Irrational decision-making

Occupational health and safety often gets sidetracked from the main issue of preventing injury and illness at work.   I often hear employers, particularly in small business, complaining that their workers continue to do the wrong thing even though the employers have done everything they can think of.  

Sometimes an approach is offered that seems like a quick-fix to all the safety problems.  The one that always annoys me is behavioural-based safety.  BBS is like the Hydra and reappears regularly in different guises and with different jargon.

A podcast crossed my desktop this morning that provides a different perspective on “why rational people make irrational decisions”.  

The podcast illustrates the conflicts in trying to make the right decision by discussing the decision of a pilot in the Canary Islands who caused a major crash.  The pilot was also the head of safety at KLM Airlines.

The podcast does not focus on workplace safety but the discussion is probably the better for it.

Foster’s unforgiveable fatality

Foster’s Brewing has received one of the largest fines for a health and safety infringement in Victoria’s history, $1.125 million.  In 2006 Cuu Huynh was jammed by the neck between the doors of a de-palletiser and a handrail and died as a consequence. The same circumstances injured another worker in 2002.

A major reason for the large fine is because, as WorkSafe’s John Merritt put it

“The problem had been identified, someone had been hurt previously, the solution was known and it wasn’t fixed until after a man had died. The opportunities to make improvements were repeatedly deferred.”

Foster’s chose to upgrade the de-palletiser involved in the 2002 incident but neglected the other de-palletisers in the same plant.  This is where stupidity or laziness enters the equation.  The OHS Plant Regulations allow for the risk assessment and findings on one type of machine to be applied to the same machines without revisiting the assessment process.  Foster’s chose not to learn from a mistake.

It seems what is “reasonably practicable” for one machine is not so for another.

Readers would be aware that I support companies who choose to keep with the status quo through a risk assessment process, as long as they own up to when that decision may be proven wrong; in the case of Foster’s fatally wrong.

There is no indication that Foster’s will appeal the fine.  This is to be applauded as, on top of the fine, the company has had to spend almost $4 million in plant safety upgrades.  This is a substantial cost that probably would have been cheaper in 2002, or even earlier, but it remains little comfort to Cuu Huynh’s family.

Below are some of the points that WorkSafe is making in relation to Foster’s handling of safety on their depalletisers.

  • An employee was hurt in similar circumstances on another machine in 2002. While safety was improved on that machine, improvements were not made to the machine which killed the man in 2006.  
  • Operators were required to enter the operating area of their machines to remove broken bottles and plastic binding tape and ensure sensor lights worked. Workers estimated they would do this up to 20 times per shift.
  • There was no adequate visual and no audible warning of the opening of the pneumatic doors, unguarded chain sprockets created hazards, while safety devices were easily over-ridden to prevent sudden stoppage of the machine which caused bottles to fall over and break;.
  • Written standard operating procedures (SOP’s) for operating the depalletisers and cleaning them during breaks in production had been produced, but they did not deal with clearing jams during production. A specific SOP covering this was produced after the workers’ death.
  • Various operators told WorkSafe they were unfamiliar with the SOP’s and did not have sufficient English to read them. Much training was done ‘on the job’.
  • Workers were allowed to leave work an hour earlier on the last shift of the week if they had completed cleaning the machine. As a result they would clean the machine while production continued. The man who died was on this position.

This is a litany of poor safety management that any company should be ashamed of.  Of particular concern, and should be noted by other companies and OHS regulators, is that written instructions for the machine were inadequate and in a format that could not be easily understood by the machine operators. 

One of my safety colleagues has mentioned to me the absurdity that the first of WorkSafe’s new Compliance Codes is expected to be on workplace amenities.  This workplace element rarely leads to death or injury and the release of a “minor” code does not auger well for the rest of the codes.  It is understandable that Amenities may be one of the easier-to-produce codes but, to my mind, the most neglected guidance material in the last 20 years has been the provision of safety information in languages other than English – a workplace issue that WorkSafe has indicated was directly relevant to the death of Cuu Huynh.

For all of those corporations that say that safety is the first priority and that production will be suspended if a safety hazard is identified, Foster’s did not follow its own policies.  According to its own HSE Policy

“We will work towards our goals through a process of continuous improvement and, in particular, fulfil these commitments by:

1. Meeting or exceeding all health, safety and environment regulations in each of our workplaces around the globe.”

Cuu Huynh’s death has shown, as mentioned by WorkSafe above and mentioned in media reports

“…the workplace culture encouraged the machine operators to maintain production by not stopping depalletisers when they were clearing jams or cleaning the machine.” 

