Two little words……If only!
The concept of incident prediction is fraught with controversy and a topic which is guaranteed to generate debate.
The notion that you could predict precisely where and when an incident will occur is as flawed as the ability to predict precisely when and where the next hurricane or tornado will strike… however, it’s safe to assume one will!
It is also the case that as you get closer to the occurrence of a weather event, the precision around its timing, location and ferocity becomes greater.
Over the years, through exposure to many weather events and of course the advancement in technology, we have developed highly sophisticated weather modelling and pattern prediction… we understand the geographical locations most likely to be affected and the times of the year where risk is at its highest and of course the likely severity.
We can therefore prepare and mitigate the consequences…
Not so with incidents, as we don’t get warned of their imminent arrival…. Or do we but is it the case we have simply become incident blind?
Having investigated dozens of serious and fatal workplace incidents over the years there is an unfortunate pattern where almost inevitably the words “if only” will at some point be uttered;
o “If only we had picked up on this issue earlier!”
o “If only we had heeded the signals”
o “If only we had acted on the audit findings”
o “If only we had listened!”
I doubt there has ever been an incident where no warning signals were present… if so, I certainly haven’t encountered one.
Conversely, every incident I have investigated has uncovered latent issues that pre-existed but were somehow missed or seemingly went undetected…. or more likely the dots were simply not joined!
I recall a fatality investigation in the Gulf of Mexico where a worker was crushed by a steel sheet he was helping to manually handle. The helicopter summoned to medivac him arrived without key medical equipment that would have saved his life. His injuries were survivable.
Six weeks earlier, a platform audit had uncovered this non-conformance but failed to determine the causation which involved an in-flight inventory shortfall with the contract medic evac company. Accordingly, it was simply recorded as a failing and no remedial actions were taken.
How dreadful for the family of this young victim that the audit offered up a gift of life which was heartbreakingly missed by those with the duty of care.
This break in the causal chain between proactive assurance activity and reactive incident investigation is endemic across most industries and worryingly, it is seemingly accepted as the norm, but this doesn’t have to be the case….
Key to bridging this proactive/reactive gap is talking the same root cause language. Understanding the causation behind audit and inspection non-conformance and having the ability to compare this to investigation root cause outcomes is fundamental. Without this, you as an organisation will remain incident-blind!
We are being asked time and time again to help clients to effectively risk profile their repeatable high-risk activities, essentially providing the previously unseen combined insight that takes the blindness away!
So, if you want to transform the way you action findings from your assurance activities and shift the dial from ‘what’ to ‘why’, then allow us to introduce COMET Assured.
An innovative and frankly game changing feature of the COMET Ecosystem that allows you to plan, build, and execute audit and inspection activities and root cause analyse your priority findings.
Find out how to utilise big data analytics to understand proactive and reactive root cause relationships and diagnose compliance gaps before they result in harm.
Never again will you or your people need to utter the words….”if only”.
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