Safety at Work 6 E Part 8 potx

The observers audit the work area recording the number of safetycritical behaviours observed and the number of unsafe behavioursobserved to produce a ‘percentage safe behaviour’ score as

consequences of the behaviour are also listed and analysed to establishthe features they possess.

It can be seen that the avoidance of musculoskeletal injury or eyestrainare weak consequences because they are ‘late’, ‘uncertain’ and ‘negative’

in nature The other consequences arising from not adjusting theworkstation are ‘immediate’, certain’, and ‘positive’ to the individualsand thus reinforce the unwanted behaviour Whilst it is possible to debateeach component the overall balance of consequences is disproportionaland in favour of reinforcing the unwanted behaviour, namely the failure

to adjust the chair height, or alter the screen tilt, or draw the blinds so as

to prevent glare from windows etc

The next step in the process is to state in precise terms the observablebehaviours which are desired Then the antecedents and consequenceswhich influence the desired behaviour can be added This is demon-

strated in Figure 2.8.6.

The antecedents are likely to focus around education and trainingfollowed by ongoing reminders The consequences would includecomments and intervention by supervisors and fellow workers For theconsequences to be effective, supervisors would need regularly andfrequently to observe and comment on the individual’s use of, andperformance at, the workstation The comments should be positive andapproving when the desired behaviour has occurred Commenting onlywhen the desired behaviour has not occurred is far less effective.Reducing accidents in the workplace requires that the performancemanagement approach is applied to all unsafe behaviours Clearly this is

a mammoth task that should be approached systematically It can beachieved either by an analysis of the accident data (i.e using historicaldata) or by using Job Hazard Analysis of tasks undertaken (i.e using

Observation andcomment bysupervisor

Expectation ofcolleagues

Observation andcomment bycolleagues

Figure 2.8.6 Revised ABC analysis of computer workstations

predictive data) In either case the analysis is looked at from abehavioural perspective.

Using the accidents analysis data, the first step is to group it by taskand by area, e.g ‘fork-lift truck accidents in the distribution area’ Thesecond step is to examine how each accident occurred and to identify thesignificant behaviours which contributed to the accident This list isvariously termed the ‘critical behaviour list’ or the ‘key behaviour list’ forfork-lift truck accidents in the area The third step is to analyse each of thecritical behaviours identifying their antecedents and consequences, andthe features of each consequence (the ‘ABC’ analysis) The fourth step is

to state the desired behaviour which would avoid the accident and togive it consequences which will reinforce the use of the desiredconsequences At this stage this analysis is complete

Job hazard analysis begins by examining the task and listing the desired

behaviours to accomplish it safely Each desired behaviour is examinedand the necessary antecedents and consequences added

The analysis is the first part of the programme which then has to beimplemented In practice this means that a number of observers have to

be trained Their task is to understand the safety critical behaviours forthe workplace and to become skilled in identifying them

The observers audit the work area recording the number of safetycritical behaviours observed and the number of unsafe behavioursobserved to produce a ‘percentage safe behaviour’ score as follows:

% Safe behaviour score = number of safe behaviours observed

total number of behaviours observedThis data is plotted and posted in the workplace so that the workgroup

is encouraged to work toward a rising trend A typical graph of the

results is shown in Figure 2.8.7.

Figure 2.8.7 Typical effect of behaviour intervention process in the workplace

The strength of the process is more than an analysis of actions in theworkplace and observations of activity It works best where theemployees take a leading role in managing and implementing it.Employees thus undertake the analysis of behaviours, add the con-sequences necessary to achieve the safe behaviours and subsequentlyaudit each other By this means greater commitment to improving safetyoccurs In addition the workgroup often know how a job is actually done(as opposed to what the procedure for it says) and is in the best position

to draw up the list of desired safety behaviours in the first place and tomonitor compliance with it

When accidents occur they are analysed to see what might have gonewrong It may be that the safety critical behaviours were not identifiedcorrectly in the first place Alternatively the analysis might reveal that theconsequence modifiers are ineffective and have to be rethought

2.8.2.2 The structural feedback approach

Performance management requires that consequences are first analysedand then restructured to encourage the preferred (safe) behaviours Thechart demonstrating the improvement in the percentage of safe behav-iours is a feedback tool demonstrating the gains made

Other work by Cooper et al.10,11,12,13places greater emphasis upon thefeedback process In particular they stress that publicly displaying a chartshowing how well, or otherwise, a group of employees is doing inrelation to the areas of safety in which improvement is sought is itself avery powerful agent for change Consequently it becomes important thatfeedback charts are posted prominently and are regularly updated Inorder to achieve this it is necessary that managers adopt a particular role,namely:

1 Champion the behavioural process and inform his workpeople of itand of his support for it

2 Encourage employees to become active in the process especially asobservers

3 Allow employees the time to be involved in the training and meetingsneeded for goal setting

4 Allow each observer one observation session each working day Anobservation session should last no longer than 20 to 30 minutes

5 Be committed to attend goal setting sessions with the observers therebydemonstrating his support

6 Praise employees who work safely

7 Encourage employees to reach the safety goals

8 Arrange for senior managers to visit the workplace each week toencourage the safety improvement effort

The observers, who are members of the workgroup, commence theirtraining by analysing local accident data They identify contributoryfactors for each accident and subdivide them into observable behaviours

or situations which are safe or unsafe These observable data form the

basis of a checklist Emphasis is placed upon gaining agreement from theworkforce that the items that form the checklist of behaviours are valid.This is an important step as the workforce is assessed and scored againstthe list that has been generated The process of gaining agreement is itself

a type of feedback which seeks to gain involvement of and ownership byemployees of the safety programme

