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Safeguard Magazine

All harms are not equal

MIKE COSMAN argues we need a different approach to each type of work-related harm (or, with apologies to Orwell, “all harms are equal but some are more equal than others”.)

How many people in New Zealand are harmed each year as a result of work? The question is a familiar party trick I indulge in when speaking to groups of directors, managers and workers, and one that the Independent Taskforce has also been asking itself. There is one correct answer and many incorrect ones. Anything with a number in it is incorrect as we simply don’t know how many are killed, let alone harmed in some other way. The only honest answer is “too many”.

The “official” figure of around 100 deaths and nearly 400 serious injuries1 on which the 25% national improvement targets have been set is one of the questionable ones. As far as I can see it has not been clearly defined in terms of what is included – baseline year, period of measurement (three year rolling average, etc) – and hence will be hard to measure progress against. It also ignores all occupational illness and disease.

Zero harm is now a familiar mantra in boardrooms worldwide and is increasingly heard in New Zealand. The idea behind ZH is based on the original work of Bird and Heinrich, whose pyramid model of accident ratios is known to any student of health and safety. The theory goes that if you can reduce the true size of the base of the pyramid by tackling near hits, minor incidents and property damage, then you will shrink the overall size of the pyramid and hence reduce the chances of a fatal or other top level event.

The other side of the ZH coin is that it’s conceptually difficult for any ethically minded business to say that some harm is an acceptable consequence of their operation. By expressing ZH as an “aspirational” goal it allows them to salve their conscience on the one hand while accepting a level of harm in the interim as the practical reality.

On the other hand, successive high level reports into major disasters such as BP Texas City, Gulf of Mexico and (more locally and recently) the Pike River Royal Commission have highlighted the failings of organisations whose focus on driving down LTIFR or TRIFR left them exposed to “black swan” low probability/high consequence events2.

Meanwhile in the blue corner we have occupational illness and disease. We all know about them (except ACC who only compensate a tiny percentage of them) but they don’t seem to feature on anybody’s radar despite NOHSAC and others clearly identifying that harms from these causes outweigh the others many times over.

And finally we have a whole group of harms to a range of people that we don’t think of as being part of occupational health and safety and which don’t seem to get counted in any official statistics. But should we?

So in this article I want to ask the question – which harms do we want to prevent and how do we go about it? What is clear is that not all harms are equal and that one strategy is not going to be adequate to try and reduce all forms of harm. My proposal is that we describe harms in five categories and develop approaches specifically targeted at each one.

The five harms are:

Acute harm

A situation where the harm will be immediate and obvious. It could be a fracture, amputation, back strain, chemical splash in the eye or unconsciousness from lack of oxygen. The cause could be “safety” such as a fall from height, or “health” due to exposure to an acutely toxic or corrosive substance.

Chronic harm

There is likely to be a significant delay between exposure to the hazardous agent and the harm becoming apparent. This might involve gradual process injuries from repeat exposures such as noise induced hearing loss or repetitive strain injury, or occupational disease such as mesothelioma from exposure to asbestos. Often exposure will occur in one or more workplaces but the harm only manifests itself later in a working life or even during retirement.

Catastrophic harm

These are rare events but can involve multiple casualties – sometimes outside the workplace – and may also have serious environmental consequences.

Reversible harm

This is by far the biggest group of workplace harms, yet due to internal reporting rules (which in some cases treat all reportable injuries as equal in measuring LTIFR and TRIFR), if we are not careful we can end up spending a disproportionate amount of time worrying about self-limiting and often trivial harms such as minor cuts, scrapes, bruises and aches which don’t have the potential to cause more serious harm.

Hidden Harm

Harms that occur but which we largely ignore.

Having described the harms, where do they occur and who is at risk? Acute harm mainly affects workers – predominantly men in traditional so-called “high risk” industries such as forestry, fishing, farming, manufacturing and construction. This is the group around whom our national improvement targets are set.

Chronic harm is also almost exclusively amongst workers – but in occupations such as construction trades (asbestos, noise, dust) spray painters (isocyanates and solvents), shotblasters (silica), bakers (asthma) and even hairdressers ( hair dye and postural). Chronic harm can also arise in areas such as psychosocial harm – stress, bullying, suicide, etc. Many chronic harms are not diagnosed as being work-related, and even where they are the harm has generally already occurred by the time of diagnosis. So we need a focus on exposure prevention and control rather than using trying to collect harm data at a firm level.

