Synonyms: Ambulance driver (government services); Red Cross (or similar organization) ambulance driver

Job profile

Definition and/or description

Drives ambulance to transport sick, injured or convalescent persons. Places patients on stretcher and loads stretcher into ambulance, usually with help of ambulance attendant (medical services). Takes sick or injured persons to hospital, or convalescent to destination, using knowledge and skill to avoid sudden motions detrimental to patients. Changes soiled linen on stretcher. Administers first aid as needed. May shackle violent patients. May report facts concerning accident or emergency to hospital personnel or law enforcement officials (DOT). Also: a person who drives a medical emergency vehicle, ambulance or hospital services (civil or military) vehicle; may assist in delivering babies inside the ambulance.

Related and specific occupations

Ambulance attendant; ambulance-team/nursing aid; funeral car/hearse driver/ chauffeur; hospital/clinic driver; medical services driver; military ambulance driver; motor-vehicle driver (medical services); police ambulance driver; private ambulance driver.

Tasks

Administering (medicines, oxygen, etc.); assisting; carrying; changing; cleaning; communicating; driving; documenting; handling; honking; lifting; loading; locating; logging; maintaining; mending; operating; placing; pulling and pushing; repairing; reporting; restraining; reviving; servicing; shackling; stretching; transporting; warning; writing.

Hazards

Accident hazards

– Increased risk of road accidents due to high driving speeds under emergency conditions (including crossing intersections during red traffic light, driving on sidewalks and steep slopes while trying to reach destination through traffic jams);

– Slips, trips and falls (on stairs or on the level) while carrying stretchers and loads or assisting patients;

– Injuries as a result of carrying out various functions (field repair tasks, tyre changes, etc.) of a vehicle driver (see truck driver, chauffeur, etc.);

– Sudden release of compressed gases (e.g., oxygen or anaesthetic gases) inside the ambulance.

Physical hazards

– Exposure to high noise levels from the emergency horn;

– Exposure to radioactive isotopes (in some countries where ambulance are used for the transport of radioisotopes to hospitals).

Chemical hazards

– Exposure to anaesthetic gases administered to patients inside the ambulance;

– Dermatitis caused by excessive use of rinsing, cleaning and disinfecting agents.

Biological hazards

– Exposure to contagious diseases from patients;

– Potential exposure to body fluids of patients (e.g., blood from wounds).

Ergonomic and social factors

– Back pains and other musculoskeletal problems resulting from overexertion and wrong postures during lifting and otherwise moving of patients, driving over bumpy roads, repairing vehicles on road, etc.;

– Psychological stress due to dangerous driving under time pressure, contact with accident victims, terminal patients and dead bodies, unusual working schedules, prolonged states of alertness, etc.

Addendum

References

International Occupational Safety and Health Information Centre (CIS). 1995. International Safety Datasheets on Occupations. Steering Committee meeting, 9-10 March. Geneva: ILO.

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Background

At present, there is no handbook, manual or other single source which contains the essential data on the various occupational hazards which exist in specific occupations. The variety of the occupations is so great that not even experienced specialists—safety engineers, industrial hygienists, industrial physicians, consultants and researchers—can be familiar with all the hazards existing in each specific occupation. Therefore, occupational safety and health (OSH) experts must search information in the very extensive relevant professional literature and databases and, sometimes, have to scan scores of technical documents. Such searches are complicated, tedious, time-consuming and require access to specialized information sources. Usually, they are beyond the ability and resources of an OSH field worker (industrial hygienist, safety officer, inspector, occupational physician, sanitarian or instructor), and much beyond the possibilities of a non-professional (plant manager, safety committee member or employees’ representative). As a result, quite frequently an OSH worker comes to the workplace without adequate preliminary technical preparation.

