Is It Worth The Risk?

By Phil La Duke

On Friday, I left Toronto to drive back to Detroit in a blizzard that at least one weatherman described as “the storm of the century”.  As I headed out from the Toronto office to my car, several colleagues told me to “be careful” or to “be safe”.  While the sentiments were sincere and the intentions well meaning and heartfelt, I wondered how useful this advice really was.

I want to be clear, I value the sentiments that people express when they say be careful, but it really doesn’t change my behavior.  I had a lot of time to think during my five-hour sojourn home—my policy is no cellphone use in the car, but it didn’t matter since my service wasn’t working since I was out of my home country.  It occurred to me that better advice would probably have been “is it worth the risk?”

This is an important topic, because whether you are talking about worker safety,  Just Culture, or virtually any personal or business decision, it all comes down to risk and whether or not the value is aligned with the risk. Despite this, many organizations continue to rely on telling people to be more careful as their primary defense against serious injury or fatality.

For my part, I had business that needing attending to on Saturday, so staying an extra night in Toronto was, for me, not a viable option.  So I was faced with a simple decision: was the risk of driving through a snowstorm worth getting home as scheduled (albeit almost certainly far later than I had planned or expected)?

I didn’t make the decision lightly; the possibility of dying in a blizzard or car accident was not something that I trivialized.  So I did a basic risk assessment, something that workers do every day, whether they realize it or not and irrespective of whether or not they have been trained to properly assess risk.

I looked at two factors as I conducted my ad hoc risk assessment, and they weren’t probability and severity.  Instead, I looked at factors that would increase my risks of accident and factors that would reduce my risks.

Increased Risk

Decreased Risk

Snow Unfamiliar route Icy conditions

Worst of the storm was east of me headed north-east of me The storm was predicted to lighten in Toronto at noon Much of the route between Toronto and Detroit was expected to be clear There were fairly larger cities (Cambridge, Hamilton, London, and Chatham) where I could stop and spend the night if my assumptions proved false Traffic was far lighter than usual I grew up in rural Michigan and have been driving in wintery conditions for over 35 years I used my own car and was well aware of its performance characteristics on snow and ice My vehicle was recently winterized I keep a snow shovel and emergency response kit in my trunk The bulk of my route would be a single expressway (fewer intersections) Leaving afternoon afforded the ploughs to salt and clear the route. I recognized that additional stopping time and slower speeds would be essential. After reviewing the weather patterns and maps I believed that the bulk of my route would be clear.

I made it home safely and without incident.  Some of you may look at my decision as unduly risky, or even reckless, but I disagree. In fact, I believe that I identified my risks and took careful measures to ensure that should my assumptions turn out to be untrue I had contingencies in mind that I could implement.

Many serious injuries could be prevented if we taught workers a similar approach to their work. Instead of reminding workers to work safely we should be assisting them in making better decisions about their jobs, and teaching workers to ask these simple questions can do this:

What risk factors are present today that weren’t present yesterday? The workplace is always changing, everyday the tools get a bit duller, equipment parts are more fatigued and more likely to fail, there are part shortages, facility issues, and let’s face it, our bodies are getting older and a little less able to perform at peak levels.

1. What factors are shaping my performance, and how effectively am I managing them? What are the things that are going on in my life that could take my head out of the game and cause problems? Did I have a fight with my spouse? Is my teenager in trouble with the law? Did I get enough sleep? Am I hungry, angry, or otherwise distracted? Am I hung over? Do I have the flu? While any one of these factors alone aren’t highly likely to cause an injury they add risk.
2. Is there anything in the work area that doesn’t belong here?  Too often work areas become the dumping ground for obsolete stock, unused tools, and the general workplace dross that collects in any work environment.
3. Am I using the right tools and equipment?  Human beings have a natural drive toward expediency and if the correct tool or machine isn’t available they have a wonderful tendency to improvise.  But this improvisation adds process variability and thus risk. (the people who design processes can only engineer the risks out of a process if they can predict those risk, using a spanner as a hammer isn’t exactly the kinds of things they look for in an FMEA.
4. Have I been adequately trained and qualified to do this work? In many cases, workers BELIEVE they have been trained and qualified to do a job when in fact, the “training” they received is little more than observing a demonstration of how an experienced worker does the job.  Too often core training is so poor that a new worker may actually be received less than 10% of the skills that they need to do their job as designed.  Some of you may be thinking, “how does he figure?” well, let me tell you.

