Phil La Duke's Blog

Fresh perspectives on safety and Performance Improvement

No post this week

Sorry folks, suffering from a severe writer’s block this week and a fair amount of depression.  I worked on no fewer than 8 pieces that I discarded because they were rambling pieces of crap.  Better to post nothing than to waste your time.

Filed under: Safety

Discouraging Workers from Reporting Injuries Is Bad Business


By Phil La Duke

Under-reporting injuries is a poor business practice bordering on criminal behavior. Nowhere was this better evidence than when the U.S. government leveed a whopping $70 million fine on Honda of America for doing just that. In what The New York Times describes as a “sharp escalation of penalties against automakers that skirt safety laws” Honda Fined for Violations of Safety Law, Honda was fined for not reporting consumer injuries and deaths caused by quality defects and for not reporting the defects themselves. Last year, General Motors faced similar sanctions.

It’s worth noting that neither company has been accused (at least formally) of underreporting worker injuries, but is that such a stretch? General Motors has consistently reported one of the best safety records in industry and Honda of America hasn’t made OSHA’s radar since 1999 when one of its contractors were fined over $1 million for machine guarding issues.

All that having been said, is it a stretch to believe that companies that deliberately lie to and one branch of the government (the Department of Transportation) about public safety might not also lie to another branch of the government (OSHA) about the safety of its workers? How confidant are you that companies that do not report one set of data (in this case public deaths and defect claims) that is publicly available and can easily be discovered will willingly and openly and accurately report injuries that happen under the shroud of company secrecy? We talk a lot about indicators in this business and to me there is a strong correlation between cooking one set of books and the likelihood that another set of books is equally cooked.

Rumor has it that underreporting is an area of increasing concern among OSHA inspectors and that companies can expect stricter penalties for underreporting.

Underreporting potentially poses a much more serious threat to worker safety than injuries themselves. When a worker is injured it provides the company with irrefutable evidence that safety is not present in the workplace, assuming you define, as most persist in doing, safety as the absence of injuries. As horrible as it is to have workplace injuries the silver lining is that a heretofore-unknown hazard is revealed and can be rectified; not so if the injury goes unreported and unknown.

Companies need not hatch any insidious plot to conceal injuries in most cases thirty years or more of hackneyed incentive programs and half-baked schemes from safety pundits have created a culture where injuries are taboo and only those injuries that cannot be manipulated via case management are reported.

It’s no accident that recordable injuries are falling while fatalities are staying flat (or in some industries actually rising)—it’s tough to turn a corpse into a first aid case no matter how creative you are. Case management has become a crucial part of the safety management system and it should be. No one should be allowed to fraudulently file injury claims in an attempt to cheat the system, but then again, as loathsome as it is, the company has to balance the cost of fighting the cost of fraud against the actual cost of the fraud. This is well known in the insurance and legal communities where it is common practice to settle a dubious lawsuit rather than face a lengthy and costly legal battle. And yet companies still invest considerable sums into case management. Why? Is fraud so widespread that something has to be done or western civilization itself would collapse? No, at least according to studies cited by Lisa Cullen in her article The Myth of Workers’ Compensation Fraud only 1–2% of Worker Compensation claims are fraudulent. So why do so many companies continue to fund Case Management efforts. Is it fiscally responsible to invest money disputing claims when only 2% or less are fraudulent? Not unless disputing claims serves some other, more profitable purpose. In the instance of case management the purpose is clear (although seldom admitted): reducing recordable injuries. I know of cases where companies have sent representatives to the clinic with injured employees to instruct the medical professionals in how to treat an injuries—weighing in on everything from the type of pain reliever used to whether to suture a cut or to close it using butterfly bandages. Such practices smack of questionable ethics but are widespread nonetheless.

Some efforts that discourage injury reporting are less malignant in intent but are just as damaging to the overall efforts to reduce risk. Companies routinely sponsor incentive programs for workers to not get hurt. If that phrasing sounds odd to you it should. When you provide incentive for someone not to do something that they can’t control and aren’t doing on purpose, what message are you sending? When you provide incentive for something beyond one’s control—whether that be injuries or sales—the only true incentive is to cheat and lie. The incentive in the case of zero injury rewards is to underreport.

One can take this effort to discourage reporting injuries even further and pit worker against worker through “behavior observations” which in effect vilify the injured worker; the injured worker spoils the Safety BINGO, and may even cost coworkers their bonuses. The coercive pressure to conceal workplace injuries can be overwhelming.

We talk a lot about changing the culture and about how workers need to change how they view safety, but maybe the cultural change needs to be in who we view injury and injury reporting. If we as organizations and individuals truly value safety we have to stop pretending that condoning injuries provided that they aren’t recordable injuries is the same thing as valuing safety.

Filed under: Behavior Based Safety, Injury reporting, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Lone-Gunman Based Safety

Multiple causes

By Phil La Duke

Ever since Jack Ruby gunned down Lee Harvey Oswald while being transferred from a Dallas police station to county jail debate has raged as to whether or not Oswald acted alone or if he was part of a larger conspiracy. There’s not much satisfaction in the “Lone Gunman” theory; it lacks the panache and high drama of a conspiracy, but beyond that, the Lone Gunman theory seems too simple, too convenient, and too pat. I got thinking about the Lone Gunman theory as it pertains to safety and think the comparison is apt.

I came to realize that most safety professionals see injuries as the result of “Lone Gunman” thinking after listening to yet another argument about the nature of injures. “Injuries are caused by behaviors” “no they’re caused by process flaws” “no they’re caused by…” it sure sounds to me like the people who argue whether or not Oswald acted alone. Sound crazy? Think about it: if you believe that the majority of injuries are caused by a single thing you are essentially dismissing the possibility that worker injuries are caused by a complex situations with multiple and often inter-related cause and effects.