Scoring takes the conventional form of making observations in theworkplace of safe and unsafe behaviours to generate a ‘percentage safebehaviour score’ The data are charted and posted visibly in theworkplace Feedback of the data is not the only emphasis The employeesare asked by their observers to establish their own goals and subgoalsagainst which the performance is measured

2.8.2.3 Behaviour observation and counselling techniques

Any behaviour modification technique must involve an interaction withpeople As an accident can occur at almost any time and the consequences

in terms of injury outcome are not predictable, concentrating on a list ofidentified safety critical behaviours can have the following limitations:

1 The critical behaviour list may be incomplete

2 Behaviours may appear on the list as a result of a perception of, ratherthan an analysis of, an actual risk This is more likely if the list has beencompiled from a job hazard analysis

3 As the size of the list grows to encompass more behaviours (a result ofongoing accident experience and the desire to eradicate all accidents byadding more safety critical behaviours) the whole system can becomeunwieldy because too may behaviours are included in the observationprocess

4 The very existence of a list may limit the focus of employees andobservers to only those behaviours which are on the list This becomes

a more significant problem if observers are under pressure to complete

a quota of observations per week or per month Under thesecircumstances the objective can alter subtly from one of using thetechnique to reduce accidents to becoming merely an exercise incompleting a checklist The resultant quality fall-off which takes placecan undermine and discredit the entire effort

Other approaches have been developed such as the DuPont SafetyTraining Observation Program (‘STOP’) or their similar ‘Safety Manage-ment Audit Programme’14 In both these programmes the approach tends

to be less analytical in defining prescribed unsafe behaviours with adifferent emphasis that requires a management top-down approach inwhich one level of manager, having been taught the process, subse-quently teaches the next subordinate level The emphasis is uponobservation of employee behaviour and immediate counselling of theobserved employees Implementation of the process is through members

of line management from team leaders to senior managers Eachundertakes a workplace safety behaviour audit to an agreed schedule For

example, a team leader of a large workgroup may be expected toundertake a daily audit, middle managers may do an audit each week,and senior managers and directors an audit each month The trainingthey receive assumes a degree of knowledge of the workplace and thehazards it contains This is not unreasonable given that many managerswill have several years’ experience and knowledge of the work areas.Furthermore they are not necessarily expected to know in detail how safeworking on each job should be achieved They are expected, however, torecognise how injury might occur.

The training emphasises the skill in observing people as they work andlearning to approach and discuss safety with them in a constructivemanner This applies to employees who are observed working safely aswell as those working unsafely In the former case discussion cancommend the safe behaviour and be widened to encompass other tasksthe employee might do, seeking out any safety concerns arising fromthem The very fact that a person in authority is discussing safety issueswith the employee is of great importance in raising awareness andcommitment to accident-free working Thus in these programmes, there

is greater emphasis on observation and immediate intervention than onobservation, completion of a checklist, and the posting of a chart in theworkplace Nevertheless as employees do voice their concerns they haveexpectations that remedial measures will be taken Feedback in this caseoften takes the form of a list of actions identified from the audits and arolling calculation of the percentage completed

2.8.2.4 Behaviour modification and the lone worker

Behaviour modification is most easily applied where large groups ofpeople work in a systematic activity Examples of applications includefactory production lines, call centres, packaging and assembly lines andlarge construction sites In these situations the tasks can be easilyidentified and the safe behaviours required to perform them withoutinjury specified Other jobs, where employees work alone and away fromthe direct control of the supervisor present different challenges Anexample is maintenance tasks that require employees to work away fromthe workshop In these situations specific risks can arise that cannot beidentified until the job is underway For example, maintaining a pump on

a workbench is far simpler than performing the same task while thepump remains in its original location two miles away from the workshop.Typical of the problems that can arise are:

 Access to the pump is restricted

 Bolt fixings may be corroded and the use of a blow torch to free themmay not be permitted in the area

 Particular internal parts of the pump may need additional tenance work due to unexpected wear and tear, but the spare parts are

main-at the workshop and the mechanic must make a decision to use theexisting part believing ‘it will last until next time’ or stop productionwhile the part is replaced

The individual employee can rarely be kept under observation as thesedecisions and actions are taken Guidance from the Health and SafetyExecutive15recommends the use of:

 structured incident reviews where the assessor lists contributingcauses and seeks clarification and comment from employees;

 workforce questionnaires that seek to capture the perception ofemployees in identifying which of a list of eighteen management issueswarrant improvement

Approaches such as this are indirect behaviour modification and can beeffective where there is extensive employee participation with feedbackprovided on progress made Communication is critical to success Theobjective is to address and influence the behaviour of the remotemaintenance worker so that he can deal with the hazard at the time when

it becomes a serious risk

2.8.2.5 Behaviour modification and employee involvement

The application of behavioural techniques to improve the control of risks

in normal employment have usually occurred as a result of a seniormanagement initiative It occurs as a dictate from on high and is imposed

on the workforce A typical response from the workforce is three-fold:

 it is seen as a management lay-on by middle managers and supervisorsadding greater burden to their (the operator’s) busy working lives;

 it is viewed with scepticism by employees who have seen initiativescome and go over past years (‘flavour-of-the-month’ syndrome);

 managers, supervisors and employees alike do not expect the initiative

to last beyond the lifespan of the current senior management team oruntil something else comes along to distract their attention

The result of these attitudes is that a minimum commitment is made tothe initiative until senior management show by continuous example thatthe initiative is here to stay A significant new safety initiative is likely torequire at least two years of operations to convince middle managers andsupervisors and four years to convince employees that the initiative isseriously intended!

