The background story:
A recent article in the October 13, 2016 Daily Mail reported a £1.6 Million fine (equivalent of $2 Million) against Disney after actor, Harrison Ford, was crushed by the Millennium Falcon’s hydraulic door on the set of the latest Star Wars Episode VII, “The Force Awakens”, movie which was being filmed in June, 2014.
Ford had gone through the door, hit a button, walked out the door, and unexpectedly turned to walk back through the door when it came down on him. He assumed that the set was not live since it was a rehearsal. In this scene, Ford was helping his injured Wookiee friend through the door into the spacecraft. The door, which was operated by a person who was remotely located and could not see Ford, quickly closed it as he unexpectedly turned back into the spacecraft. Ford screamed and an emergency stop button was pressed, stopping the door just eight inches from being completely shut. They described it like a blunt-edged guillotine with a force comparable to being hit by a small car. Ford was pinned to the ground, suffering a broken tibia and fibula, a dislocated ankle and cut hand. The door had to be opened by the operator.
Disney’s subsidiary, Foodles Production (UK) Ltd., admitted to two counts of safety violations. In the main violation, while the company had done a risk assessment recognizing the risk of death, they had failed to talk to Ford so he was unaware of the precautions he needed to take. In earlier films, the door was operated slowly by a rope and pulley by a stagehand. The mechanized operation moved the door very quickly, surprising the 71-year-old Ford. After Ford’s recovery of about eight weeks, the film was completed.
The Meaning of the Story: Looking at the Blunt End and the Sharp End of Safety
This story illustrates so many of the changing conditions and people involved in our work places. Most of our companies do a good job in risk assessments and developing safe working procedures. However, this planning often takes place away from the actual location where the work will be done. This is sometimes called the “blunt end” of the safety process where the people doing the planning do not understand what happens in the work at “sharp-end” where conditions and demands may be quite different, and where most of the injuries happen.
Relating this Story to Safety Theory and Practice
In Erik Hollnagel’s book, “Safety-I and Safety-II” (2014. Ashgate Publishing Ltd., Surrey, UK), he discusses ideas like the significance of the gap between “the work-as-imagined” done by managers and engineers planning and designing the work and the “work-as-done” by the people actually doing the work. This is illustrated nicely by the Ford Star Wars incident where the people doing the “work-as-imagined” failed to understand the actual conditions and mindset of Ford doing the “work-as-done.”
Hollnagel describes the way in which we have traditionally done our safety work as reactive and where so much of it relates to “work-as-imagined” as Safety-I. The gap between where the “work-as-imagined” and “work-as-done” is where there are very difficult communication challenges. We tend to react to what has gone wrong. Bridging this gap moves our safety work into Safety-II where we move into the world of more performance variability, more adaptability and resilience. This is a world where everyone needs a better understanding of how and why things work, particularly our organizations. It is a world where we need to have a sense of both the whole and the parts. It is a world where we focus more on understanding what is going right than just on what went wrong. It is a world where we are more proactive in our safety work.
The Bottom Line: Re-engaging the Force…People and Business Together
At Richard N. Knowles & Associates, we help organizations move into a world similar to Hollnagel’s Safety-II world. Our work environments and tasks are complex. Our organizations are complex, adapting, self-organizing networks of people. Building on these ideas, we help organizations to learn how to open up the communications, to engage everyone, to help and support each other, to listen and learn from each other, and connect real caring with the work that needs to be done. We help organizations to reconcile the relationship between the needs of the business and the needs of the people, which results in the release of enormous energy and creativity.
Give us a call so we can explore this more fully with you and help you see the sorts of improvements you and your people can make. We are here at 716-622-6467 to meet your needs.
Consider the Golden Gate Suspension Bridge (San Francisco) built between 1933 and 1937, an architectural marvel, thought to be impossible because in order to bridge that 6,700 ft. strait, in the middle of the bay channel, against strong tides, fierce winds, and thick fog, meant overcoming almost impossible odds. But it was built, with a grand opening in May of 1937, deemed, at the time of its completion, to be the tallest suspension bridge in the world as well as the longest. A man named Joseph Strauss engineered many new ideas, including developing safety devices such as movable netting, which saved 19 lives; though in all, there were 11 men lost during this construction. Thousands of men – workers of varying ages and from varied ethnic groups – came together to complete this project. (They had to listen and learn to be successful together.)