The lone gunman theories are attractive; they boil our problem down to a single factor that we can rigorously attack and solve it. This kind of thinking is satisfying because it means that all we need do is to solve one problem and we don’t have to be distracted by all the other things that may or may not be causing injuries.

Now some reading this will immediately hide behind the fact that they never said that ALL injuries are caused by (fill in the blank) but that MOST injuries are caused by (fill in the blank). That’s a convenient (albeit cowardly) way to stack the deck in your favor but it’s a specious and facile argument, even if we can say with credibility that 99% of injuries are caused by a single cause we have always have that 1% that aren’t and that allows us to dismiss it as an outlier.. Dismissing causes that don’t neatly fit into your view of the world as statistical aberrations or outliers is just another form of calling a fatality an unforeseeable act of God.

No One is So Dangerous as the Man with the Whole World Figured Out

When we start to see any topic with a fanatic’s singularity we become dangerous. If we believe that most injuries are caused by a single cause—whether it be leadership, or culture, or process failures, or human error, or risk taking, or pixies, faeries, and trolls—we create a world where anyone who disagrees must be heretics and heretics must die or at very least publicly mocked behind the walls of anonymity of a LinkedIn discussion thread.

Call Us Legion, For We Are Many

I am distrustful of the “one-size-fits-all” approaches to injury reduction, which let’s face it, isn’t the same as safety and yet many of the programs, snake-oils, and magic bullets our there promise safety and only sometimes deliver injury reduction. It’s dangerous to think in terms of a lone-gunman cause for injuries (even when allowing for the possibility that there could be other lone gunman working simultaneously. The opposite of lone gun thinking is conspiracy theory, which okay, I admit, makes me sound like even more of a whack-job than usual. But for our purposes think of injury causes as being somewhat, or at least potentially, benign by themselves. We interact with hazards every day and in the fast majority of those interactions we don’t get harmed. But the more hazards that are present the greater the probability of injury and the presence of some catalyst causes us to be injured. Think of the straw that broke the camel’s back: up until that last minute the camel was uninjured, but given enough objects loaded onto the camel’s back eventually the camel will exceed its capacity to hold the weight.

There are many things, often working in tandem, that cause injuries and we have to stop arguing over whether the straw broke the camel’s back or whether the man who overloaded the camel was to blame, or whether the camel made poor choices, or whether both camel and man had been poorly trained, or whether we could provide an incentive for the camel’s back not to break and realize that there is seldom only one thing going on, and in most cases hazards work together to achieve a lethal synergy that can maim, cripple, and kill.

We Need To Look for Questions Not Answers

I taught problem solving for many years. One technique we used was called Situation Analysis. This technique is used to solve problems with more than one cause, has inter-related causes and effects, and grew over time. The technique was useful for solving broad problems (like…I don’t know…injuries). What I found interesting is that this technique taught people that if you only focus on one of the causes and ignore the others you won’t really SOLVE the problems you would merely make the symptoms go away until the other causes would cross a threshold causing the problem to return even worse than it had been before. I think of the conundrum of fatalities. Injury rates seem to be going down (although many believe that this is largely the result of under-reporting or more rigorous case management) while fatalities are staying flat or in some cases rising. This is the exact pattern one would expect from methodologies that attack one cause while ignoring others─ the problem seemed to be going away until it roared back worse than ever. It has left safety professionals scratching their heads, but if we attack the lack of safety as a complex problem that has multiple causes that are interrelated we might just be able to manage things better and save some lives.

I’m Not Alone

I know I may sound like a broken record, but when you sell hammers all the world looks like a nail, and while I have heard many say “well BBS is just a tool in my toolbox” (and I use BBS as an example because I hear this more then let’s say “human performance” or “leadership improvement”) I get skeptical. I want to ask what other tools do you use? When do you use them? When is it inappropriate to use them? But I don’t; frankly I’m tired of arguing with fanatics. One bright spot is that I am meeting more and more people who are beginning to think like me. Rockwell, for example, talks about the 3Cs of safety. The 3 C’s are Capital, Compliance, and Culture. Now I’m not here to promote Rockwell but I like where their heads are at on this. I’m over simplifying their spiel here but effectively what they are saying is that you have to consider all three of these things when attacking safety issues. Capital-you have to make capital expenditures to fund projects to improve your equipment. I would expand that to include your facilities as well, but I think their point is well taken. Compliance-let’s not forget that we have to follow the law and that basic compliance is the gateway to more advanced safety solutions. And Culture-hiring qualified organizational development professionals to make substantive changes in how your organization views and values safety is important. To hear Rockwell tell it, you can’t expect great results without looking at all three; I think they are right.

Filed under: Safety, Safety Culture, Phil La Duke, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

2014 New Year’s Resolutions for Safety Professionals

by Phil LaDuke

Last year I wrote a list of New Year’s resolutions for Safety Professionals. The piece proved popular and people this time of year seem to come looking for them. I decided to write this piece without looking at the previous list and after doing so taking a look at them to see if I am capable of any sort of growth. 2014 has been a rough year for me. I lost my father-in-law and one of my few remaining uncles to work-related illness and despite by best efforts through writing and speaking and working I don’t seem to have changed anything, not a single mind. But this time of year makes the best of us reflective and after doing some soul searching and reflecting I came up with a short list of things I think we as professionals can do to be even more effective:

  1. Seek first to understand before seeking to be understood. Okay, I borrowed this one from St. Frances of Assisi but I think safety practitioners need to adopt it, especially those of us who sell safety services and solutions. We need to listen to the organization and ask probing questions—not in an attempt to lead people to our preordained solutions but so that we can understand their pain points, we cannot solve a problem that we don’t fully understand.
  2. Keep things simple. When we offer advice we need to do so because we truly want the other to benefit from our wisdom and experience not because we want to show off or demonstrate our brilliance. The best advice I have received in life was simply stated and to the point. Perhaps the absolute best advice ever given me was a single word, “stop” (my friend Ken said to me as I was about to mindlessly walk into the path of speeding Chicago traffic). We don’t need to write grand, self-serving treatises to be effective.