In order to gain acceptance of behaviour change initiatives, but also topromote a wider safety culture, the involvement of employees in apartnership is recommended A Health and Safety Executive publica-tion16suggests that workforce involvement can improve performance in

an organisation which:

 does not involve the workforce in determining company policy;

 does not treat the workforce or its representatives as equal partners inthe health and safety committee;

 does not allow employees to set the health and safety agenda duringmeetings; and

 does not involve workers in writing safe operating procedures.

If these and other aspects show that workforce involvement is limited, it

is unlikely that a positive health and safety culture exists

The concept of partnership is promoted in a union publication17that

quotes from a study by Reilly et al.18 which shows that in-depthconsultation with employees reduces serious injury rates Data are

reproduced in Figure 2.8.8.

2.8.2.6 Refreshing behaviour modification processes

Employee behaviour modification processes, as with all other humanprocesses, can become stale and ineffective A significant proportion ofthe safety improvement comes from the early interaction between theobserver and the observed If this process becomes superficial then fewimprovements in safety performance can be expected Refreshing thewhole intervention process periodically is essential and can be achievedby:

 training new observers;

 using trained observers from one department in an adjacentdepartment;

 changing the mix of observers to include managers, supervisors andemployees in rotation;

 revising the checklist of critical behaviours If some behaviours alwaysremain on the critical list then generate two lists and mix theobservation sequence;

 revising the checklist and discussing the changes in the light ofincident experience from within the area and from appropriate externaldata

2.8.2.7 Generic behaviour modification model

Most studies have focused upon modifying the behaviour of productionoperators to improve safety performance While variations in detail exist,the basic generic behavioural process consists of:

 Specify/knowthe behaviours that are necessary for safe working.

 Observe. The observation step can take the form of a generalobservation of an employee’s behaviour and counselling in theappropriate target behaviour Alternatively the observer can refer to apreviously established critical behaviour checklist and score thenumber of safe and unsafe behaviours observed

 Intervene and discuss. The observer discusses with the individualtheir personal safety performance This step can take several forms.The discussion can simply be a comparison of their performanceagainst the critical behaviour checklist, safe behaviours and anemphasising of the recommended advice on the immediate correctiveaction, that should be taken to remedy unsafe situations

 Follow-up action. A review of the data are collected and the actionnecessary to ensure safe operator behaviour

 Feedbackcan take a number of forms ranging from a chart showingthe percentage of safe and unsafe behaviours to a rolling list of openand closed corrective actions

2.8.3 Behaviour modification for managers and

supervisors

Wrong behaviour occurs at all levels The narrow focus on front lineemployees behaviour has been criticised by labour unions19 because itinfers:

 only front line employee behaviour causes accidents;

 the employee is to blame;

 that a blame environment drives safety problems underground;

 that capital expenditure is not authorised because incidents would beavoided if employees did not make errors

Figure 2.8.9 provides an illustrative example that demonstrates how

several levels and functions of management as well as front lineemployees can contribute to the occurrence of an unsafe situation It istherefore important that behaviour modification processes are applied topeople in management and supervisory roles

The generic behaviour modification model can be applied to managers

and supervisors as illustrated in Figure 2.8.10.

The observer of a supervisor’s behaviour can be the direct manager or

a third party, such as a safety professional A procedure that has provedsuccessful comprises a list of fifty behaviours that align with the overall

safety initiative for that year (Figure 2.8.11) with the results plotted on a

‘radar screen’ chart (Figure 2.8.12) Measurement occurred in several

different ways which included:

supervisor;

OPPORTUNITIES FOR ERRORS LEADING TO A PIPE RUPTURE WITH

CONSEQUENTIAL LOSS OF OUTPUT

The research chemist The chemist recommended in his report a minimum

operating temperature for the new compound butfailed to emphasise that it froze below thattemperature and expanded as it froze

The design engineer The designer did not allow for extremes of

temperature and failed to specify adequate heattracing for a heat exchanger bypass line

The construction contractor Because the bypass pipe was awkward to get at, did

not lay the trace heating evenly along its length.The supervisor Wrote into the operating instructions turning on the

trace heating when the temperature of the incomingcompound dropped below a specified temperature Hedid not incorporate a check to ensure the compoundwas flowing

The plant operator Neglected to check that the trace heating was on and

that the compound was flowing

The maintenance mechanic Failed to report or repair damage to the trace heating

caused during earlier maintenance

The plant manager Delayed activating the trace heating system to save

energy but failed to recognise the cooling effect of acold spell

The corporate director Cut the plant budget causing staff shortages that

prevented all the safety checks being carried out,particularly to the trace heating system

Result Compound temperature dropped and it froze,

expanded and fractured the bypass pipe Process shutdown for 6 hours while a repair was effected Noinjuries but much lost production

Figure 2.8.9 Error opportunities at different organisational levels (adapted from

Observe that the behaviour is occurring Check/attend/sample the toolbox talks

Intervene to commend the activity or

counsel if improvements are needed

Provide comment to the supervisor onthe content and the impact of thetoolbox talk

Follow-up on actions that the observer

what I expect the line organization to do and what I expect the HSE staff organization to do

demonstrate a leadership style that is co-operativ

tested within the last 12 months

 personal self-assessment which was reviewed with the directsuperior;

 the divisional management team set the minimum behaviours ted with achievement against or beyond these targets being recognised

expec-in the annual performance review;

 direct reports of the manager or supervisor scoring the performance ofthe senior manager

