Posted By richard1 Try TKJ Training. specialises in behavioral safety. Dr Tony Hayes is the contact. Detail on the Internet

Posted By Barry Cooper I couldn't have put it better merv Barry

Posted By peter gotch The problem is that many investigations don't get down to the root causes, so that the systemic issues are not identified. Instead let's blame the Injured Party! P

Posted By Dominic Cooper Hi All Interesting question and responses. To my knowledge there is no definitive answer to the original question. In truth, I doubt if anyone really knows. Over the years there have been a lot of 'educated guesses' based on various bits of evidence from various 'experts'(usually those who have something to gain). In my own work, I have often see dramatic reductions in incidents related to the 'unsafe' behaviors on the checklists we develop - usually between 40-80 percent per annum). These are based on analysis of a facilities previous two years incidents. This often show's that a small proportion of unsafe behaviors are involved in the lions share of incidents. However, they are often not the cause, merely the trigger! - That said, their ARE some instances where a person has deliberately behaved unsafely, for no other reason than the person wanted to. It is also true to say, that we often find the behavior of those running or involved in various managment systems at the functional level (e.g. engineering, human resources, purchasing & supply AND SAFETY) are also implicated in the very same incidents and these are more akin to the actual 'root causes'. Equally, we have noticed that some very well known organisation wide 'administrative computer systems'- they shall remain nameless - are heavily involved in the very same incidents, simply by virtue of the fact that they are not designed to support the safety effort and use 'old and antiquated' data input/output methods that make them difficult to use to mitigate risks in 'real-time'. Thus, the behavior of the systems themselves can also be called into question. The safety climate at any one moment in time in a particular company / department / workarea and the prevailing organisational safety culture are also involved, but often overlooked in 'root cause' incident investigations. (The separation of safety climate and culture is deliberate!). Both of these are set by the prevailing management style vis a vis production and the levels of safety leadership exhibited on a daily basis. In my experience, ALL of these factors will be found in most incidents.

Posted By Merv Newman Sorry, but the title is "surfacing your safety culture" Dom, I have a copy of your 2002 draft on this computer. Can I send it to Kieran or would you ? Merv

Posted By Kieran J Duignan Many thanks for access to this paper - much appreciated. The co-ordination of 'safety culture' with levels of an organisation and the management process in HSG (65) as well as Reason's classification of errors is particularly insightful and useful.