This was realized many years ago. An early attempt to create a practical list of hazards according to occupations was undertaken by A.D. Brandt in his 1946 book Industrial Health Engineering. Brandt presented a compilation of about 1,300 various occupations with the relevant occupational hazards in each occupation. The total number of hazards listed was roughly 150, most of them chemical hazards. Since Brandt’s pioneering effort, no systematic work was carried out on the subject, except for a few partial lists related to limited aspects of occupational hazards. However, there were some other efforts in this field, such as the 1964 book Accident Research: Methods and Approaches, by W. Haddon, E.A. Suchman and D. Klein, which attempted to classify the various types of accidents; a “table of health hazards listed by occupation”, which appeared in the 1973 book Work Is Dangerous to Your Health, by J.M. Stellman and S.M. Daum; a set of partial lists of “potential occupational exposures” published in 1977 in the comprehensive National Institute for Occupational Safety and Health (NIOSH) monograph Occupational Diseases: A Guide to their Recognition; and a list of about 1,000 various potential health hazards that might exist in about 2,000 different occupations, which was compiled in 1973 by the School of Medicine of Tel-Aviv University.

All of the projects mentioned above suffer from a number of shortcomings: they are not up-to-date; the lists are only partial and refer to specific aspects rather than to the entire OSH field; and they deal mostly with the chronic occupational hygiene aspect, neglecting largely the safety and acute aspects of the problem. Moreover, none of those lists is in a concise, practical form, such as a pocket-size and easy-to-use manual, or separate single cards that could be used directly in the field.

A compilation of 100 “hazard cards”, in Hebrew, was recently prepared for the Israeli Ministry of Health and deals with the various hazards to which this ministry’s employees (mostly hospital staff and field workers) are exposed. In preparing this compilation, different United Nations and International Labour Organization (ILO) documents related to the classification of occupations and economic activities were used, as were various documents issued by the Commission of the European Communities (CEC) within the framework of its International Programme on Chemical Safety.

The experience gained during the above work gave rise to the idea of starting a project of International Safety Datasheets on Occupations that has been subsequently endorsed by the ILO’s International Occupational Safety and Health Information Centre (CIS) and is currently in progress. For this chapter of the Encyclopaedia, a number of such datasheets has been selected, in order to demonstrate a systematic approach that would be widely applicable and not confined to any specific professional domain. From this point of view, the selection was based on two main criteria: broad diversity of selected occupations with regard to the types of activities involved and their relative risk and the “cross-boundary” character of each occupation, i.e. its presence in many fields of economy.

Methodological Aspects

A consistent conceptual and procedural framework has been elaborated and used in the preparation of the datasheets. It is organized around a checklist, or matrix, serving as a guideline for a systematic and comprehensive analysis of the hazards existing in a given occupation. While helping to reveal and evaluate different hazards that may be present in the occupation, this checklist has an additional function of serving as a template, according to which a hazard datasheet is actually compiled (see table 1).

The use of such a standard and well-itemized template provides a uniform datasheet structure, assuring quick familiarization and easy orientation by a user. Another important consideration is the use of standard phrases and expressions across the whole range of occupations, the advantage being an instant recognition of similar hazards present in different occupations.

The checklist (template), together with a set of standard phrases and key-words, will serve in the future as a basis for developing a Guide for Compilers of Hazard Datasheets, with a purpose similar to that of the Compiler’s Guide for the Preparation of International Chemical Safety Cards (a joint project of the CEC, the ILO, the World Health Organization (WHO) and the United Nations Environment Programme (UNEP)).