The particular method selected must depend on the maturity, fidence and interpersonal skills of the people involved The fiftybehaviours are organised into five dimensions each containing tendesirable behaviours In this example, the behaviours are not ranked inany order and each behaviour bears the same value The number ofbehaviours that a manager or supervisor demonstrates in each dimen-sion is plotted along the appropriate axis of the radar screen It is thenpossible to see at a glance what behaviours are being achieved andwhat behaviours should be undertaken The radar screen was chosen inone organisation for a particular reason – that other production datawas also displayed in the same format Consequently ‘safety’ was seen

con-as an integral part of the manager’s or supervisor’s work in the sameway that production was

Figure 2.8.12 Safety leadership radar screen

2.8.4 Applying behaviour concepts to incident

The question asked is who could have done what to prevent the incident occurring or reduce the likelihood of it occurring, or reduce the consequence when

it occurred The investigation process should first focus on the managers’

behaviours (the system controllers), then the supervisors’ behaviours (theworkplace controllers) and finally the activity controller(s) (the oper-ators’) If this sequence is reversed it is easy to give an impression oftrying to blame the operator Once all the possible contributory factorshave emerged, suitable remedial actions can be chosen according to thecircumstances, the risks and the costs Several actions can usually beidentified and the behavioural responses addressed through the behav-ioural audit process

When carried out within a mutually supportive culture, the processpromotes greater personal responsibility, accountability and commitment

to improve

2.8.4.1 Stress and using the incident model

A previous chapter used an example of Joe falling from a stepladder (see

Figure 2.6.12) That analysis was undertaken using the Incident Model

Figure 2.8.13 Domino incident model related to behavioural activity

and it was discussed in terms of the organisational responsibilities for

health and safety

The example provided in Figure 2.8.14 relates to the condition of stress

and demonstrates how the model can be applied to chronic health andsafety issues It shows how stress incidents can be analysed in such a way

to influence the behaviours of managers, supervisors and operators.Stress has been the subject of much recent research and comment Lifeitself is not without stress but the addition of work-related stress cancontribute to a situation where the individual is emotionally andpsychologically overcome Stress affects the individual’s decision-makingability and also his actions (behaviours) and can lead to acute accidents.Research by the Health and Safety Executive21 indicates that a risk

Figure 2.8.14 Behavioural incident model applied to a stress incident

assessment approach to managing stress can stimulate new and tive ways of dealing with the problem.

innova-The model can be used with a checklist of behaviours expected fromeach contributor to avoid stress problems Only a partial list is shown

2.8.5 Behaviour concepts and the safety management system

In chapter 2.6 the elements of safety management systems werediscussed Systems as systems can amount to no more than a list of sterileprocedures and general expectations that deliver little improvement Inorder to put ‘flesh on the bones’ of a system thought must be given to thebehaviour that is necessary to support it and the system must beconstructed empathetically with those behavioural aims A safetymanagement system based on the model suggested by the Health andSafety Executive22can be designed to generate the practical behaviours

that make the system effective An example is provided in Figure 2.8.15.

The process demonstrates the following features:

 expectations are specific;

 expectations have an assigned owner;

 expectations are measurable

The whole system must be visible to the operator workgroup and theirrepresentatives The process is most effective where the workgroup play

a large role in assessing performance In large organisations the systemelements and behavioural expectations can be established and measuredlevel by level down the chain of command Each manager or supervisorshould ask their work group to monitor its performance and reportupwards

2.8.6 Risk, behaviour, leadership and commitment

Changing peoples’ behaviour to avoid hazards and reduce risks can

become a transactional process and increasingly ineffective A tional style of leadership can be defined as a rule-following approach that

transac-is mainly concerned with achieving a task By contrast, a transformational

leadership style is mostly focused upon people and is more effective inchanging behaviours An HSE research report23 quotes a study24whichconcluded that a transformational leadership style had a strong positiveimpact on the safety performance of those individuals who generallywere otherwise less committed to safety Some differences between a

transactional and transformational leadership style are listed in Figure 2.8.16.

The behavioural processes that have been described in this chapter can

be applied with either a transactional or a transformational style Forexample if a behavioural checklist becomes a rule-based observation andintervention activity, then it is being applied in a transactional manner In

Figure 2.8.15 Example of behaviour shaping associated with a safety management

system

REQUIREMENT

MEASURE

POLICY 1 The board to review

and reissue the policyevery 3 years

A policy less than threeyears old

2 Each board member toensure that the policy isreviewed in cascadeddiscussions throughoutthe organisation

At least 80% of a sample

of employees to confirmtheir knowledge of thenew policy within 3months of its issue

3 Independent auditors

to assess that the policycovers all risks etc

An audit report to bereviewed at the seniorsafety committeeORGANISING 1 Each job will have

specified safetyresponsibilities which arereviewed every 3 years

Job responsibilities to bereviewed/checked by thesafety department

2 All work procedureswill be reviewed everythree years

Work procedures to bereviewed by theworkplace representative

3 Safety committees atappropriate organisationallevels will meet bi-monthly etc

Records of meetingminutes to be kept underreview

PLANNING AND

IMPLEMENTING

1 Employees will receive

a copy of the safety plan

Operator reaction to besampled by the safetyreps

2 Suitable training will beundertaken for key planpersonnel etc

The safety department tospecify the training andensure delivery of itMEASURING

PERFORMANCE

1 Safety committees willmonitor their area’s part

in the overall plan

Data from safetycommittees to besummarised for theboard

2 Incidents will bereviewed and key findingsshared widely etc

Safety department tomonitor compliance

AUDIT & REVIEW 1 The safety department

will provide a review ofplan progress andincidents each quarter

A report will be sent tothe board, members ofthe management teamand safety committeemembers

