Health and safety

Monday, September 18, 2006

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Friday, September 01, 2006

Health & Safety

Definitions, causes and factors affecting accidents

Definition -

According to Pheasant (1991) an accident is ' an unplanned unforeseen or uncontrolled event; generally one that has unhappy consequences'.

Causes of accidents -

Accidents are caused by either:

  • Unsafe behaviours or
  • Unsafe systems

An example of how both can be involved is work areas is provided by Roberts and Holly (1996). They found that the basic causes of accidents in hospital settings are -

  1. Inadequate work standards: through a lack of training and supervision.
  2. Inadequate equipment or maintenance of equipment
  3. Abuse or misuse of equipment, or failure to check equipment.
  4. Lack of knowledge (for example in not being able to use equipment correctly).
  5. Inadequate physical or mental capacity to do the required job.
  6. Mental or physical stress
  7. Improper motivation (e.g. Dr Shipman)

Thus we can see that whilst accidents are due to either behaviour or systems, nevertheless both are involved in many work settings. Thus both behaviours and procedures need to be looked into when wanting to understand why an accident occured.

Some more specific causes of accidents are detailed below -

Deskilling: A source of error in the relationship between operators and machines is the deskilling of the workers. Bainbridge (1987) referred to this as the irony of automation. She pointed out that designers view human operators as unreliable and inefficient, and try to replace them wherever possible with automated devices. Yet this policy often leads directly to an increased number of errors and accidents.

Cognitive overload: The study of selective attention highlights some limitations on our ability to process information and that if too much information is being processed at any one time that this may lead to an 'overload' experience. An example of this problem was reported by Barber (1988), in a description of an aircraft accident in the area of Zagreb, which was then part of Yugoslavia. One of the factors identified as leading to the collision was the cognitive overload of the air traffic controller responsible for the sector the planes were flying in.

Human error: Riggio (1990) identified four types of error that can lead to accidents -

  • Errors of omission; failing to carry out a task; for example, not closing the bow doors on the ferry in Zeebrugge harbour
  • Errors of commission; making an incorrect action, for example, a health worker giving someone the wrong medicine
  • Timing errors; working too quickly, or working too slowly
  • Sequence errors; doing things in the wrong order

Factors affecting accidents -

There are numerous factors which can affect accidents and why they are more or less likely to occur. Detailed below are two factors which can affect individual error -

Substance and alcohol abuse: The most commonly cited cause of accidents is alcohol or substance abuse. When chemicals impair our judgement we are more likely to underestimate the risks of a situation, and overestimate our ability to deal with it. A study of over 500 people attending accident and emergency departments in Scotland examined levels of alcohol (Simpson et al. 2001). About 25% of the attendees showed signs of alcohol. It was especially noticeable in people attending for reasons of self-harm (95%), collapse (47%), assault (50%), and in those who were subsequently admitted to the hospital (50%). These figures suggest that alcohol might well be a factor in a range of accidents that lead to serious injury. A less well researched area is the effect of prescription drugs on performance. Barbone et al. (1998) looked at the medical records of drivers in Scotland involved in their first car accident over a three-year period to identify how many had been prescribed psychoactive drugs such as tranquillisers and antidepressants. There were 19,400 drivers involved in accidents in that period, of which over 1,700 were on some form of psychoactive medication.

Lack of sleep: It is a robust finding from sleep research that sleep deprivation affects people so that they (a) make more errors, and (b) need longer to complete a task (Asken, 1983). One particular area of concern is sleep-related vehicle accidents (SRVAs). A substantial survey of 4,600 UK drivers found that 29% admitted to having felt close to falling asleep at the wheel during the previous 12 months (Maycock, 1996). Sleepiness is brought on by long, undemanding, monotonous driving, such as on a motorway. It is also, not surprisingly, affected by the time of day, as our bodily rhythms affect our level of arousal and alertness. One of the problems for drivers who are feeling sleepy is they are often not aware of dropping off for a few seconds. It is a general finding from sleep research that people who are woken within a minute or two of falling asleep commonly deny having been asleep (Home and Reyner, 1999).