Consider the feat of building the monumental Hoover Dam (1931-1936) – a miracle of technology and engineering. No dam project of this scale had ever been attempted before. There were 21,000 people working at that site with approximately 100 industrial deaths. The walls for this structure – that would uphold the weight of the dam – required workers called “high-scalers” who excavated the cliffs, dangling on ropes from the rim of the canyon. Can you even fathom this?
Consider the great Niagara Power Project (1957-1961). During construction, over 12 million cubic yards of rock were excavated. A total of 20 workers died. When it opened in 1961, it was the Western world’s largest hydropower facility. Many people, including from the “greatest generation” and the “traditionalist generation,” worked together on this project. It was a 24/7, multi-year project.
In my June 29th presentation at the American Society of Safety Engineers 2016 Professional Development Conference, I discussed the fact that one of the best ways for the safety professional attending the talk to help to improve the safety performance in their workplaces was to show the people that they cared about them and to enable them to make decisions about their specific work. I want to elaborate on these ideas in this newsletter. This is not just for the safety professional. This is for every team leader, supervisor, and workgroup leader. Going into your workplaces and opening up the conversations is a journey; each time you do this it gets easier and more effective. (Caring, Understanding and Openness!)
Eighty (80) pages and counting…that’s how far I got while perusing the numerous pages for the 2015 fatalities logged on OSHA reports – there were still many names and circumstances yet to read.
Hardly any of us can do our best work all by ourselves.
In our Partner-Centered Safety realm, we go beyond this to having everyone (the people on the floor, the supervisors, the managers, and all the others) feel they are cared about. Caring means helping each other, listening to each other, sharing information, being respectful, asking for help and receiving it, looking out for each other, saying we are sorry when we make a mistake, and treating each other as whole persons. Just what caring means for people is something on which they should all agree. Management, alone, should not do it for their approach can often be quite patronizing – treating the people in the work place as if they are children. All the people, at all levels, together, need to come up with their ideas about what caring is for them. Management should not try to dictate the answers, but management needs to open up and lead this discussion about caring or it will not be addressed. Caring is visible; as is non-caring. Partner-Centered Safety is visible caring. Mistreatment of people is non-caring.
At one of the highest geographical points in Florida, at Lake Wales, is a large, 205-ft high, carillon tower. It is beautiful, as are the gardens surrounding this tower structure, made of glistening coquina stone. The tower and gardens were a gift from benefactor Edward W. Bok, who cared deeply about nature, beauty and sanctuary spaces. Millions of visitors have traversed this place of solace since it opened in 1929. Edward Bok was all about CARING for future generations – to be able to enjoy peace and beauty. His tribute signature is this:
When the Safety Culture is right…what do you see? What does Excellence look like?
On December 16-18, 2015, I was able to attend the Cruise Line International Association Safety Conference in Miami. The focus was on improving the safety culture and Bridge Resource Management. This is a very interesting business for me to learn about. I was there to give some perspective from the chemical industry.
There is a big need to be sure the managers of chemical plants are qualified so that their employees and neighboring communities do not suffer the consequences of chemical releases and spills. Many manufacturing businesses that do hazardous work, aside from chemical manufacturing, should heed this thinking too.
I’m reminded about the organization that thought their safety performance was always good, because they were primarily an office environment. They scoffed over how bad could a paper cut be? Or, what’s the worst that could happen if someone fell off their chair? Little did they expect that one of their office workers, when on a healthy outdoor walk during her scheduled break time, tripped over some roped off tape that had been blown by the wind. She actually walked into it – not paying attention to her surroundings – got caught up in it as it wrapped about her feet. She fell, twisted her knee, required surgical repair, etc., etc. Try to explain that office worker lost-time injury! (The good: healthy walk; The bad: not paying attention; The ugly: lost time injury).
We see organizations as complex adapting networks of people who are the vital keys to its success. When the people in the various parts of the network are sharing information and helping each other, all aspects of EHS Performance rapidly improves, resistance to change disappears and the energy bubbles up spilling over into all other parts of the work lifting the organization to new, higher levels of performance.