The datasheet structure contains the following sections, according to the template:

• Name of occupation: the title taken either from the Dictionary of Occupational Titles (DOT) or from the International Standard Classification of Occupations (ISCO)
• Synonyms: taken from DOT and/or other sources, typically an English-language thesaurus
• Definition and/or description: mostly quoted or adapted from DOT or ISCO. Some definitions quoted from DOT contain abbreviated designations of different industries, according to the “Industry Index” (DOT, Vol. 2). “Professional and kindred occupations” (“Occupations requiring extensive study or experience in professions, technical services, sciences, art, and related types of work”) are designated “Profess. & kin.”; occupations that are “not elsewhere classified” are designated “n.e.c.”; most of the other abbreviations are self-explanatory.
• Related and specific occupations: compiled on the basis of DOT, ISCO, discussions with experts and personal knowledge
• Tasks: compiled from various sources, including the Revised Handbook for Analyzing Jobs (RHAJ), DOT, ISCO, suggestions by experts, etc., and arranged alphabetically
• Primary equipment used and Industries where this occupation is common: The lists of tools, machines and industries were compiled on the basis of discussions with field workers and experts, as well as information found in various technical job descriptions; personal expert knowledge was also extensively used.
• Hazards: The lists of hazards of various types were compiled following thorough examination of numerous information resources, including: previous lists of occupational hazards compiled by various researchers; job descriptions of DOT and ISCO; technical documents issued by national OSH organizations, such as INRS (France), HSE (United Kingdom), NIOSH (US), IIOSH (Israel), etc.; professional literature, including the ILO Encyclopaedia of Occupational Health and Safety; computerized databases (e.g., CISDOC, NIOSHTIC, HSELINE and TOXLINE); interviews with field workers and OSH professionals, as well as personal knowledge and expert evaluation.
• Notes: any additional important and relevant information not included elsewhere, such as information on synergistic effects and warnings about some high-risk situations
• Appendices: auxiliary and supplementary data, such as lists of substances used in a given occupation, etc.

Following its compilation, each hazard datasheet was subjected to peer reviewing and comments by at least two competent specialists.

Table 1. Checklist (template)

NAME OF OCCUPATION

Synonyms

Job profile

Definition and/or description

Related and specific occupations

Tasks

Primary equipment used

Industries in which this occupation is common

Hazards

Accident hazards

Mechanical and general

– Machinery accidents

– Transport accidents

– Falls of persons (e.g., slips, trips on the level, from heights, from a moving vehicle, etc.)

– Falls of heavy objects, materials, wall collapses, etc.

– Stabs, cuts, amputations

– Striking against or struck by objects (bone fracture, bruises)

– Stepping on objects

– Being caught in or between objects, including crushing and tearing accidents

– Pressure vessels, vacuum vessels (bursting, mechanical explosions or implosions)

– Burns and scalds (by hot or cold fluids or surfaces)

– Penetration of foreign particles into eyes

– Swallowing of bulky or sharp-edged non-poisonous solids

– Drowning

– Acute injuries caused by animals (e.g., bites, scratches, kicks, squeezing and trampling, stings, rammings, etc.)

– Overexertion or overstrenuous movements

Chemical accidents

– All acute injuries and effects related to accidental release, spillage, inhalation, swallowing of, or contact with, chemical agents (except fire or explosions)

Electrical accidents

– All injuries and effects related to electric current and static electricity

Fires and chemical explosions
Radiation accidents

– Injuries involving accidental exposure to high doses of ionizing and non-ionizing radiation, including laser beams and strong light, UV, etc.

Physical hazards

– Ionizing radiation (including, e.g., x rays, alpha-, beta- and gamma radiation, neutron and particle beams, radon, etc.)

– Non-ionizing radiation (including the whole spectrum of electromagnetic non-ionizing radiation, e.g., visible light, UV and IR, laser beams, RF, MW, etc.); electric and magnetic fields

– Vibration (affecting whole body; vibration-related hazards affecting specific organs appear under “Ergonomic and social factors”)

– Noise (including also ultra- and infrasound)

– Exposure to weather, extreme heat or cold, reduced or increased barometric pressure (including heat stroke, sun stroke, heat stress, cold stress, frostbite, etc.)

Chemical hazards*

* Hazards related to non-accidental exposure to chemicals

Direct/immediate effects:

– Irritation of mucous membranes, eyes and respiratory system

– Effects on the nervous system (headaches, reduced alertness, intoxication, etc.)

