Accident Repeaters

Robert Pater, SSA/MoveSMART Director

Description

A small percentage of "accident repeaters" have a large share of injuries. But accident repetition involves more than a few disgruntled or uninvolved employees.

Accident repetition has multiple causes - and there are many types of "accident repeaters." An initial necessary paradigm shift in breaking the chain of accident repetition is reducing the label of "accident repeater"--one that suggests that multiple incidents are the fault of individual employees personality or lack of ability. Moving from an "accident repeater" to an "accident repetition" approach broadens an organization's ability to perceive and control the range of underlying contributing forces in accident repetition.

A systematic approach can prevent initial incidents from turning into repeat problems, interrupt continuation of accident clusters, and break the chain of long-standing accident patterns. In addition, such as system should simultaneously strengthen organizational safety culture.

It is critical to:

Understand the hidden problems in accident repetition.
Explore a systematic approach and innovative interventions to reduce multiple incidents.

Breaking the Chain of Accident Repetition

Many organizational safety professionals and managers have long been frustrated with "accident repeaters." Even with an otherwise strong safety record, it seems as if a small percentage of employees account for a disproportionate share of injuries. These employees seem immune to the limited arsenal of interventions that managers have traditionally employed--threats, other forms of discipline or counseling. And for many organizations, the chosen response of dismissing employees who have repeat accidents (or even screening them out of the hiring process) is not a valid option, due to legal, contractual or other reasons.

But a systematic approach can prevent initial incidents from turning into repeat problems, interrupt continuation of accident clusters, and break the chain of long-standing accident patterns. In addition, it is possible to craft such a system to simultaneously strengthen organizational safety culture.

The Problem

Although there has been little recent validated research in the field on "accident repeaters," the concept of repeat accidents has been discussed in the literature for some time. This phenomena has also been described as "accident propensity," "accident magnetism" or "accident proneness." Sass and Cook suggest "The 'accident proneness' thesis has been with us since the early 1900's."

Accident proneness, which blames worker lack of awareness, skills or experience for repeat accidents, "has no empirical foundations" according to Sass and Cook.

This lack of "proof" of accident proneness doesn't, however, negate the fact that accident repetition is an observable phenomena. Anecdotally, many safety professionals have confidentially suggested a Pareto distribution at work: that 20% of employees account for 80% of all accidents.

Further anecdotal information shows that, while some few workers have a chain of accidents for a period of time, they seem to move out of this "repeater" pattern--and others move in to account for multiple incidents.

Schulzinger states "The evidence indicates that, when the period of observation is sufficiently long, the 'small group of persons who are responsible for most of the accidents' is essentially a shifting group of individuals falling in and out of the group."

Some professionals have suggested that accident repetition is somehow related to lack of involvement on the "perpetrator's" part.

Traditional approaches to dealing with "accident repeaters" have ranged from:

Solving the problem in advance - somehow setting up screening procedures to not hire those destined to have repeat accidents.
With already existing repeaters, using some kind of threat or discipline - "You had better not have any more of these occurrences"
Also with existing repeaters, a counseling intervention - "Let us see if we can uncover why you are having so many accidents."
Giving up in frustration - "there's nothing we can do about it."

Unfortunately, each of these approaches have been somewhat unsuccessful. Some organizations find it legally or contractually difficult to screen out repeaters. In addition, they often don't have effective criteria that enables them to determine in advance who might be prone to repeat accidents.

Threat, discipline or counseling interventions seem to work for a short time but labels workers as deficient. This often results in the negative side effects of reduced employee morale. And like the myth of Pygmalion, it may actually create repeater problems. Further, thinking of a worker as the problem makes it less likely the organization will search for other, more salient sources of accident repetition. As Sass and Crook stated "Blaming the victims for accidents is...fruitless, since it does not provide impetus for the elimination of hazardous conditions."

Finally, never give up. The sources of accident repetition can be controlled--if you start by looking for them in the right places. This paper will explore strategies and techniques we have devised and helped put into place at a range of organizations. At this point, there is no statistical base to back our hypotheses.

Different Kinds of Repeat Incidents

We have been able to distinguish 6 kinds of "repeaters."

Exposure - workers who have a higher degree of potential risks associated with their jobs. An example might be an employee who engages in repeated heavy lifting.
Cumulative - employees who have a wearing down from cumulative trauma. Often physical job stresses (or off the job activities) lead to progressive illnesses--each of which may be reported as separate incidents.
Reinjury - sometimes an injured part of the body is weakened. This can lead to reinjury of the same area, to the same or more acute degree.
Referred injury - Injury in one part of the body can lead to injury another area. For example, a foot injury can change how weight is distributed, which in turn can lead to a change of gait and potential knee pain. Also, many with lower back pain have discovered their posture changes to reduce pain; this change in spinal alignment can lead to neck pain.
"Random" - where there are apparently no patterns detectable in accident repetition.