Catastrophic harm can come in many forms. We know the “major hazard” industries such as oil and gas, mining, nuclear, railways, aviation, chemical processes, space exploration, and so on. But catastrophic harm has also occurred in recent years in areas such as sports stadia, adventure tourism, amusement devices, ballooning, skydiving, legionnaires disease outbreaks etc.

Then we come to others who suffer various forms of hidden harm arising out of or in connection with work but who we somehow ring-fence. Missing from the official workplace target are around 100 people who die each year while driving for work, or to and from work, or who are killed by a work vehicle such as a reversing refuse truck or a school bus crash. Or by an out-of-control company car that crosses the centre line due to a fatigued rep falling asleep or trying to make a call on his mobile.

Hidden harms might also include the police officer who chases a suspect vehicle which crashes, the shop owner fatally shot in an armed robbery, the All Black who fractures a cheek bone, the mental health patient who commits suicide, the territorial soldier who gets shot on exercises, or the hospital patient who is given the wrong drug or gets a hospital-acquired infection through poor technique by an overworked carer.

Two recent attempts to take private prosecutions under the HSE Act in relation to such events (the killing of Karl Kuchenbecker by Graeme Burton while on parole, and Debbie Ashton killed by a driver in a witness protection programme3) have only failed to progress through the courts for being out of time. As yet there has been no judicial review to determine if in fact they are matters subject to the Act. My view is that the wording of the current legislation is sufficiently broad that they may well be.

So where to from here? Each issue needs a clear strategy which reflects its unique circumstances. The current MBIE harm reduction programmes – if properly implemented – are a sound way of addressing particular acute harms based on the “pick a problem” approach expounded by Malcolm Sparrow, a professor at Harvard. There is a current shortage of reliable root causation data but recent experience with the quadbike programme has shown how this can be managed if there is a will.

Chronic harm also lends itself to a more focused risk-based approach rather than simply relying on trying to improve general compliance with HSNO (which a recent survey4 showed was a round 2 5%). If we just targeted a few critical risks such as carcinogens (in particular asbestos), silica (quarries, abrasive blasting, demolition) and noise we could make huge inroads. But the approach has to focus on controlling and actively monitoring exposures rather than just improving diagnosis and reporting.

Catastrophic harm needs a more thoughtful and analytical approach based on well understood principles of formal risk analysis – QRA, HAZOP, FMEA, Bowtie, etc – operating within a documented and audited safety management system (including potentially an approved safety case) with an emphasis on reliability, redundancy and integrity, supported by robust emergency response planning.

And if we do all of this do we really need to worry too much about a few minor cuts and bruises and other reversible harms when we have ACC to put things right?

But I do worry about the hidden harm. In the UK in particular we have seen this group of harms hijack the health and safety agenda and cause the regulator to divert scarce resources into areas where often there are already other regulatory mechanisms, but which have failed to satisfy grieving families or pressure groups. Much as I would like to think we could embrace all of these issues I feel the best approach may be to specifically exempt them from coverage under health and safety legislation and to look instead at the adequacy of other regulatory regimes, bolstering those as appropriate.

It is a sobering thought that New Zealand hurts more people across a range of areas such as suicide, drowning and domestic violence than many of our international comparators. The Pike River Royal Commission told us there was regulatory failure, so let’s sort our core workplace issues out first before we can even begin to claim the right to solve these wider societal problems.

Zero death and irreversible harm – yes!

Zero harm – what do you think?

MIKE COSMAN is a member of the Independent Taskforce and managing director of Impac Services. His views here are purely personal and intentionally provocative!

Footnotes

  1. *MIKE COSMAN is a member of the Independent Taskforce and managing director of Impac Services. His views here are purely personal and intentionally provocative!
  2. 1Using the Serious Injury Outcome Indicator, see dol.govt.nz/whss/state-of-workplace/index.asp
  3. 2See the Baker report on the BP Texas City Refinery disaster and the commentary by Andrew Hopkins in his book  Failure to Learn.
  4. 3Commentary at franksogilvie.co.nz, search In the News for 18 April 2011 item entitled “Davis v Goliath battle for justice”.
  5. 4epa.govt.nz/Publications/HSNO-Compliance-Survey.pdf
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