Trust is one of the fundamental aspects contained in the British Health & Safety Executive’s ubiquitous definition of Safety Culture, which states “organizations with a positive Safety Culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventative measures”[i].
Trust is thought to be a gateway for open and frequent safety communication in organizations, and has also been ascribed a role in the success of safety initiatives[ii]. Evidence shows that trust in management is the strongest predictor of safety performance in industry, as it is thought to be a facilitator of effective safety leadership[iii].
Distrust curtails open safety communication and limits organizational learning. Consequently, any system deficiencies remain unnoticed and increase the risks of an incident. Distrust typically arises when management blames workers and/or when the companies blame contractor groups for poor performance[iv]. This leads to people restricting the reporting of accidents, while contractors engage in defensive practices that manipulate performance information simply to avoid blame situations.
Developing a “Just and Fair” culture is about creating mutual trust between management and workers, where everyone understands and agrees to what is, and what is not, acceptable in terms of safety. Everyone understands where the line must be drawn between unacceptable behavior deserving of disciplinary action, and the remainder, where punishment is neither appropriate nor helpful in furthering the cause of safety[v].
To be effective, a just and fair culture must promote learning from mistakes, rather than focus on blame. In a just and fair culture, everyone knows that safety is highly valued in the organization, and they continually look for risks that could pose a threat to their well-being. People are thoughtful about their behavioral choices and always thinking about the most reliable ways to get the job done safely. Managers are constantly looking for system design features that would provide the best opportunities for people to perform safely. Recognizing that every endeavor carries the risk of human error, management and the administrative team are held accountable for the things that are under their control (e.g. system and process design), while employees are held accountable for their behavioral choices[vi].
Introducing the principles of a just and fair culture is a major undertaking that is likely to be achieved gradually over an extended period of time (e.g. two years or more). It requires continual education and discussion among staff at all levels and a commitment to examining and changing many of the systems, policies, and procedures that guide the company’s approach to safety. It is especially importantto educate and involve managerial and administrative leaders (e.g. Human Resources), who work directly with staff and play a pivotal role in translating the principles into practice[vii].
Actions required to develop a “Just and Fair” culture
In practical terms, developing a just and fair culture is about creating a company atmosphere that promotes a questioning attitude, is resistant to complacency, is committed to excellence, and fosters both personal accountability and corporate self-regulation in safety matters. Some of the key features that need to be addressed when developing and maintaining a just and fair culture in a company include:
1. Appointing and determining people’s roles, responsibilities and tasks for the development and administration of the just and fair culture policy.
2. Management and the workforce jointly developing a documented just and fair culture policy that provides guidelines for confidentiality and anonymity of reporting and punitive actions.
a. Agreeing on definitions about what is acceptable behavior, and what is not acceptable, that recognize honest mistakes (e.g. Human Error), without fear or favor.
b. Agreeing on pre-determined sanctions for unacceptable behavior.
c. Developing a process to deal with actions that might fall into any grey areas between acceptable and unacceptable behavior.
3. Creating an incident reporting system that people feel is safe to use that is linked to the just and fair culture policy.
a. Breachesof the policy being monitored (e.g. Unintended Human Errors being punished or unacceptable behavioral choices being excused).
b. Reports being followed-up with appropriate corrective actions being taken to address error-producing conditions (e.g. Error Traps).
4. Educatingeveryone about the policy, and how it is to operate.
a. Developing and distributing appropriate marketing materials to all.
b. Distributing the jointly agreed just and fair safety guidelines to all.
c. Communicating any changesto existing incident reporting systems to all.
d. Trainingpeople in the new reporting procedures.
5. Everyone being treated fairly according to the just and fair policy.
6. Recognizing and reinforcing people for submitting reports.
7. Developing feedback mechanisms so that everyone knows what corrective actions have arisen from analysis of the incident reports.
a. Providing feedback to all about the numbers of corrective actions completed arising from the incidents reported.
b. Providing regular summary feedback to all about the types of conditions / behaviors / systems involved in the Incidents reported
c. Monitoring the number of reports more fully investigated.
d. Monitoring the number of incident reports by location and providing feedback to all.
e. Appointing a joint management / employee committee to analyze the incident reports to identify opportunities to make appropriate changes to systems, procedures, etc.
The just and fair policy should also be periodically reviewed (e.g. annually) to assess how it is working in practice, so that any necessary adjustments can be made.
Five Just and Fair Takeaways
Create a Just and Fair Policy
Agree on acceptable and unacceptable behavior and pre-determined sanctions. Identify grey areas. Encourage incident reporting.
Develop an Incident Database
Provide a database for incident data so that trends and system faults can be identified.
Communicate Changes to the Reporting System
Communicate changes to all and provide any necessary training.
Recognize Submission of Reports
Recognize and reinforce those submitting incident reports.
Provide feedback on conditions, behaviors, and systems involved in the incidents reports and how these impact safety performance.
B-Safe Management Solutions
[i]Health & Safety Commission (1993) ACSNI Study Group on Human Factors. 3rd Report: Organizing for Safety. HMSO, London.
[ii]Fleming, M. & Lardner, R. (2001), Behavior Modification to Improve Safety: A Review of the Literature, Suffolk: HSE Books.
[iii]Conchie, M.S. & Donald, I.J. (2006) The Role of Distrust in Offshore Safety Performance, Risk Analysis, 26(5), 1151-1159.
[iv]Collinson, D.L. (1999), “Surviving the rigs”: Safety and surveillance on North Sea oil installations. Organization Studies, 20, 579-600
[v]Reason, J. (1998). Achieving a safe culture: theory and practice. Work & Stress, 12, (3), 293-306.
[vi]GAIN Working Group. (2004). A Roadmap to a Just Culture: Enhancing the safety environment. Retrieved from http://flightsafety.org/files/just_culture.pdf
[vii]Connor, M., Duncombe, D., Barclay, E., et al (2007 ). Creating a fair and just culture: one institution's pat toward organizational change. Joint Commission of the Journal of Quality Patient Safety.