When incidents and accidents occur in business, usually a call goes out to find those who are responsible and hold them accountable for their actions. Of course, in safety, accountability is essential, but the question is, does accountability always have to include negative consequences? In too many cases, accountability translates into disciplinary action against the frontline worker(s) directly tied to the accident (such as verbal and written warnings, suspension, and even termination). If a frontline employee engaged in at-risk behavior that resulted in an accident, you might wonder why discipline is a bad idea. The answer is that discipline might sometimes be appropriate, but in many instances, it’s the wrong reaction. Most accidents and incidents are the result of a combination of root causes. While frontline workers are often the ones who engage in the final at-risk behavior, typically multiple upstream at-risk behaviors on the part of management, engineers, and executives contribute as well. A simple example is a frontline employee who fails to put on gloves when handling chemicals and experiences a burn. On the surface it is reasonable to blame the worker if he has been trained and clear expectations have been set that gloves must be used. What we may learn, however, is that the employee has very large hands and only medium-sized gloves are provided, despite his repeated requests for larger sizes. In such cases, when the blame is assigned only to the person at the point of the accident, it is, quite simply, unjust. Hourly workers often feel they are blamed for accidents when circumstances beyond their control (but within the control of management) play a part.
A system that seems unjust or unfair leads to the erosion of trust and respect between management and hourly employees. Without trust, excellence in safety is unattainable. Safety excellence requires all employees be engaged in proactive safety efforts. Lack of trust, created through unfair disciplinary action (perceived or real), erodes the willingness of people to be more engaged. In the words of one hourly employee, “Why should we do any more than we have to in safety? No matter what we do, management will still blame us when there is an accident.” Without trust, open and honest discussions about at-risk behavior, near misses, and unsafe conditions will never take place. Without those discussions, risk and exposure cannot be minimized. In addition to undermining trust, there are other reasons to be cautious with the use of discipline and blame. Research shows that punishing consequences (like discipline) have detrimental side effects that often outweigh any positive benefit. Some side effects include lower morale, lower productivity, decreased teamwork, decreased volunteerism, and suppressed reporting of incidents, accidents, and near misses. Most importantly, discipline often does not result in safety improvement. My experience, and that of many behavioral safety specialists, shows that it is more effective to reduce the use of discipline and other forms of punishment in safety. We do not, however, suggest reducing accountability, but rather recommend making a shift in the type of accountability. Virginia Sharpe, in her studies of medical errors and harm, has made an important discrimination between what she calls “forward-looking accountability” and “backward-looking accountability.” Backward-looking accountability is about finding blame, finding the individual who made the mistake, and delivering punishment. As noted previously, there are many downsides to such action, and blaming and punishment seldom results in a safer workplace. According to Sharpe, forward-looking accountability acknowledges the mistake and any harm it caused but, more importantly, it identifies changes that need to be made, and assigns responsibility for making those changes. The accountability is focused around making changes—building safe habits and a safe physical environment—that will prevent a recurrence, not on punishing those who made the mistake. This kind of accountability will positively contribute to building a safe culture.
When responding to incidents and accidents, the primary goal is (or should be) to ensure that similar incidents do not happen again. However, time and time again, more effort is expended on backward-looking accountability. After the investigation is done, the appropriate parties have been disciplined, and any damage repaired, there is often spotty follow-through on the action items identified to prevent a reoccurrence. Concrete action items such as repairing a piece of equipment have a high probability of completion. It is the less-tangible action items such as changing supervisory practices, modifying processes for ensuring better engineering designs, and encouraging peer feedback around behaviors that lead to incidents, for which accountability often falls apart. This is precisely the accountability that should be the focus. Holding the appropriate parties accountable for fixing the behavioral conditions that lead to the incident should be of primary concern.
To read more about accountability and the use of discipline in safety, read Safe by Accident? Take the Luck out of Safety–Leadership Practices that Build a Sustainable Safety Culture.
Published October 18, 2010