In the past year the UK has seen a 4% increase in the number of fatal injuries while the number of major injuries remains at around 20,000 per year. The rate of serious injuries and fatalities in the UK has plateaued and we've not seen reductions for several years. A similar pattern can be seen in other countries, notably the United States. Despite significant investments by many organisations in their safety programmes, we are not seeing a reduction in the most devastating injuries. The trend bucks conventional safety thinking, causing many to suggest that traditional approaches are failing, and that new thinking is required.
Safety can be subjective, so clear definitions are important. A serious injury refers to one that has life-changing outcomes for the individuals concerned and their families.
This issue first arose when several US multinationals came together to explore a shared issue: why were their own minor injuries declining but the same wasn't happening with serious injuries and fatalities?
Five potential explanations have been offered to help understand how this situation has arisen:
False correlation: According to Heinrich's Triangle (see below), focusing on low-level events at the bottom reduces serious accidents at the top. However, Donald Martin and Alison Black's research paper "Preventing serious injuries and fatalities", published in Professional Safety, in 2015, demonstrated that only 21% of the incidents reported by these multinationals were found to correlate with the serious events at the top. This supports the thinking that the things that injure people are not the same as those that kill them. Reducing minor events at the bottom does not correspond to a proportionate reduction of serious injuries and fatalities.
People vs. systems: Much of the focus over the past two decades has been on behavioural-based safety. These programmes have helped reduce the rates of minor injuries by about 60%. However, the general focus of behavioural safety is on modifying the worker's behaviour, or "fixing the worker" as Todd Conklin calls it in the "5 Principles of Human Performance". In fact, it is the organisational rather than the individual failures that frequently underlie serious injuries and fatalities and are often down to the way work is planned and managed. The prevention of serious injuries and fatalities requires strategies that focus on eliminating hazards and some have argued that the OSH profession has not pushed for these more effective control measures. Major reductions in fatalities have arisen through engineering improvements and advances in safety technology will build on this further.
Wrong metrics: Because accident outcomes are arbitrary, and many injuries result from low hazards, the standard injury metrics are inappropriate for measuring serious injuries and fatalities. Moreover, when we measure success through absence of accidents, we create a false sense of security and introduce blind spots, which prevent us from focusing on what is really important. This is referred to as the "Iceberg of Ignorance" where success is measured by the accidents visible above the waterline. However, we are blind to the high potential near misses below.
Normalisation of risk: Studies have found that a large number of serious injuries and fatalities occur during normal work, or when an unexpected change occurs. Individuals who conduct such tasks can become normalised to a hazard and consequently unacceptable practices become the "norm". Similarly, those involved in assessing high-risk activities can underestimate the probability of such events occurring because they view the hazard in the context of only the events that resulted in harm. Importantly, they can become unaware of the variance between the procedure ("work as imagined") versus what happens in practice ("work as done").
Blame the worker: Despite strong evidence that human behaviour is determined by context, the belief that injuries are caused by the unsafe acts of workers pervades. This misplaced thinking is perpetuated when human error is identified as a factor with little effort made to explore why an individual acted as they did.
The Campbell Institute's research provides further insights and highlights three contributors, which account for 82% of serious injuries and fatalities (see above). To start with, 42% could be attributed to a breakdown in the processes surrounding high-risk activities. There could be many reasons why life-safety programmes are failing but exploring the gap between "work as imagined" and "work as done" is a good starting point.
A further 29% of incidents that lead to serious injury or a fatality involved a worker being exposed to a hazard that changed during a routine task but was not recognised at the time and could have been prevented in the pre-task assessment. These are environmental conditions or situational factors that increase the incident's severity or probability, such as weather or a work interruption. This indicates more work is required to teach teams how to recognise when a task, environment or workplace has changed.
Finally, 11% of incidents were related to human factors not connected to the implementation of a life-saving process. These could be routine production or repair tasks.
For OSH practitioners, there is some good news. It is possible to use many of the existing safety activities, such as auditing, observations and training focus on serious injuries and fatalities. It does, however, require a change in mindset, such as where you look for learning opportunities and what you view as success. Here are some considerations:
Education is key to build consensus. Employees need to understand why detailed investigations are being conducted on non-injury incidents and management will start to receive information on close call events that they were previously blind to.
Take a sense check: Review the significant risks and consider the individual and organisational factors that could amplify the hazard or weaken controls, such as outages, high production or low manning levels.
Monitor the right things: Drawing on 2019 research by Dominic Cooper in Safety Science, it is important to establish and monitor the high-risk situations which, if not addressed, could lead to a serious or fatal injury.
Definitions of serious injuries and fatalities are necessary to identify high potential near misses.
Check your vital signs: It's important to ensure that existing monitoring activities are focused on high-risk activities. Preconditions of most serious injuries and fatalities can be identified through targeted tours and observations.
Talk to the experts: There is always a variance between procedures and practice, so learning from how work is conducted is essential.
Step-up the hierarchy: Look again at risk controls to prevent serious injuries and fatalities to see what else can be done to eliminate or strengthen controls. New technologies provide a host of new ways of redesigning high-risk work.
Measure the pulse by reporting a high potential or serious injuries and fatalities and frequency rate using actual and potential incidents.