The “PSM Lessons Shared” project

Recently, during a PSM class, I had a student with an all-too-common issue: How do I change the incident reporting culture at my facility? As a new PSM coordinator he was struggling because he couldn’t get his operators to report any incidents or near-misses that occurred on the process. We discussed it as a group for a while because changing safety culture is one of the most difficult things you will ever attempt.

It helps if we start with a common definition of culture. “A way of thinking, behaving, or working that exists in a place or organization” is the Merriam Webster dictionary definition that seems to apply best to safety culture. When dealing with culture, it’s good to keep in mind this Tony Robbins quote as well: “It’s not what we do once in a while that shapes our lives, but what we do consistently.”

Your safety culture is the result of the consistent actions and experiences that your company has provided for its employees. This kind of deeply established culture isn’t going to change just by issuing a new corporate policy. It’s likely that your safety culture has built up over years.  Culture has inertia and you shouldn’t expect to counter-act that overnight. If you are to have any chance of changing it, you have to first understand what has caused this culture to form.

In this particular case, it became clear that the culture of not reporting incidents was due to a past practice of criticizing and punishing anyone who reported an incident. It’s a fundamental principle of human nature that we get more of something we reward and less of something we punish. The culture of not reporting incidents can only be changed by changing the perception that negative things will occur if you share your incident with your colleagues and management.

It’s going to take time and careful attention to change such a culture.  For this case, he wanted something low key – something that wouldn’t seem like an overt attempt at changing culture because the employees were instinctively resistant to any type of direct change. How could we begin to change the culture for this student? We decided to attempt to change the culture – not by changing the culture directly – but by changing the perceptions and values of the employees through consistent action on the part of the PSM coordinator. He is going to share incidents from other facilities in the hopes that they start a conversation about similar situations in the plant. If such discussions do occur, he is going to focus the conversations ONLY on the lessons we can learn from the incidents, rather than trying to assess blame or fault.

This is such an interesting idea to me that I decided to help him out. Over the next year, I will provide a monthly post about a single incident relevant to Ammonia PSM so that they can discuss it and learn from it. We’re hoping that just the act of discussing these situations will make the facility more comfortable with the failings of human nature. Hopefully, they will begin to understand the value of incident investigation and the reporting rate will naturally change in response to the changing perception of the value of incident investigation.

If you have any PSM incidents that you would like to share (even anonymously) please email them to me at ammoniapsm@gmail.com

Look for the first of these monthly incident posts in the next few days. I look forward to the reports concerning the culture change (if any) over the next year and I will keep you updated as well.

About Brian Chapin

PSM / RMP Compliance Consultant
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