Pointing Fingers


Now that I have your attention, I’d like to turn your attention to a belief system that continues to injure employees in every industry.  I call it the “blame game”.  When I go out and investigate an incident or injury, the first thing I hear is “Joe should have been doing XYZ, that’s why he got hurt!”.  While Joe may have failed to follow a procedure to a T, received inadequate training to perform his job, tried to take a shortcut, or maybe Joe just isn’t the sharpest tool in the chest; Joe is not the problem.  It is time we stop blaming people and investigate work related incidents more thoroughly.

He was just not paying attention, right?

If he was working instead of goofing off, how could he have possibly gotten hurt?  You only get hurt if you are goofing off and “not paying attention” right?  I get that a lot in incident reports for root causes, “employee was not paying attention and got hurt”.  Before Joe was injured he had to have been doing something reasonably related to his job, if not we would never have work related injuries and I’d be out of a job.  So it is safe to assume that Joe was participating in production when he was hurt, regardless of what he did or failed to do; Joe was performing duties related to one of the company’s processes.  Joe…Was…Working.

There has to be Someone to Blame!

If the problem is not Joe, whose fault is it?  While at a micro level there may be plenty of blame to go around, it is impossible to target the single accountable person that allowed Joe to get hurt.  Why?  The fault lies within the process Joe was performing; the work, the product, and perhaps even the environment.  The purpose of an investigation is to drill down to the single most important factor that allowed Joe to be involved in the accident.  That is the root cause, if not for that one factor Joe would not have been hurt.  That is not to say that other factors were not also at play which contributed to the incident; but a good, solid investigation should uncover both.

It was all about Technique.

Once Root Cause and contributing factors have been gathered, the next step is to devise corrective actions.  Corrective actions are meant to ensure the same incident never happens again, correcting the root cause and if applicable the contributing factors.  However, these should also focus on the process and not on the person.  Take for instance these two hypothetical situations.  An employee struck by a falling object and another who smashed his finger while hammering a component onto another.  Commonly witnesses to the incident will say, the employee was using the “wrong technique”.  This is another one I get all the time.  “He was doing it all wrong, you are supposed to do it like this”.  This means that the hazard was recognized long ago by workers, but they just found a tribal technique to work around it.  If you are new to the tribe, you don’t know the technique and get hurt.  Why else do you think new employees are 3x more likely to get hurt than seasoned employees?

Solving Real Problems.

In both instances, the final corrective actions should have nothing to do with technique adjustment, additional training, wearing two hardhats instead of just one, or padding employees securely with bubble wrap.  They should focus on how to make the process safer for the co-workers to interact with.  The best corrective actions focus on solving multiple issues, correcting hazards inherent in the process, increasing production, and overall improving the lives of the employees on whom the company relies.  Investigating injuries and incidents thoroughly helps uncover not only hazards, but inefficiencies in the manufacturing process.  This puts to bed the whole notion that the Safety function places a damper on an organization’s performance.

 Bringing it Together.

Blaming the employee for being hurt is a cop-out to prevent doing the extra work it takes to find out what really happened.  By doing this we are doing a disservice to both our companies and to the employees who perform the valuable work in production each day. Before someone gets hurt, there are usually ample warning signs (i.e. the need to adjust technique to prevent getting hurt). One-off, freak accidents are very rare.  If even after the warning signs, near misses, reported injuries, and recordable injuries we have still failed to implement any corrective actions to control the now well-known hazards; there is finally someone to blame…ourselves as Leaders.

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