From constraints to facilitation

 “Safety is boring. And it does my head in!”

From the very start I could tell that my meeting with a top level manager of an Australian hospital was going to be interesting.

“Don’t get me wrong! We have serious safety issues here. We occasionally do wrong side surgery. We chop off the wrong leg and we give out the wrong medicine. We have people falling out of bed at night, we mix up patients, there are depressed mothers killing themselves. All these are issues that we should be working on. But we spend most of our safety efforts inventing procedures that really don’t improve anything at all“.

Her frustration was obvious. She seemed very passionate about safety – caring for both her workers and the patients. But for reasons that seemed to be primarily of a legal or bureaucratic nature, she was increasingly prevented from doing anything meaningful to improve safety. Even worse, I thought, “safety” had become an obstacle for the hospital to do the job effectively. The waiting periods for surgery and in the emergency wards were getting longer and longer. Additional safety requirements would most likely further exacerbate the situation. Simultaneously, politicians had begun talking about legislating a patient’s right to receive care within a certain time frame.

Her story was all too familiar. Safety seems to have become something dreadfully negative. Perhaps understandably so. Deaths, injuries, illnesses and material damage are indeed unwanted deviations. So it makes sense that safety efforts focus on either preventing such events from happening, or protecting against their consequences.

 

Safety I

Safety programs like Zero Harm, and much of the current safety legislation, aim to reduce the likelihood of negative events. Measurements of safety typically contain statistics over Lost Time Injuries, near misses, accidents, and other negatives. Similarly, an internet image search on the word “safety” turns up red, yellow and orange inspired pictures of warnings, prohibitions, reminders and protective gear.

Seemingly underlying these conventional safety ideas is the assumption that safety will be achieved if only we were able to stay away from unwanted deviations. To ensure that outcomes do not deviate from what is desired, the predominant solution is to constrain performance. So we seek to decrease mess, variety, creativity, instability, uncertainty, autonomy, and reactivity at work. This is done by increasing order, conformity, compliance, stability, predictability, discipline, and repetition. The result is an ever-increasing number of rules, procedures, checklist, restrictions, prohibitions, reminders, audits, and other measures to ensure control. Similarly, safety departments have become a sort of organisational internal police, assuring that people comply with procedures, that they wear their protective equipment, that they hold the handrail when using stairs, and so on.

Professor Erik Hollnagel at the University of Southern Denmark has labeled this approach “Safety I”, based on a definition of safety as being the absence of (the risk of) negative events or outcomes. Put differently, safety is traditionally defined in relation to what it is not.

Safety I has been a rather successful way to reduce accidents, especially when the task is given to safety professionals. But the success of the Safety I approach is not without problems. In various safety critical industries, like transportation, healthcare, and power generation, additional safety investments in procedures, training, and safety barriers yield less and less return, if any at all. In fact, in some industries accident rates are rising despite increasing efforts to control people and processes.

 

Safety II

A growing community of safety thinkers and practitioners have recognised that safety is more than just the absence of negative events. Although they have the same ambition of reducing unwanted deviations, they take a different path towards that goal and focus on the things that go right. Identifying the factors that enable people and organisations to achieve success, their goal is to increase the number of events and outcomes that go right.

Safety is, in this sense, not the absence of negatives, but the presence of a capacity that enables success under varying conditions. Professor Hollnagel identifies this approach as Safety II.

Safety II thinking not only shifts the focus from negative to positive events, but also changes the questions we ask to improve safety. Safety I efforts are geared towards tightening control of the system, often by reducing available degrees of freedom. Safety II efforts, on the other hand, seek first to understand how success is achieved, and then to support and enhance the identified critical functions. This presents a radically different approach to how we think about, for example, safety in design and operational safety, as well as the role safety plays in an organisation.

 

Towards a new role for safety

Safety is, or has the capacity to be, a positive value. As a positive value, safety efforts are no longer mere expenditure to avoid events that may or may not happen, but an investment to improve efficiency and productivity. Hence, the role of safety goes from having a constraining and potentially business-hostile function, to having an improvement and facilitating function – something that should be in the interest even of those who primarily want to optimize profitability.

This, however, requires a better understanding of work as actually done. Have we understood what the capacities are that help people steer activities and events towards success? If not, that is where we need to begin. Safety professionals should in this sense not tell people what to do to be safe, but be interested and inquisitive about how people go about their work, what workers think they need, what their resources are, how people understand dangers in the workplace, and so on.

People may need simple things, like lighting, ventilation, or the tool shed closer to where work is performed. Perhaps even procedures, checklists or reminders are what they need. However, deciding how to support safety is not a one way, top-down process, but a collaborative effort between several professional groups in an organisation.

In summary, safety is traditionally focused on adapting people or designs to prevent failure: trying to make things less bad. The Safety II approach suggests that failures can be prevented by adapting systems and designs to achieve success. As allegedly claimed by prize fighter Jack Dempsey, “the best defence is a good offence”.

 

A version of this text was published in September 2012 in the Safety Institute of Australia’s magazine “OHS professional”

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