The word "safety" is interesting because it has different meanings, and even different "expectations" as to what the word can or will do for someone who practices it. Even nations, nationalities and cultures treat the word differently.
In the English language, synonyms for safety are words like immunity, protection, security, care, custody, defense, insusceptibility, preservation, protection and surety. The antonyms for safety are danger, hazard and peril.
When we think about what the expectation of safety is to the worker, we see that he or she looks at it in its synonym form. Yet when we try to "manage" safety, those of us in the safety field look at it from the antonym point of view. We prepare for the danger, we engineer out the hazards and we look for the peril. And, of course, we expect the employee to understand and appreciate all of our hard work to keep him safe and are constantly amazed and perplexed when he does not respond to our efforts by "being safe."
So perhaps we are on to something when we begin to think of the word safety in the same context as the worker does. When we examine the words immunity, protection and security, we begin to get a sense of what some of the employee's expectations are in safety. He wants immunity from hazards, protection from unsafe equipment and security for himself in the work place.
When we look at the words care, custody, defense, insusceptibility and preservation, we begin to understand his mistrust of our motives, and his misgivings about our ability to understand his needs. The word care goes right to the root cause of his mistrust. He really does want us to care about him him as a person, not as a number or a means to achieve production quotas or cost reductions. The word defense has a special meaning to employees, in that they feel they are on the defensive if they are injured on the job (and no matter what we say about not finding fault, they know better). Insusceptibility and preservation are words which conjure up images of "circling the wagons" by the management team when the investigation of the incident begins to point toward systems, and the managing of those systems.
So by defining the word "safety" from different perspectives, what have we done to get beyond this cycle ? Well, we have embarked on a journey using behavior and the changing of that behavior as the means of addressing the word "safety." We have introduced the concept of culture a way of thinking, acting, perceiving and reacting to those situations around us that could get us hurt. We have looked again at managing safety by dissecting our systems, re-examining our methodologies and focusing on managers.
This is in contrast to much of our safety activity in the United States. Everyone is for safety. No one in his or her right mind, in this day of litigation at the drop of a hat, can afford not to be for safety. No supervisor, manager, director or executive is willing to say that the time, effort and money devoted to safety is not showing positive dividends. Anyone who has dared, the lawyers make him see the error of his ways in short order. He is not perceived as a team player, and he certainly can kiss his career path goodbye.
The only time this does not apply is when the messenger is the CEO of the organization. Then, of course, everyone nods their heads in agreement and goes back to the drawing board to resurrect the program of the month, or activity of the week in order to show that something is being done about safety in the organization. And sure enough, the statistics for the next several months show a slight dip, which, of course, proves how smart we all are because our new program or activity obviously has paid off. In reality, all that is happening is that people are responding to the attention being paid to the latest program or activity, either in a negative way (hiding incidents because of fear of what the CEO might do), or in a positive way (people reacting to the attention). But soon, all is normal again, and the incidents begin to crop up again. We are constantly amazed as to why this pattern occurs over and over again. Managers, directors and executives are frustrated and exasperated when the phenomenon occurs. The cycle of mistrust repeats itself. Management is convinced we have done all we can do to instill safety into the work force, and the work force is convinced management has done all it will do to keep them safe.
Breaking the Cycle
What can be done to break this cycle of misunderstanding and mistrust? What must be done to reach an acceptable level of safeness within the organization, and keep it there for a long period of time?
I believe we must go back to systems. We must install a management system that encompasses every aspect of how we perform our tasks and measure our performance. The management system should include elements such as:
- How we communicate, vertically and horizontally.
- How we plan for safety throughout the entire organization, both operationally day-to-day and for projects.
- How we plan our resources, both money and people.
- How we train our people, both in safety and in the line organization.
- How we manage change, and include the change in everything we do.
- How we assess our performance, both the statistics as well as the activities which support the organization's safety achievements.
- How we manage our corrective actions, monitor their effectiveness and measure their results.
Those are the management system elements. Now let's look at the management systems.
Once an accident/incident or error occurs, the investigation should incorporate every possible avenue of cause.1 A way to do this is to break the organization down into two basic halves. The equipment-facility-infrastructure half, and the human performance-interface-interaction half.
The easy part is, of course, the equipment-facility-infrastructure half. Either the equipment broke down, slowed down, or in some way did not perform to specifications. This was due to a fault in the preventive/predictive maintenance system; the equipment has had repeat failures due to over-capacity, or a design flaw, which was not caught prior to going into operation. In each case, the fix is a relatively simple one. Once discovered, however, the cost to replace or repair it can have a major impact on the organization's ability to continue to produce.
The other half, the people half, is where we struggle. When we look at the human performance side of the equation, the list of probable causes of the incident, accident or error gets much longer.
The major elements of human performance difficulties are:
- Human Engineering
- Quality Control
- Standards, Policies, Programs
- Immediate Supervision
When we break these down into sub-systems, the list gets even longer. For example:
Procedures Not used/not followed? Why? Was there a procedure? Was the procedure not available or inconvenient? Was the procedure difficult to use? Was the procedure use not required but should be? Was it wrong? Why? Was there a typo; sequence wrong; facts wrong; situation not covered; wrong revision used? If it was followed incorrectly, was the format confusing? Were excess references used? Did the limits need improvement; details need improvement? Was the data/computations wrong or incomplete? Did the graphics need improvement? Were the instructions ambiguous or the equipment identified wrong?