   Studies suggest that only about 20–30% of the skills taught in traditional training make it to the work area, and this falls to less than 5% unless the skills are practiced on the job within 48-hours of training (so much for training on Fridays and sending the workers home for the weekend immediately following the session.) So armed with this 5% of the skills the workers need to do the job, they begin working.  They are smart people so they figure out a way to do the job.  They learn safety issues through near misses, first aid cases, and the odd recordable.  They also drift from the 5% of the standard that they were “taught” to follow.  They also discover shortcuts—some actual and valuable time savers and others that increase the risk of injury.  In this case, we now have a veteran worker who is only 5% capable of doing the job as designed (and has 95% out of process behavior) who is tasked with “training” the new guy.  The new guy will probably retain only about 5%, but this 5% has been diluted by the veteran worker’s self-taught, on the job training.   The problem isn’t that the veteran is necessarily teaching the recruit dangerous practices, the problem is that we have no idea how much variation the veteran has added to the process and how much risk of injury now exists in this particular job.  And acting without any clue as to how much risk is endemic to a process is recklessness.

Assessing your risk of injury every time you do a job may seem like a ridiculous expectation of workers, but in cases where the most likely injury is lethal or fatal, this expectation should be institutionalized and enforced.

Filed under: Just Culture, Phil La Duke, Risk, Safety, Just culture, risk, Risk Assessment and Safety, Risk factors, Worker Injuries

Are You Turning A Blind Eye To Hazards?

By Phil La Duke

 “He’s as blind as he can be, just sees what he wants to see”—John Lennon, Nowhere Man

Hazards come in many shapes and sizes—from the physical to the behavioral and all points in between.  And the efficacy with which hazards are identified to a large extent shape the overall effectiveness of your safety management system. So what happens when your personal or organizational biases prevent you from seeing things accurately and honestly?

In broad strokes you tend to find the things for which you are looking and scarce little else.  If your organization, for example, gathers most of it’s information about hazards by watching workers perform their jobs they are likely to find a host of unsafe behaviors at the expense of other hazards that are equally (or potentially more) dangerous.  Think you are immune to letting your prejudices getting in the way of your observations and decision-making? Experts would disagree.

“When You Sell Hammers, All The World Is A Nail”—Source unknown

Bias 1: Most Injuries Are Caused by Unsafe Behavior.

Entire methodologies have grown up around the belief that you can reduce injuries by reducing unsafe behaviors.  Irrespective of your personal opinions around BBS, when you believe that worker behavior is the overwhelmingly most frequent causative factor what sense is there in looking at things like poorly maintained machinery, facility issues, or ineffectual training.

Furthermore, many injuries are that ARE the result of unsafe behaviors are in fact, basic human error and may not be proceeded by overtly observable unsafe acts. So the bias toward behavior, even when behavior is INDEED a risk factor, may blind you to other threats.

Bias 2: Severity Bias.   Author David Marx, identifies several biases that he believes can directly undermine worker safety (and public safety). Marx, in his book, Whack a Mole: The Price We Pay for Expecting Perfection Marx introduces the concept of severity bias.  According to Marx, severity bias is the practice of enforcing greater consequences for those events that produce a more severe outcome.  Marx argues that the outcome of at risk behavior is immaterial—that the true risk lies in the flawed decision making and recklessness. In other words, it doesn’t matter whether or not an employee’s actions have never killed or injured someone, the fact that the behavior’s rewards are so out of proportion with the potential for harm is enough to judge it inappropriate.  If we buy into this bias, we tend to excuse inappropriate risk taking—and even recklessness—provided that the behaviors don’t result in an incident.

Bias 3: Professional Bias.  Marx also identifies a tendency to treat behaviors more harshly as one gets closer to the front line of operations.  Research has shown that people tend to let higher ranking professionals off the hook not out of fear of retaliation, but simply because the higher the rank of a professional the more likely that people will assume that the executive knows what he or she is doing and is therefore less deserving of coaching or discipline.  When you exhibit professional bias you create a multi-tiered system of accountability. Simply stated, you have a double (or triple) standard.

Bias 4: Some Hazards Are Just Common Sense.  Another great thinker on the topic of bias as it pertains to safety is Dr. Robert Long.  Long explores the relationship between risk and human judgment in his book, Risk Makes Sense. Long contends that there is no such thing as common sense. According to Long intelligent people make sense of the situation based on there personal experiences, things they have been taught by their parents, teachers, and peers.  To expect that a worker will intuitively assess the risk of a hazard the way others in the population would is unreasonable.  But often we take it for granted that people will understand the intrinsic dangers of a circumstance and fail to manage the hazard as being too trivial, condescending, or even insulting were we to mention it.

Bias 5: The All’s Well Expectation.  In the fantastic book, Why We Make Mistakes,: How We Look Without Seeing, Forget Things In Seconds, And Are All Pretty Sure We are Way Above Average Joseph  Hallinan takes a critical look at the factors that cause us to…well, screw up.  Hallinan notes that people tend to see the world through rose colored glasses (particularly when they are examining themselves).  This tendency to see things that aren’t there can cause us to miss hazards rooted in the absence of an element.  Remember the puzzles “what’s wrong with this picture?” the same phenomena is at play in our assessments of the safety of the work environment.