– Gastrointestinal disturbances

– Skin effects (itching, erythema, blistering, etc.)

– Effects of “routine” exposure on ultrasensitive persons; effect of combination of “routine” factors, e.g., non-accidental formation of phosgene when smoking in presence of organochlorine compounds

– Asphyxia

Delayed, chronic or long-term effects:

– Chronic systemic poisoning

– Other systemic effects (e.g., hematopoietic, on the gastro-intestinal, urogenital nervous systems, etc.)

– Skin effects (dermatoses, skin sensitization and allergies, etc.)

– Eye effects (cataracts, impaired vision, corrosive damage, etc.)

– Inhalation effects (lung oedema, chemical pneumonitis, pneumoconiosis, asthmatic reactions, etc.)

– Ingestion effects (sore throat, abdominal pain and/or cramps, diarrhoea, nausea, vomiting, reduced consciousness, coma, etc.)

– Chemical allergies not included above

– Effects on reproductive system, pregnancy (spontaneous abortion, embryo- and foetotoxicity), birth defects

– Carcinogenesis and mutagenesis

Biological hazards

– Microorganisms and their toxic products

– Poisonous and allergenic plants

– Exposure to animals which can lead to diseases and allergies (from hair, furs, etc.)

Ergonomic and social factors

Hazards related to working postures, man-machine interactions, lifting, mental or physical stress, nuisance and discomfort (e.g., sick building syndrome, poor illumination, air pollution from sources not related to workplace, human relations, violence, biorhythms, bad smells, vibration affecting specific body organ, e.g., carpal tunnel syndrome, etc.)

Addendum

Notes

– Special alerts

– Statistical data (e.g., “increased risk of ...”; “excess mortality...”, etc.)

– Synergistic effects

– Special circumstances or combinations of factors

– Any important relevant information not included elsewhere

References

Appendixes

List of chemicals, etc.

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Background

This case study, which presents an example of a successful national safety campaign, is based on 24 years of experience organizing the annual National Safety Day (NSD) Campaign in India. The Campaign celebrates the foundation by the Government of India of the National Safety Council (NSC) in the Ministry of Labour on 4 March 1966 as an autonomous, non-political and non-profit-making organization at the national level to generate, develop and sustain a voluntary movement with respect to occupational safety and health (OSH). The NSC’s Board of Governors is broad-based, with representation from all the central organizations of employers and trade unions. Total membership was approximately 4,000 in April 1995, drawn predominantly from the industrial sector, although there also is some membership from non-industrial sectors. In 1966, industrial workplaces in India experienced a rising trend of accidents, and enforcement of safety and health statutes by government agencies alone was not sufficient to reverse this trend. The birth of the NSC as a voluntary body in such a national perspective therefore constituted an important milestone. For many years, the NSC mainly concerned itself with industrial safety; however, with the coverage of some non-industrial sectors in recent years, its scope has been expanded from industrial to occupational safety. The coverage of occupational health, however, is still in its infancy in India. As the idea found favour of commemorating the foundation day of the NSC in the form of a national awareness campaign, the first NSD Campaign was launched in 1972. NSD became an annual event, and even though the duration of the Campaign has been increased to a week, it continues to be known as the National Safety Day Campaign due to the popularity that the title has gained.

Objectives

The objectives of the NSD Campaign, which have been kept broad, general and flexible, include the following:

• to increase OSH standards throughout India
• to enlist the support and participation of all major participants in different sectors at different levels, such as the central and state governments and their regulatory agencies and institutions; district and local administrations; non-governmental organizations (NGOs); employers’ organizations; public, private and joint-sector undertakings; trade unions
• to promote the active participation of employers in the education of their employees to achieve OSH goals in their workplace through the use of local knowledge, experience and talent
• to foster development of need-based programmes and activities, self-compliance with statutory requirements, and strengthening of professional OSH management systems in undertakings
• to bring into the fold of the voluntary OSH movement certain sectors not so far covered by safety and health legislation in the country—for instance, the construction sector, the research and development sector, and small shops and establishments using hazardous machines, equipment and materials.