Training Was there no training? Why? Was the task not analyzed? Did someone decide not to train? Was there a learning objective? Did employees understand the training? Does the learning objective need improvement? Does the lesson plan need improvement? Was the instruction adequate? Does there need to be a place and time for practice/repetition? Is the testing mechanism adequate? When was the last time the employee was trained?
Communications Was there communication and was it timely? If not, why? Was there a method available? Was the communication late? Was there a turnover problem during shift changes? Is there a standard turnover process? Was the turnover process used? Does the turnover process need improvement? Was there a misunderstood verbal command? Is standard terminology used? Is there a repeat-back mechanism used?
Human Engineering How was the human-machine interface? Do the tools/instruments need improvement? Is excessive lifting required? Did labels need improvement? Was the arrangement/placement adequate? Did displays need improvement? Did the controls need improvement? Is the monitoring system adequate? How does the employee stay alert? Are there plant/unit differences?
Quality Control Is there an inspection system in place? Is an inspection required? Are the inspection instruments adequate? Are the inspection techniques adequate?
Standards, Policies, Programs Are there standards, policies or administrative controls in place? Is the standard strict enough? Is it confusing or incomplete? Are the drawings or prints adequate? Is the communication of the standard adequate? Has it recently been changed? Is there consistent enforcement of the standard by managers? Is there a way to implement the standard? Have managers been held accountable for implementing the standard? Have employees been held accountable for not following the standard? Have there been sufficient audits of the standard? Has the standard been adequately communicated to all employees? Has there been corrective action relative to the standard?
Immediate Supervision Has the job been adequately prepared by the supervisor? Are work packages looked at by supervision prior to start-up of work? Are there pre-job briefings? Are lockout/tagouts performed? Are jobs scheduled properly? How are workers selected for the jobs they perform? How are the workers qualified for the work they perform? How are teams selected? Is adequate supervision performed during the work?
The elements referred to above are the minimum components of any safety management system. These systems go right to the antonyms of safety the danger, hazard and peril aspects of safety.
These systems must be installed throughout the work environment in order to achieve and maintain an acceptable level of "safeness" relative to human performance-interface-interaction.
The synonyms for safety the words such as immunity, protection, security and care are addressed by the culture we instill throughout the work force, and the kind of behaviors we condone in order to get the job done. When we look at behavior, we find that most of the accidents/incidents/errors that occur are based on people taking shortcuts or following the examples of their peers in order to get the job done faster and easier. This is to be expected and should be no surprise. How many of us have heard an employee admit that he knew better than to do it that way, but "it was only going to take a few minutes"? Of course, our response is to retrain the individual, or even have him disciplined, but we all know those are not long-term solutions. The culture must find a way to change the old paradigm from taking the short cut or performing the bad habit to the entire work force (not just a few or just the safety staff or supervisors) working safely.
The psychology of safety has come a long way in the last 10 years, and those organizations involved in selling the concept are making strong inroads into how employees perceive their role in safety and the role of safety itself. Safety is becoming more than just an abstract more than just a word. It is becoming a combination of the synonyms and antonyms of the word. They are coming together so that the perception of management and the perception of the work force are merging into the reality of what it means to work safely and what it means to have a safety management system in place.
Safety systems and behavior- and culture-based elements must be integrated into the organization as a seamless mechanism, achieved through employee involvement, commitment and solution-making. The employees are the key, and management must understand that for the key to work, it must provide the will, resources and expertise to achieve the goal of operating a safe and healthy place to work.
The three elements outlined in this article systems, behavior and culture must be in place in order for a holistic approach to safety to have the desired effect of reducing and eliminating accidents, incidents and, eventually, errors which occur within the organization because of equipment, facility or infrastructure situations, or human performance difficulties.
The systems approach to safety management is, in my experience, the answer to long-term safeness within an organization. The systems approach must include the building of a culture where the employee feels he is a part of the efforts and solutions toward creating his safety. A behavior model must, through training, awareness and involvement, make him aware of the at-risk shortcuts and habits he has formed over the years in order to get the job done the easiest and fastest way.
The systems must be truly seamless, and involve every aspect of how we do our business in order to be successful.
The last, and most important, factor in making the system work is involvement from every level within the organization. We must ask our senior executives to not only support us in words, but support us in activities they perform when they visit plants and facilities. They must lead by example, get involved in one-on-one conversations with workers, and follow-up personally with concerns they might have. The directors, managers and front-line supervisors must also be expected to conduct certain safety activities while performing their daily tasks. Their performance ratings must include their safety activities and how well they performed them. The accountability for safety should be shared by both the line and staff organizations. In this way, safety will be linked to what the line organization feels is vital to their success. It is not by chance that production, quality and cost are premier factors in the line organization's sense of accomplishment. Once safety is included as an equally important element in the overall success of the organization, the systems used to accomplish the goals will be more uniformly applied and accepted as "the way we do business" in this organization.
James J. Thatcher, Ph.D., is the president of the National Safety Management Society. He is president and partner in Safety Management Systems LLP. He can be contacted at (985) 856-6734 or (409) 751-5261.