We have become a profession of theorists who, when proven wrong, change the rules. We need to get back to basics, as my boss if fond of saying “the best companies get the basics right and they get them right every time”. So what are the basics? Competency, Risk Management, Process Capability, Accountability and Engagement. But on an even more basic level we need to tackle the basics of hazard identification, containment, correction, and communication.

  1. Be kind. I know it may sound hypocritical of me to preach kindness but as a wise man once said to me, “make the day, don’t let the day make you”. To a large extent what we send out comes back to us and when we are kind people are more likely to be persuaded by us than when we are jerks. Besides, being the safety jerk is my job. When someone has been injured they are particularly vulnerable, “I told you so” or “you should have…” never soothed an injured worker.
  2. Serve the Organization. I spent last weekend poring over incident reports and Workers’ Compensation reports and I was struck by how often we assume the injury was intentional until proven otherwise. Are their liars and cheats who want to fake claims? Sure, but far more of the injured are victims and if we just lived our lives in service to the organization instead of standing in judgment of the injured we would see that most injuries are painful, embarrassing moments in the lives of workers. Do we have to protect the company against fraud? Absolutely, but let’s resolve to do so without treating everyone as criminals.
  3. Collaborate. We cannot be successful trying to do this alone and we have to swallow our pride and reach out to other disciplines. I have seen so many safety professionals wrestling for control with the continuous improvement group only to have both groups remain impotent in the organization. Reach out and help someone and ask for help in return; at the end of the day we’re all in this together.
  4. Teach. To be truly safe workers need to be able to do their jobs and they need to have mastered their jobs. I wrote this to a safety executive once and he wrote me back with scorn. “Why do they have to master their jobs?” he scoffed at me. I resolved right then and there never to do business with him. I don’t think he can be reached and if he can learn, he cannot learn from me.
    But in answer to his question, why do they have to master their job? Because the level of mastery of one’s job equates to the level of risk one operates under while working. Workers who don’t know how to do their jobs—or our just marginally competent—are far more likely to be injured or to injure another worker. This is most acutely evident in how companies view training temporary workers; in the minds of many better to kill a temp than to waste money training one. It’s ugly, but it’s true.
  5. The more we sharpen our skills as safety professionals the more good we can do, but I’m not talking about learning the latest safety fad. We need to learn how our businesses work, how our organizations survive, and how our companies make money. We can’t change anything unless we know how our businesses work. Instead of going to the same tired professional conferences and hearing the same tired speeches from the same tired hucksters why not attend a business seminar, or a Lean Management course? You will be a better professional for it.
  6. Safety is a tough way to make a buck, and it’s getting tougher. Hang in there, this isn’t a job for quitters.

Last year I gave you 10, but this year only eight. But I will make you a bargain. If you do these eight come see me and I’ll give you another 10.

Filed under: Safety, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Why BBS will Live Forever

By Phil La Duke

Just when you think the debate over Behavior-Based Safety has faded from the landscape something brings it crashing back into your consciousness. For me it was a recent article (and the response to it) by Dr. James Leemann. Jim asked the question “will Human and Organization Performance (HOP) finally supplant BBS” as the prevalent approach to worker safety? As one might suppose the BBS zealots and whack-jobs came crawling out of the woodwork to complain.

I’m a big proponent of HOP because it fixes system problems not the blame. HOP goes beyond the behavior and address the system-wide antecedents, the things that precede and encourage the very behaviors that influence safety. I don’t think it’s a perfect system for protecting workers but I believe that safety is the output of well-managed business systems and so HOP makes a lot of sense to my clients and me.

The backlash to Jim’s article was predictable; the usual suspects accused Jim of not understanding BBS, not having seen BBS properly deployed, etc. etc. etc.

The whole argument exhausts me. I’ve said before that arguing against BBS is like telling someone you don’t like eating fricasseed squirrel anus. The first response is always, “well you just haven’t had it cooked right; you need to try MY fricasseed squirrel anus—you’ll love it!” So you try there version and it tastes even worse that the last time. But you still don’t, in the eyes of the fricasseed squirrel anus lobby, have any real standing, how many squirrel anuses (anusi?) does a man have to eat before the nut jobs cooking it will allow that said man to refuse on the grounds that squirrel anus is unpalatable?

To speak up against BBS is, in the mind fanatics, to speak out against safety, God, apple-pie and motherhood; it doesn’t matter how much evidence you produce that BBS doesn’t work, creates bloated bureaucracies, and encourages under-reporting of injuries, you will never convince the true believers that BBS is anything less than the one true path. It’s like trying to convince Lynette “Squeaky” Fromme that Charles Manson isn’t a pure soul; talking about it is like doing a card trick for a dog.

I’m at a loss to explain why BBS lingers in the same way I’m at a loss to explain why some people still believe in the Loch Ness Monster when most of the most credible evidence has since been exposed as so much bunk, or why there are Big Foot sightings in every state of the Union (including Hawaii), or why people believe in alien autopsies while others refuse to believe that the moon landing was anything more than a government conspiracy with a Hollywood twist.