Personality and accident proneness

Due to the fact that a relatively small number of people have many accidents (Pheasant, 1991) there has been investigation into the relationship (if any) between personality and accidents. This phenomena is not new and therefore psychologists have been trying to explain this for some time. For example, Freud gave many examples of unconsciously motivated accidents, notably in 'The Psychopathology of Everyday Life' (1901). In one, a spurned lover, apparently by accident, stepped in front of a car when he happened to meet the woman in the street, and was killed before her eyes. Menninger (1938), following Freud, took the view that we sometimes have an unconscious wish to punish ourselves as a kind of penance for some wrongdoing or guilty thought, and that in some guilt laden individuals this can manifest itself quite frequently as accident proneness. Psychoanalytic theory can also be used to explain accident proneness as a form of withdrawal from a situation. Hill and Trist (1953), have shown that accident-prone workers are also likely to have higher absenteeism than other workers, both being examples of withdrawal behaviour. The problem, as with most psychoanalytic explanations, is that it is extremely difficult to see how unconscious motivation can be convincingly demonstrated. While the existence of accident proneness is not doubted, it is not easy to find a satisfactory way to test the psychoanalytic explanation against the alternative explanation that some people are just a lot more clumsy or inattentive than others.

More recently according to Pitts (1996) there is an Injury-Prone Personality which has these two predictable features; aggression and over-activity. He found that boys are three times more likely to have an injury-prone personality. Whereas Pheasant (1991) describes accident proneness in more broader terms, identifying factors that may lead some people to be more accident prone than others. These are -

  • Personal characteristics - such as cognitive abilities and personality traits. He argues that extroverts, for example, have more accidents than introverts.
  • Transient states, which may be to do with illness or mood. For example, menstrual periods making women more accident-prone.
  • Illness is also likely to make people more accident prone, either because they are not physically capable of performing the tasks they are trying to do or because their illness makes them lose concentration. Similarly, mood can have an effect on concentration and a person's ability to think clearly.

The person approach is the dominant explanation of accidents, especially in medicine (Reason, 2000). Among the advantages of this approach is the satisfying option of naming and blaming people. Individuals are seen as being free agents with the option of choosing between safe and unsafe behaviours. If something goes wrong, it is obvious that it must be the fault of the individual. Taking this view is clearly in the interests of managers and institutions if they want to avoid institutional responsibility.

However because accidents can occur in all shapes and sizes, it seems unlikely that that we can define a single personality type that makes an individual more likely to experience all of them. The way to look at the issues around the personal approach might be to identify the behaviours or personality traits that are most associated with errors and accidents. Detailed below are some of the behaviours associated with accidents and it may be that certain individuals are more likely to show these behaviours thus making them more accident prone -

Repeaters: While accidents at work may happen to anyone, it is clear that they occur more frequently with some people than with others. Hill and Trist (1962) suggested that this might be seen in terms of group norms and compliance; or rather, a refusal to be compliant. On investigating absenteeism and accident rates in a steel works in the early 1950s, they found that strong social norms operated as to which types of absenteeism were acceptable and which were not. Absences which had been certified (for example by a sick note) were regarded as acceptable; unexpected ones and those due to accidents were not. Consequently, the researchers argued, the 'accident repeaters' were actually showing a form of withdrawal from work and a refusal to comply with group norms. It should be noted, though, that an attempted replication of these findings with workers in a photographic process plant failed to produce the same observations (Castle, 1956).

Type A Behaviour: One of the personality characteristics that has attracted some attention is the Type A behaviour pattern. It might be that the time urgency of the Type A pattern leads people into risky situations. The existence of the Type A person is very controversial, though some people believe that the Type A is more disease prone and more likely to have accidents (Suls et al., 1988). There has been some work looking at whether Type A behaviours in drivers increase their accident risk; for example a study of Italian police drivers (Magnavita, 1997) found that drivers with the Type A behaviours had a greater risk of traffic accidents.

An examination of the Type A behaviour pattern raises the question of whether accidents can be reduced by careful personnel selection. Jones and Wuebker (1988) describe how a personnel inventory can be used to predict a number of accident-related events. Using the questionnaire they were able to identify high-risk individuals on the basis of their attitudes and personality, and to place them in less hazardous positions, or send them on special safety training programmes.

