Uncle Bill goes to Washington. (OSHA Leading Indicators Stakeholders Meeting Part 3)

If you ask most business owners or executives, they can effectively describe their business operations, and what differentiates them from their competitors. They can describe why their approach results in a superior product or service delivery. If you ask that same person about their safety program, shouldn't they also be able to explain it in detail?

There is an old saying, that nobody wants to know how the sausage is made. But shouldn't everyone be interested in how we ensure that our workers/employees/teammates are not turned into sausage?

If a business owner or executive says that their safety program meets all requirements, is that an answer that they would give about their product or service? Would you buy the product that meets all requirements, but nothing more?

Ownership of safety is crucial to any effective safety program. How can we regulate that business owners and executives take ownership of their organizational safety programs?

The thing is that regulations are designed around quantitative measurements not qualitative measurements. Speed limits are easy to post and enforce, because they are quantifiable. Even driving under the influence is measured in quantifiable ways not qualitative measurements. Our whole legal system is based on quantitative measurements, so much so that opinion and subjective statements are generally against the rules in court.

This does not make qualitative measurements useless, it just makes them more work, but I would also offer that they can be infinitely more valuable when measuring probability of outcomes.

If a firefighter/emt has an unconscious trauma patient, the first set of vital signs (blood pressure, pulse, respirations and skin signs) are not the key to success in all cases. Most of the time, this is considered a baseline reading. What is crucial is do these measurements and indicators stay the same, improve or worsen in the next few minutes.

This same unconscious patient should have their cervical spine stabilized prior to being moved, unless they are in danger of further injury or death. This is a qualitative measurement. It is easy to judge hazards quantitatively after the fact, but it is a qualitative measurement at the time of making a decision about a hazard. Improving the ability of first responders to make this decision correctly is critical in improving patient outcomes, but it is subjective, and difficult to judge one responder against another even under the exact same circumstances and with the same observer making the judgement. But a robust training program coupled with proper leadership, communication and mentoring can produce statistically relevant improvements to the decision-making process, and ultimately to patient outcomes.

So will the hours of training directly correlate to the quality of any given responder’s decision making? Will 20 hours always be twice as good as 10 hours? No. Will the responders score on a test be a direct correlation to their decision-making abilities 1 week later? No.

So how can I effectively and repeatedly ensure that I have prepared all my responders to make the best decision for patient outcomes each and every time?

Different fire departments in different states and counties may have different ways of structuring their programs. On a state by state basis the fire marshal sets curriculum requirements for firefighter certification, but each department is responsible for signing off completion of practical and classroom requirements.

Additionally, emts must pass a national test and a state or county managed set of requirements. But again, the individual department is responsible for verification of both the practical and educational requirements.

Because the department has a vested interest in the ability of their firefighters to perform all tasks well, this process works. But, this is not training alone, this is training, leadership, supervision, teamwork, communication and mentoring. Without the rest, hours of training or education will only get you so far.

Each department will measure a firefighter, operator or officer in its own way. If we try to make them all follow the same measurements, so that we can benchmark the departmental metrics against each other, it would not be as effective.

However, each department is able to successfully develop, implement and maintain its own system of scoring these leading indicators, because they own their measurements, and they are based on all the individuals involved, and the associated organizational dynamics.

Each of these departments must individually satisfy the requirements of the department of labor, a state fire marshal, the jurisdictions insurance carrier, and the jurisdictional government.

They are required to be able to successfully defend their programs to all these groups, and others. They have to show how their programs give them the ability to protect their workers, patients, the public, property and the environment. They are graded both by their quantitative results, and the qualitative assessment of their programs, procedures and processes.

Since this process obviously works a majority of the time based on the quantitative measurements of historical outcomes, we can expect a similar program of regulatory guidance (as opposed to strict definitions and standardization of methods, measurements and processes) to be an effective method for managing leading indicator based safety programs across multiple organizations in multiple industries.