Part 2 of 2
By: Shawn Galloway
Recorded: 04 May 2008
Welcome to Safety Culture Excellence®. Today's topic: Part 2 of 2, Using a Behavioral Approach to Focus on Hand Injury Prevention. My name is Shawn Galloway, and I'm proud to be your host.
Well, hello, everyone, from Tarrytown, New York, located in the majestic Hudson River Valley area. Today's topic is a continuation of last week's podcast. You'll find in this one that a lot of editing also had to be done because there was some fantastic open dialogue. During that open dialogue, many company names were mentioned and, specifically, the processes that they were taking to reduce injuries. So I wanted to make sure I maintained confidentiality. It was a great session with some great ideas, and I wish you could have been there. I hope you're able to take some of these ideas and implement them at your site, and I encourage you to share yours with us as well. Here's Part 2 of 2.
So what we're talking about here, if you look at performance management, the first thing that we want to do is define behaviorally, what do we want people to do? And we have to make it as specific as possible, not just behave safely, not just even line of fire. If we're going to get very specific on body part injury, we have to try to make it as specific as possible as it relates to the hands if that's what we're going to try to accomplish here.
Next thing is we have to set a level of expectations. We've got to look at how to communicate out to these folks. First thing is, we need to understand what the exposure is, and I'll talk about that. But the two behavioral science questions after this, and this is generally what we try to accomplish in behavior-based safety, but the two behavioral science questions is, "What happens if they do it? Do we have a positive consequence?" If we get people that voluntarily take the jewelry off, do we let them know, "Hey, I just want you to recognize, I saw you weren't wearing any jewelry, and a lot of people do. Hey, that's a really good idea. I'm glad you made that decision."
Those things are really impactful when you use positive reinforcement. Everybody knows we have a lot of negative consequences when people don't do the things that we've asked of them. We need to start focusing on the positive consequences. The more specific we make it, that means the more specific examples we've got to give as it relates to the hand.
In general, how we try to coach safety here – and I'll get past some of this model, and start making it more specific – is what we want to do is, we want to give people a focus. We want to focus them on something, and the focus is always going to change based on the data. But as it relates to safety, we have to give people a focus on a priority. Whatever the exposure is, whatever the contributing factors that lead up to those incidents, and where you're putting your hands, how you're positioning your body, you have to give them feedback when you actually see them doing it, and that's as it relates to the process as a whole, and you have to facilitate. You have to remove the barriers. But you have to continuously be in that cycle of learning from the exposure stuff that you see rather than just the incident data, and not enough people are doing that.
So, these are the actionable steps that I came up with, and I wanted to kind of bounce some of these off you guys. The first thing that we've got to do is we've got to conduct a hazard investigation and analysis. We've got to go out there and look for what engineering controls that we have in place, what skin care products are available? Do people use those skin care products? What kind of hand protection, and what are the common work practices? So we've got to do the risk analysis, the hazard audits, the inspections that we normally do, but focus them as it relates to hand prevention.
But also then focus – and this is an opportunity to leverage the additional observers that you have – is give them an opportunity to further focus the objectives there. Have them go out there and look specifically at how their hands are used, where they place their hands. After you put that together, you look at when you're doing your normal observation, you look at why people take risks. Well, the first thing is, by default, those that we work with, the common example we give when we're training on this risk pyramid, is what happens if you observe somebody and they're working on a tool? And if they say to you that, "Well, in my opinion, nothing's wrong with it," I mean, we use the hand example every single time, and it's kind of by default. It's kind of nice that it's coming full circle, and we can actually use it specific to what we're trying to do here.
Or if they say that, "I'm up on this ladder, and I left it over there on the bench over there, and I just forgot it." Many sites, a lot of the nuclear sites that it's required when you walk in, even us as contractors, we have to clip a pair of gloves on our belt. Because that was one of the things that the observers found is that people are getting away from the jobs and forgetting the gloves, either on their tool cart, or they've left them somewhere. So one of the things that they did is try to engineer that out to make sure everybody always had a set of gloves with them. Just because we made it available, are they using it? Are they the right ones?