Assumptions

Sometimes it isn’t a bias, per se, that gets us into trouble. Sometimes we miss hazards because we make assumptions.  One of the most deadly assumptions is that something is true when it is not.  Dangerous assumptions pervade our work assessments like the assumption that one worker does the job exactly the same as another.  Another such assumption is that the work is done the same across shifts. Because we make these assumptions our hazard assessment is intrinsically flawed.

What’s The Answer?

Putting aside our biases isn’t easy—for one, just because we have a predisposition toward a certain belief doesn’t mean we are always wrong—but being mindful of our prejudices is a great place to start.  If we can find ways to look at the work place differently (for example, listing all the individual actions, like walking, carrying, etc.) we have a better chance of getting a good view of our workplace.  Another useful method of overcoming our biases is to invite someone who knows little or nothing about the process to help in assess the risk.  The fresh set of eyes is likely to yield surprisingly results. A similar, yet no less effective method of hazard analysis is to “swap” an area with another inspector. Like the person with no experience with the process, the other inspector is likely to find hazards that you have walked by a dozen times without noticing.

Filed under: Phil La Duke, Safety, Worker Safety, assumptions about safety, bias, hazard investigation, Just culture, Professional bias, safety blindspots, Severity bias, Worker Safety

What Can Traffic Fatalities Teach Us About Worker Safety?

Last week in metropolitan Detroit two stranded drivers were killed in two separate and unrelated incidents. Both cases can teach us much about worker safety, and indeed the nature of safety in general. In the first incident, an experienced fire-fighter was struck and killed as he changed a tire on a busy interstate highway during rush hour in the pre-dawn hours of a bleak Michigan winter day. A day later, another man was killed after he was stranded because his automobile was disabled. The two stories are important illustrations that some of our most cherished truisms in safety are bunk.

Let’s take a look at the facts of the first incident. A man decides to change a tire in the dark. As he gets out of the car to assess the situation maybe he notices that he is closer to traffic than he would like, maybe he doesn’t. In either case, he decides against repositioning the care. Not far away, another driver heads to work, she left a bit early and isn’t in a particular hurry so she decides to stay in the right hand lane. While the day is dark, unseasonably warm weather has made driving conditions unusually good—no ice, good visibility, she is paying attention, well as much as one can when one makes the routine daily commute. She’s careful by nature, she makes it a point not to text or talk on the phone while driving. She isn’t going particularly fast, but she is keeping up with traffic, like most drivers she drifts a bit in the lane, but she’s not swerving. Back at our first driver, he’s ticked off, this isn’t the way he wanted to start his day, and the tire isn’t just flat, it’s ruined. He hadn’t planned on the $150 or so expense of replacing a tire, especially with the holiday bills coming in. He didn’t need this and he’s getting more and more ticked off. A car whizzes by and his heart quickens, “that was close” he thinks, and he realizes that he’s in trouble, but the car is up on the jack and there is scarce little time to move the car, besides that would take more time. As the second driver negotiates the heavy traffic she notices too late the man crouched in her lane. A moment later the man lay dead run over by three motorists.

Less than 24 hours later, on a different patch of the same freeway, a small business owner’s car gives out and strands him, he struggles to get it off the road, he puts on the flashers, and mindful of yesterday’s tragedy makes sure the car is well out of traffic and completely on the shoulder. It’s 4:00 a.m.; he picks up his cell phone; “damn, it’s dead”. “Looks like there’s no choice but to walk to the nearest gas station and get help” he thinks. Reluctantly he gets out and starts walking to the closest exit. Meanwhile a postal truck swerves to miss one of Michigan’s ubiquitous potholes and strikes the pedestrian, killing him instantly. Are these so different from workplace fatalities? I don’t think so. In fact, I think there are some important lessons that challenge conventional thinking regarding workplace injuries.

Lesson 1: Many injuries, if not most, are a collection of hazards that only cause injuries when there is a catalyst. I call it Hazard Stack, and explore this idea a bit more in this week’s http://www.rockfordgreeneinternational.wordpress.com post.

Think of all the elements, that had to be present for the firefighter to be killed. He had to be too close to the road, traffic had to be heavy, a driver had to fail to notice that he was in harms way, and more. None of these elements alone caused his death, and the elements collectively did not cause his death, until there was some catalyst. Sadly we will likely never know what the catalyst was that caused this accident.

