People Make Mistakes
Here's the deal. People make mistakes; it is a condition of being human. I make them all the time. Do you? 🙋 I firmly believe it's the only way to grow.
In “An Essay on Criticism,” Alexander Pope said, “To err is human; to forgive, divine.” I might add, “to protect regardless, moral.”
In the Human Organization Performance approach to Safety, there are five fundamental principles. This post explores the very first one: People Make Mistakes.
As Safety Professionals, we must assume that our workforce – made 𝘰𝘧 people or made 𝘣𝘺 people – will make mistakes, just as we do! I can't think of a more humanizing thought. Consequently, when we design safety systems that rely on a worker's [perfect] actions, we set them up to fail, and therefore, get injured. A great example? Ergonomic lifting. “Bend at the knees! Nose over toes!” All it takes is one moment of distraction, a simple mistake, and that method of preventing an injury goes out the window. It's completely human.
Occasionally I hear Operations folks say things like, “If they only focused on what they were doing, they wouldn't get hurt.” I ask this: “How often do other thoughts and things distract you from what you're doing? Oh, all the time? Literally? Like probably 5 times since you started reading this? Yeah, your workforce too.”
My favorite safety philosopher, Todd Conklin, PhD., speaks about the need for safety systems to be 𝘳𝘦𝘴𝘪𝘭𝘪𝘦𝘯𝘵 enough to withstand the mistakes of humans. This is our ultimate goal as professionals, to 𝘱𝘳𝘰𝘵𝘦𝘤𝘵 𝘳𝘦𝘨𝘢𝘳𝘥𝘭𝘦𝘴𝘴.
My most significant opposition to behavior-based safety, despite Scott Geller's best intentions of being a “comprehensive approach,” is that it leads to the “can't fix stupid” mentality, unforgiving of the mistakes humans are destined to make.
I do, however, think that mistakes can & should be coached and addressed. Like I said, making mistakes is how we grow. If we don't know we made a mistake, we can't learn or improve. The trouble comes when we end our incident investigations there, finalizing our root cause analyses with “worker did not do x, y, z.” I would ask the following:
Did we consider their humanity? Did we ask if they had other things going on in their lives that could have led to the mistake? Were they trained? Are they stressed? Rushed? Did they have adequate space or an appropriate layout? The right tools?
If we haven't asked those questions, have we truly identified the root cause, and can we find an appropriate action to prevent the injury from happening to someone else? I don't think we can.
What Do You Think?
I'm curious if you agree or disagree. Ultimately, our shared goal is to keep our workforce safe and protected, even though, inherently, humans make mistakes.
“To err, human; to forgive, divine; to protect regardless, moral.”