The EI recently attended the launch of Step Change in Safety’s new human factors publication Human factors: How to take the first steps… (see http://www.stepchangeinsafety.net/knowledgecentre/publications/publication.cfm/publicationid/22) launched in Aberdeen on 26th May 2010.
The event included a presentation by Rob Miles of the HSE, and Bill Gall of Kingsley Management, both members of the EI’s Human and Organisational Factors Working Group. (Click http://energyinst.org/technical/human-and-organisational-factors/human-and-organisational-factors-incident-accident–invest-analy for the presentation given by Bill Gall).
The publication provides 12 real case studies, each one presenting an incident or near miss, including a release of burning material from a flare stack and a worker falling through a hole on an offshore platform. Each case study briefly explains what happened, what were the immediate underlying causes that led to an incident (including what people did intentionally and unintentionally), and what barriers failed. In doing so, the publication introduces the three major barriers of safety – plant and equipment; processes; and people – in a way that encourages their use in a ‘Swiss-cheese’ model (i.e. all three need to fail for the incident to happen). The publication also encourages the reader to think about the different types of errors and non-compliances, helping them to think further than ‘human error’ as a (non-)explanation for accidents.
In practice, human factors practitioners may explore the case studies further to reveal even deeper underlying causes to the incidents other than those given for each incident (e.g. fatigue, working patterns, management style, etc.). However, as Step Change say:
“The aim of this publication is to help raise awareness & understanding of human factors in accident causation & to encourage people, at all levels in an organisation, to take some simple steps to help manage human factors. It asks the reader to think about how this applies to their own work activities & encourages them to take action.”
The focus is on fixing immediate and obvious problems, and this is a very worthwhile goal – when it comes to improving safety, there is the temptation to over interpret findings at the expense of taking much needed action, which this publication may help to address.
How to take the first steps… is intended for use by frontline staff, and Step Change are looking for feedback on its use. How are you using it? Has it been successful? Please contact Dave Nicholls e: Dave@stepchangeinsafety.net for more information or to provide feedback.