For some BBS is an important source of income and in those cases it is not inconceivable that either they unethically cling to something that they know is snake oil or they have convinced themselves to ignore information that threatens their livelihoods; either way they have the strongest possible financial incentive to refute any claim that BBS doesn’t work. It’s much like a child who begins to doubt the existence of Santa Clause but is terrified that if he or she voices this doubt the Christmas gravy train will end and there will be no more Christmas present bonanza; the pragmatist in each of us will play it safe and perpetuate the Santa Claus myth even though long after we ourselves have long stopped believing.

For others BBS is a crutch on which they lean to compensate for the lack of real competency in safety. When one doesn’t quite get it, one clings to those things that they CAN understand. If you have a safety practitioner who lacks understanding of the basic safety regulations will find BBS a comforting alternative, with it’s simplistic “just reward safe behaviors” philosophy. Many people who don’t know the hard science side of safety will gravitate toward the simple argument that “if 80% of injuries is caused by behavior then we should focus on behaviors”.

In a broader sense BBS has a wide appeal to the key players within an organization. Management likes the “let’s hold workers accountable for working safe” underpinnings of BBS. Safety professionals like the number of resources that fall under their control; they get to spend money and engage in a wide range of activities. Employees love the pizza parties and safety BINGOs and safety bonuses. And of course vendors love the revenue it brings in. There is a conspiratorial feel to all this that sets off alarm bells.

Still others, and I believe this is the largest group speak about BBS in philosophical terms. Those in this group will insist vendors have a behavior-based safety system in place as a condition of doing business; it’s a nice thought but what then constitutes a “behavior-based safety” system? Is it enough that the safety system address unsafe behaviors? If so, this is fundamentally flawed unless the definition includes some context, and because all behavior exists within a context the definition would have to be exhaustive to be of any use whatever. What’s that old saying about the road to Hell being paved with good intentions? Wikipedia, granted nobody’s vision of a credible source, defines Behavior Based Safety as “the “application of science of behavior change to real world problems”.or “(their spelling error not mine). A process that creates a safety partnership between management and employees that continually focuses people’s attentions and actions on theirs, and others, daily safety behavior.BBS (again their screw up) “focuses on what people do, analyzes why they do it, and then applies a research-supported intervention strategy to improve what people do” Let’s take that one phrase at a time:

“application of science of behavior change” according to the science of behavior change is behaviorism. And according to the American Board of Professional Psychology (people who it would seem ought to know) “behaviorism” “emphasizes an experimental-clinical approach to the application of behavioral and cognitive sciences to understand human behavior and develop interventions that enhance the human condition.” I’m pretty sure that BBS as practiced is just about as far from this as can be reasonably imagined.

“A process that creates a safety partnership between management and employees that continually focuses people’s attentions and actions on theirs, and others, daily safety behavior”. Here, while many BBS systems aspire to this none can honestly say they have achieved it, for if such a system does exist there would be no injuries, no near misses, no need for the hapless companies to frantically feed the BBS money machine.

“focuses on what people do, analyzes why they do it, and then applies a research-supported intervention strategy to improve what people do” Again, while BBS may do all these things, to what end? They haven’t and never will prove that all this focus and research changes human behavior one whit, nor does it change the ingrained tendency for people to make errors, take risks, and behave unpredictably. No, I am not condemning anyone who requires his or her vendors to have a behavior-based safety system—just using safety performance as a criteria for selection will save more lives than not doing so. I am not condemning anything really, I just want to know why merely asking the question “is it time to dump BBS and consider another approach” is seen as abject ignorance or malicious heresy. Is a world without BBS so threatening and scary?

Filed under: Safety, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Insights on Culture

By Phil LaDuke

On Friday I went to the neighborhood bar as I am wont to do from time to time. While there I saw a regular who works with my brother in an open die forge. I passed the pleasantries with him and asked him how he was. He said he was doing a lot better and was healing. I didn’t know what he was talking about so I asked him. He explained that he was burned badly at work; second-degree burns over most of his lower leg. He quickly produced a cellphone and proudly displayed a gruesome photo of a badly burned leg. As I looked at the sickening display he recounted the details. He prefaced his story with a quick, “It was my own fault, I was so (expletive) stupid”, and told his tale of his not paying attention to a hot piece and having his pants catch on fire. Instead of using sand to put out the flames he panicked and ran. There were some jokes made in poor taste about the old Bill Cosby “Stop, Drop, and Roll” television ads, and I asked him how much time he missed. “Not a day. I took it like a man.” Took it like a man; his comment made me think about culture.

Culture is all the rage in safety these days. Circa 1972 James Reason made the observation that before an organization can create a “Just Culture” it must first create a “Safety Culture”. Reason wasn’t talking about worker safety, at least not in the way we tend to think of it. Unfortunately, the snake oil salesmen have glommed onto the term like lampreys on a fish’s soft white underbelly and subvert it more and more each day.

My acquaintance’s story tells us a lot about culture and the relationship between safety and culture. It occurred to me that there are levels within culture and if we are hoping to change the culture of our organizations we need to examine the nuances of culture. Each level of safety culture is characterized by a perception of a reaction of some sort; each one is driven by a fear of some sort.

Fear of Discipline

The other day I was late for a doctor’s appointment and I was tempted to speed; I didn’t. My first thought was, “I don’t need a ticket”. The idea of spending money on a ticket and the time it would take up just didn’t seem to favorably balance against the time I might save. As many times as my doctor made me wait (ultimately I had to wait in the doctor’s office anyway) I figured I was owed some slack. In the moment of decision, I placed more value on compliance than I did on the potential value.