Lesson 2: Reminding People to Act More Safely is Ineffective in Keeping People Safe. The first case shut down traffic for 3 hours or more, in fact, all of northwest metro Detroit was disrupted. This was big news and was at the forefront of drivers’ minds for weeks. Despite this chilling reminder, an almost identical incident happened in less than 24 hours. I would be stunned to learn that either driver in the second incident hadn’t heard about the first incident, and yet this heightened awareness failed to prevent the second incident. Similarly, it is unlikely that warning signs or some sort of reward for not walking on the shoulder of a busy interstate highway would be effective.

Lesson 3: The Human Drive Toward Expediency Trumps The Need to Act Safely. Too often we see workplace fatalities that would have been prevented had the individual spent a little more time or suffered a small bit of inconvenience. But we need to understand that humans are hardwired to take risks—hell, getting out of bed in the morning carries with it at least some risk. But the need for expediency, to accomplish a task as simply, quickly, and easily is far stronger than our drive for self-preservation, at least to a point that is. Too often workplaces are configured so workers are forced to choose between expediency and safety. While employers generally want people to work safely, many times the message—produce efficiently and quickly—over shadows the message to work safe. Sometimes it may seem that employers encourage at risk behavior, but in general, employers do not want employees taking reckless chances. But we do take chances nonetheless. It real terms we don’t care what our employers are telling us to do, we want to get the job done as efficiently and expeditiously as possible.

Lesson 4: It’s Easy to Get So Absorbed In The Moment That We Lose Sight of the Big Picture. Consider our cast of characters, the Fireman, the Driver who struck him, the Postal Worker, and the Business Owner. All components of a large and complex system we call traffic. Each one is fairly absorbed in situation at hand, and the specific tasks associated with their activities (changing a tire, walking for help, driving to work, and driving as part of the normal workday.) Because each was so absorbed in each one’s individual task each has lost sight of the global process. Here again, this illustrates the lack of effectiveness of reminding people to work safely. It’s fair to say that none our cast believed that they were acting in a way that would result in a fatality, because if they had such awareness, one would expect them to have taken measures to change the environment. Walk on the grass along side the shoulder, reposition the car before attempting to change a tire, or move from the right lane to the center. We can’t be sure that all four didn’t see the situation as life threatening and decided to recklessly endanger themselves or others, but we can’t default to that thinking either. Safety is about managing both the big picture and the details.

Lesson 5: Accidents Happen More Frequently As The Risk Threshold Is Approached. Safety isn’t about not getting injured. Many people behave unsafely every day and aren’t injured, nor do they cause others to be injured; they’re lucky. Safety is about the probability that someone will be injured. As hazards become more numerous the risk rises until the probability that someone will be injured is all but certain, Because this is probability and not cause and effect, no work environment can ever be pronounced completely and irrefutably safe.

Lesson 6: While Training Is Important, Merely Knowing the Risk is Insufficient For Keeping People Safe. I have a lot of respect for firefighters and I use them as examples of how more people should work safely. For examples I have trained nurses who will complain that they often have to engage in high-risk activities because a patient’s life is at stake. I tell them how glad I am that firefighters don’t act that way. I point out that firefighters don’t rush into burning buildings to safe a person without first donning their protective equipment. It’s not because firefighters care less about saving people than nurses do, it’s because firefighters understand that dead firefighters can’t safe people. I am sure that the unfortunate firefighter who died that fateful day had far more safety training and awareness than the average motorist. This training and awareness did not save his life, however. I’m not arguing against training and awareness, but let’s not bank on these things alone saving lives in the workplace. Accidental fatalities are tragic whether they happen on the highway or in the workplace.

As I think about these most recent tragedies I am reminded of how similar they probably are to the kinds of injuries that happen in the workplace. Let’s learn from these cases and try to ensure that we apply these lessons in the workplace.

Filed under: Behavior Based Safety, Loss Prevention, Loss Prevention, Phil La Duke, Safety, Worker Safety, Behaviour Based Safety, geometric design and tolerancing, hazard management, hazard stacking, Just culture, Loss Prevention, Phil La Duke, Phil LaDuke, Philip La Duke, Philip LaDuke, Process safety, risk, risk management, Rockford Greene International, Safety, what can highway fatalities teach us about worker safety, Worker Safety

Pulling it all Together (Approaching Safety Holistically Part 2)