The above objectives are part of an overall goal of creating and strengthening OSH culture in workplaces and integrating it with the work culture. In a developing country, achievement of this goal continues to be a highly challenging task.

Methodology and Approach

The methodology and approach used to introduce and promote the Campaign initially comprised two elements: (1) issuing of letters of appeal to NSC member organizations to organize the Campaign; and (2) providing them with professionally designed promotional materials such as badges, copies of the NSD pledge (see box), cloth banners, posters, stickers and so on, and promotional-cum-utility items such as key chains, ball-point pens, and paperweights with OSH messages printed on them. These materials are centrally designed, produced and distributed by the NSC with the following three aims.

1. to make it convenient for the participants to organize the Campaign without having to go through the time-consuming and costly process of designing and producing such materials in small quantities themselves
2. to ensure that the Campaign materials are of professional quality with appealing messages reflecting national OSH issues
3. to generate income to contribute to NSC’s financial self-reliance with respect to the fulfilment of the wider objective of strengthening the voluntary OSH movement in India.

Text of National Safety Day Pledge

On this day, I solemnly affirm that I will rededicate myself to the cause of safety, health and protection of environment and will do my best to observe rules, regulations and procedures and develop attitudes and habits conducive for achieving these objectives.

I fully realize that accidents and diseases are a drain on the national economy and may lead to disablement, death, damage to health and property, social suffering and general degradation of environment.

I will do everything possible for prevention of accidents and occupational diseases and protection of environment in the interest of self, my family, community and the nation at large.

(In some states, the above pledge has been administered by the Governor of State to state ministers, other government officials, executives and workers from industries, and the public participating in NSD functions. In private enterprise, it is usual for the chief executive or some other top executive to administer the pledge to all employees.)

In its initial years, the Campaign was confined to NSC members and grew gradually. After about a decade, the methodology and approach were widened in the following strategic ways:

1. The Union Ministry of Labour, responsible for OSH in the workplace, was asked to extend support to the NSC’s efforts to approach the State Governments for aid in the organization of celebrations. Since then, the Union Labour Minister has requested that the State Labour Ministers organize celebrations by constituting Campaign Committees at the state and district levels; these committees would be comprised of representatives of industries, workers and officials of the concerned government departments, and would send reports to the Central Government. Such support has given the Campaign national stature.
2. The electronic media (television and radio) under state control has been advised by the Government to cover the Campaign. Such coverage has made the Campaign highly visible.
3. The NSC’s own journals, as well as newspapers and magazines published by employers and trade unions and the national and local press, have been involved more effectively.
4. The duration of the Campaign has been increased to a week, and flexibility has been provided to participants to start or conclude the Campaign on any convenient date, taking care to include 4 March (NSC foundation day) in the week. This has increased the span of visible impact of the Campaign.
5. The state chapters and district action centres of the NSC have actively involved the state governments and district administrations in the Campaign at the grass roots.
6. The Campaign has grown over the years. Figure 1, figure 2 and figure 3 show this growth in terms of the persons reached for the pinning of the badge and the financial receipts from the sale of Campaign materials.

Figure 1. Growth of NSD campaign in terms of persons reached for pinning badge

Figure 2. Growth in terms of financial receipts from sale of NSD campaign materials (1972-1982)

Figure 3. Growth in terms of financial receipts from sale of NSD campaign materials (1983-1995)

Participation at Different Levels

Participation by all stakeholders at the national, state, district and individual enterprise levels has been of vital importance to the success and effectiveness of the Campaign. However, the degree of involvement by various stakeholders has not been uniform. In the first instance, different stakeholders started participating in the Campaign in different years. Furthermore, their perceptions regarding their roles and needs vary greatly. For example, some governments, particularly those of industrialized states, have been organizing elaborate and purposeful activities, but in some other less industrialized states, they have been low-key. Similarly, while some industry associations have lent great support to the Campaign, others have yet to start participating. While activities at the national, state and district levels have dealt with broad issues, those at the individual enterprise/undertaking level have been more detailed and need-based.

