death – Page 75 – SafetyAtWorkBlog

Grappler death in forestry operations – WorkSafeBC Slide Show

Below is the latest safety video from WorkSafeBC. It is included not only as an important indication of a hazard that can be readily controlled or avoided but as a terrific example of how generic safety alerts can be given currency by using the available technology.

It is one thing for text-based safety alerts to be circulated, or for media releases to be broadcast, but this type of safety alert has more influence and provides a clearer understanding of the hazard than text ever could.

Yes, the video is Canadian and may not reflect the work practices in other countries but the hazard is usually the same. In this case, it was the location of the spotter, the level of communication between the workers and overall a clearly inadequate system of work.

WorkSafeBC should be applauded for its efforts in communicating safety to a broad audience in an effective manner.

Kevin Jones

A spotter working in blind conditions was struck by a grapple. Confirm spotters are in the clear before throwing a grapple.

[vodpod id=ExternalVideo.882790&w=425&h=350&fv=allowfullscreen%3Dtrue%26quality%3Dhigh%26bgcolor%3D%23ffffff%26]

more about “WorkSafeBC Slide Shows – Mon Oct 12, …“, posted with vodpod

France Telecome becoming a case study

The managerial turmoil at France Telecome over a spate of work-related suicides is likely to become a case study in failed change management, firstly, and public relations, secondly.

A report in The Guardian on 6 October 2009, points to a (French) video of the company’s chairman and CEO, Didier Lombard, speaking to Telecome’s managers in January 2009. The paper reports that Lombard says

“those who think they can just stick to their routine and not worry about a thing are sorely mistaken”.

The article goes on to say

“He went on to suggest that staff outside Paris spent their time at the beach, fishing for mussels, adding those days were “over”.”

The last quote sounds like a joke between colleagues but as suicides had already occurred at the time of this speech, it was in poor taste even then.

For those outside of France, Lombard was set on the path of making the company relevant to contemporary ICT needs. A short article from 2005 says

“France Telecom Chief Executive Didier Lombard is merging telephone, Internet and mobile offerings under the Orange brand as part of a three-year program called NExT, an acronym for New Experience in Telecom services.”

There are similarities with a range of telecommunications companies that needed to change – British Telecom, New Zealand Telecom and Telstra to name a few. Telstra’s management change earlier this century with Sol Trujillo and Phil Burgess caused considerable shareholder and political turmoil with their change strategies.

Organisational change from administrative agencies to commercial entities can be a life challenge but it can be done with time and careful planning. The suicides at France Telecome seem to be an extreme example of how this process can be mishandled. However, just as with cancer clusters, the actual cause is often difficult to identify and sometimes can remain a mystery or coincidence. The circumstances at France Telecome need to be carefully studied from when the change management process began, well before the first suicide.

At the moment we are in the period of shock and panic responses by the company. Every suicide heightens this panic. Hopefully the measures being put in place now by the company will achieve a more considered, and long-lasting, corporate result.

Kevin Jones

What Trevor Keltz gets right

Madonna has just released another greatest hits CD. Trevor Kletz has done similar in releasing the fifth edition of “What Went Wrong?” He admits that almost all of the content has appeared elsewhere. It’s been almost 20 years since I had to read Kletz’s books and articles as part of working in a Major Hazards Branch of an OHS regulator in Australia. Not being an engineer, the books informed me but were a chore. This is not the case with the last edition.

Kletz has two parts to the book. The first is a collection of short case notes recording as he says

“…the immediate technical causes of the accidents and the changes in design and methods of working needed to prevent them from happening again”.

The second discusses the weaknesses of management systems. In short, the book reflects the expanding nature of safety management over the last forty years. Kletz may be from the Olde School of safety engineers (he is 87 years old) but often one needs a fresh perspective on a profession and coming from a person with such extensive experience, Kletz is worth listening to. Thankfully, he does not sound like a grumpy old man.

Kletz notes that process industry lessons seem to fade after a few years. In my opinion this may be an effect of the transience of modern careers where corporate memory is often fragmented. It may also be due to the shipping of manufacturing and process industries off-shore and the establishment of large complexes in countries with different (lax) safety requirements. It may also be due to a corporate performance regime where maintenance is not valued or understood as that supports long term thinking rather than quite returns on investment.

Regardless of the cause, the short-term memory makes the need for such books as this as more important than never.

In anticipation of his look at management systems he notes in his preface, that management systems need maintaining and, more importantly, reading. In some circumstances, too much faith is placed in the system (I would refer to the Esso Longford explosion as an example). Kletz says all systems have limitations.

“All they can do is make the most of people’s knowledge and experience by applying them in a systematic way. If people lack knowledge and experience, the systems are empty shells.”

What Kletz does not write about is human error because, as he says, “all accidents are due to human error”. He avoids making the weak logic jump that the behaviouralists make where, “if all accidents are due to human error then fix the human and you fix the hazard”. Kletz devotes a whole chapter to his classification of human errors as

Mistakes;
Violations or noncompliance;
Mismatches;
Slips and lapses of attention.