Fear of Loss of Reputation

As I reflected on my decision I thought about culture. What, I asked myself, would I have done if my speeding had been through a school zone. What influence would the opinions of my friends and neighbors have on my decision. I think it would be fair to say that for many the risk of damaging our public image (coupled with the fear of discipline) would put more pressure on me to conform to a norm and to adhere to the values of the community. My desire to preserve my reputation was stronger than my desire to get to the doctor’s on time.

Fear of Culpability

Of course there also was my concern for public safety. I’d like to think that most of us want to behave safely when the lives of innocent school children are at stake. But even when the situation isn’t about endangering school children there is on some level a desire to be a good person and good member of the population; a good citizen, if you will. In our heart of hearts we all want to conform to the shared values of the culture. We go along to get along.

Putting It Into Practice

If these fears are the drivers of culture then what are we to do with this information. Well think back to the guy in the bar who set fire to his leg. Clearly the culture of his company valued guys who “man up” when it comes to injury. Here is a guy who is working while heavily medicated; doped up on pain medication. This is a culture that values a lower DART rate than it does the safety of the remaining employees (how do you think the performance of a heavily medicated employee will be effected?). This is a culture that encourages workers to “man up” and work while injured. This is a culture that doesn’t seem to value worker safety much. I realize this is harsh criticism and that I can’t really make judgments on the company simply because of an account from an injured worker. I think it’s important to note that the worker in question likes his employers and generally has good things to say about his company. The net sum total is this worker’s willingness to go to work rather than to stay home and recuperate he didn’t do it out of fear of repercussions he did it out of fear for his reputation and to conform to the shared values of the population.

The takeaway here is to change your culture you first have to understand the coercive pressures you put on people every day. You need to ask yourself three basic questions:

  • What value does the organization place on discipline? Are people hailed as heroes for “manning up” or dismissed as wimps because they report injuries or seek appropriate medical attention.
  • How are people who value safety viewed? Are they seen as solid professionals
  • How is risk viewed? Are people with a low risk tolerance seen as top performers or as “worry warts”?

The point I’m trying to make is that you may be fostering a culture that actually promotes the things that you are trying to change.


Filed under: Behavior Based Safety, Hazard Management, Just Culture, Safety, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Worshiping at the altar of false gods


By Phil La Duke

Yesterday was the anniversary of the attack on Pearl Harbor. Last week I buried an uncle. He, like his brother before him, my father, died the agonizing death that only mesothelioma can bring. Watching the rapid deterioration of someone who was recently so full of life is hard enough to watch, but watch it repeatedly unfold is tough. My brother was one of seven boys in his family and all but one of them served in World War II and even though one served at Guadalcanal and another flew Corsairs over the Pacific they all came home safe. The workplace did what World War II couldn’t kill these men of the greatest generation. But injury rates are down so maybe I should just shut up about it. I guess it just grinds me that so many of our profession look at one of indicator (Incident Rates) and pronounce the battle if not won, certainly nearly so.

Incident rates are falling, any safety professional will tell you that. But according to the Bureau of Labor Statistics over 8,000 people get injured on the job every day in the United States alone. EVERY DAMNED DAY! Add to that that fatalities are trending flat and we have an alarming statistic. Last week I talked about indicators and (in part) how indicators in a vacuum lead us astray. When we consider these two indicators together it would seem that they tell us very different things. When considered together, however they can mean any number of confusing, contradictory things, and maybe they can tell us something we don’t want to face.

What could reduced injury rates mean? Certainly it could mean that fewer people are getting hurt and I guess that’s cause for celebration, unless of course you are one of the 8,000 who will get hurt this today. Reduced injury rates could also mean more accurate case management; that is, perhaps organizations are doing a better job exposing fraud, which is a good thing. Of course reduced injury rates could indicate a dangerous trend of under-reported injuries or injuries deliberately manipulated such that they are no longer “recordables”.

Without any other evidence, no further indicators, all of these explanations are equally plausible. But the ugly fact is that taken together we have scant little explanation for this discordance. One of two states exists: either the workplace is getting safer or it is not. On the side of the safer workplace argument is the reduced injury trend, but on the side of the “things are more less the same “ argument is the flat fatalities trend. Either reduced injuries mean that the work place is getting safer or flat fatality trends mean that things aren’t getting any better. There are other possibilities, however unlikely. For example the workplace could be increasingly free of “low hanging fruit” those simple hazards that are quick, cheap, and easy to fix. Walk through any industrial setting and you will soon be convinced that this isn’t true. It could also indicate that while fewer people are getting hurt the chances of a worker getting killed aren’t getting any lower. We should either see fewer injuries and a corresponding drop in fatalities or a flat trend in both figures indicating that nothing is improving.

What then are we to make of the flat trend in fatalities? Certainly it is exceedingly difficult for an organization to use case management to turn a first aid or case into a fatality, so I think we can rule out better case management or even case management fraud as the reason that fatalities aren’t improving. It is also incredibly difficult to over-report fatalities so we can rule that out as a reason that we don’t see fewer fatalities. So we must accept the possibility that there are indeed other forces acting on the incident rates and that these other forces aren’t really making the workplace safer, they are just making it possible to “juke the stats”. We can play games with the numbers to make our performance look better without actually making the workplace safer.

I’m no conspiracy fanatic, I don’t believe there is a conscious effort on the part of most companies to mislead the government or workers, but I do believe that many companies have misused incentives, perpetuated antiquated thinking that convinces senior leadership that behavior-based nonsense somehow is making the workplace safer when it is not. We have to consider that maybe, just maybe, the falling incident trend is a lie, or at very least an indication not of improved safety but of organizations bowing to pressure to get their rates down and doing so by means other than lowering their risk to workers. This is dangerous ground. If we fail to recognize our risk, because we believe our risk of injury is artificially lower than it is we place our workers and ourselves in harms way. It’s high time that we take a hard look at this cherished fact that incident rates have been falling and that falling incident rates mean a safer workplace.  If it is a pure fact that incident rates are falling for no other reason than because fewer people are getting injured that means that the workplace is getting more dangerous because a higher percentage of workers die because of their injuries.  I don’t think this is true.