2 An external audit will

be performed every 3years etc

– the audit will beavailable to employees

these circumstances behavioural processes will be less successful A study

by Griffin et al.25concluded that safety performance improved where themanager adopted a supportive and caring style This is not surprisingbecause a good manager will seek to explain and understand a poor or

‘at-risk’ behaviour before applying a workplace safety rule Specific rules,generally speaking, do not cover every situation in and nuance ofworkaday life Different levels of manager have different impacts.O’Dea’s study24 indicates that senior managers influence the generalclimate and expectations for proactive safe behaviour while middlemanagers and supervisors influence the adherence to local procedures

and rules Simard et al.26 found that low accident rates occurred wherethe supervisor adopted a participatory leadership style whereas higheraccident rates occurred where a hierarchical style was used A study ofsafety on construction sites27concludes that management commitment is

vitally important Duff et al.28noted that the best performing constructionsites in their study were those where managers showed theircommitment

Leadership style and committed application at all levels, but especiallyfrom managers and supervisors, are essential to the success of behaviourmodification programmes Experience has shown that success occurswhere senior managers create the fertile soil in which safety professionalscan plant appropriate seeds for supervisors to tend and bring to fullbloom A flowery metaphor, but apposite!

2.8.7 Behaviour modification processes: the hazards

Behaviour modification processes can fail to have the aimed-for impactfor a number of reasons including:

1 Behaviour processes have not been placed within the context of thewider safety management system but have been viewed as analternative to it

2 The behaviour modification process designed does not includemanagers or supervisors, only front-line operators

TRANSACTIONAL

LEADERSHIP STYLE

TRANSFORMATIONAL

LEADERSHIP STYLE

Managers command Managers involve

Managers ‘have the answers’ Managers ask employees for answersManagers resist change – conform to

‘same old way’

Managers seek out and consider newideas – prepared to change

Managers communicate one-way Managers listen and encourage everyone

to communicateManagers ignore failings Managers right wrongs

Figure 2.8.16 Features of transactional and transformational leadership styles

3 The cost and time commitment has been underestimated especially inregard to initial training, refresher training, and employee time taken inobservation and intervention.

4 There is a lack of willingness to make a sustained commitment overseveral years Behaviour modification processes are seen as a ‘quick fix’

to boost safety performance

For success, the organisation must be ready to adopt a behaviourmodification process and the factors which indicate this is so include:

 Accident levels have stopped falling

 Management is frustrated at the lack of improvement in safetyperformance and is willing to embrace a new initiative

 Poor improvements in safety performance have resulted from capitalexpenditure

 Incident analyses indicate that behaviour modifications by employeescould have avoided many of the accidents

It must be understood that behaviour modification processes areinappropriate where failure will result in a serious or fatal injury Humanbeings by their very nature are not perfect – they fail If the consequence

of a single failure is so serious, the risk must be controlled by othermeans

2.8.8 Behaviour and safety culture

A positive safety culture is often seen as the endpoint of the systematicefforts to improve safety Once attained any hazards will be controlled in

a coherent, supportive, constructive, even happy environment But what

is a positive safety culture? There are many answers The Confederation

of British Industry29 lists eleven features:

1 Leadership and commitment from the top which is genuine andvisible This is the most important feature

2 Acceptance that it is a long term strategy which requires sustainedeffort and interest

3 A policy statement of high expectations and conveying a sense ofoptimism about what is possible, supported by adequate codes ofpractice and safety standards

4 Health and safety should be treated as other corporate aims, andproperly resourced

5 It must be a line management responsibility

6 ‘Ownership’ of health and safety must permeate at all levels of theworkforce This requires employee involvement, training andcommunication

7 Realistic and achievable targets should be set and performancemeasured against them

8 Incidents should be thoroughly investigated

9 Consistency of behaviour against agreed standards should beachieved by auditing and good safety behaviour should be acondition of employment.

10 Deficiencies revealed by an investigation or audit should be remediedpromptly

11 Management must receive adequate and up-to-date information to beable to assess performance

Research by Pidgeon30 implies three major features constitute a goodsafety culture:

 the existence of procedures and rules reinforced by high expectations

of compliance;

 attitudes toward safety that are constructive and positive;

 an ability, capacity and willingness to consider and learn fromexperience from within and without the organisation

A technique for assessing where the organisation stands in respect ofsafety behaviours at any point in time is to ask those most exposed to thehazards – the operators The deliberations in the boardroom lead todecisions that can affect the health and safety of employees If asked,employees can indicate the impact of these high level decisions and showwhether their intentions and objectives are being achieved This reflectsthe ‘culture in being’

Understanding employees’ perceptions and opinions can be considered

as a ‘reality check’ and can help to focus on concerns that they see asimpediments to good safety performance Psychologists such as Stantonand Glendon31have developed structured survey tools for this purpose.Another is available from the HSE32 This latter publication asks 71questions covering the following 10 factors:

1 Organisational commitment and communication

2 Line management commitment

3 Supervisor’s role

4 Personal role

5 Workmates’ influence

6 Competence

7 Risk-taking behaviour and some contributory influences

8 Some obstacles to safe behaviour

9 Permit-to-work

10 Reporting of accidents and near misses

Using the tool requires that managers, supervisors and their operatorseach provide their opinion on these 10 topics This permits the views thatmanagers hold to be compared with the views of other levels in theorganisation The survey can be undertaken in other areas of thecompany and at other dates enabling comparison across an organisationand over a period of time