All safety systems have their strengths and weaknesses and no individual methodology has a monopoly on answers. The right approach to worker safety will depend to some extent on an organization’s industry, maturity, and size. But even with the considerable business variability one thing remains universally true: organizations must develop a philosophy and processes flexible and robust enough to quickly adapt to a rapidly changing business environment. It is said that the most dangerous thing an organism can do is misread its environment; that is as in business as it is true in biology. Organizations who wish to nimbly respond to changes in the environment will need to adopt a blended training solution. Deciding the specific mix of safety tools, techniques, and process that an organization needs to deploy isn’t easy; in many ways it’s like trying to hit a moving target but it can be done with a little hard work and perseverance. As organizations move to a holistic approach they should make some basic changes in their views of their industries, their workforce and their values. 1) Blur the lines. Proponents of one school of thoughts about safety are generally zealots who are completely intolerant of other competing and seemingly contrary viewpoints. When one sells hammers one tends to see the whole world as a nail. Organizations need to blur the lines between these approaches and cherry pick the things of value to its specific needs as an organization. 2) Focus on the decisions people make and not on the outcomes of these decisions. In general industry tends to see safety in terms of intent and outcomes. The problem with such an approach is that it leads to (in the former case) excuse making and institutionalization of blame in the latter. As a boy I used to repeatedly try to excuse my reckless or careless behavior by telling my late father that I hadn’t done it on purpose. “If I thought you did it on purpose I would kick your ass” he would answer irritated. In the case of intent and blame, organizations can get so wrapped up in playing “who shot John” that they have little time for anything more meaningful. Blame is only useful for firing someone and replacing them equally likely to make the same mistakes because organizations in the business of blame seldom fix the system flaw that is the root cause. Blame tends to answer question, who did this? And the conversation ends there. Blame obviate any need for conducting root cause analysis and in many cases encourages an environment mistakes are driven underground and mistakes + shame = criminality. Successful organizations will make “fix the problem, not the blame” their mantras. we  can bridge the gap between hazards created by poor processes and those created by unsafe behaviors and draw together a system focused on reducing risk. 3) Understand and Embrace the Great Truths of Safety: a. Everyone makes mistakes. It is a biological imperative. b. Nobody wants, or expects, to get hurt. c. Risk endemic to life. d. No one deserves to die because of a mistake or a bad decision. 4) Safety is not a value; it’s a criterion for success. As long as organizations view safety as a value it can hide behind value conflicts, shifting priorities, and a forced hierarchy of values. Safety is the price of admission without it, nothing else matters. 5) Fear of lawsuits does not give organizations license to avoid doing the right thing. Far too often companies resist doing the smart business decision because it’s difficult. The business leaders, Human Resources, and lawyers in particular, frequently raise the specter of lawsuits and potential civil liability to freighted away those who would bring them more work. Not everything a lawyer says is stupid, but so too not everything a lawyer says is sterling. Creating a worker safety process that makes sense, protects workers and treats those who make mistakes justly should take precedence over averting the remote chance of a lawsuit. 6) An Engaged Workforce Is a Safety Workforce. In his seminal work, Carrots and Sticks Don’t Work: Build a Culture of Employee Engagement with the Principles of RESPECT, Dr. Paul Marcino, outlines a process for truly engaging your workers instead of trying to motivate them. Read this book and embrace it as the guiding principle for your safety processes and philosophy. When I first read this book over a year ago I described it as the most important book on safety of the 21st century and I stand by that opinion now. Marcino’s model will help organizations to transform their workforce and improve a host of workforce issues. This book was not intended to be applied to safety, but it serves on levels no “safety book” has yet to begin to explore. 7) Invest in Training. The single greatest investment focused on improving worker safety is in the construction of a instructionally sound and focused job-specific training program. Years ago a published study found that companies tended to see a 35:1 return on investment when they committed resources to improving the skills of their workers. While safety training is important, the real pay off for investing in training comes from monies spent on imparting the most basic skills workers will need to do their jobs. If you are a welding operation teach welding skills, but when you do embed the safety information workers need to stay safe while doing there jobs. The safety industry has grown to such an extent that it’s easy for business owners to see it as an insurmountable effort that is overkill. But safety need not be a waste of a company’s time and money. If properly managed, strategically planned, and artfully executed by engaged professionals safety efforts can improve employee morale, boost productivity, and increase profits. But ultimately, safety isn’t about not getting hurt; it’s about lowering our risk of injury to miniscule levels while at the same time recognizing that the risk of injury will never be zero and a perfect safety record is always realized to some extent by luck.

Filed under: Loss Prevention, Phil La Duke, Safety, hiearchy of controls. engineering controls, human error, Just culture, mistake proofing, mistakes, Phil La Duke, Phil LaDuke, Philip La Duke, Philip LaDuke, Process safety, Safety, safety systems, state of safety, state of the safety industry, the nature of mistakes

More Deming on Safety: Adopt the New Philosophy

Deming’s second point is “Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.” In writing this point Deming could well be describing safety.  For years Japanese companies have viewed the worker as a resource, as the best source of ideas for improvement, but also long-term partners in business; certainly a wise organization would do everything in its power to preserve and nurture something so vital to its success.

