one way to keep workers safe?

Last week I was in Brisbane, Queensland on Australia’s east coast. Here’s a jurisdiction a bit bigger in population than British Columbia, a little smaller than Washington State, with a low injury rate and low workers’ compensation premiums (“workcover” as it’s called in Australia).

Brisbane is a modern, cosmopolitan city of three million. There are obvious signs of a vital economy. Buildings are going up, transportation networks are expanding, and unemployment is around five percent (vs. B.C. and Washington state where unemployment is hovering around the eight percent mark).

The workers that keep this economy running are engaged in similar activities to those in any large city. Perhaps because I’m aware of occupational safety and health issues, I couldn’t help but notice some similarities and differences.

Above the city, the complex choreography of cranes carries on as it does over urban construction sites everywhere. The cranes; however, are predominantly luffing jib cranes rather than the straight boom, hammerhead slewing cranes more commonly seen in many North American cities.

Brisbane South Bank construction - August 2012

Workers wear hardhats, but given the greater exposure to the sun, many have wide brim tinted visors and neck shades. Brightly coloured safety garments are seen everywhere. Fluorescent green or orange and contrasting blue polo shirts, fleece, and jackets are common on, and, off the jobsite. Delivery drivers, traffic patrol, baggage handlers — even cyclists — can be seen wearing these distinctive (from a North American perspective), high-visibility garments. It’s not that wearing hi-viz garments in jobs other than construction or traffic control is unheard of in North America, it’s just that wearing of this type of apparel outside the usual job sites is more common in Brisbane.

I’m not certain if Australians generally have a richer “safety culture” than North Americans. Overall, the workers’ compensation injury and fatality rates appear lower than most North American jurisdictions, although true “apples to apples” comparisons are, in my view, absent from the published, peer-reviewed literature.Perhaps an experience I had at the convention centre might be an indicator of something different in the way Aussies manage risk. Before several of the banquets I attended, a server came to our table and instructed us on safety procedures in the event of an emergency. That was something I’ve experienced occasionally at events in many countries. The server also explained a safety rule about always wearing shoes because of the risk posed by errant shards from occasionally broken glassware. I’ve attended a lot of conferences and this was an entirely new caution to me. It was a perfectly logical and important rule when you think about it, but (to be honest) I had never thought of broken glass as a risk in a carpeted banquet hall. And this in a brand new, spotless facility: Brisbane Convention and Exhibition Centre, on Grey Street.

I mention these examples to illustrate a point. Regardless of our national context, employers, workers, and OH&S regulators face similar workplace safety and health challenges. Each jurisdiction has developed solutions to manage risks to workers and other persons in the workplace. Not all solutions are the same. Sure, exit signs are ubiquitous, but the green and white graphic signs in Australia seemed just as clear to me as the red and black text-based exit signs we see in North America.

I’m not sure you could say any given solution is the only right way to protect workers, nor am I saying that you can simply transplant a standard from one jurisdiction to another. What I’m saying is that the diversity among developed western societies creates an opportunity for OH&S professionals to consider solutions others have implemented. Another important reason for building relationships across our jurisdictions.

What keeps workers safe?

I’ve spent many days enjoying the view of False Creek and the Roundhouse Community Centre from an apartment near the top of a residential tower in Vancouver’s Yaletown district. The stunning views of sparkling waters, emerald parks and gleaming residential towers are amazing. The natural beauty of the area has a lot to do with that but I can’t help but notice the thousands of workers that are involved in building and maintaining the structures, green spaces, waterways and infrastructure.

Recently, I’ve focused on the crews refurbishing the exterior decks and maintaining the rails on neighbouring towers. As I look down from the 26th floor, I can see the swing stages raise and lower workers to the various levels. What was keeping these workers safe on the job? There are standards in the regulation that apply but words on paper are not what keep these workers safe. So, what does?

Clearly, design is a big factor. The scaffolding and rigging are carefully designed to match the structure’s shape, secure and stabilize the scaffold, and minimize gaps through which a worker could fall. The guardrails and fall restraint systems are designed with worker protection in mind.

Design alone is not enough to keep these workers safe. For design to be effective there has to be safe work procedures. I watched as workers transferred their tethers, donned masks during grinding, descended during windy spells or approaching thunderstorms. Design and adherence to safe work procedures work together. But was that really what was keeping these workers safe?

I began to think about the human elements that were involved. These workers knew what they were doing. They appeared to be well trained, knew how to handle the work stage and the order in which things were to be done. Still, knowing what to do is only part of what was keeping the workers safe. Attitude plays a role, too.

Supervision was certainly present on the site. I observed interactions between workers and supervisors and, when the wind was blowing in the right direction, could overhear what was said. Safety-oriented content was often part of those conversations—not always the main point but usually part of the discussion. There was the occasional direction to check a cable or adjust a load but was supervision what kept these workers safe? Or was it a cultural thing—was it a strong safety culture that was really what was protecting these workers from harm?

The old locomotive turntable at the Roundhouse has now been equipped with a mechanical retractable canopy for shade and performances. At the rear of the canopy mechanism in meter-high letters are the words “Safety First”. Whether you interpret these words as an admonishment, a reminder or an aspiration, “safety first” fits well with what I see through the window: It is not one thing that keeps workers safe, it is all of these. Safeguards, barriers, and defences like training, supervision, design and safe work procedures are essential but a strong safety culture—putting safety first—is what keeps workers safe

Part 2 Do the words we use to describe WC claims matter?

The basic terms we use in workers’ compensation have meanings, associations and connotations whether we like them or not. I received a lot of questions and comments on my last post about terms such as “old dog” and “long tail” claims and I want to explore the idea that the other basic terms we use in workers’ compensation can influence how we and other stakeholders think and potentially act.