Some believe that this discrepancy between fatality number and injury rates is because fatal injuries fundamentally caused by different factors than less serious injury. They may be right, but it’s also possible that they believe this because the idea of improving incident rates is so appealing that many will reject any suggestion that this trend is bogus. We in safety love our idols, our false gods; falling incident may be just one myth with which we are so enamored. Meanwhile, in the time it took to write this article approximately 223 workers were injured. Isn’t it time for us to rethink this statistic and stop trotting it out as proof that we are doing a good job?

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Incentives and Indicators

By Phil La Duke

The use of incentives is something of the Great White Whale of safety. Safety practitioners often find mounting pressure to use incentives to reduce workplace injuries. Incentives are popular because they seem to make sense—and I am not against incentives, provided that they encourage the right things. Sadly, incentives too often create unintended consequences, chiefly because the incentives are for the absence of injuries instead of the presence of safety.

There is a gulf between the apparent absence of injuries and the presence of safety and unfortunately neither of these are particularly easy to measure. One can’t measure the absence of injuries because one must depend on the injuries being discovered—either via self-reporting or discovery by the organization. Effectively zero injuries (or any number of injuries for that matter) is zero reported injuries; it’s a case of “we don’t know, what we don’t know”. But measuring safety is just as difficult because we don’t really have a hard and fast definition of exactly what constitutes safety. What we describe as “safety” is more accurately “safe enough” and ask seven Safety Practitioners what Safe Enough means and you are likely to get 19 answers. Safety is a continuum and is relative so it cannot be accurately (in and of itself) measured. Safety can only be measured as a state relative to another state. Something can be said to be safer than something else, but as long as any risk exists something can never be pronounced completely and utterly safe. If we can’t pronounce something qualitatively “safe” we have to rely on indicators, unfortunately, incentives are often misapplied or misinterpreted. It’s impossible (well at least foolish) to talk about incentives without considering indicators, and if we are going to provide incentive for the right things we need to understand, first and foremost, what indicators are telling us.

The Absence of Evidence is Not Evidence of Absence

The most commonly used indicator of safety is the extent to which injuries occurred. If people were injured it’s appropriate to say that they weren’t safe; that’s intuitive and people like it because it’s a simple calculation to make, provided that people report injuries. But as I’ve said, safety isn’t just the absence of injuries; it’s also the presence of things that drive a safer workplace, and that is the crux of the issue with indicators and incentives. Let me illustrate: the opposite of injuring workers (i.e. an indicating a lack of safety) is the absence of injuries. What does the absence of injuries indicate? Safe work habits? I know many people with incredibly unsafe work (or driving) habits who don’t get hurt, so while it’s possible that a lack of injuries indicate safe work habits it’s equally (perhaps more) likely that a lack of injuries indicates luck. Could it indicate that no one has been hurt? Possibly, but here again it could also indicate that people have been concealing their injuries. Could it indicate overly zealous case management? It might. In fact, there are numerous things that a lack of injuries could be indicative of so we can’t really use them as a good indicator.

Look For the Things That Produce Safer Outputs

I’ve come to realize that “safety” is really an output of sound business practices in five areas (there are many subsets within these areas, but five is a nice manageable number):

  • People who are incapable of doing their jobs—whether it be because of a lack of training, or physical incapacity or insufficient intellectual ability—are less likely to work safely than the workers who possess these attributes.
  • Process Capability. Work environments that lack a standard way to do the job that contains minimal variation are safer than work environments where workers half to figure out how to do the job each time they repeat a task. Similarly, workplaces with weak process discipline (the practice of following the prescribed process) are less safe than environments with strong process discipline. In other words if your jobs and tasks are poorly defined or your people are working out of process you are at greater risk of injury than if you have a well-defined process that people don’t follow.
  • Risk Management. Organizations that appropriately assess and mitigate their risks are far safer than organizations that don’t manage hazards.
  • Accountability. From the CEO to contractors, it is important to hold people appropriately accountable for doing their jobs correctly. Accountability systems must reflect corporate justice (in Just Culture parlance console human error, coach risk taking, and discipline recklessness).
  • Engagement.  Workers who are actively trying to improve the safety of the workplace because they believe that it’s the right thing to do are more likely to produce safe outcomes than those who aren’t engaged.

If we can accept that these five processes, if managed appropriately, will produce safe outcomes (and for the record, there are others, but like I said, they can be managed within these categories, but if you choose others I won’t gripe.) than we can look for things that indicate the presence of well-managed processes in these areas.

Indicators of Well Managed Processes

Indicators of well-managed processes may differ from industry to industry, even from site to site, but in broad strokes we can measure indicators of success in these areas.

Indicators of competency

How do you measure competency? If you don’t know ask your training department; you are likely to find that they are adept at measuring competency, but here are some suggestions:

  • % trained. Personally, I wouldn’t limit this to safety training, although the percentage of people who have successfully completed training on time is a good indicator of competency. Of course it’s not the only indicator and the more indicators you use the stronger your confidence can be that whatever you are measuring is true. Since we are only looking at five areas we can use several indicators for each and have a much stronger correlation between the indicator and reality.
  • % hired with all required/desired skills. We all know that job postings are essentially wish lists and there is seldom a new hire that hits ALL the requirements. The greater the percentage qualified the higher the likelihood that the person will be able to perform safely.
  • Those individuals with higher skills tend to have higher productivity than those who don’t, so while productivity is an indicator for more than just competency it can be useful in conjunction with other indicators.