Production, at Foster’s, was more important than safety.

Stress and job mobility

In The Age newspaper for 31 July 2008, James Adonis wrote the article “Eight signs your workplace is crook”.  One of those signs was stressed workers.  He quoted a report by Watson Wyatt where employees listed stress  as a major reason for leaving a job.  Stress did not rank in the employers’ top five reasons for people leaving.

This disconnect illustrates a major misunderstanding about workplace stress by employers and, maybe, employees.  The ultimate control measure for workplace stress is to leave a job and I recommend this to colleagues who do not see it as a viable hazard control option.

The challenge is to make sure that the next job is not, or does not become, a similarly stressful job.

The executive summary of the report says

“Forty-eight percent of organizations say that job-related stress — created by long hours and doing more with less — affects business performance. Although only 5 percent are taking strong action to address it…”

The focus on business performance may reflect the perspective of the report writers but as it is only available for purchase for $US49, I would ask for the report (2007/2008 Staying@Work Report: Building an Effective Health & Productivity Framework) at a library.

Closing of Don Smallgoods factory in Victoria

Manual Handling in the Food Industry - First Edition

 

Manual Handling in the Food Industry - First Edition

 

Several years ago, I visited the Don Smallgoods food manufacturers in the west of Melbourne. I was visiting food manufacturers during the writing and design of the first edition of the WorkSafe Victoria guide on Manual Handling in the Food Industry. (The current edition is available HERE) Many photos in that first edition came from the Don factory.

Now its owners have decided to close the plant which has a workforce of 600 people.  Many of the workers I spoke with had worked there for decades.  Many of them had multiple relatives working alongside them and most of the workforce came from non-English speaking backgrounds.

The closure will have a heavy economic effect on those families and the economy of the western suburbs.  My sympathy and best wishes go to those workers.

Bank influence on Beaconsfield Mine

It is all too easy to misread the headline on page 7 of today’s Australian newspaper:

MacBank ‘had input’ into goldmine

This seems to confirm the recent statements by miners to the coronial inquest into Larry Knight’s death at Beaconsfield Mine, and accusations by unions.  The headline is based on the statements made by Michael Ryan who was the administrator to Allstate Explorations.  Ryan said that the Macquarie Bank had representatives on the joint venture committee and those bank representatives asked questions about the mine.  However Ryan could not recall if questions were raised by them about production levels.  

Ryan said that Matthew Gill, the mine manager, had made several unsuccessful attempts to have government safety inspectors visit the mine.  The article does not specify the reason for Gill’s attempts.

Michael Ryan said that he would approve any expenditure on safety at the mine.

The article says that in the month prior to the April 2006 rockfall, Ryan asked about safety in the mine.

“He said he asked Mr Gill on a number of occasions if the mine was safe, including in March 2006, after observing an unusual number of rocks caught in support mesh. “(Gill’s) answers were to the effect that it was (safe).”

Matthew Gill has spoken publicly several times about his experiences following the rockfall and is now on the professional speakers’ circuit.  He was appointed the Managing Director of Monarch Gold Mining Company.

Presenteeism in the US

Presenteeism is when a worker attends work when they should not due to illness.  Frequently ill workers attend the office or the factory because they feel that they are indispensable.  This may be the case but they can then present health risks to others by communicating their flu or other disease to their colleagues.  However, the worker is also impaired and may undertake work tasks or make decisions that put themselves at risk, a clear breach of their OHS obligations.

Presenteeism is an obvious overlap between OHS and Human Resources.  Sick leave has an important role to play in managing a safe and healthy work environment.

A 28 July 2008 article on NPR reports on a poll about presenteeism.  The US context is slightly different from Europe and Australia because paid sick leave is not a workplace entitlement although many workplaces provide health insurance.

I don’t agree with Marc Burgat, vice president of government relations for the California Chamber of Commerce who argues against the imposition of sick leave entitlements on employers.

Good managers have structured their workforces or production deadlines to accommodate levels of absence due to illness.  Health absences should be an element considered in a risk management plan.  Good employers can cope with sick workers and foster good relationship (a good workplace culture) by accommodating unavoidable human foibles.

Managers doing what they think the boss wants

The walkout from the Tasmanian Coronial inquest of the Beaconsfield Mine legal team has given the issues associated with the death of Larry Knight more media prominence than it would otherwise have received.  The withdrawal also allows statements concerning the financial pressures on the mine to continue uncontested. An ABC podcast on the coronial inquest…

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