EDITORIAL COMMENTS: Evidence-based safety

September 1, 2005
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Safety and health pros might learn a thing or two from the reaction of healthcare professionals, specifically physicians and nurses, to rising demands for improved patient safety after a 1999 report by the prestigious Institute of Medicine estimated 44,000-98,000 Americans die each year of medical errors.

Safety on the job is like safe driving, offered a physician when I asked him about healthcare attitudes toward patient safety. “How can you argue against it?” But what this doc particularly objected to was safety lectures that take on a tone of morality. “If you slip up or cut corners, and let’s face, we all do, though none of us certainly intend for anyone to get hurt, it’s like you’ve committed a sin,” he explained.

He finds this guilt complex running all through safety training, investigations, audits, meetings — tainting almost anything having to do with safety.

It leaves a bad taste all around, with administrators and front-line workers feeling they’ve done wrong, or haven’t done enough, for safety. Safety training, meetings, audits, almost anything related to safety, comes down to exposing people, said this doc. Exposing flaws in people’s attitudes and behaviors, and beyond the personal, in an organization and how things are done.

Natural defenses

The human reaction to negative exposure is predictable — you cover up. This happens in both subtle and overt ways. Employees don’t report incidents or close calls. In training classes, students nod along — “yes, yes, of course we must do better.” When a serious incident occurs, management’s first call is usually to a lawyer, the second to public relations counsel, then maybe the victim’s family is contacted.

Safety pros have long favored “set piece” training classes or committee meetings to stage lectures about needed improvements. More recently, pros have been urged to engage workers in informal “conversations” about safety to get their message across. But if the “sales pitch” — formal or informal — leaves someone feeling guilty or exposed, you’re not going to get the sincere cooperation or participation you want.

Clinching the deal

What can bring closure and resolve a safety issue is data. Base your argument for better safety not on guilt. Not on the moral imperative. But on evidence.

What sort of evidence? Results of perception surveys. Audit findings. Near-hit reports. Workers’ comp costs. Injury rates. Benchmark your findings, your data, against companies outside your organization. Or draw internal comparisons between departments, shifts, or facility locations around the world, if you’re a multinational.

Expose data — don’t expose people.

Resist the temptation

And don’t be preoccupied with data showing negative outcomes, such as injury and illness rates. That’s another thing the doc noted as safety looms larger in healthcare — “All the stories, the lessons, the lectures are essentially negative,” he remarked. Nothing to feel good about, to take pride in.

(We’ve heard this critique before, but it carries a fresh sting when delivered from someone outside the workplace safety sphere.)

If data reveal you’re doing certain things “right” in safety, draw attention to it. Dig deeper to understand why it is that one facility’s audit scores (or one department’s or one shift’s safety performance) are consistently higher than the rest.

Behavioral safety boosters learned these lessons 30 years ago. Behavior-based safety is a process of collecting data (observations), publicizing data (posting numbers of at-risk versus safe behaviors), analyzing data (why do employees in the warehouse keep walking in front of forklift pathways?), and celebrating “good” data — milestone achievements in safe performance.

Another lesson from behavioral safety is you can get carried away chasing numbers, buried in too much data. Managers can and do in many cases love the numbers a little too much. “Give me more observations. Let’s crank it up and do a thousand a month.” And so the quality of the data goes down and recordkeepers burn out trying to keep up.

From exposure to protection

Still, safety can do a better job of collecting evidence (any number of leading and trailing metrics) to support sales pitches for improved performance, and rely less on platitudes and passion plays. And here’s the interesting thing about data — usually in the beginning it exposes flaws; eventually it provides protection.

Employees, managers, supervisors all can point to improving audit scores, perception scores, lower comp costs, lower injury rates — whatever mix of metrics you choose — and say, “Look, I’m doing my job. We’re doing our job. Anyone question my safety commitment? Check the numbers.” It becomes a matter of pride.

Evidence-based safety takes an organization from exposure to protection. That’s what is happening in healthcare now, with hospitals striving to improve patient safety and quality performance indicators, prodded by newspapers reporting “health grades.” Note the focus is on organizations, not individuals. Note, too, the immediate connection healthcare makes between safety and quality. But that’s for another month’s editorial.

— Dave Johnson, Editor

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