Measurement is only the first step in using survey techniques.Collected data, including accident and incident data, should be used for

discussion with operators Utilising the data in this way is as important

as getting it in the first place The involvement of operators in this wayraises expectations – operators expect more from managers and managersexpect a greater contribution from operators

The process measures opinions, and it also generates a focus on, andcommitment to, improved safety performance, behaviours that even-tually produce a positive safety culture

Whilst an understanding of the links between attitude, behaviour andthe consequences of the behaviour are still developing, enough is known

Figure 2.8.17 Safety emphasis and post-war accidents trends

to establish that certain key elements of a behaviour approach are morelikely to yield success These key elements include:

1 Management commitment This should take the form of providingencouragement, being supportive and offering coaching to the work-group A ‘command and control’ approach is not a recipe for lastingsuccess

2 Workforce involvement It is essential that the employees, whothemselves suffer the accidents, are thoroughly immersed in theprocess Their involvement is crucial because they are the people whoknow the unsafe acts that are committed and the reasons for them.Clearly the workgroup themselves are in the best position to know theantecedents and consequences which operate and how they can beadjusted to promote safer working

3 Effective feedback is essential and should be twofold in content First,there should be immediate interaction with the employee beingobserved irrespective of whether safe or unsafe working is noticed.Second, there should be feedback to the work group as a whole forcomparison with the agreed checklist of safety critical behaviours Thiscan give a behaviour score which can be compared with goals agreed

by the work group The result can be used to measure progress and can

be posted on a chart in the workplace

Behavioural processes may have limitations as to their effectiveness.Most examples come from areas where the hazards are acute andunderstood and the behaviour is observable, such as the wearing ofpersonal protective equipment It may be harder to apply thesetechniques to work systems such as ‘permits-to-work’ or where the risk islow in probability but high in consequence and where precautions aretaken but effects not immediately visible An example might include themaintenance of pressure systems where poor work may not becomevisible until an explosion occurs much later

The objective of a behaviour-based approach is to change work habitsfor the better There is evidence to show that success does result fromsuch programmes However, they require considerable resources andcommitment which might not always be forthcoming Little work hasbeen undertaken to show if improvements in performance continue toaccrue or can even be maintained when resources are scaled down, forexample, by undertaking less frequent audits It may be that theimposed effort can be scaled down because attitudes have effectivelyand permanently altered in favour of ongoing safe working Theevidence from major companies which have reputations for con-

tinuously superior safety performance seems to be that the formality can

be reduced but there must be an ongoing management focus Inpractical terms this involves being seen to be committed to safeworking, walking the workplace, coaching employees in safety behav-iours, and encouraging their full participation into what is a statedmajor workplace value, namely an ongoing reduction in accidents andill-health at work When this point is attained, a culture change hasbeen achieved

1 Skinner, B.F., The Behaviour of Organisms, Appleton-Century-Crofts, New York (1938)

2 Health and Safety Executive, Guidance publication no HSG 48 Reducing Error and Influencing Behaviour, HSE Books, Sudbury (1999)

3 Komaki, J., Barwick, K.D and Scott, L.R., A behavioural approach to occupational

safety: Pinpointing and reinforcing safe performace in a food manufacturing plant J.

Appl Psychol., 63: 434–445 (1978)

4 Komaki, J., Heinzman, A.T and Lawson, L., Effect of training and feedback: component

analysis of a behavioural safety program J Appl Psychol., 65: 261–270 (1980)

5 Komaki, J.D., Collins, R.L and Penn, P., The role of performance antecedents and

consequences in work motivation J Appl Psychol., 67: 334–340 (1982)

6 Suzler-Azaroff, B., The Modification of Occupational Safety Behaviour J Occupational

Accidents, 9: 177–197 (1987)

7 Nasanen, M and Saari, J., The effects of positive feedback on housekeeping and

accidents at a shipyard Journal of Occupational Accidents, 8: 237–250 (1987)

8 Daniels, A.C and Rosen, T.A., Performance Management: Improving Quality and Productivity through Positive Reinforcement Performance Management Publications, Inc.,

Tucker, Georgia (1987)

9 Krause, T.R., Hidley, J.H and Hodsen, S.J., The Behaviour-Bases Safety Process Van

Nostrand Reinhold, New York (1990)

10 Cooper, M.D., Makin, P.J., Phillips, R.A and Sutherland, V.J., Improving safety in a large, continuous shift, production plant using goal setting and feedback: benefits and pitfalls Brit Psychol Soc Annual Occ Psychol Conference, Brighton, Jan 3–5 (1993)

11 Cooper, M.D., Goalsetting for safety The Safety and Health Practitioner, November 1993,

32–37.

12 Cooper, M.D., Implementing the behaviour based approach, a practical guide The Safety and Health Practitioner, November 1994, 18–23.

13 Cooper, M.D., Phillips, R.A., Sutherland, V.J and Makin, P.J., Reducing accidents using

goal setting and feedback: A field study J Occ & Org Psychol., 67, 219–240, (1994)

14 Safety Training Observation Program E.I du Pont de Nemours and Company, Wilmington, Delaware, 1989.

15 Health and Safety Executive, Guidance publication, Improving Maintenance: a Guide to Reducing Human Error, HSE Books, Sudbury (2000)

16 Health and Safety Executive, Guidance publication no HSG 217, Involving Employees in Health and Safety, HSE Books, Sudbury (2001)

17 The Trades Union Congress, Partners in Prevention: Revitalising Health and Safety in the Workplace, Trades Union Congress, London

18 Reilly, Paci and Hall, British Journal of Industrial Relations, 33(2): June (1995)

19 Howe, J., Warning, Behavior Based Safety Can Be Hazardous To Your Health And Safety Program!, Union of Automotive Worker, International Union, September 1993