This edition of “What Went Wrong?” provides a baseline for the safety concepts we have come to accept but also a critical eye on safety and manufacturing management shortcomings. The style is very easy to read although occasionally repetitive. Thankfully the process technicalities are avoided unless they relate to the technical point Kletz is making. I found part B hugely useful but it is recommended for all safety professionals.

Kevin Jones

23rd suicide at France Telecome in 18 months

Adam Sage has been following the suicides that have occurred in France Telecome for some time. On 23 September 2009 in the TimesOnline (a week later in The Australian newspaper??), Sage provides a useful summary and cogitation on the “cluster”.

But although this number of suicides in one company should be alarming, it is not really a cluster as the suicide rate for Telecome’s employees was only slightly above the national average of 14.7 per 100,000 people. Sage reports that France is a country with a high comparative suicide rate. The relevance to SafetyAtWorkBlog is that Sage goes on to identify work-related factors that contribute to suicides.

He quotes a sociology professor who says the French “define themselves by their professions”. The risk with this basis for identity is always when the demand for the profession declines, one needs to redefine and this is not easy.

Sage finds a psychoanalyst who says that his patients feel isolated at work and have no support mechanisms.

A suicide prevention expert says that often a problem at home is the suicide trigger with someone who is feeling stressed at work.

Sage provides a potted history of the privatisation of France Telecome and speaks to a current employee bemoans the loss of camaraderie.

What is surprising about this article is that it seems France, and particularly France Telecome, are way behind other Western nations in having control measures in place for employee support programs and change management.

It is not as if France is ignorant of workplace stress issues or that workplace suicides have only occurred at France Telecome. A major reason for its experiment with the 35-hour week was to

“…to take advantage of improvements in productivity of modern society to give workers some more personal time to enhance quality of life.”

In January 2008 (well before the current financial crises), the Institute for Economic and Social Research published “Workplace suicides highlight issue of rising stress levels at work “. After some suicides at Renault and Peugeot it assessed the issues, acknowledged the trade union assertion that

“…excessive isolation of workers due to high workloads and fierce competition leads to a malaise in companies and thus call for a reflection on choices of work organisation.”

The article also reported

“The French Democratic Confederation of Labour (Confédération française démocratique du travail, CFDT) welcomed the ‘recognition of psychological factors being the cause of an occupational accident’ as it ‘opens the way to taking into account a form of suffering and malaise that, until now, has been minimised by companies’.”

A longer-lasting improvement will only come if this recognition is built on by all social structures in France. Perhaps it should look across the channel at how the Health & Safety Executive and the corporate sector have responded to the report by Dame Carol Black – “Working for Health” – calling for an integrated approach to health management involving work, public health, health promotion and other elements of social capital.

France Telecome held an extraordinary Board meeting on 15 September concerning its suicide rate. It made the following commitments:

“The national health, safety and working conditions committee (CNSHSCT) will be meeting on Thursday next week in the presence of Jean-Denis Combrexelle, the Ministry’s Director General for Employment.

To stop the phenomenon from spreading, it has been decided to immediately put in place a freephone number to promote dialogue. Psychologists from outside the company will be available to listen to and talk with any employees who may be having difficulties.

The first meeting for the negotiations on stress will be taking place on Friday September 18. On this occasion, the employee representatives will appoint an external consultancy to conduct an audit of the situation within France Telecom.

These negotiations will focus on the prevention of stress and psychosocial risks in the event of geographical or professional mobility among staff. To address this issue, a forward-looking employment and skills management (GPEC) system will be set-up with a view to offering employees and their direct managers visibility over their professional development and support.”

Didier Lombard, France Telecom’s Chairman and Chief Executive Officer, has set a tight timeframe for improvement. On 15 September 2009 Lombard said

“December’s France Telecom will not be the France Telecom of today.”

Kevin Jones

UPDATE 30 SEPTEMBER 2009

Agence France Presse has reported a 24th suicide associated with France Telecom. According to the report the 51-year-old male jumped to his death from an overpass onto a busy highway. His suicide note to his wife expressly referred to the work environment as a reason for his action.

The harmonisation challenge in Australia gets more difficult

There are few motivations that are more effective for improving workplace safety than facing a grieving relative.

On 17 September 2009, the impact of the OHS law harmonisation on workers and their families came to the fore in an article in the Sydney Morning Herald (SMH) entitled “Deaths at work put sharper focus on liability”. The workplace support advocates make a clear case for holding those who control the workplace accountable for injuries, illnesses and fatalities that occur in their businesses.

A letter sent to the Federal Minister for Workplace Relations, Julia Gillard, by the Workplace Tragedy Family Support Group reportedly says

”Dealing with a serious injury or the death of a family member is difficult, particularly if there is no sense of justice. Employees must be able to seek justice against employers who do the wrong thing,” said the conveners’ letter.

Families wanted to know the responsible organisation had been held to account, the letter said.

Justice, but not revenge. The avoidance of this justice and accountability through companies choosing to go out of business has been highlighted in New South Wales many times, so it is understandable that the reduction of the avenue to pursue justice that may occur in the OHS harmonisation process can generate such letters to politicians.