We have to go further than that, but we have to look at it and say, "Is it just a habit?" And, of course, the last thing, if they say, "I'd love to wear gloves, but we ran out last Thursday. We ordered new pairs, we got the wrong size," you can't give them more information to address it. You can't change their habits if they don't have the right gloves. So we have to look at that. When we're asking the questions, try to make it specific to hand injury prevention.
Well, there's another pyramid that I kind of came up with that I wanted to bounce off of you, but we have to look at it and say, "Well, what are the reasons? What if it's the 12-hour shifts? What if it's the overtime? What are the things that encourage organizational risk taking as it relates to the hand?" Now you could look at this kind of upstream as you're looking at other body part injuries or other exposure. What if they tell you that there's some sort of distracters, there's other things going? There's loud noises occasionally that divert people's attention and takes their mind off their task. What if there's all those things? What if it's the dull cutting edges? What if you don't have the right cutting equipment?
And then if you add the exposure that they're cutting towards themselves and they're pushing really hard, it's easy to slip and then nick yourself - same thing with pushing through something. If it's pretty dull, they're going to put forth more energy. When that energy releases, that's how they get exposed there. If the way you've set up your work station, it's difficult for people to get the job done – although that's a perception – it's difficult to get their job done, they're going to view that as a conditional issue. And maybe the way that you've set up the guarding, if it makes it too difficult for people and encourages risk taking, that's kind of a conditional thing that we're going to have to look at.
What if the other side when you're trying to analyze these things, either looking at the incident investigation, or while you're talking to people, what if it's a matter of stress? What if there's so many stressful things? What if there's job cuts? And these are a lot of the things that take people's mind off their task. What if it's fatigue? What if they've been working 18 hours on this shift, 12 hours on this shift? We have to look at these things, and I'm not by any means saying, "Let's find fault or place blame in any of these areas." But we have to go back, and this is the organizational cultural aspect that we're talking about here. What are the things that make up the way we do things that encourage organizational risk taking specific to the hands?
Again, you could look at these things in a broader range of behavior-based safety or cultural improvement. People don't recognize that where they're placing their hands present some sort of danger, some sort of exposure. Of course, a lot of it also is body position, how they're using their body. Or when something happens, what's their response? They usually don't have something that's behaviorally defined as when you move because, a lot of people when they fall, you automatically put your hand out somewhere to catch yourself. And that's good, especially when you're ascending and descending three points of contact. That's the whole purpose of that.
But a lot of times, people don't look at the motion of how they're moving, and what happens, and where they put their hands. That could potentially maybe fall into pre-job inspection. But if you're looking at, and if this ground gives way, where am I going to catch myself? Where am I going to go? And this is where we have to try to start looking upstream.
Well, the last thing that I started looking at, is what are the true organizational and cultural issues, what about if it's a matter of training? What about if it's production pressure? Again, these are the things that we have to start looking at when we're analyzing the incident, start breaking them down a little bit further: eye/hand coordination, matching a person to the job. And that's what we talk about as onboarding norms that we've talked about in a couple of the other ones, the way that we bring people up to speed in a new facility, or bring people up to speed when we're training them on new tasks.
That onboarding norms is, I believe, what you're talking about there. If they don't have good hand/eye coordination and how we're training people on that, or at least being able to recognize they have bad hand/eye coordination and we're putting them in jobs, is that what you're saying? Yeah, yes, sir. A procedure? Yeah. Lack of procedure, having procedures actually at the machine, how to run the machine. Yep. Absolutely. I mean, you should, but I think that's something you potentially identify when you're doing the first step of investigating those things is, do we have procedures specific to that job and how that job gets run at the machine available to the operator?
Just because we train people on something, too often we'll say, "Well-trained, go on and conquer." But do we have the right job aides to them, and part of the job aides is making specific procedures available. You bring up a good point, and that's a great question. Again, this is just my thoughts on putting this stuff together. Are there other things that I didn't think of or that you think would be important on something like this? Yes, sir. Safe work permit. At his location, they have safe work permit if it's a job they haven't done in a while, or haven't done before they go through all the steps, look at it and sign off on it. Do some of the other guys, do you use safe work permits at your locations? Aside from hand, have you seen that help and incident reduction when you started putting those things in place?