Adopting the new philosophy in safety manifests itself in several important ways.

1. Injuries are waste and need to be managed as such.  Far too many safety pundits are still preaching that “safety is the right thing to do”, they continue to preach about moral imperatives for companies to protect worker at all costs.  Whether or not companies have any compunction to protect workers is between them and the workers.  That having been said, organizations need to protect their competitiveness, their profits, and their efficiency and all this begins with a relentless pursuit of waste reductions.
2. Stop worrying about changing the culture and start worrying about changing your processes.  Too often safety professionals stick with what they know and don’t venture too far beyond it. Unfortunately, safety professionals typically don’t know all that much about organizational development, transformational change, or organizational psychology.  Even so, that doesn’t seem to be sufficient to stop safety vendors from shilling half-baked culture change solutions to organizations. Nor does it stop internal safety professionals from championing initiatives of which their sole qualifications are limited to reading an article in the odd safety magazine or attending a session at a safety conference.
   That some organizational cultures inappropriately undervalue safety is indisputable, but making the leap that the Safety function is capable of changing that on some grand, enterprise-wide scale is laughable. On the other hand few safety professionals understand process mapping, value stream analysis, and the other tools and methods necessary for process improvement.
3. Integrate the Safety Into Other Business Functions. The days where Safety is a separate business function are rapidly coming to a close.  Maintaining a safety infrastructure with Safety professionals must end.  Just as the Quality function evolved into a vehicle for process improvement so too must safety.  As long as Safety professionals see themselves as discrete from the overall operations and somehow able to operate in isolation from production it will always be at risk of being dropped from the corporate team.
4. Leadership Must Advocate for Change. Leaders are often maligned by safety professionals. Too many times safety professionals blame their own failures on a lack of leadership commitment. In this case Safety professionals are right:  Leaders SHOULD be visible and outspoken advocates for safety and organizational change that supports it.  That’s not to say that safety professionals shouldn’t play a role in this initiative.  Safety professionals should provide expertise and guidance to leaders, many of whom, don’t know how to begin to advocate change.
   If safety professionals are going to be trusted counselors to the leaders there is much work they need to do:
1. Quit pretending to know more than they do. Safety is an area of expertise that requires practitioners to have a deep understanding of a diverse range of disciplines, but there are limits to even the most learned safety professionals’ curricula verities.  There is a natural tendency (bordering on compulsion) for safety professionals to advise far beyond their knowledge base and once labeled a vacuous windbag it’s hard to been seen as having any opinion of value to offer.
2. Research and Analysis. Perhaps the most useful service a safety professional can offer is comprehensive research coupled with razor-sharp analysis on the best way to leverage the things uncovered by the research.
3. Offer Guidance, Not Advice or Opinions. One of the most important thing that I recently learned is that offering guidance is tough. Frequently, what we see as guidance is opinion or just plain butting in. Guidance is marked more by listening than by advising someone as to what they had ought to do.  Guidance is invited; advice or opinions are not.  Safety professionals need to transition to trusted counselors than pouting eunuchs that huff and sigh when they don’t get their ways.  But offering guidance requires trust, and trust takes time to build.
5. Recognize the Realities and Challenges Endemic to the New Global Economy.  Deming developed his 14 points over 50 years ago, yet even then he was able to recognize that even then we were in a new economic reality.  Even as safety comes under increasing government scrutiny the scarcity of resources available for workplace safety continues to plague safety professionals.  The stark reality is that while the number of demands placed on safety increase, the resources are shrinking or trending flat.    
6.  Improve the quality of safety training and ensure its efficacy. My background is in organizational development and training and I will say unequivocally that the most safety training is wholly inadequate for anything except for checking the compliance box.  The biggest opportunity to transform the safety of the workplace lies in the improvements that can be made in training.  The better a worker is prepared in the tasks associated with his or her job the safer that worker will be.  I wrote an article on how safety training could be improved, What’s Wrong With Safety Training and How to Fix It so I won’t revisit it here.

Deming’s work remains the quintessential guide to quality, but the lessons one can glean and apply to safety are timeless and substantial. In studying Deming’s thoughts on quality we can transform safety and in so doing our industries.

Footnote: Phil La Duke will be speaking at 1:30 p.m at the National Safety Council on October 31, 2011

About Phil La Duke.  Phil La Duke is a contributing editor and safety columnist for Fabricating and Metal Working magazine, an editorial advisor and contributor to  Facility Safety Management magazine, and a contributor to ISHN magazine.  La Duke is a highly sought after international speaker and author whose brash style and often controversial take on emerging issue is a favorite of the international safety community.