A significant element in the SMH article is the inclusion of the union perspective. Trade unions often provide grieving relatives the only support, particularly in the period shortly after a workplace fatality. And there is the shared grief of losing a loved one and losing an often long-serving union member.

This article and the letter to the Minister add an important emotional and social element to the development of the new national model OHS laws. Whether the government will incorporate mechanisms to achieve justice in the legislative framework or in secondary processes could give a good indication to the broader political picture of workplace safety over the next decade.

Kevin Jones

Man crushed by unstable stack

On 1 September 2009 there were early reports that

“… a man died at Stanhope in northern Victoria when a one-tonne bag of salt fell from a stack and crushed him at a cheese factory.”

Further details were revealed in a media report on 4 September 2009. The media officer for WorkSafe, Michael Birt, discussed the stacking of multiple, one-tonne, bags of salt.

“The improvement notice is requiring them to develop a safer system of work in relation to storing the salt because they can’t stack it three high in these bales which are about a metre tall,” he said. “It’s symptomatic of what happens in typical cases after this, we look at it and we find the systems need to be further improved. Our aim is to get safety improvements happening sooner rather than later and if those improvement notices are dealt with promptly everyone’s life moves on.”

WorkSafe informed SafetyAtWorkBlog that the 50-year-old man was at the base of a stack of three bags of salt. Each bag had been placed in the factory on a pallet, so the stack from the floor was pallet – bag – pallet – bag – pallet – bag. The bottom bag had leaked and has possibly destabilised the stack. The stack fell, crushing the man. There was not racking around the stack.

The bags (similar to the one pictured right) are large bale-type bags with handles. The bags are used for a variety of contents and are in common use.

There were no witnesses to the man’s death on the Tuesday afternoon. Gaffer tape was found near the man’s body

WorkSafe has placed a “do not disturb” notice on the fatality site and has formally directed the company to review its bulk handling procedures in the salt store.

WorkSafe Victoria has a range of advice and guidances concerning the bulk handling of raw material, a couple are below.

Kevin Jones

Restorative Justice and workplace fatalities – Part 1

The city in which SafetyAtWorkBlog is edited, Melbourne, is struggling to manage a spate of street violence – some racially-based, a lot influenced by alcohol and drugs. The Age newspaper carried a feature article on 25 August 2009 discussing the concept of “restorative justice”, a concept that is barely known outside of some legal or civil liberties areas, in relation to handling offenders and victims of street violence.

Only last week, there was an important launch of a research report into the application of restorative justice for those affected by workplace fatalities. It is a fascinating new area of application for restorative justice in Australia and one that seems a more natural fit than for the more common acts of violence.

The research project builds on a lot of the work already undertaken into workplace fatalities by the Creative Ministries Network. Their research, mentioned in the project report, has shown

“…that families and company directors, managers and workers grieving a traumatic death suffer more prolonged and complicated grief due to delays in legal proceedings, public disclosure of personal information, lack of information, and increased stress from involvement in the prosecution process and coronial and other litigated processes.”

Over the next few days SafetyAtWorkBlog will run a series of articles on the concept and its application as well as being able to make available copies of the research reports and transcripts of interviews with research participants.

As SafetyAtWorkBlog has no legal expertise restorative justice needed some investigation. Below are some useful definitions and descriptions:

“Restorative justice is a theory of justice that relies on reconciliation rather than punishment. The theory relies on the idea that a well-functioning society operates with a balance of rights and responsibilities. When an incident occurs which upsets that balance, methods must be found to restore the balance, so that members of the community, the victim, and offender, can come to terms with the incident and carry on with their lives.”

“Restorative justice brings victims, offenders and communities together to decide on a response to a particular crime. It’s about putting victims’ needs at the centre of the criminal justice system and finding positive solutions to crime by encouraging offenders to face up to their actions.”

“The term “restorative justice” is often used to describe many different practices that occur at various stages of the criminal justice system including:

Diversion from court prosecution (i.e. to a separate process for determining justice);

Actions taken in parallel with court decisions (e.g. referral to health, education and employment assessment, etc.); and

Meetings between victims and offenders at any stage of the criminal process (e.g. arrest, pres-sentence and prison release.”

[Of course, one can also read the Wikipedia entry)

The intention of restorative justice has more often been to reduce the likelihood of a re-offence. The application of restorative justice for workplace fatalities seems to be slightly different. In America, it would be difficult to avoid using the word “closure” (a phrase SafetyAtWorkBlog refuses to use as there is never a close to grief, only a way of living with it) as one of the aims of the workplace fatality application.

There are many effects of a workplace fatality on executives and companies. It is hard to imagine a company that, after one fatality, would not do all it could to avoid another. Restorative justice has the potential to heal the surviving victims – family and company. It can also reduce the animosity that often results from the traditional adversarial justice system, particularly for those participants who may not have been exposed to such processes before.

Kevin Jones

Category: death

Grappler death in forestry operations – WorkSafeBC Slide Show

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France Telecome becoming a case study

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What Trevor Keltz gets right

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23rd suicide at France Telecome in 18 months

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The harmonisation challenge in Australia gets more difficult

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Man crushed by unstable stack

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Restorative Justice and workplace fatalities – Part 1

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