Profiles of "Repeaters"

Our interviews and work with companies such as Schlumberger, Anheuser-Busch, Alcoa and many others suggest employees who have repeat injuries don't come in only one type:

Proud, tough repeaters often don't report "minor" pains and pride themselves on working through difficulties.
Some work harder than others and therefore may be at risk of greater physical stressors.
Fatigued workers may endure longer shifts, increasing workloads or forced overtime.
Distracted employees may have work or personal concerns that reduce their safety awareness.
Uninvolved people may not pay attention to safety procedures or care about doing things the safest way.
Unappreciated workers are often angry and their attention is expended on dwelling on what they should rightly be receiving.
Some don't report all or some incidents. This may be due to pressure they receive from their peers, supervisors or managers. Some organizations report that safety incentive award systems may have the unforeseen result of reducing accident reports. Not reporting means hazards are still working in the system, like a cobra undercover.
Some are angry at their supervisors and have accidents to make their supervisors look bad. It is critical to define in advance what an incident is prior to determining who are "repeaters."
Some employees are looking to bail out of work to receive workers compensation payment. I suggest this percentage of employees is often overly focused on by managers and is a smaller group than most think.

A New Paradigm

If accident repetition only happened to disgruntled or uninvolved employees, there might be more merit to the 'accident repeater' concept. If you think of accident repetition, rather than accident repeaters, you will be able to consider and adjust to the following three factors in accident repetition.

Human Factors

Prior injuries may lead to future ones (cumulative or weak spot)
Physical condition. Being out of shape can make sprains or strains more likely. Slower reaction times may make it more difficult to recover from changing risks.
Use of medication that has side effects on balance, judgment or reaction time (these may include common cold medications sold over the counter)
Body mechanics that leave a person poorly balanced, overextended or not able to effectively apply strength. An example here is working with elbows abducted more than 10° from the body ("winged"). There is much to safe and efficient body mechanics that most people do not know.
Learning style. Some people learn slower than others. Some learn best by doing (kinesthetic learners), yet receive training based upon lecture (more effective for auditory learners).
Pace. Some work faster than others. This may leave them more vulnerable to cumulative or acute injuries.
Self-image. If a person sees them self as accident prone, they may be less likely to make needed adjustments to avoid repetitive injuries, taking a fatalistic view of their safety.
Age. As we age, there are normal effects on our bodies. Our need for illumination increases, ability to tolerate heat lessens, muscle strength lowers. But it is possible to overcome most of these effects through awareness and planning.
Change. Experiencing a certain degree of life changes may be associated with injuries. Levenson and Hirschfeld wrote, "In addition to experiencing more life change than the average person...the industrially injured workers were having increasing difficulties in health, work, social, and financial areas."
Emotional disruption. Depression may be associated with injuries in that strong emotional states may overshadow risk awareness or adversely affect motivation to prevent injury.
Stress. Mental stress narrows attention span, resulting in tunnel vision. This adversely affects awareness and may be a contributing factor in accidents.

Task Factors

Job design. Jobs that are overly repetitive, forceful or static may lead increase concentration of forces on smaller parts of the body more prone to cumulative breakdown.
Workstation layout. Distance of the workstation from the person affects the amount of force he or she must apply to do a task. Distance of a task from a workers center of gravity is a major factor in back injuries.
Lighting. Illumination adequate for a 22 year old worker may be inadequate for that same worker who has been on the job for 20 years. According to the National Safety Council, an average 65 year old needs fifteen times more illumination to see the same object with clarity as an eight year old.
Exposure. Some have working jobs that are more risky than others.
Climate. Exposure to the elements can make a job more risky. These need not be outside jobs. Working at a loading dock, crossing an icy parking lot or frequently walking between buildings also qualifies here.
Pacing. For example, machine-paced jobs may be associated with lower back pain.

Organizational Factors

Management expectations about reporting injuries play a strong role in whether non-recordable incidents and near-misses are utilized to engineer or train out potential repeat injury risks.
Medical management. In our experience, medical management frequently is a weak spot in prevention of multiple incidents. Poor diagnosis of early cumulative trauma symptoms often lead to expensive re-injuries. Not knowing real job tasks may lead to poor alternative or "light"duty recommendations. For example, workers with lower back pain are frequently provided seated "light duty" jobs, even though pressure on the lumbar spine is often worsened by sitting.
Training. Lack of training or inadequate training handicaps workers attempting to do a job safely and efficiently. Frequently, training is by observation. New employees who are not provided strong initial training pattern their work behaviors after a more experienced peer. Unfortunately, this "model" may be using poor body mechanics themselves or making adjustments to a prior injury they have but the onlooker doesn't.
Personal Protective Equipment. Is equipment provided in appropriate sizes for workers? In sufficient quantities? Near enough to their tasks so the PPE will be easy to use?
Level of staffing. In these challenging times, employees are often working thin and hard. Inadequate staffing levels may make it difficult for employees to recover from physical work stresses and lead to a series of injuries.
Accident investigation. Is your organization's accident investigation system one of witch-hunts and war-fare? Are people tacitly blamed for any accident so they become naturally defensive about honestly exploring factors that could prevent future injuries to themselves or others?
History. Consider the history of communications and trust between management and employees. Lack of trust results in lowered morale, which can contribute to safety problems
Regulations. What internal procedures and external standards affect jobs? How effectively are these communicated to employees? Are they communicated so workers can understand without defensiveness?
Stress. How well does the organization help employees manage stress and change? Is stress deemed as a non-issue or sign of weakness that employees are expected to ignore? Is an Employee Assistance Program provided?

