Reinvigorate your Incident Management Process

24 May 2017

Many companies are becoming proactive and realizing there is a lot of learning to be gained from near misses and observations, but they’re not doing a good job of getting enough data reported. The reasons why run along some common themes:  There is a fear of disciplinary action or some other type of negative response for those who report; there is a fear of blame in looking for a culprit; and there is the fear of looking like a “do-gooder” or “rat”.

The disinclination to report can also come from a historical tendency for a company not to act. Workers become skeptical when reporting does not produce results. They also may wish to avoid a cumbersome process and the follow-up red tape.In order to remove these obstacles, we need to emphasize the positives. 

It’s important to turn your workforce into keen observers. What traits do good observers have? They are open-minded. They engage in “what if” thinking, looking at the future potential instead of only the present situation.

They want to solve the problem, not just put a bandage on it. They respect their instincts. They have the mindset of a helper. Finally, they need to be okay with not finding anything wrong occasionally.Managers and supervisors also have an important role to play. We need to learn why and how incidents and near-misses happen. We need to be open to the input that we receive. We need to follow a process.

We need to address issues as they arise, not as part of a long list that will be addressed tomorrow. We should find and fix things on the spot when we can, but make sure to document it so we can uncover trends. Getting information into the management system is important, so we have a good base for that pyramid. Workers need to notify supervisors about issues in their work area, and supervisors need to encourage reporting.

It comes down to what the late Stephen Covey has said is, “Seek first to understand, and then to be understood.” Whatever the case might be, whether it’s good or bad, we need to ask questions and get underneath the surface of what’s happening. When we do that, we can get the right kind of information out of the situation that can either perpetuate good things or help us to discontinue bad things.

Human error happens and workers receive unwarranted discipline. They never meant to do this thing wrong, but they pulled out the Jenga block and the whole tower collapses. Then they receive discipline for doing the job, which may have been to pull that block out in the first place. Now they receive discipline and the system’s not addressed. We need to look at the full system and not only the people who are involved in the system or the process. We need to increase trust rather than reduce it. In short, people don’t fail. It’s the processes that surround people. People are part of the process, but the process overall fails. We need to address the entire process.

If you’re looking at near-misses and observations and asking why these things exist, you can see a systemic weakness and restore resilience to that system. A reliable operation can spot an action that’s going wrong, rather than one that’s already gone wrong. We need to know the way it should be, the way it shouldn’t be, and how to react if we see it deviating from the way it needs to be.

A resilient system won’t require impossible standards that real people can’t possibly meet. Your safety program will be more tolerant of the kinds of human error that are simply unavoidable sometimes. Safety relies on people, and we are not always on our “A” game. It’s incumbent on management to create and maintain a system that encourages workers to be our brother’s or sister’s keeper without fear of retribution. page 

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