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Training to be Unsafe
Posted on June 13th, 2017 by Mike Schmidt in Chemical Manufacturing Excellence
“When you gamble with safety, you bet your life.” Slogan on an industrial entrance mat
The biggest obstacle to getting people to heed safety training is that unsafe behavior does not result in certain death. The problem with a safety slogan like, “When you gamble with safety, you bet your life,” is that most people, most of the time, win the bet. We all learn from experience. The more experience we have doing unsafe acts successfully, the more we accept them as okay, as normal.
Lapses, Mistakes, and Violations
Trevor Kletz, a pioneer in process safety and a prolific writer, characterized human error as one of three types: lapses, mistakes, or violations.
A lapse occurs when someone knows what they are supposed to do, is able to do what they are supposed to do, wants to do what they are supposed to do, and yet, for some reason, doesn’t do it. An example I am fond of using is that of a driver who finds themselves halfway into an intersection when they realize, “Oh my, I just ran a stop sign.” A lapse. Lapses are part of the human condition and occur at random to everyone, even those with the best intentions. Training won’t help, and neither will disciplinary action.
A mistake occurs when someone simply doesn’t know what they are supposed to do. Disciplinary action won’t help. Can someone be punished into learning something? Training, on the other hand, will help, as long as the training is not presented as a form of disciplinary action.
A violation occurs when someone knows what they are supposed to do, but decides not to.
Why Be Unsafe?
Why do violations occur? Why would someone who knows what they are supposed to do decide not to do it? Why would someone choose to be unsafe? It is typically not because they are evil. Nor is it typically because they have a death wish. Both are possible, I suppose, but the typical reason for a violation is that the benefit outweighs the cost. More accurately, the perception of probable benefit outweighs the perception of probable cost.
Many violations are in the form of shortcuts. What is the benefit of a shortcut? It takes less time. What is the cost? Usually, nothing. Some violations are not about time. What is the benefit of not wearing certain personal protective equipment? It is more comfortable to go without. What is the cost of not wearing certain PPE? Again, usually nothing.
Fortunately, safety incidents are relatively rare. When a safety measure is put in place, it is there to prevent those rare incidents or reduce the severity of the impact of those rare incidents. This means that most of the time, the safety measure is unnecessary. The rarer the incident, the more unnecessary the safety measure seems.
The benefit of the safety measure is only experienced when there is an incident. For rare incidents, the benefit of ignoring the safety measure is experienced almost every time the safety measure is ignored. The cost of safety measure, however, is incurred every time it is used, whether it was necessary in that instance or not. The rarer the incident, the more experience there is demonstrating that its safety measures are unnecessary. Cicero said, “Usus magister est optimus,” – “Experience is the best teacher.” Experience teaches that most safety measures aren’t necessary. Perhaps experience is not the best teacher.
One of the fundamentals of behavior modification is that the consequences of behaviors influence those behaviors. The degree to which consequences influence behavior depends on three characteristics: timing, consistency, and significance. In terms of timing, consequences that occur soon are far more influential than consequences that occur later. In terms of consistency, consequences that are certain are far more influential than consequences that are uncertain or unpredictable. In terms of significance, positive consequences are far more influential on behavior than negative consequence.
Consider two ad campaigns to reduce smoking. In the first, viewers are shown desperately ill old people who talk about how smoking led to their sorry condition. The message is “quit smoking now, while you’re young, or this may happen to you when you get old.” The consequences are later (not sooner), uncertain (not certain), and negative (not positive). In the second, viewers are shown someone deciding not to buy a pack of cigarettes. Instead. They pocket the cash. The message is “quit smoking, and you’ll immediately have more cash to spend on better things.” The consequences are immediate, certain, and positive. Which campaign do you think will be more effective?
Now consider safety measures. Like the advertisements showing old smokers with crippling emphysema, most safety training focuses on the potentially dire consequences that might occur, albeit rarely, if the safety measure is not applied—if the shortcut is taken or the PPE is not worn. Experience, on the other hand, demonstrates that the usual outcome of not applying safety measures—time saved, discomfort avoided—is immediate, certain, and positive. By any measure, it will be a challenge for the training about the safety measure to overcome the learning that comes from experience.
No Harm, No Foul?
There is a legal principal captured in the Latin phrase, “de minimum non curat lex”: the law does not concern itself with trifles. In sports, we just say, “no harm, no foul.” In matters of safety, however, harm is rarely the outcome. While it is consequences that are of concern, behaviors are the points of control. Yet when organizations are confronted with unsafe behaviors, the response is often dependent on the consequences.
When asked, “What happens when you see someone with their safety goggles up on their forehead?” the response is likely to be, “I tell them to put them back on.” When asked, “What happens if someone gets an eye injury while their safety goggles were up on their forehead?” the response then becomes, “Well, someone has to write them up.” In those circumstances, the difference between harm and no harm often comes down luck. When an employee is subject to disciplinary action because of consequences, rather than behaviors, they are going to feel, quite correctly, that they are being punished for bad luck, not for what they did.
Whether using carrots or sticks, the response has to be to behaviors, not consequences. No harm, no foul? No. If it’s a foul, it’s a foul, regardless of whether there is any harm.
Change the Bet
When you are working to encourage safety, or more specifically, to discourage unsafe behaviors, you must first recognize that not all unsafe behaviors are the result of conscious choices. Lapses happen as part of the human condition and mistakes are the result of poor training. They each require different strategies.
Violations, on the other hand, are conscious choices. They are behaviors that can be discouraged. Discouraging deliberate unsafe behaviors requires that you acknowledge that these conscious choices are made for a reason. You must address the reason. Otherwise, the perception of the probable benefit of the unsafe choice will always outweigh the perception of the probable benefit of the safe choice.
Choices are the result of cost-benefit decisions that everyone makes, consciously or unconsciously. People’s experience trains them that the benefit of unsafe behaviors exceeds the cost of those behaviors. For your efforts to encourage safe behaviors to succeed, they have to rebalance the equation, to change the bet.
All opinions shared in this post are the author’s own.
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Principal, Bluefield Process Safety, LLC
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