So how do we create incentives around these factors? Simple: reward people (at all levels) for completing their training on time, for hiring more skilled workers, and for maintaining high productivity.

Indicators of Process Capability

This is the easiest area for which to develop indicators because in many organizations there are already measurements that we can use to gage safety:

  • Unplanned downtime. Unplanned downtime tends to indicate process breakdowns and the greater the frequency of unplanned downtime the higher the likelihood that workers are at risk of injury.
  • Like unplanned downtime, scrap indicates a process that is out of control. Workers who are working in a process that is out of control are by definition working out of process. Since we tend to see more people hurt while they are working out of process this is a good indication of the level of safety.

Indicators of Risk Management

For our purposes we will define risk management as how the organization identifies, contains, corrects, and communicates hazards (including injuries). In this area there are a lot of things from which we can choose:

  • % of walk-throughs completed on time. Whether you have BBS audits, Safety Observation Tours, Layered Process Audits, you probably have some formal requirement for the supervisor to identify hazards. Your requirement should have a frequency requirement that is easy to measure. The indicator here is mathematical—the less time someone is exposed to a hazard the less risk of injury. Meeting the requirement to complete these tasks on time is a strong indicator of safety.
  • Number of hazards per tour. Hazards (especially behavioral) are dynamic so the number of hazards a person finds each tour correlates to the safety of the workplace.
  • Number of overdue hazards. The priority assigned to the correction of a hazard should have a corresponding deadline and when that deadline isn’t met it indicates an increase in the time of exposure and perhaps a degradation of the containment measures.

Of course there are a lot more indicators you can use in this area, but I think you get my point.

Indicators of Accountability

Accountability should be just; the punishment should fit the crime. Justice is largely circumstantial—not every situation can be treated according to the same standard of accountability. Would you discipline a worker who mistakenly used the wrong we chemical and caused property damage as you would someone who engaged in sabotage? Or would you react the same way to a worker who faced with two pretty bad choices (after careful analysis) decided to choose the lesser of two evils as the worker who engages in clear recklessness? Of course not.   Unfortunately we can’t feasibly measure the justice of a decision, but we can of course measure the number of write-ups, improvement plans, and similar efforts. We should also be looking at the number of times we “caught them doing something good”. Some examples I can think of off-hand include:

  • Number of disciplinary actions. Clearly the number of disciplinary actions directly correlate to accountability; the more disciplinary actions the higher the accountability. But what if there are few disciplinary actions simply because there are less people who are acting inappropriately? Clearly this indicator cannot be interpreted alone and should be paired with an indicator that people are being recognized and rewarded for desirable behavior.
  • Number of employees recognized for exemplary service. The number of people who are recognized for doing things like identifying a serious hazard, participating in safety efforts, leading a safety event, or something similar is also an indicator of accountability—rewarding desired behaviors. By pairing this with the number of disciplinary actions one can get a better picture of the overall performance of accountability.

Indicators of Engagement

Engagement, like process capability, is likely already being measured by your organization, but you can use some combination of the following to ascertain the level of worker engagement:

  • Number of Grievances. Unhappy workers tend to have more “performance inhibitors”; that is, the things like stress, preoccupation, anger, frustration, etc. that increase the likelihood of human error. Not to mention unhappy workers may make poor choices rooted in frustration.
  • Number of Suggestions. The flipside of grievances is suggestions. The greater the number of suggestions for approval the higher engagement tends to be.
  • Participation in continuous improvement efforts. People who care about their work tend to get involved in making it better and this tendency is a good indicator of engagement.
  • Participation in safety meeting. Participation in a safety meeting, like so many other indicators, cannot be seen as an absolute indicator of engagement; it could indicate that someone would rather sit in a meeting than do what they are paid to do. But when taken with these other indicators it can provide insight into the level of engagement of workers in an organization.
  • Here again is an indicator of more than a lack of engagement, but this is a strong indicator of the relative safety of a workplace. High absenteeism is linked to poor morale, unhealthy working conditions, workers not managing their performance inhibitors (drinking to excess, drug use, sleep deprivation, etc.), but more than that, high absenteeism means more replacement workers who tend to be less skilled at performing the job. This ties into competence, process capability, and perhaps even risk management.
  • Moral is also an indicator of many factors, but low moral does correlate to higher incidence of human error and risk taking.
  • Turnover is a good indicator of an overall healthy or unhealthy workplace. As people are churned it lowers competency and impedes process capability.

Okay, but what about incentives?

One can only effectively set incentives that reduce the chance of unintended consequences after one has appropriate indicators of safe outputs. Once one has determined the best measures for the desired state one can then create appropriate incentives. When developing incentives:

  1. Look for (and avoid) potential unintended consequences. Too often incentives create an environment where the desired behavior isn’t rewarded and people game the system.
  2. Don’t provide incentives (or hold people accountable) for things they can’t control. When you provide incentives for things people can’t control the only real incentive is to lie, cheat, and steal. Takes sales incentives for example. While a salesman can control how many meetings he has with prospects (which is necessary to MAKE sales) he can’t really control whether or not a sale is made. This leads to bickering between sales professionals, stealing of clients and leads, undermining competitor’s success, and generally stabbing one another in the back. It actually diminishes teamwork, collaboration, and ultimately the likelihood of success for the company.
  3. Make it meaningful. Not everyone likes to be recognized or rewarded in the same way. Be sure to consider different people’s needs.

