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Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters



Safeguard Magazine

A fundamental error

You read about an injury incident and respond: “What an idiot!” We’ve all done it. PETER BATEMAN asked human performance guru Todd Conklin how we can respond more usefully.

It’s fair to say Todd Conklin loves the topic of this brief interview because it’s an opportunity to riff on some of his favourite themes.

To the person who would exclaim “What an idiot!” following a report of an injury incident, he retorts: “What kind of idiot hires an idiot?”

He chuckles while he ponders if the managers in such an organisation are actually turning people into idiots. Then he gets serious. No, managers aren’t hiring idiots, but the “idiot” response is a fundamental attribution error which attributes failure to you and success to me.

Even so, he doesn’t condemn it. He says it’s normal to respond emotionally when an incident is reported. What isn’t normal is to remain with that emotional response and adopt it as some kind of causal explanation for what happened.

“When you feel ‘What an idiot!’ coming on, shut the door and say it,” he advises. “Let it hang in the air a while. Then cleanse yourself of it, open the door, and ask this question: how did we get into a position where one of my people could have an outcome like this?”

The fundamental attribution error, he explains, is to assume that in the injured worker’s place, you would have done something different and not been injured. Hence the rush to attribute stupidity to the injured worker, followed shortly thereafter by blame.

“We can respond emotionally. We just have to be able to respond systemically as well.”

Conklin is a natural storyteller. Imagine, he says, that your “goofiest” employee comes in on Monday, parks his car, and on the path towards the office steps on a stone and twists his ankle. It’s a reportable injury. Your response? “What an idiot!” You tell him to be more careful, to look where he’s walking, to not step on stones.

Next day the boss from head office arrives, parks her Porsche, and walks towards the office. Steps on the same stone. Twists an ankle. Your response? To get the maintenance crew out there sweeping the parking lot.

“We respond differently to the first person, who has no power, than to the second person who has lots of power.”

Everybody is prone to making the fundamental attribution error, says Conklin, but good organisations have learned to move beyond it.

“We can start there, we can just never end there. The more we learn about the event, the less stupid the worker becomes.

“The more complex the event becomes, the smarter and more adaptable the worker appears, not dumber and more of an idiot.”

I suggest the corollary to “What an idiot!” is the accident investigation which stops at operator error, which Conklin views as just a nicer way of saying the same thing.

“We have to help organisations move from who failed to what failed.”

The challenge, he says, is to de-value the “who?” part of the question, so that event learning teams start at the what.

“If they do a good job describing what happened, the who part of it – the local rationale in that environment – is never really talked about.”

Operator error, he says, is a reasonable finding if you see workers as the problem to be fixed. But if we view workers as the solution, as problem-solvers, then it is not helpful at all. When he sees an event learning team moving towards “operator error” he knows their learning has stopped too early; that they are convinced at a cultural level that the problem is the organisation’s workforce.

He tells the story about the vehicle manufacturer whose workers were losing six fingers a year, every year, on a certain high-speed rotating part. Their initial response was to blame the workers for not being careful enough and to implement a fix-the-worker solution which cost a fortune and did nothing to reduce the amputation rate.

Later, they had glove manufacturers experiment with tear-away fingers that would be torn off by a rotating machine part instead of dragging in the worker’s hand, giving the worker time to get his hand out of the way. Amputations disappeared.

“The thing about the ‘fix the worker’ approach is that it isn’t a sustainable solution. The worker doesn’t get better.”

And with that Conklin is off, to prepare for a session the next day at Eden Park in which he will tell many compelling stories, including the lesson of the gloves and our human need to locate idiocy in others and perfection in ourselves.

PETER BATEMAN

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