Filed under: Loss Prevention, Near Miss Reporting, Phil La Duke, Safety, Safety Culture, Adopt the New Philosophy, Aerospace, Aerospace safety, Attitude, Attitudes toward safety, Behavior Based Safety, culture change, Deminjg on Safety, Freightliner, Heavy Truck Manufacturing, increasing efficiency, Just Cause, Just culture, Leadership, Mexico, Mine safety, National Safety Council, oil and gas, Peru, Phil La Duke, Phil LaDuke, Philip La Duke, Philip LaDuke, Process failure, Process Failure Modes Effects Analysis, Process safety, rockford greene, Rockford Greene International, Safety, Safety Culture, Safety Leadership, Williams International, Worker Safety

A Just Culture Starts With Just Leadership

Just Culture, a concept James Reason proffered decades ago is growing in popularity.  At its essential core Just Culture is pretty simple: people make mistakes and punishing people for making honest mistakes is a basic form of injustice.  Reason, and his successors, argue that organizations must foster blame-free environments where workers are encouraged to report mistakes and near miss if they hope to ever address the root causes of workplace injuries.

But implementing a just culture is far more difficult than merely deciding not to punish people for screwing up.  Far too many business leaders are unable to see past their petty biases and the traditional legal department party line that a blame-free culture needlessly and recklessly exposes organizations from malpractice lawsuits or other liabilities.  This is unfortunate.  So many business leaders are afraid to do what is right in favor of what is safe.

For a just culture to take hold and blossom organizations need a different sort of leader. A Just culture  needs to be led by what I describe as just leaders, and these executives are a rarity.

Traits of a Just Leader

Just leaders share characteristics that set them apart from the pack. These leaders see themselves as leaders first and foremost and they live there lives by a code of conduct that is set not be some artificial external criteria but by their personal values.

Courage

It takes a lot of moral fortitude to stand up to corporate attorneys who advise you on a course of action that pits you against your core values.  If the corporate attorney insists that you hang someone out to dry, it’s tempting to throw someone under the bus and blame the oily skinned legal department (or corporate communication or IT).  It takes real courage to stand up to the corporate pitch fork and torch toting mob screaming for the blood of some hapless bureaucrat who mad a bad decision in good faith, but that’s what a just leader does.  A just leader recognizes that courage lies not fearlessness, but in recognizing one’s fear and forging forward despite them.

A just leader is able to clearly articulate his or her values and institutionalize  those values into a work culture that is fair and just.

Vision

It’s scary what passes for vision these days. Corruption is rampant, which one could argue was always the case, but even when Chief Tammany bore witness through his lifeless wooden eyes, people recognized corruption, incompetence and dare I say it, corporate sin. Just leaders need vision and that vision must take them beyond what’s good for themselves and their stockholders.  Just leaders know that they cast long shadows and that to create an organization that will endure it takes more than their own skills and includes the skills of most everyone in the organization.

Recent years have seen the growth of a sickening cottage industry—executives who take companies into bankruptcy.  This is pointedly obvious in the auto industry.  There are a handful of executives whose only value seems to be screwing people out of money to which they are legally entitled via bankruptcy. These slim-witted weasels are hired to bankrupt a company not as a last resort reset of the company’s debts but as a corporate strategy.

A just leader looks beyond the goals by which his or her compensation is based  and instead focuses on how organizations can serve the needs of their stock holders, their environments, their employees, and their customers.  A good leader knows the importance of being a good corporate citizen.

Consistency

Rudyard Kipling once wrote “if you can trust yourself while all men doubt you while still allowing for the doubting too.” Just leaders do this by consistently holding the line as others in their industry are melting down in panic.  Because these leaders have a clear cut vision you can always predict what they will do in a crisis,  you can set your watch by them and trust they will do what is required even if it is painful

Consistency isn’t easy, especially when an industry is melting down.  But no one will ever admit mistakes without knowing exactly what consequences are likely to befall them. So unless a leader can consistently react to unexpected circumstances a just culture can never emerge.

Honesty

A just leader cannot expect others to be forth coming about their mistakes unless he or she clearly acknowledges his or her own mistakes.  Everyone makes mistakes and for a leader to gloss over his or her business faux pas is the height of arrogance and hubris.  Just leaders aren’t afraid to acknowledge their mistakes and the best of them learn from their mistakes and teach others the lessons they learned.

Honesty transcends being straight-forward with board members, the media, the workers, the unions, and the stockholders and reaches the depths of the just leader’s subconscious and lays bare the soul, in short the just leader is MOST honest with him- or herself.

Integrity

Just leaders don’t just know the difference between right and wrong, they also know the difference between right and legal. In this day and age it’s easy to hide behind the law and commit corporate atrocities.  For most leaders doing something heinous is softened a bit if you can get your corporate lobbyist to get it legalized first.  Just leaders worry about what is right, not what is legal.  And when they act with integrity and transparency they need not worry about investigations or accusations.