They’re a great idea, and that's something that we could look for when we're investigating these things is, first off, is that possible? Do we have safe work permits in this? Well, good, think about those things as we start moving forward through this because, again, these are just my thoughts on this. But we want to be looking when we're investigating the incidents, when we go out there and do some risk audits, and when we focus the behavioral coaching or the observation coaching. We want to give them things to really look out for.
And I believe, when I first started putting this stuff together and doing some research on it, the reason I came up with this is because we encourage people to use that risk pyramid when we're doing the behavioral observations, kind of classify them. So I started thinking about it and saying, "Well, if we're looking at deeper issues, we've got to have a way to classify that as well." So that, quite frankly, was just my best guess at it. If you're having the conversations, how might those conversations fall? If you're looking at the reasons why things are happening, I think we might want to take it a level deeper, if this is possible at your sites to gather that insight, either through investigation of an incident or during the coaching, or is it some sort of organizational cultural issue here?
You guys are familiar with this. What we're trying to accomplish here is coaching responsibility. We're trying to see what people are doing and why they're doing it, and gather that insight throughout. And from that, of course, we want to focus on the positive feedback, but we also want to be expressing concern. And this is where I thought about, "Would it make sense to while we're, of course, focusing on the risk pyramid, could we focus on asking other questions?" What about if you looked at the incident investigation and started trying to classify those things during the incident investigation? What about a variable on your checklist like body part exposed? What about if you see something concerning, what body part was exposed that you're concerned about?
And this might help when you're developing this importance of looking at our – hand injuries represent 25 percent of all incidents in industrial setting. What does it represent your exposure at your sites? What about next to the concern or whatever what body part was that exposed? Somebody could write that in. That'll at least help you classify, what are the things that we're seeing? Is it mostly foot issues? Is it hand issues? Is it where they're putting their heads, where they're sitting down at?
So going back to the actionable steps, what I kind of came up with was, once we've done some sort of incident investigation, but you've got to gather some sort of additional information. Now if using the additional pyramid is too much, if that's too advanced for your site, no problem, but you've got to at least gather a deeper understanding of why the hands represent the majority of the exposure at some of these sites. Because until we figure out we can't make appropriate action plans, and we want these action plans that we come up to minimize the greatest amount of hand injury exposure out there.
So we have to first look at it and say, do we need to have some sort of training on there? Do we need to train people on being able to use the right gloves, being able to identify the conditional and even damaged gloves? Do you train people on how to inspect their own gloves, being able to identify what does a damaged glove look like? Because a lot of the damage to the structural integrity of cut resistant gloves, sometimes you can't see those things.
He's saying it's up to the individual to kind of inspect those gloves, and I think it should be some individual accountability for inspecting those things. But a lot of times we don't really teach them how to inspect them by showing them what a good glove would look like, and what would happen to a cut resistant glove that's lost its structural integrity? Take a look at what glove they're using, aside from just, is it a good inspection, are they using the right one? That's absolutely right.
And a lot of times, we forget that we put the onus on the individual to do that inspection, to be able to make the determination for themselves. Some of your sites I've been to do a really good job at showing each individual task and what type of glove you should be using, and I see those posters all over the facility. Great hand posters that put out there and show what type of glove should you be using in this condition. Those are great things to remind people. And again, going back to it, those are just antecedents. Again, these are just action plans to look at and say, "What about training people on how to select the right gloves, how to use it, and the ability to be able to identify dangerous condition, damage to those particular gloves. How do you remove the gloves from the workplace? How do you store the gloves afterwards?"
Some sites you know, want to store some of your particular gloves. You don't want to just leave them lying about. How do you actually store them? Where do you put those gloves? And then once, "where do you put them?", how do you get access to them again? Does one person only have the key to the gloves? Are they locked up somewhere? Most importantly, we see a lot of this. You've got to make additional sizes and additional styles available to the folks.
We go to a lot of sites where they just don't wear PPE because they don't like the way that the PPE looks. Consider if you could find it in the budget there to make a couple of additional sizes available. People support what they help create, and get some of the employees involved in helping you make that decision out there. But keep enough of the additional sizes available. Just because you only have five people that need a different size, don't just keep five gloves out there. Keep enough of the additional sizes out there to make sure that we have enough protection for the people.