If you ask someone about the purpose of workers’ compensation, you generally get a response about compensation for accidents and a few will add something about prevention. “Accident” is often defined or understood to mean a “fortuitous event” and has the connotation of randomness and inevitability. An analysis of work-related injuries shows that the vast majority of work-related events that result in injury are preventable. Calling the specifics of a work-related injury event an “accident” may subtly shift thinking away from causation and prevention and towards inevitability and “bad luck”.


A few years ago, WorkSafeBC shifted its terminology with respect to work-related injuries involving motor vehicles from Motor Vehicle Accidents (MVAs) to Motor Vehicle Incidents (MVIs). Unless referring to a specific term in legislation (such as the Accident Fund), WorkSafeBC actively avoids using the term accident in its annual report and services plan as well as other publications.


The word “claim” as a noun has several possible meanings, the most common of which has a connotative meaning of a statement that is not yet substantiated, doubted or contested. By extension, the connotation of the word “claimant” can be similar to that of supplicant—a connotation that sets up a power relationship that can be problematic. Even the synonyms of Plaintiff and Complainant set up an adversarial relationship. Although terms like claimant may be necessary in some very specific contexts, I use “injured worker” in place of claimant wherever possible. Workers’ compensation systems are there for injured workers. “Worker” generally has a positive connotation, a sense of dignity and attachment to an occupation and employer. “Injured” speaks to the the consequences of a work-related event rather than the bureaucratic process of filing a “claim” for workers’ compensation. This may not be a perfect alternative, but in my view, it is preferable. (As an aside, in the British Columbia, the word “claimant” only occurs in Schedule B to the Workers Compensation Act and only in the context of certain occupational cancers and hand-arm vibration).


Finally, the term “benefit” connotes something different from “compensation” in common parlance. “Benefit” is often thought of as an advantage or profit gained from something; it is hard to think of an injured worker profiting or gaining from a work-related injury particularly a serious one. Do we really need to tack on the word “benefit” to workers’ compensation?


My advice is use words that keep the focus on the needs of person and his or her family. Just think about the way the words sound and how they make you feel in the sentences below:


a) The injured worker requested assistance in obtaining a wheel chair to aid in recovery

b) The claimant made a claim for medical aid benefits to cover the cost of a wheel chair.


Both sentences convey similar meeting but the first is focused on the worker and the worker’s needs while the second is focussed on a claim for a benefit with a tone, to my ear, that questions entitlement and focuses on costs.


Not every situation will allow you to avoid the terms mentioned in this series. Even if you cannot avoid the terms, thinking about the words we use may help improve understanding of how words influence perceptions and actions in workers’ compensation

Do the words we use to describe WC claims matter?

Workers’ compensation is an extremely complex form of social insurance. Those who specialize in workers’ compensation tend to adopt jargon as a kind of shorthand to express concepts to those in the know. I’m sure you have heard (maybe even said), “I have this back claim…” when what is really meant is, “I am assisting a person with a work-related injury to the back…”. Unfortunately, this use of jargon can have unintended and negative consequences.


Recently, I have read blog posts and heard speakers at conferences referring to “old dog” claims. I have heard many explanations for the source of this idiom. One commentator said the term arose from the dog-eared corners of the large paper files that are the inevitable consequence of serious injuries and long-term claims management. Another suggested the term related to those serious and long-term claims that “hound” adjudicators and frustrate administrators due to their lack of resolution. Regardless its origin, those unfamiliar with the term may interpret “old dog” claims as somehow disparaging the people who made them. Worse yet, the internal use of a term with such a negative connotation may influence the way we think about or act on some claims.
A related term, “long-tail” claims can create barriers between workers’ compensation insurers and those the system intends to help. The “long tail” in workers’ compensation refers to the statistical property of the distribution of claims, particularly as it relates to duration. The vast majority of claims are very short duration but a few go on much longer and a very few go on with some benefits that may last a lifetime. It is impossible to know just how long a particular claim for a particular injury might require active claims management, adjudication of medical costs, and payment of benefits. Insurers use actuarial estimates based on experience to quantify the costs. Claims at the far end of the claim duration distribution—the “long tail” of a graphical depiction—will generally have the greatest costs.

Most of us are not actuaries or statisticians. Those of us who endured rather than enjoyed the statistics courses in our academic careers can probably still recognize the statistical aspect of the “long tail” and recall vaguely the problems of asymtopical distributions, skewing, and corrections for right-hand truncation. For those without statistical knowledge, the term “long tail” has a somewhat negative connotation, an implied variance from some level of “normal” or “typical”. To those individuals, the use of the term may create a barrier or put them on the defensive with the insurer, adjudicator, case manager or other workers’ compensation personnel. It is not hard to imagine people worrying that adjudicators in WC would be actively working to terminate claims in the interests of shortening that long tail—not a recipe for a trusting relationship.
A 2010 survey had good news and bad news for insurers regarding trust. The headline read “Trust in Canadian insurance industry jumps 17%”. The article revealed this significant increase was on a base of only 38%. At 51% of opinion leaders trusting insurers, this improved standing is still well down the in the ranking behind other sectors like health care and technology. Given this significant lack of trust in insurers, it is time we stopped using terms that have such negative connotations even in internal discussions.
I believe workers’ compensation professionals in state funds, private carriers, TPAs and related agencies are sincerely working in the best interests of those WC was created to serve. Abandoning jargon and shorthand terms like “old dog” and “long tail” claims may seem like a small thing but words matter. Words create perceptions and perceptions create reality.