Introversion and Extroversion: Injury data collected over a 12-year period from 171 fire-fighters from a city in the USA found that personality traits, including introversion, were related to higher injury rates on the job (Liao et al. 2001). They suggested that introverts were less likely to call for assistance, and as fire-fighting requires a high degree of teamwork, it might be that the less integrated and sociable members of the team exposed themselves to greater personal risks. Another finding of the study was that women fire-fighters reported 33% more injuries than their male colleagues, although they returned to work more quickly after injury than the men. The research points to another factor that might contribute to accidents, and that is male culture. They suggested that within groups of male fire-fighters there is a strong cultural norm for not reporting minor injuries because it might be seen as a sign of weakness.

The study of the fire-fighters is particularly interesting because the general view in psychology is that extroversion is the characteristic that is associated with accidents. Extroversion is associated with being impulsive and this has been found to be a feature in people who have car accidents, and accidents at work (Furnham and Heaven, 1999). These apparently contradictory findings illustrate how personality characteristics can interact with the situation someone is in, and the type of task they are asked to carry out, so as to produce an unsafe environment.

Age: Age is associated with accidents in a number of ways. First, it influences the number and severity of the hazards individuals are exposed to. Second, it is connected to the competence that individuals have at particular tasks, such as crossing the road, and also their skills and attitudes. Children and older people are at the greatest risk of accidents as pedestrians, and they are also at the greatest risk of falls, though for different reasons. In children, the judgement of depth and speed is not fully developed and they may well be unaware of some dangers. For the older person, the problem is limited mobility or failing eyesight. The third problem for the young and old with accidents concerns their ability to respond to and recover from injury (Donaldson and Donaldson, 2000).

Some accidents can be put down to human error or carelessness or whatever, but many cannot, and following this approach does not offer much advice on how to improve accident rates. Research into quality lapses in the maintenance of aeroplanes found that 90 per cent of them were blameless. If we want to reduce risk, it is important to encourage a culture where errors, slips and near-misses are reported, and a culture where people are named and blamed is not likely to do this. It is believed that the absence of a reporting culture in the Soviet Union contributed to the Chernobyl disaster in 1986. Two explosions blew the 1 000-tonne concrete cap off one of the nuclear reactors and released molten core fragments into the surrounding countryside and radioactive material into the atmosphere. This entirely man­made disaster killed more than 30 people at the time, damaged the health of thousands, and contaminated over 400 square miles (Reason, 1990).

Reducing accidents and promoting safety behaviours

There are a variety of measures that can be taken to help in reducing accidents and promoting safety behaviours. Four examples are detailed below -

1. Use of Protective Equipment

Injuries and deaths can be prevented if drivers and passengers use protective equipment, such as seat belts in cars and helmets when riding motorcycles (Latimer & Lave, 1987; Robertson. 1986; Waller, 1987). But after seat belts were installed as standard equipment in cars, few people opted to use them. As a result, researchers began to try a wide variety of methods to promote the use of protective equipment in cars. Some of these studies were conducted to improve car safety for children by providing instruction and information to parents through hospitals and paediatricians. These programs have had mixed success (Cataldo et al, 1986; Christophersen, 1984, 1989). A successful hospital-based program provided computer-assisted video instruction on using an infant safety seat to mothers before leaving the hospital after giving birth (Hletko, Robin, Hletko, & Stone, 1987). A parking lot attendant at the hospital subsequently assessed the use of a safety seat when the mother brought the baby back for a check-up nine months later. Many more of these mothers than untrained mothers had their infants correctly restrained.

Some programs to increase seat belt use have been directed at the child, rather than the parent. One study presented a 2-week passenger safety curriculum to children in several preschools, using a theme character called 'Bucklebear' (Chang et al. 1985). Two of the curriculum's main messages were that buckling up for every ride is a good thing for everyone to do and that the best seat in the car is the back seat. Some of the parents also took part in activities to promote seat belt use. The children in several other preschools served as a control group who were matched to the experimental subjects for their prior seat belt use. Follow-up observations in the preschool parking lots 3 weeks after the program was completed revealed that over 44% of the "Bucklebear' children and only about 22% of the control children were using seat belts.

Another program used rewards to encourage seat belt use by children (Roberts & Fanurik, 1986). Before the rewards were introduced, about 5% of the children used the belts; after the rewards were introduced, about 70% used the belts. As you might expect, follow-up observations, 2½ months after the program and rewards ended, revealed that seat belt use declined - but between 10% and 20% of the children were still using the belts.