Just leaders hold themselves to a higher standard than the one to which they hold all others and the one against which society measures them. And when it comes to creating a just cultures having the right leaders is more important than having the right consultants, the right tag lines, or even the right policies.

Filed under: Behavior Based Safety, Loss Prevention, Near Miss Reporting, Phil La Duke, Safety, Safety Culture, Worker Safety, Attitude, Attitudes toward safety, Behavior Based Safety, Behaviour Based Safety, corporate atrocities, Courage, don't hurt yourself, efficiency, Honesty, Integrity, Just Cause, Just culture, Just Leaders, Mine safety, rockford greene, Safety Culture, Stop trying to prevent every possible accident

To Coach Or Not To Coach?

The debate over safety culture continues to rage largely among people who aren’t qualified to way  in one way or the other. But let’s suppose that we do achieve that Utopian safety culture, we reach El Dorado; then what? Organizations are dynamic and exist in a dynamic environment; to think that we can preserve this elusive state without taking active measures to preserve it is naive at best and reckless at worst. A simple, practical, fast way to sustain cultural improvements is through coaching.

Coaching is one of those skills that charlatans hawk as quick fixes—not quite training, not quite supervision coaching has become one of those non-skills that people shill without any real foundation. But there are also some terrific programs designed to teach and institutionalize coaching skills so I guess my message is simply to be careful in what you invest.

One of the greatest challenges to sustaining a culture change isn’t in the efficacy of the coaching it’s knowing when and how to coach.  This table is based on coaching an organization with a fairly robust safety process, but I think it will serve as an adequate model for less sophisticated environments as well.

Indicator	What does it indicate	Where do I get the information?	How do I coach?	How do I know if I’ve been successful
Inspections are not being done	Less priority is being placed on safety by the supervisor  The safety committee is not effectively ensuring that the inspections are being conducted	Safety Inspection Report from the Hazard Tracking Database	Raise the issue at the safety meeting and coach the meeting owner prior to the meeting to have the supervisor report to the safety meeting the reason that his or her inspection has not been done	A review of the Safety Inspection Report should indicate that the inspections are being done
Inspections do not find enough hazards	No hazards are found on an inspection, or a small number of inspections are found in an area with a number of injuries  The safety committee is not effectively ensuring that the inspections are being conducted properly	Safety Inspection Report from the  Hazard Tracking Database	Raise the issue at the safety committee meeting and coach the meeting owner prior to the meeting to have the supervisor report to the HIT the reason that his or her inspection has not been done	A review of the Safety Inspection Report should indicate that the inspections are being done
The risk of  a hazard is inappropriately assessed	The inspector lacks the skills to properly assess risk  ~or~ The inspector has an ulterior motive for increasing or decreasing the risk level	Randomly reviewing hazards	Speak to the inspector and find out why he or she is inappropriately assessing the risk of a hazard, if the inspector doesn’t know that he or she has assessed the risk inappropriately then review the process for assessing hazards.  If the inspector has an ulterior motive for this behavior, advise him or her to refrain from the behavior in the future.  If the problem persists raise it at the HIT meeting.	A review of  hazards entered by the inspector should show improvement.
The containment action is inappropriate	The inspector lacks the skills to specify an appropriate containment action	Randomly reviewing hazards	Speak to the inspector and provide feedback as to why the containment action is inappropriate and suggest ways on which the action could be improved	A review of the hazards entered by the inspector should show improvement.
The hazard entered is not a safety issue	The inspector lacks sufficient skills in hazard identification or is hoping entering an issue as a safety issue will get faster action	An email from the database disputing the hazard	Talk to the inspector and explain why the issue is not a safety issue.  Retrain the inspector in hazard investigation if necessary	No further emails that dispute hazards
A hazard IS a safety issue but the person responsible for correcting it disputes it	The person responsible for correcting it lacks sufficient skills in hazard identification or is hoping to avoid fixing an issue	An email from the database disputing the hazard	Talk to the person responsible for correcting the hazard and explain why the issue is not a safety issue.  Retrain the person responsible for correcting the  hazard	No further emails that dispute hazards

Filed under: Safety, Safety Culture, Attitude, Attitudes toward safety, Behavior Based Safety, Behaviour Based Safety, contingency planning, culture change, don't hurt yourself, driver safety, efficiency, Fabricating and Metalworking magazine, increasing efficiency, increasing productivity, Just Cause, Just culture, oil and gas, Phil LaDuke, Philip La Duke, Philip LaDuke, Process safety, rockford greene, variability in human behavior, Worker Safety