2 minute read
What Were They Thinking
Gene Scott
After an incident occurs, how many times have you heard or even said, “What were they thinking?” Not knowing what led up to the incident, it is easy to assume what they should have done.
In the past, we would do an accident investigation, what thoughts come to your mind when you hear the word investigation? Most would answer that they would question the witnesses, management, and employee/ employees assigned to the task, and anyone who was injured. The word “investigation” can give a negative connotation and automatically puts everyone on the defense.
In order to determine “What Were They Thinking?” you may need to change the way you look at your safety culture. The assumptions, values, and beliefs that people and companies hold onto can strongly influence the way they react after an incident.
The first place to start is by building trust with employees. You must look at safety differently than you have in the past. The safety culture must include open communications at all levels, from management to front-line employees, and peers. The more people involved in the safety of your organization, the better the outcomes.
Instead of an investigation, we need to use this opportunity for an event learning to determine what happened leading up to the incident. An event learning is comprised of the employee, their peers, and management. It is one step in human performance that allows the employee to explain what they were doing and thinking before the incident. Human performance addresses the roles of individuals, leaders, and organizational improvements. Employees are more likely to openly communicate when given an opportunity to be heard. The outcome of the event learning can give helpful insight into preventing the same incident from occurring in the future, which could save lives.
The Five Principles of Human Performance:
1. People are fallible, even the best people make mistakes. 2. Error-likely situations are predictable, manageable, and preventable. 3. Individual behavior is influenced by organizational processes and values. 4. People achieve high performance largely because of encouragement and reinforcement received from leaders, peers, and subordinates. 5. Events can be avoided through an understanding of the reasons mistakes occurred and the application of the lessons learned from past events (or errors).
When it comes to safety, I am a firm believer in human performance. I have experienced first-hand the positive impact of reducing error, managing controls, and improving leadership and culture, as well as putting a new perspective on human error.