Less than 5% of Americans were using seat belts by the early 1980's, despite public health announcements and other programs to promote this behaviour (Latimer & Lave, 1987). As a result, many states began to pass laws requiring adults and children to use protective equipment in cars. Seat belt and safety seat use has generally increased sharply and traffic fatalities have decreased after these laws went into effect (Latimer & Lave, 1987; Robertson, 1986; Wagenaar & Webster, 1986; WaIler, 1987).

2. Accident reduction in the workplace.

Health promotion can be used at work to reduce accidents. The most frequently cited methods for reducing accidents at work are stress reduction programmes. For example, Kunz (1987) describes how a stress intervention programme reduced medical costs and accident claims in a hospital. The programme more than paid for itself with the savings from reduction in accidents.

Another way of reducing accidents is through incentive programmes. Fox et al. (1987) looked at the effects of a token economy programme at open cast pits. Employees earned stamps for working without time lost for injuries, for being in work groups in which none of the workers had lost time through injury, for not being involved in equipment damaging accidents, for making safety suggestions, and for behaviour that prevented injury or accident. They lost stamps for equipment damage, injuries to their work group and failure to report accidents and injuries. The token economy produced a dramatic reduction in days lost through injury and reduced the costs of accidents and injuries. These improvements were maintained over a number of years.

A relatively simple intervention to reduce fatigue and accidents in logging workers involved encouraging them to take regular fluids. Sports science has shown that the use of regular fluid intake is one way to reduce the sense of strain in a task and delay the onset of physical and mental fatigue. A study of loggers in New Zealand (Paterson et al., 1998) looked at the normal performance of the loggers and compared it with performance when they were taking a sports drink every 15 minutes. In the normal condition, the loggers lost on average about 1 per cent of their body weight during the working day, but in the fluid condition they maintained or increased their body weight. Also in the fluid condition, the heart rate was lower, and the loggers reported feeling fresher, stronger, more alert and more vigorous. Reducing fatigue and strain can reduce errors so it is a useful intervention to keep a worker properly hydrated.

3. Preventing slips, trips and falls.

Slips, trips and falls make up around a third of injuries leading to absence from work (HSE, 1999). Older people are especially susceptible to health-damaging falls, with approximately 30% of people over 65 falling each year and about 50% of the over 80s (Dept of Health, 2000). The consequences of falling can be:

  • physical injury such as fractures
  • psychological impacts such as increased fear of falling
  • reduced mobility
  • needing to be cared for in an institution
  • death.

There have been many programmes aimed at reducing damaging falls in older people. Studies that have targeted high-risk groups and offered programmes of exercise aimed at increasing mobility and strength have been relatively ineffective in reducing the number of falls. Programmes which have the greatest success combine a number of interventions such as a review of the medication the older person is taking, a safety review of their house and taking moderate exercise (D0H, 2000). For people at particular risk, there have been some interventions using hip protection so that falls are cushioned and less damaging. The problem with such interventions is that the compliance rate for wearing the devices is relatively low.

4. Media campaigns.

Public information films on TV often tell us to do very sensible things like dip our headlights or fit smoke alarms. They might well affect our attitudes to these procedures and products but do they affect our behaviour? In the field of accidents it is possible to estimate changes in behaviour by comparing accident rates before and after an advertising campaign. This discrepancy between attitude (what we think) and behaviour (what we do) is illustrated in a report by Cowpe (1989). This report looked at the effectiveness of a series of advertisements about the dangers of chip pan fires. Before the advertisements, people were asked about this hazard and most of them claimed that they always adopted safe practices. However, the statistics from fire brigades about the frequency of chip pan fires and the descriptions by people of what they should do suggested that their behaviour was not as safe as they thought. A television advertising campaign was developed and broadcast showing dramatic images of exactly how these fires develop, and how people should deal with them. The adverts ended with a simple statement, such as 'Of course, if you don't overfill your chip pan in the first place, you won't have to do any of this'.

By comparing fire brigade statistics for the areas which received the advertisements, and those for the areas which did not, the advertisers found that the advertisements had produced a 25%t reduction in the number of chip pan fires in some areas, with a 12% reduction overall. Surveys taken after the series of advertisements showed that people had more accurate knowledge about what they should do in the event of a chip pan fire than before. The implication from this report is very clear. Public information films and health promotion advertisements are most effective if they contain information about what to do rather than what to think or what to be scared of.