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Why Safety Culture? Historical & Conceptual Issues Kathryn Mearns ‘It is a testament to our naïveté about culture that we think that we can change it by simply declaring new values. Such declarations usually produce only cynicism’. Peter Senge, The Fifth Discipline Fieldbook (1994) Safety Culture • • • • • History What is it? Why are organizations focused on it? Can we measure it? Can we manage it? Chernobyl “…that assembly of characteristics and attitudes in organizations and individuals which established that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance” (IAEA, 1986) Piper Alpha ‘It is essential to create a corporate atmosphere or culture in which safety is understood to be and is accepted as, the number one priority” .’ (Cullen, 1990, p300) UK Health & Safety Executive, 1999 “Reducing error and influencing behaviour” Companies should measure safety culture Definition of safety culture • ‘The safety culture of an organisation is the product of individual and group competencies and patterns of behaviour that determine commitment to, and the style and proficiency of, an organisation’s health and safety management’ Advisory Committee for Safety on Nuclear Installations (HSC, 1993, p. 23) Disentangle this.. • • • • • • • • • • Individuals Groups Values Attitudes Competencies Patterns of Behaviour Commitment Style Proficiency Health and Safety Management Is safety culture… • Something the organization has? – – – – Imposed on the organization (top down) Can be measured and managed Functional approach Assumes culture can be changed through management interventions • Something the organization is? – – – – Emerges from interactions between organizational members Has a life of its own? Interpretative approach Assumes the culture is a pattern of underlying meanings and symbols that are not easily changed Model of Safety Culture VISIBLE BEHAVIOUR (what people do) ESPOUSED VALUES (what is said) BASIC ASSUMPTIONS (what is believed) Adapted from Schein (1992) Organizational layers Organizational Level: Management Supervisors Operations Technicians Team Divisional Organisational National Regional Safety Culture in a Nutshell What is believed What is said What is done Safety performance Eurocontrol model MODEL OF SAFETY CULTURE ECONOMIC, NATIONAL & REGULATORY INFLUENCES Enacted by Leaders Work/production pressure •Supervisor commitment •Management commitment SOCIETAL CULTURE Organisational Culture Safety Management Practices Safety Climate Attitudes and feelings •Risk-taking •Unsafe acts •Violations •Citizenship •Reporting •Learning •Values •Beliefs •Norms •Assumptions •Expectations •H&S policy •Organising for H&S •Communication •H&S auditing •H&S training/promotion •Satisfaction with safety •Attitudes to reporting •Risk perception •Involvement Behaviour Organisational Safety Set by Leaders? •Accidents •Incidents •Near-misses Safety culture should measure: • • • • • Values Attitudes Norms Assumptions Expectations • Extent to which these are ‘shared’ by members of the organization & across different groups Measuring Safety Culture: Methodological Approaches Kathryn Mearns Measures should have: • Validity – Face – Construct • Content • Discriminant – Predictive • Reliability – Consistent – Robust Some Initial Requirements • Robustness – Strength of Evidence • SMS Coherence – SMS compatible (not competing) • Diagnosticity – Showing how to improve • Usability – Not too demanding of organization’s resources Possible Approaches • • • • • Safety Culture Maturity Enablers/Disablers Interviews Questionnaires/Rating Scales Stories Safety Culture Maturity 1 (Parker & Hudson, 2001) 2 Increasing maturity 3 • Why do we need to waste our time on risk management and safety issues? • We take risk seriously and do something every time we have an incident • We have systems in place to manage all likely risks Pathological Reactive Calculative Proactive 4 • We are always on the alert thinking about the risks that might arise Generative 5 • Risk management is an integral part of everything we do Safety Culture Enablers & Disablers Just, Reporting & Learning Culture – Enablers: • Management believe that it is human to make errors • We learn from incidents in a way that people don’t feel they will be punished – Disablers: • Some people don’t report incidents because they believe they might get blamed • There is a lack of consistency in the organization regarding discipline and retraining Enablers/Disablers Enablers: Operators stay in position during handover until incoming operator is comfortable with job Agree Disagree Disablers: Operators sometimes have to deviate from the procedures to get their job done Agree Disagree Safety Culture Story: Developing trust Management Operations What was Management do not punish those who report, DONE instead they are supported and the report is addressed The ATCO reports the incident to the supervisor, they discuss the incident What was BELIEVED Both controllers and management believe they should submit reports of all occurrences Both controllers and management believe human errors exist and reports are an important basis for learning and improving safety OUTCOME Controllers and management trust each other and a just culture exists where occurrences are reported Management believe that it is human to make errors Questionnaire Rating Scales Strongly Agree Strongly Disagree 1 2 3 4 We learn from incidents in a way that people don’t feel punished Strongly Agree Strongly Disagree 1 employees are motivated for safety by doing interesting tasks 5 2 2 1 0 3 1 2 4 5 employees are bound to safety by strict control Scenarios Possible error for the operator is higher in: Scenario A Scenario B Scenario A Scenario B Operator has low competency Operator has average competency Average supervision and team decision making Excellent supervision and team decision making Capacity pressure Capacity pressure Company has an excellent ‘safety culture’ Company has average ‘safety culture’ No difference Don’t know Collecting Evidence during semi-structured interviews • Number of reports – – – – 1 person reports 2 people report 3 people report 4+ people report • Type of evidence – – – – Hearsay Internal evidence Public evidence Change request Can provide evidence of how widely spread this view is held Can provide evidence of how trustworthy the evidence is (or important) Evidence / stories • can provide a detailed assessment of how widely spread the issue is believed, and how important it is • can identify level of shared views between management and controllers • can identify specific areas where improvements could be targeted – aimed either at a specific group or in general Eurocontrol approach • Questionnaire to determine what people perceive • Workshops to determine why people perceive things as they do and how to bring about change – workforce involvement • Scenarios used to develop questionnaire but not applied to safety culture measurement – used in ‘Safety Intelligence’ measurement