20 Lorenzo, D.K., A Manager’s Guide to Reducing Human Errors, Chemical Manufacturers

Association, USA (1990)

21 Health and Safety Executive, Contract Research Report no CRR 435/2002, Interventions

to Control Stress at Work in Hospital Staff, HSE Books, Sudbury (2002)

22 Health and Safety Executive, Guidance publication no HSG 65, Successful Health and Safety Management, 2nd edn, HSE Books, Sudbury (1999)

23 Health and Safety Executive, Contract Research Report no CRR 430/2002, Strategies to Promote Safe Behaviour as part of a Health and Safety Management System, HSE Books,

26 Simard, M and Marchand, A., Workgroup’s propensity to comply with safety rules: the

influence of micro-macro organisational factors Ergonomics, 40(2): 172–188 (1997)

27 Health and Safety Executive, Contract Reasearch Report no CRR 299/1999, Improving Safety on Construction Sites by Changing Personal Behaviour, HSE Books, Sudbury

(1999)

28 Duff, A.R., Robertson, I.T., Phillips, R.A and Cooper, M.D., Improving safety by the

modification of behaviour Construction Management and Economics, 12: 67–78 (1994)

29 Confederation of British Industry, Developing a Safety Culture, CBI, London (1991)

30 Pidgeon, N.F., Safety culture and risk management in organisations, Journal of

Cross-Cultural Psychology, 22: 129–140.

31 Stanton, N and Glendon, I., Safety Culture Questionnaire, Griffith University, Australia

and University of Southampton, England, 1996 (Private communication)

32 Health and Safety Executive, Health and Safety Climate Survey Tool (Diskette), HSE Books,

Sudbury (1998)

Occupational health and hygiene

Chapter 3.1 The structure and functions of the human body

(Dr T Coates) 421

Chapter 3.2 Occupational diseases (Dr A R L Clark) 447

Chapter 3.3 Occupational hygiene (Dr C Hartley) 492

Chapter 3.4 Radiation (Dr A D Wrixon and updated by Peter Shaw

and Dr M Maslanyj) 524

Chapter 3.5 Noise and vibration (R W Smith) 543

Chapter 3.6 Workplace pollution, heat and ventilation

(F S Gill) 568

Chapter 3.7 Lighting (E G Hooper and updated by Jonathan

Chapter 3.8 Managing ergonomics (Nick Cook) 594

Chapter 3.9 Applied ergonomics (John Ridley) 617

In his work, the safety adviser may be called upon to recommendmeasures to overcome health problems that have been identified by thedoctor or nurse Part of his duties may include the identification ofprocesses and substances that are known to give rise to health risks andadvising on the procedures to be followed for their safe use

The advice he can give will be more pertinent if the safety adviser has

an understanding of the nature of the substance and the manner in which

it affects the functioning of the human body

This Part explains the functions of the major organs of the body,considers the characteristics and hazards of a range of commonly usedsubstances and processes and discusses the techniques that can beemployed to reduce the effects of those risks on the health and well-being

of the workpeople

The structure and functions of

the human body

Dr T Coates

3.1.1 Introduction

Occupational medicine is that branch of medicine concerned with healthproblems caused by or manifest at work Some health problems, althoughnot caused by the job, may be aggravated by it

A knowledge of the structure and functioning of the organs and tissues

of the body is of value in the understanding of occupational illness andinjury

Some substances are particularly liable to damage certain organs; e.g.hydrocarbon solvents may affect the liver, cadmium may damage thelungs or kidneys and mercury may affect the brain

A brief description of anatomy and physiology is given below andmore details may be obtained from textbooks on the subject

3.1.2 History

Although many hazards of work were well recognised in ancient times,very little was done to prevent occupational disease Mining was adangerous unpleasant occupation performed by slaves The latter wereexpendable and the frightful conditions in which they worked may havebeen a deterrent to slaves on the surface!

By the second century AD some miners were using bladders to protectthemselves from dust inhalation (Apart from armour and shields this isprobably the first example of protective clothing worn at work.)

Little is known about occupational diseases in the dark ages but by thesixteenth century there was extensive mining for metals in central Europeand several accounts of associated diseases The year 1556 saw thepublication of a work of 12 books on metal mining by a mining engineerand doctor called Agricola The latter part of book VI was devoted to thediseases of miners Agricola advised the use of loose veils worn over theface to protect the miner against dust and ventilating machines to purifythe air

Eleven years later another doctor with an interest in mining published

a work on diseases of mining and smelting Paracelsus was physician to

an Austrian town and local metallurgist He used several metalsincluding lead, mercury, iron and copper to treat diseases He describedthe signs and symptoms of mercury poisoning and recommended the use

of mercury in treating syphilis When challenged that some of his drugswere poisonous he replied ‘All things are poisons, for there is nothingwithout poisonous qualities It is only the dose which make things apoison’

In 1700 a book on trade diseases was published by an Italian physician

by the name of Bernardino Ramazzini He based the book on personalobservations in the workshops of Modena where he was professor ofmedicine and on the writings of earlier doctors Ramazzini was the firstperson to advise that physicians should ask specifically about thepatient’s occupation when diagnosing illness

The development of the factory system saw the rapid movement ofpeople from the country to the towns with consequent disruption offamily life Large numbers of workers and their families housed near thefactories resulted in overcrowding, poor housing and poor sanitation Atwork, people suffered appalling injury and disease and worked very longhours until eventually the pressures of humanitarians such as the Earl ofShaftesbury promoted legislation which improved working conditionsand reduced the hours of employment of workers in factories, mines andelsewhere

