Originally posted on August 6, 2015 @ 6:30 PM
Queensland Mining Tragedies – What Could be the Response?
We learned recently that Queensland Mining has its worst rate of fatalities in 20 years in 2014-15. (http://www.internationalcoalnews.com/storyview.asp?storyID=826953720§ion=News§ionsource=s46&aspdsc=yes). Yes, this is tragic, distressing and sad for many families and friends affected by the loss of their loved one. How should we respond?
Let’s reflect for a minute on a similar situation and what happened in the ACT in 2011-2012. In 2012 the ACT Attorney General called for an enquiry into a spike in fatalities in the Territory’s Building and Construction Industry. For such a small jurisdiction, four fatalities in a short period of time was alarming and the calls for responses were overwhelming. Compared to the population of Queensland, the statistics of four fatalities in this small jurisdiction in a calendar year is extraordinary and in percentage terms more pronounced than the Queensland statistics above. (Let me state here that this article is not about statistics nor should my reference be interpreted as being cold hearted.)
I was involved in two of the resulting inquiries (the MBA Inquiry) including featuring in the Getting Them Home Safely Report published by the Regulator in September 2012 (p. 30-34, p. 44, p. 79). http://www.worksafe.act.gov.au/publication/view/1991 The focus of my involvement was in discussion about culture, the psychology of risk and risk maturity. I was also involved in the first prosecution under the new (harmonized) WHS Act in the ACT (as a witness in the Kenoss case http://www.abc.net.au/news/2015-06-23/kenoss-company-found-guilty-over-truck-drivers-electrocution/6568268?site=canberra ). It is from these perspectives that I offer my thoughts about the Queensland Mining position.
A major feature of the Getting Them Home Safely Report was a focus on culture. Chapter Three of the Report is entirely devoted to the issue of culture. Recommendation 5 of the Report states: ‘The ACT construction industry partners should endorse the need to build positive, inclusive safety cultures on local worksites. The Master Builders Association and the Housing Industry Association should take the lead in moving the industry forward, from an approach to safety which is focusing on systems, compliance and reaction to one that focuses genuinely on people and attempts to create healthy safety cultures on construction sites’. So what happened, what was the response? Twenty new inspectors on the beat and an increase in regulation. None of the recommendations on culture in the report were actioned.
What do we learn from this? At the time the language everywhere was alarmist and sensationalist. Vested interests were jockeying for airtime and political muscle, riding off the back of the tragedies. Statistical gymnastics emerged everywhere distorting the longitudinal reality declaring that the ACT was the most dangerous in Australia, when that is not statically the case, longitudinally. We became the ‘Death Capital of Australia’ ((http://enpassant.com.au/2012/11/26/canberra-the-building-site-death-and-injury-capital-of-australia/). The CFMEU, whilst conducting bribery, blackmail, corruption and bullying in the background, (http://www.theaustralian.com.au/national-affairs/industrial-relations/cfmeu-raised-thousands-through-hidden-clauses/story-fn59noo3-1227469373457?nk=b553a889717fe813402b3604d2a4b080-1438811832) and being prosecuted for safety breaches (http://www.smh.com.au/business/federal-agency-to-prosecute-act-cfmeu-for-safety-breaches-20150109-12kz5c.html) were prominent in the mix, calling the industry a ‘bloodbath’
Unfortunately, when tragedy strikes and people are vulnerable, the emotive sell is powerful. So what should happen in Queensland?
As much as the 20 fatalities in Mining in Queensland is a tragedy, now is a time for cool heads and leadership. Perhaps now is the time to question whether the focus of ‘the Zero Harm in Leadership Program’ running in Queensland for many years, and endorsed by the Regulator, has had any positive effect? (https://www.worksafe.qld.gov.au/construction/articles/zero-harm-at-work-leadership-program) I know, maybe we need to go ‘Beyond Zero Harm’??? Strangely Worksafe Australia has also fallen in line with the mindless spin of zero (http://www.safeworkaustralia.gov.au/sites/swa/australian-strategy/case-studies/pages/zero-harm-at-work)
Now is the time for someone to step in and sell the best snake oil. Maybe it’s ‘Extra Zero’, ‘Zero Future Plus’, ‘Accident Free Future’ or the ‘Beyond Maximum Zero Infinity’ Program? Maybe, we haven’t been vigilant enough on zero. Maybe, the next step is ‘Tough Zero’ or ‘Zero More’? The truth is, according to Regression to the Mean (https://en.wikipedia.org/wiki/Regression_toward_the_mean), so well explained by Kahneman (Thinking Fast and Slow p. 175ff.), no matter what comes next, the statistics will drop. Then everyone can attribute meaning to whatever action was taken and turn it in to the savior. This has happened in the ACT (http://www.cmd.act.gov.au/open_government/inform/act_government_media_releases/gentleman/2015/no-construction-deaths-since-getting-home-safely-report-implementation). The truth is, even by the time of the Getting Them Home Safely Report, over a period of 12 months, while nothing was implemented, the statistics improved 100%.
Here are some ideas for my friends in the Queensland Mining Industry:
- Be receptive to the language and discourse associated with tragedy and people selling products.
- Understand the principle of Regression to the Mean and the nature of Social Psychology.
- Be aware of Fundamental Attribution Error and look for those who want to exploit the moment politically and economically.
- Try to be culturally astute and watch out for culture spin without definition or understanding of culture.
- If there is an inquiry, make it meaningful.
- Don’t judge the culture by statistics, culture is not measureable by statistics, LTIs and LTIFRs, curves and pyramids used in safety are all an attribution.
- Listen more than react.
- Don’t believe promises and absolutes, human fallibility is real.
- Keep the semiotics and balance right, falling for the jargon of deficit discourse simply exacerbates problems in the collective unconscious of the industry. The industry does have an archetype.
Seek broad understanding and understand risk complexity as a ‘wicked problem’. https://sia.org.au/downloads/News-Updates/Safety_A_Wicked_Problem.pdf
Whilst we all want the world to be a safer place, we also know that Mining is risky and increasing bureaucracy and regulation will simply increase bounded rationality (flooding) in the culture and drive greater ‘tick and flick’. That is, an over reaction now could actually make things worse. Let’s reduce the focus on statistical proofs and start thinking more about how fallible people make decisions and judgments in social context.