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News In Brief

By Phil La Duke

Just a couple of brief topics before I get into this weeks’ post. First, it is with sadness that I announce the death of my uncle. Robert P. LaDuke died this week, another casualty of workplace illness. Uncle Bob had been suffering with mesothelioma. The bastards who knew it would kill workers but concealed this fact to protect profits remain at large. No one will ever be held accountable for his or her depraved indifference. The lawsuits (that George W. Bush derided as frivolous) will never come close to allaying the enormous human suffering these people caused. Were we in China they would have been taken to a sports stadium and shot dead. May God have mercy on their souls;. I mention this not as a ploy for sympathy but as a reminder that the death toll will continue to rise, not just from asbestos but from hazards not yet known or imagined. At any rate, RIP Uncle Bob.

On a much lighter note, I have started a new group on LinkedIn: Best Practices in Health and Safety. I’m envisioning it as a place where safety practitioners can go to get and share the best practices and thought leadership in worker safety. I won’t tolerate commercials and promotions so I think it will be worthwhile; at very least I won’t have some half-wit deciding that I can’t post links to my blog to the discussion groups.

Also, my abstract to speak at the National Safety Council’s Texas Safety Conference and Expo in Austin next March. I will be speaking on the role that social networks can play in safety and I think it will be a spirited, lively presentation.

There WILL be a post today, but right now I have to watch football

Filed under: Safety

Where’s the Value In “Safety Day”?

safety day graphic

By Phil LaDuke

Next week I will be conducting the activities surrounding “safety day”. As leader and as a safety practitioner I was the logical selection. The notion of me getting up in front of a group of associates and trumpeting on about safety one day a year may seem laughable to some of my more loyal readers and downright hypocritical to my devoted detractors.

Years ago, as a relatively young man, I made myself a promise: I would never teach or promote something that I myself didn’t believe in or support. That has made it tough in some cases, as I have had a lot of bosses and customers—internal and external—who wanted me to present what at first blush seemed to be propaganda. It sucks having principles. I was true to those principles and pushed back and challenged the presentation sponsors until I was convinced of the value of the topic.

But “safety day”? I mean…come on, right? Doesn’t taking a day to focus on safety mean by implication that there are 364 days where we can take foolish chances, ignore performance inhibitors (thus making more mistakes) and engage in outright recklessness like some sort of misguided version of The Purge?

I’ve done a lot of soul searching and reflecting on the value of having a “safety day” and it may surprise you to learn that I happen to support safety days, health & safety fairs, and similar efforts provided they are done properly. I happen to think these events serve a number of wonderful purposes and can provide real value by:

  • Taking Stock of Safety. Whenever we pursue a goal we need to stop and take a look around every once in a while to ensure that we are making appropriate progress a safety day isn’t about doing something differently (i.e. working safely for a day) but about gauging the effectiveness of what we are doing better. Think of a well-executed safety day as a way of checking your organization’s pulse in terms of safety.
  • Clarifying your safety messaging. We often cling to safety messages that are either inane, soft-headed, or out dated. Having a safety day is a good way to review the messages are delivered and received. You can open a frank dialog about what messages the organization is hearing and compare that to what you had hoped to communicate. On safety day, people tend to feel more comfortable being candid about the real message being sent (“you tell us you want us to stop work when it’s not safe but then you gig us for lost production.”) Instead of arguing about the veracity of people’s opinions, you should listen to what they are saying. Don’t dismiss it as so much hogwash or griping or whining and recognize that when it comes to messaging perception IS reality irrespective of your view of the world.
  • Celebrating your success. Safety is an ugly business with the best news usually being pretty lousy “hey everybody, we didn’t kill anyone last year! Or our injuries are down, huzzah! Huzzah!” Even so, there is usually plenty to celebrate. By focusing not on injury reductions but on positive, proactive behaviors you can generally find something worth celebrating without being trite or contrived. Even if things are looking pretty dismal you can always celebrate your efforts to improve.
  • Recalibrating your tactics. Everyone plays a role in safety, but unfortunately there is no cast in stone recipe for making the workplace safer. Safety day can be a great time to take a look at your tactics and asking all who participate what is working, what is not working, and why? From hear you can recalibrate your safety tactics and, because most of the organization has participated in deciding what should be done, you will have greater buy-in then if the safety committee had made these decisions in a perceived vacuum.
  • Demonstrating commitment. I am giving up a BIG opportunity to make a series of sales calls so that I can lead safety day at my office. Why? Certainly sales are important, and sales I make have a specific and meaningful impact on my success, but I am choosing (as a partner, no one is forcing me to do this) to lead safety day instead. It’s that important to me. Demonstrating commitment is more than waiving your hands around the room and saying “see how much we value safety? We brought in lunch! We are paying you to be here. It’s about making tough choices and putting aside what might be great sales opportunity or an important client meeting to participate in a day focused on the organization’s safety performance and the importance of committing to people and their safety.
  • Modelling behavior. The world loves a hypocrite, and for whatever reason, people tend to take a hard look at safety practitioners for any sign of hypocrisy. I’ve always thought it was because if you could point out that the safety guy is inconsistent or doesn’t walk the talk it absolves you from ever listening to him or her. If safety truly is important than we have to live it, and living it means planning, supporting, and leading safety. Modelling behavior is so important because it tends to be what people end up doing when they are stressed, working unsupervised, or having to make the tough decisions. If people don’t clearly understand and believe that you value safety—above and beyond the other distractions in your life—then they will only value safety when it suits them; when it’s convenient for them.

So while it may surprise, even shock, some of you come Thursday, I won’t be working on client accounts, writing proposals, or flying off to exotic locales to pitch my wares. Instead I will be meeting with a group of people who I like and respect and having a frank conversation about leading safety.

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