I was reading an Internet Forum called EHSQ Elite, composed largely of high-end, experienced professionals as the name would imply, and was surprised to find two questions posted for comments that seem to be Safety 101 issues: “Are we respected as a profession or not?” and “Can you get to zero harm?”

Other issues and questions never seem to go away in the job safety and health world, too. Why do they linger for decades? Where are the definitive answers? Do other business disciplines — human resources, accounting, production, quality, engineering, sales — face as many unresolved issues, or is there something unique about safety and health work that stymies or complicates reaching consensus about long-standing debates involving the field’s goals and strategies?

I’ve been reporting on the work of safety and health professionals since 1980 and these questions have consistently defied consensus:

1. Are we respected as a profession or not?
   
   Other than HR, perhaps, and journalists, what profession in 2010 worries about getting respect?
2. Can you get to zero injuries?
   
   Yes, no, maybe. Where’s the research?
3. Should we call fatalities and injuries “accidents” or “incidents”?
   
   Accidents imply loss of control, nothing could be done. Defeatism. But isn’t that life sometimes? Randomness.
4. Is there safety in sustainability?
   
   Most corporate sustainability reports mention safety and health only in the old terms of injury and fatality rates.
5. Why don’t more CEO’s “get” safety?
   
   Oh but they do, safety organizations will assert. Some hand out awards to CEOs every year. This amounts to only anecdotal evidence. How many safety articles are published by the Harvard Business Journal, Forbes, Fortune, BusinessWeek? How many management and leadership books and CEO memoirs even list “safety” in the index?
6. Is OSHA a help or a hindrance?
   
   The sole agreement: OSHA has a wonderfully rich website. Otherwise, 40 years on, the debate still exists: Is OSHA a law enforcement agency, an educator, or can it be both?
7. Can you make the business case for workplace safety and health?
   
   Some say a convincing business case is the salvation of the safety field, and particularly industrial hygiene. Others are adamant: Don’t tell employees safety is about saving money, not lives.
8. Why can’t we get the public and press more interested in workplace safety and health issues?
   
   A well-functioning safety program delivers invisible results. Bad safety — when plants go boom — is morbid material that attracts that accident “rubberneckers.”
9. “Safety first” — is that the truth?
   
   Absolutely, say some. Never, argue others. Too many times, it’s lip service after things go boom.
10. How long does it take to build a safety culture?
    
    A month. A year. A half-dozen years. Where is the research? And where is the definitive definition of a safety culture?

Patient safety vs. worker safety

See any common themes here? One is the regrettable lack of research in the occupational health and safety field. In medicine, the movement for greater patient safety and reducing medical errors, which is only about ten years old as a serious nationwide endeavor, is awash in research. Simply compare Google results for “patient safety research” to “workplace safety research.” Outcome: 5,230,000 results for patient safety research, 1,870,000 for workplace safety research. And that’s comparing about ten years of patient safety history versus 100 years of workplace safety history.

Comparing patient safety to worker safety — research aside — surfaces other reasons why occupational safety has struggled to resolve some fundamental issues.

• Every member of the public will be a patient at some point. Not so with blue-collar work.
• Medical practitioners demand evidence-based research to substantiate changes to traditional procedures. Safety practitioners are not as demanding.
• Victims of medical error, or their next of kin, are much more likely to go public with their grievances, and organize at the grassroots level, compared to workers and their families. One factor: many victims of medical errors are children, women, and the elderly. Vulnerable populations that cynically or not, make for “good copy” in the press.
• Commercial competition, share of market, and consumer perceptions increasingly motivate healthcare system CEOs to “get” patient safety. Hospitals now are publicly ranked based on patient safety performance. Highway billboards tout a hospital’s patient safety reputation. Occupational safety is off the public and media radar screens, and is not seen as affecting market share and profits.

Top down vs. bottom up

The patient safety movement and reducing medical errors — which have a long, long way to go to achieve the success desired by advocates — is an ever-expanding “bottom up” grassroots movement. Occupational safety, in contrast, is more “top down,” driven by the federal government in the form of OSHA. Ask any behaviorist which model will beget more engagement.

Waiting on OSHA to act, taking the cue from OSHA, trying to evade OSHA or meet its minimums, all stifle innovation in occupational safety. Patient safety, meanwhile, continues to attract press and researchers and authors, with hardly any federal mandates. Free from “thou shall” lists, the patient safety movement is more enterprising, going “outside of the box” to learn from other industries, experimenting with reporting systems, human factors processes, and slowly but surely moving medicine from an individualist paradigm to more of a team paradigm. And scores of avenues exist — journals, blogs, Internet forums, conferences — to share findings compared to occupational safety.

A final thought: workplace safety is a perpetual confrontation with human nature. The attitudes, behaviors, biases, wants and needs of CEOs, supervisors and workers. Human nature doesn’t lend itself to easy explanations. “Why do people act like that?” The problem answering that complex question has much to do with the trouble answering the other safety questions that don’t go away.