Campaign Materials

The national OSH issues and messages to be projected through a particular year’s campaign materials produced by the NSC are identified by a core group of professionals from the NSC, industry and trade unions. The visuals for communicating them in a simple, humorous and effective way are designed by eminent cartoonists. In this way it is ensured that the campaign materials are original, attractive, appealing and rooted in Indian culture.

These materials fall into two broad categories: (1) purely promotional materials used for display and educational purposes; and (2) promotional-cum-utility materials which, besides promoting the OSH messages, are also good for day-to-day use. In the second category, most items are for the daily use of workers and are relatively inexpensive and affordable by managements of various enterprises for free distribution to all their employees. Some items appropriate for use of executives are also produced to give them a sense of involvement. To prevent the items from becoming monotonous, they are changed either completely or in style and appearance in different years.

As the Campaign has grown over the years and the demand for Campaign materials substantially increased, a number of private producers and suppliers have emerged who produce materials as per their own market research. This has been a welcome development. Individual enterprises also produce materials relevant to specific themes of their need-based campaigns. Many of these organize contests among their employees to generate ideas and then publicize the prize winners through their campaign materials.

Activities

At the national level, activities have taken the form of public functions, seminars, discussions and debates, the issuance of appeals and messages and the release of special films on national OSH issues. Participation of the Union Minister and top officials of the Ministry of Labour, Chairman and senior officials of NSC, senior executives from industry, national trade union leaders and eminent persons from institutions, NGOs and the public has imparted to these activities the desired level of impact. The national television and radio networks, the press and other print media have been involved in propagating these activities widely.

At the state level, activities vary from state to state but are generally of the same type as at the national level. The emphasis of these activities is on the projection of specific state issues through the medium of regional language. A welcome trend observed in state activities in recent years has been that an important government function, namely, distribution of state safety awards, is combined with the Campaign celebrations.

The activities at the individual enterprise level are more practical and varied. Generally, such activities are designed by the safety committee (if existing as per statutory requirements applicable to enterprises employing a certain minimum number of employees) or by a specially constituted task force set up by management. Some typical activities are contests among employees or among different departments for good housekeeping, lowest accident frequency rate, and accident-free work, safety posters, safety slogans, safety suggestions and so on, exhibitions, skits, dramas, one-act plays, songs, training programmes and seminars, lectures, screening of films, practical demonstrations, organizing of emergency drills, holding of functions, and so on. Experts from outside the enterprise are also invited as guest speakers.

Some of the most common and important approaches which have contributed to the effectiveness of activities at the enterprise level may be summarized as follows:

• The dramatizations and plays staged by employees of some enterprises have been of good professional quality and offer effective entertainment, communicating accident case histories with lessons to be learnt. Such plays have been video recorded for telecasting on state and national television networks, thereby increasing their impact.
• Qwaali, a popular form of song on the Indian subcontinent, has also been commonly used for communicating OSH messages while providing entertainment consistent with Indian cultural traditions.
• A number of large companies, in both the public and private sectors, have their own residential colonies and schools for the benefit of their employees. Many of these companies have designed activities including contests to involve families and students in safety and health; this has had a positive impact on the motivation of the employees. Even undertakings not having their own residential colony or school have used this approach to involve the families and school-age children of their employees with similar success.
• In the wake of the Bhopal disaster, many enterprises engaged in manufacture, storage or use of hazardous chemicals and having potential for major accidents have developed activities to create awareness of OSH in nearby communities. They invite members of these communities to visit their plants for exhibitions or functions during the Campaign. They also invite government authorities as guests of honour. This approach has been useful in building cooperation among industry, government and community, so important to ensure quick and effective response to chemical emergencies at the local level.
• Activities involving practical demonstrations of important safety-oriented resources such as the use of firefighting methods and personal protective equipment, the holding of emergency drills and the conducting of tailor-made in-plant training courses and seminars on specific needs have proved successful in creating enthusiasm and a supportive environment within enterprises.