Use posters and information about the right tasks and the precautions. Go out there and take pictures of what the right glove looks like for this particular job. One warning here, and I know a lot of people do this in the site, and I've seen a lot of this information out there. Sometimes, using the scare tactic to teach people about body part injury, MSHAhas fatalgrams, and they send pictures of the fatalities and all that stuff. And a lot of sites will use pictures of amputations in their training.
There's been some studies that have been done recently – Occupational Hazards, and ISHN did some studies also. But what they identified is that the potential side effect is that what will happen is, is sometimes the employees will view that, is that you're capitalizing on somebody else's injury for injury prevention. And I only say that because I've worked in places where we get all kinds of pictures sent to us, and really gruesome pictures, and you make a shock statement. It's something that's unexpected, and I talked about that in the communication talk over there, sometimes those unexpected things - and I've certainly heard of situations to where the gruesome picture changed people's behaviors. But all I'm suggesting is look at your own site and look at your own people. What would be the potential impact of using some of those gruesome pictures? Because some of the studies that have come out and said that the vast majority of the reactions are actually negative.
Now giving them that information doesn't also necessarily change behavior. Again, it'll just raise that level of awareness for the next 30 days. But if those habits are so strong there, they're going to go right back to the habits. And you don't want to be in a position where every month you're sending them a gruesome picture. That's not the way to do it either.
Also, communicate and train. If there's any change to the equipment, if there's any way that we handle the equipment, manipulate the work product, make sure that you at least facilitate that as it relates to training on the job, and look at where people are putting their hands. Also, analyze the accident reports thoroughly, and look for what are the things that are leading to the hand injury. Don't just stop at the hand injury represents 60 percent, 80 percent, 25 percent of the exposure. Really take it beyond, and go in the root cause analysis and try to figure out what are the contributing factors organizationally that lead up to that hand injury?
Last thing is, really look at the observation data, and use the what/why comments, and look specifically at the hand injury if you can use the body part exposed. If that makes sense at your site, and you can classify when you look at the average concern, what body part was it that had exposure? It could be full body if somebody's backing up some stuff and not looking. That could be full body. It could be that somebody's got their hand in the pinch point, hand in the line of fire. It could be their leg on something, what they're standing on, footing issues. But if you can do this, try to analyze your accident data and your observation data a little bit differently.
Share success stories or stop work and observe safe best practices. I really like the campaign. They put together a great initiative on the stop work. They even gave out coins to everyone that they have the right to stop the work at any time. And what they did – I was really impressed at both the sites that we worked with – is they created posters that had the employee on there, and they talked about when they used stop work and how that was supported, and the issue that they addressed. They did a really good job. From my experience, I thought it was a positive thing.
When you identify those things, when good things happen, share those success stories. Share them as it relates to hand, or share them as it relates to whatever organizational issue that we may be trying to improve as it relates to our management system, and how that could impact stuff. Got to give folks positive reinforcement for this when they're doing it. Going back to what we're trying to address here, the behavioral approach, is positive reinforcement is the most successful way to try to change habits and try to encourage the right thing out there.
Don't forget to make it personal. What does exposure in their own job look like? Do you have a question? Oh, yes, please. First aid supplies in training. We all talk about that, the bloody finger in the pocket right? Infection, good point. Managing the case of a first aid. If you have something like that, being able to be aware of what happens if you start to get a cut, and the potential for infection, is that what you're pointing out there? Absolutely, that's a very good point. I missed that in there.
When you have incidents, being able to manage the case of that first aid, what happens when somebody gets that? Those infections will turn into recordables if we don't address them appropriately. But look at your own sites, and look as it relates specific to hand injury prevention. Talk about this maybe in the toolbox topics. Talk about what they're doing. What do safe precautions look like? What are the things that could happen to you when you're doing this job? Where do you put your hands really when you're working at the station? But when you're working out there, you put your hands and how you use your hands, but because it's such an activity that happens at the subconscious, you're not consciously thinking, where am I putting my hands right now?
You get people consciously thinking about not putting any part of your body when you raise the importance of eyes on path, but you've got to get people to be really consciously aware of, where do they put their hands in their workstations?
We've got to be pursuing the objectives, and everybody has to be on the same path. We have to know what the objectives are and what's important, and we've got to have effective and clear communication here. If this is really something that represents the vast majority of your exposure there, we really have to set the objectives going after this, but we have to get everybody involved in this. We have to make sure that everybody's working off the same sheet of music here. If this really is an exposure, make sure you involve people, utilize a safety committee that you guys already have in place, and have them come up with some of the ideas.
