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Discuss the reasons why some employees in some organisations do not report accidents and near misses and discuss ways in which these organisations could improve their level of reporting.

Introduction

Because of scientific and technological advances we live in a world of increasing specialisation, with complex inter-related working practices and inter-dependence on others' services and products. As a result we have to rely on ourselves and others to minimise injury or harm workers, customers and the public at large. While To err is human: to forgive is divine (Pope 1711), and errors are an unavoidable fact of life, we the public as well as the government expect that organisations take all reasonable steps to minimise the number of accidents that occur to employees, customers or third parties. Health and Safety at work is a significant problem and a review in 1995 (Jones and Hodgson 1998) showed that over two million people in the UK were suffering from illness thought to be caused by work.  Findings such as these led the Government to implement further action plans on improving safety in the workplace (Department of Health 2000a). Another area that has been the subject of attention is the healthcare industry. Adverse outcomes in healthcare have been estimated to occur in up to 10% of hospital admissions (Department of Health 2000b).  This together with the finding that there are high levels of under-reporting in healthcare (Stanhope et al. 1999) have resulted in the government setting up the National Patient Safety Agency one of whose primary aims is to improve reporting, learn from past mistakes and thereby have a safer healthcare system. Severe errors with large scale loss of life, such as plane crashes, focussed the efforts of the aviation authorities to develop strong safety-orientated practices with excellent results.

The lack of reporting accidents and near misses in some organisations poses a threat to safety, because in such a situation risk management cannot operate effectively. To address the factors that impair reporting at the organisational and individual level, comparison was made between highly effective and safety-aware organisations and organisations with a poor safety history. An analysis of how effective organisations operate the component elements of risk management demonstrates that in the case of the aviation industry improving knowledge, attitudes and behaviour of employees through training is paramount, and this generates an organisational practice, shared between management and employees, that values safety highly while striving to reduce errors. In addition, in order to bolster this organisational culture and promote the continual participation of employees, visible action and appropriate feed-back on reports are routine. It has been shown that the adoption of the "systems approach" to investigation of accidents in aviation, and the shared understanding of the nature of errors within safety-oriented organisations, is in sharp contrast to, for example, the healthcare setting where the environment is punitive and, from the perspective of improving safety, ineffective. These examples from successful organisations demonstrate that the barriers to reporting, such as lack of understanding and feelings of uselessness in making reports, are all effectively minimised or even removed. In addition, more personal barriers such as fear of reprisal and desire for anonymity have also been addressed in successful organisations, such as aviation, nuclear and chemical plants. They have achieved this in part because of their open communication styles and "systems approach" locally, but have also done so at a national level with the introduction of reporting schemes that protect the reporter's identity and, in some cases, provide immunity from prosecution.

For failing organisations with a poor reporting and safety record, the first necessary step in addressing these problems is a willingness to improve and to learn. Without a strong desire to reduce errors any attempts to increase accident and near miss reporting will have little impact. Lessons can be learnt from studying the ways in which successful organisations set up and execute the key necessary elements of risk management. Key influences that can hamper or promote a strong safety culture and that are amenable to change, such as organisational culture and the understanding and co-operation of employees, can be improved through training. Issues such as making reporting easier to do (both in term of ease of use and relevance to the work setting) and protection of the reporter, are factors that need to be addressed and remedied. Stronger national cultural influences, of course, operate both outside and within organisations, and so public education is also required.  If failing organisations were to implement risk management systems adapted from successful organisations, the levels of reporting of accidents and near misses would be expected to increase significantly, thereby enabling these organisations to become successful in terms of an improved safety profile. While To err is human; to forgive is divine is a famous quotation, this could perhaps be re-visited and applied in the health and safety setting under a modified version of the maxim, namely; "to err is human: to reduce the risk of error occurring is admirable and achievable".

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