During this time Charles Turner Thackrah, a doctor from Leeds, wrote

a book about occupational diseases in his native city which was the firstsuch work to be published in the UK But this was 1832 and his workraised little interest, but did influence the House of Commons on futurefactory legislation

The Factories Act of 1833 saw the appointment of Factory Inspectorsand the need for doctors to certify that a child appeared to be at least nineyears of age before being employed in textile mills When birthcertification was introduced in 1837 the assessment of children’s agesbecame unnecessary In 1844, the Factory Inspectors appointed CertifyingSurgeons and by 1855 they were required to investigate industrialaccidents and to certify that young persons were not incapacitated bydisease or bodily infirmity

By the mid nineteenth century the Registrar General had amassed agreat deal of statistical information about occupational disease Dr E.H.Greenhow of St Thomas’ Hospital showed from these figures that much

of the chest disease in certain areas of the country was due to theinhalation of dust and fumes at work

In 1895, poisoning by lead, phosphorus and arsenic and cases ofanthrax became notifiable to the Factory Inspectorate Certifying sur-geons examined workers in match factories, lead paint works, tri-nitrobenzene explosive factories and india-rubber factories using thevulcanising process which involved carbon bisulphide The wide-spread occurrence of ‘phossy-jaw’ in phosphorus workers and leadpoisoning gained much publicity and provoked the appointment in

1898 of Dr Thomas Legge as the first Medical Inspector of Factories

Legge devoted the next 30 years to investigating and preventing

occupational disease His book Industrial Maladies was published

post-humously in 1934

By 1948, the Certifying Surgeons had become ‘Appointed FactoryDoctors’ and numbered over 1800 They examined young people underthe age of 18, investigated patients suffering from notifiable diseases andcarried out periodic medical examinations on people employed inspecific dangerous trades The Appointed Factory Doctor system wasreplaced by the Employment Medical Advisory Service in 1972 Thisservice, the nucleus of which was formed by the medical branch of thefactory inspectorate, gives advice to employers, employees, trade unionsand others on medical matters related to work

Occupational Health Services in private industry were slow to developand although there were rare instances of medical services at work evenbefore the industrial revolution the first Workman’s Compensation Act of

1897 was the first real stimulus which provoked employers to seekmedical advice in their factories At that time, the main reason for suchappointments was to help protect the firm against claims for compensa-tion Exposure to hazards in munitions factories in World War I initiatedmany new medical and nursing appointments and increased the number

of trained first aiders Although the depression of the 1920s reversed thetrend, interest returned in the 1930s and 1935 saw the founding of theAssociation of Industrial Medical Officers with some 20 members Thisorganisation grew into the Society of Occupational Medicine with acurrent membership of almost 2000 doctors

A new surge of growth in Occupational Health Services occurred inWorld War II The large factories were required to have their own doctors.After the war medical services grew but slowly Many larger industriesdeveloped comprehensive medical services with X-ray, laboratory andother facilities Some smaller factories shared medical services with theirneighbours in schemes set up by the Nuffield Foundation

In 1978, the Royal College of Physicians of London established aFaculty of Occupational Medicine as an academic centre for the subject.The Faculty has established criteria for the training and examination ofspecialists in the field and has a membership of over 1700

Meantime, occupational health nursing has developed as an importantaspect of health at work Many factories with no occupational healthphysician employ one or more occupational health nurses The first suchnurse was employed by Colemans of Norwich in 1877 The Royal College

of Nursing has formed a Society of Occupational Health Nursing formembers employed in industry and commerce and provides trainingcourses for those engaged in this branch of nursing The House of Lordsproduced a report on Occupational Health and Hygiene Services in 1984.The report recommended development of group services which wouldbenefit the smaller companies and suggested a Government-financedfund administered by HSE to initiate such services

In the past decade the National Health Service has developedoccupational health services for its own staff These services are organised

by individual NHS Trusts rather than on a national basis but many ofthem are extended to local authorities and local industry

3.1.3 The functions of an occupational health

2 Examination of people exposed to specific occupational hazards

3 Treatment of conditions on behalf of the hospital or general tioner This may include physiotherapy or rehabilitation for whichpurposes a physiotherapist may be employed

practi-4 Emergency treatment of illness or injury occurring at work

5 Immunological services, e.g vaccination of overseas travellers, tetanusprevention, influenza prevention Hospital workers require protectionagainst hepatitis and tuberculosis

Advisory services

1 The study and prevention of occupational disease

2 Advice on problems of medical legislation and codes of practice

3 Advice on medical aspects of new processes and plant

4 The study of sickness absence

5 Advice on the reduction or prevention of common non-occupationaldiseases such as alcoholism and the effects of smoking

6 Advice to employees prior to retirement

7 The preparation of contingency plans for major disasters at the place ofwork

Nurses have an important part to play in these activities and much ofthe clinical treatment of patients is in their hands In the UK nurses may

be State Registered (SRN) or Registered General Nurse (RGN) with 3years’ training or State Enrolled (SEN) with 2 years’ practical training.Full-time and part-time training courses in occupational health nursingare run by the Royal College of Nursing at various centres The RGN mayobtain a diploma in occupational health nursing after an examination.The SEN may take part in one of the courses which will help her carry outher duties in this field of nursing As most nurses in industry andcommerce lack full-time medical advice the need for formal training inthe subject is very clear

3.1.4 Overseas developments

Not all EC countries have introduced legislation on occupational health

In France, for example, there is no law requiring treatment services butpre-employment medical examinations are mandatory