The No. 1 answer when you ask people why they don't wear their personal protective equipment, the No. 1 answer that usually comes back is "because my boss doesn't do it," or, "because other managers don't do it," or, "other people don't do it." A lot of times people don't wear those things because we're not setting a good example out there. So I just encourage yourselves, make sure you set a good example yourself. Make sure that you're essentially walking the talk. Do what you can to integrate these ideas into toolbox topics, into other ways that you normally communicate with the folks out there.
Respond quickly to the safety issues that arise. That could be the example what you're talking about there. If you have a first aid incident here, do we quickly respond to those things to make sure that we're managing the potential for the increase in severity of the injury here? What about at your own sites? We started off talking about this, that it represents a lot of the exposure here. One of the ideas that we have is safe work permits that was talked about. What I'm talking about here is using a behavioral approach to focus on managing the performance of how we use our hands.
What are some of the things that you guys have done to increase the awareness of hand injury, or to prevent those hand injuries? Have you guys taken any approaches? Yes, sir. Do you guys, just out of curiosity, after that campaign, do you then focus your observations to pay attention to hand injury prevention to see that, has that communicated increase percent safe? Do you see a percent safe increase? Extremely? Wow, four, six, down to one. Robert, can you hear that? When they have a hand injury, they have people talking to one another about what led up to it? Has that impacted as well? That's fantastic. And that's what it's about, is learning from these things.
That's a good idea. Did you guys hear that over there? They have people put on the wrong gloves on the dominant hand, and ask them what it would be like to eat with that. Is that the, "It doesn't fit, we must acquit," type of thing there? Yes, sir. Is there a policy about glove use or anything? So they're more coach and provide instead of reprimand. That's a great idea. Making it more accessible rather than reprimanding. Yes, sir.
If they're scared about reporting, if they're scared about the potential of being caught up while they're drinking on the job, it's a complicated issue. That's why nobody's really come up with a definitive answer, say, "Here's the way that we do this." You've got to try multiple things here, and that's what this kind of topic was about is, "Here's another idea." Yes, sir. Like a hand injury prevention website or something? He's asking if we have a place or we know of a place that's kind of a consortium to go to to get all the research on gloves. Now are those free analysis that they'll perform for you because they're trying to sell you the product? That's great. Maybe have a couple of the manufacturers come out there and perform the same analysis and compare a couple of those, and see what recommendations that they make.
Occupational Hazards? Very good point. The magazines, the trade journals, you can get a lot of research off of there. You can go in there and they have some specific areas of PPE and hand injury prevention there, so there's a lot of research. I personally haven't seen anything that's kind of a one-stop shop place that has everything. Has anybody found anything? Now keep in mind the takeaway here is, even though we provide these things to the folks when we have all the right stuff, just make sure that it's possible to use, just make sure that we have access to it.
We've worked in many sites, but they'll go out there and spend millions on ergonomics improvements to work stations, yet you go out there and people are still working the same way that they always have, even if you have ergonomically correct workstations there. So just because we give people the right stuff and we make the things, the kind of takeaway that I encourage you to consider is, if you make a change, go out there and use your process to validate the change. Because whenever we're trying to get management to support the things that we're identifying from an employee-led type of team, we've got to make sure that it shows some sort of measurable results there. And if we get something, if we can show some results, they're going to have more confidence in the observed data that we get, and it helps qualify that you helped us spend some money on this glove protection, and it helped our percent safe increase. And that's what we want to look at, the things that we focus on, getting the right gloves, is that going to make an impact?
Well, that's all I could share from that talk. The rest of the time that we had together with that particular group we spent in open discussion. I hope you're able to take something away from this because, truly, the only reason I do these podcasts is to be able to share thoughts and ideas with you and hope that they're implementable at your location. So please if you have some success, or if you have some lessons learned that you'd like to share, or any other ideas in general, please feel free to contact us, and I'd love to share them with the rest of the world.
Until next time, remember, in safety, prevention trumps reaction. For more information on Safety Culture Excellence®, or if you have a topic to suggest, please email us at podcast @ proactsafety.com.
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Duration: 27 minutes