Helping Current "Repeaters"

Certainly, if you have a group of people currently caught into the chain of repeat incidents, it is critical to have a plan to help them.

Examine the real problem: Ask "why?" Examine your assumptions about repeat incidents. Determine three kinds of contributing factors. Interview those who have had repeat incidents and solicit their expertise. Interview supervisors and managers for their opinions on causes and solutions to accident repetition. Ask your Employee Assistance Program staff for any trends they have spotted regarding causes of injuries. Involve your Safety Committee in planning possible interventions so they fit your culture and reduce resistance to change.
Define your targets. For example, some organizations define repeaters as those who have had three lost-time accidents or medical claims within a one year period. Other companies focus on employee in their top 10% of repeat incidents.
Plan Your Intervention. Decide which model you will use with "repeaters"--a counseling model, one that focuses on discipline or an education and training model. I recommend the last approach for lasting positive results, both with the current "repeaters" and their peers (who in their own ways will be monitoring what you are doing). Training and education should de-victimize and de-stigmatize "repeaters," help them understand different factors in multiple incidents, solicit their opinions and teach skills and techniques for assuming greater personal control of their own safety. Experience has shown as mix of attitude control, body mechanics and stress management can result in participants being ready to make a working plan that will help them get off the repetition merry-go-round. Initially pilot the program with a small group of "repeaters." It is critical they enjoy it and recommend the program to others.
Sustain it. Monitor and evaluate the pilot program to determine its effectiveness. Find creative methods for reinforcing the program in the attitudes and behaviors of participants. You might consider having past "repeaters" who volunteer become trained to help future "repeaters."

Organizational Strategies for Breaking the Chain

Don't stop there. If you truly wish to break the chain, rather than just moving some current "repeaters" out of the multiple accident category, begin by shifting your paradigm from "accident repeaters" that focuses on the negativity of injured employees to that of "accident repetition." In the Accident Repetition (or Multiple Incident) model, emphasis in on perceiving the three factors affecting repetition, on shared responsibility for safety and change and on future prevention rather than past blame.

Words have power to set attitudes that translate in turn into behavior. Educate people that repetition, not "accident repeaters" is one of your concerns. That select people are not natively clumsy, that anyone can learn to improve. Often the most taunting "accident repeaters" receive comes from their co-workers. Help everyone support those who've been hurt, not make things worse (or set negative attitudes that "I'm an accident waiting to happen."

Make sure this message is communicated to management and employee leadership throughout your organization. Help them take their fair share of the responsibility in multiple incidents.

Train everyone in the causes of accidents and effective methods for accident prevention. For example, no matter their condition, everyone can quickly learn simple techniques for improving balance and coordination.

Have positive accident investigation that is prevention-, not blame-oriented. A good idea is to have accidents investigated by a team of employee and supervisor.

Help workers and managers recognize signs of on the job stress. Supervisors can learn to develop their antennae as the first line of organizational defense. Provide support and, above all, a vehicle for honestly listening to employee concerns. This may be an employee assistance program.

Focus on both Attitude and Behavior

Strengthen your medical management system. Assess its strengths and weaknesses, show professionals the range of real tasks and working conditions, set their expectations about preventing the different kinds of repeat incidents and continue strengthen your relationship with them. Be sure to utilize them for ongoing feedback on your safety system in general and in accidents that may be "repeat" in nature (you can easily develop a feedback system where they do this and still maintain patient confidentiality).

Design tools and workstations to reduce cumulative forces and to help workers "un-concentrate" them--spread these stressors to larger muscle groups that are less likely to break down.

Think of providing your organization a range of options. Just as there is no one kind of "repeater", company cultures also greatly vary. Experiment with different strategies to see what might work for your organization. Determine if an outside source might be helpful or if you have already existing internal resources to spark needed changes.

Above all, have high expectations. Real change is happening right now in companies throughout the world. You don't have to settle for frustrating repeat accidents. By taking strategic control, you can break the chain of multiple incidents.

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