Systems change

In document Productive Safety Management (Page 77-81)

Productive safety management involves two types of change – systems change and behavioral change. The former involves restructuring current OHS practices so that they fit the entropy model and the application of methods to quantify risk so that priorities for risk management can be established. Behavioral change is needed to create an internal business environment which allows these systems changes to translate into improved organizational safety, performance and quality through the competencies, vigilance and resourcefulness of employees.

Why is it necessary to restructure current practices? In Chapter 1 it was explained that existing accident causation models have been used to develop OHS management systems to date. A number of weaknesses were identified in these, including a lack of practical application to the organization. In addition, they were skewed towards human error as the cause of incidents and as a result, current practices tend to focus on the individual and not on the system. The restructure is, therefore, needed to shift prevailing approaches to a systems perspective. In the Introduction the analogy about the brick wall was presented to illustrate these weaknesses. It explained that traditional components of OHS systems tend to be like a wall built without mortar. Each brick is not clearly connected to the next. The restructure based on the entropy model allows a more orderly approach to these practices and establishes clearly where each brick fits into the system.

According to the model, the firm has four system factors that are applicable to all activities of the company. These are processes, technology, the physical environment and human resources. Restructuring involves the allocation of practices to the system factor that provides the best fit. For example, workplace inspections fall under processes and equipment maintenance is part of technology. This change strategy also requires the modification of tools, such as incident investigation questionnaires and JSA formats, which are provided in the relevant sections of Part 2.

Chapters 3 to 6 discuss each system factor in turn and identify the OHS practices that apply to them. An overall perspective of this restructuring process was provided in Fig. (i) in the Introduction and a summary of the specific systems change elements of productive safety management is shown in Fig. (ii). There has been extensive work undertaken by OHS professionals to develop current practices, and as a result, this book does not set out to ‘reinvent the wheel’. It presents instead a better-formatted, systems-based approach to these management components. Productive safety is designed to improve the systems that most firms already have in place and provide greater understanding of the nature of risk and OHS decision-making using the entropy model and the channel, respectively. The restructuring and risk management strategies described complement the behavioral modification initiatives that will be discussed in Part 3.

In addition, Chapters 3 to 6 detail the sources of entropic and residual risk associated with each system factor. An in-depth exploration of risk variables is

Legal provisions and safety

Figure (ii) Overview of systems change elements

undertaken supported by practical examples. Managers and workers are better equipped to manage hazards when they have a sound knowledge of the specific risks within work procedures, equipment, the work environment, people and how these interact. Incident reports are used to illustrate how these risks have translated into actual events in the workplace.

The final chapter of Part 2 – Chapter 7 – presents a method to quantify the entropic and residual risks within each system factor. The resultant relative values allow the hazards associated with various work activities to be prioritized. As a result, managers are more able to confidently allocate limited company resources to mitigate these risks. In addition, this risk quantification method permits the firm to set a baseline level of risk above which it considers risks to be unacceptable.

The overall objective is to reduce this baseline over time. In Part 4, the baseline measures together with audit results and other safety measures, such as the lost time injury frequency rate (LTIFR), are included in the productive safety management plan.


Chapter 3


Business activities involve the interaction of human resources, technology and the physical environment through processes. Processes therefore provide the interface (a point of contact or interaction) between other system factors. They can be divided into three categories which are:

(1) Process designs or work practices;

(2) Risk management practices; and (3) Post-incident practices.

The first processes are those activities required to get the work done.

These are developed prior to the firm becoming operational or when new tasks are added to the system. The second involves risk identification and monitoring activities such as job safety analysis (JSA), workplace inspections, hazard inspections and audits. Post-incident practices are the responses that follow events that are deviations from safe systems, for example, incident investigations and emergency procedures. They also include activities to rectify or manage injury such as the rehabilitation of affected workers.

When designing work practices a number of variables have to be considered. These are firstly, the levels of entropic and residual risk associated with current system factors, and secondly, the potential for degradation caused by the introduction of change. Prior to the implementation of new work practices, therefore, assessments are required of:

(1) The condition and characteristics of equipment that will be used to carry out the procedure;

(2) The state and characteristics of the environment where the work will be undertaken;

(3) The current competencies and attributes of individuals who will do the work;

(4) Any residual risks within these system factors; and

(5) The potential implications resulting from the interaction of these system factors.

New or modified work practices have a negative effect on safety and performance in the short term because employees require time to adjust to change and to learn new habits. In addition, some of the consequences

50 Productive Safety Management

of change may not have been anticipated causing unexpected rises in entropic risk. For example, if a company introduces a vehicle wash-down procedure in an area where the water run-off creates an additional hazard in an adjoining workplace then a new source of entropy is introduced.

The lack of fit between the process and one or more other system factors accelerates degradation.

In addition, all processes have some level of human input. The greater this involvement, the greater the worker’s vulnerability to the hazards associated with the interface between system factors, and the higher the likelihood of an incident involving the worker. Exposure according to the entropy model, and this is where it differs from the current understanding of exposure as a time-related variable, refers to the severity of the risks more so than simply the length of time of contact. The reason for this is that the model indicates that the probability of an incident relates to the absolute levels of residual and entropic risk at a given point in time. A worker, when exposed to hazards, may be injured in the first or last five minutes or at any time in the shift. The level of danger is treated as occurring in static time when giving a relative score to the risk using the method in Chapter 7. The worker’s susceptibility to injury is therefore related to the level of residual risk plus the variability in the entropic risk in other system factors. The individual worker also has risks specifically related to current competencies. Areas in which the employee has a lack of knowledge, skills or abilities (KSAs) are a source of residual risk, while fluctuations in capacity are a worker-specific entropic risk. Worker exposure is therefore the sum of a complex set of variables that may be expressed as the relationship:

Worker exposure at a given cross-section of time

= Level of residual risk in system factors + Levels of entropic risk in system factors + Level of worker-specific competencies + Level of worker-specific degradation

When this rationale is applied, there is a number of implications. For instance, if the process involves exposing the worker to a chemical that causes respiratory problems, his physical capability will degrade according to individual tolerance and susceptibility to such hazards. It is, therefore, not assumed that prescribed chemical exposure rates are safe because they are dependent on individual reactions. The worker is thus subjected to risks as a result of his interaction with the physical environment, technology and other human resources while carrying out a set of procedures. Therefore before process risks can be managed three issues need to be considered. The first is to identify the hazards specific to each system factor and the interactions involved when the process is undertaken.

The second is to evaluate how the hazards are affected by human parameters such as competence level, the ability to manage risk and attitudinal factors. Finally, the demands that these hazards place on the worker have to be understood before work practices can be designed to minimize these risks. According to OHS legislation, the onus is on the firm to take all reasonable measures to manage process risks. Hazard assessment at the process design stage is therefore mandatory.

Processes 51

In document Productive Safety Management (Page 77-81)