The approaches listed are particularly suitable for OSH campaigns at the unit level.

Impact Achieved

The NSD Campaign has shown a positive impact on the trend of industrial injuries (reportable under the Factories Act) in India. As shown in table 1, the incidence rate of industrial injuries (injuries per 1,000 workers) decreased from 75.67 in 1971 to 26.54 in 1992 (the latest year for which published statistics are available), a reduction of about 65%. It should be noted that this reduction is due to the combined impact on OSH of government policy and legislation, enforcement, education and training, promotion, modernization of industrial processes and operations, and so on, as well as of NSD Campaign activities.

Table 1. Number of Indian working factories, estimated average daily employment, reportable injuries and their incidence rates

Key to Symbols: P = provisional; * = incomplete data.

Source: Labour Bureau.

The research and development sector under the Central Government, comprising 40 national laboratories located all over India and employing over 26,000 employees, including over 9,000 scientists, does not fall under the purview of any OSH legislation. For the last 3 years, the corporate level and the individual laboratories have started organizing NSD celebrations, have set up safety cells and are proceeding in a systematic way towards establishing a sound system of OSH management. This is a concrete example of the impact of the NSD Campaign in strengthening the voluntary OSH movement in India.

The organizations in charge of nuclear power stations, heavy water plants and research reactors, as well as other divisions in the Department of Atomic Energy (DAE) of the Government, have been organizing celebrations during the NSD Campaign. They have instituted interdepartmental contests and awards for achievements in the fields of safety, health and environmental protection. The enforcement of safety and health statutes in the above establishments is carried out by an independent agency under the control of DAE, but these units are not open to inspection by state regulating agencies covering other workplaces. Activities under the Campaign have served to create interaction between departmental and external regulatory agencies and between the NSC and other institutions, and have furthermore facilitated the dissemination of OSH information to the public.

Located on the west coast, Gujarat is one of the most industrialized states in India. The state has 525 medium and large factories manufacturing, storing or using one or more of 38 hazardous chemicals. All these factories have prepared and rehearsed emergency plans. As a part of the last NSD Campaign, each of these larger entities was requested by the Chief Inspector of Factories to impart practical training in the use of breathing apparatus and fire extinguishers to emergency-response workers from 10 small factories located in its neighbourhood. Six workers (two from each shift) were selected from each small unit, for a total of 31,500 workers from 5,250 units. This case is illustrative of the impact of the Campaign in making available practical emergency training to small units engaged in hazardous processes.

In conclusion, the most important contribution of the NSD Campaign may be summed up as creating awareness in business and industrial circles and the public that safety, health and environmental protection constitute a vital and integral part of the strategy for sustainable development. However, there is a long way to go before this strategy is translated into a greater reality. The NSD Campaign will no doubt have an increasing role to play in achieving this reality.

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The aim of safety promotion is to induce employees to improve their own protective behaviour and that of their co-workers, and to support an organization’s stated safety goals. Safety promotion objectives include increasing safety awareness at all organizational levels and confirming the furtherance of employee safety as a top management priority.

The ultimate effectiveness of any promotion programme or activity depends directly on how well an organization manages its safety programme. Safety promotion can play an important contributory role in improving workplace safety when sound hazard management practice exists at all operational phases, including facilities planning, machine design, employee training and supervision, personal protective equipment, environmental maintenance, housekeeping, emergency response and rehabilitation.

No matter how intrinsically effective and efficient a safety promotion scheme is in changing employee attitudes and behaviour, it requires management support in the form of visible leadership and commitment. This condition is a prerequisite for a successful promotion, be it focused on production, product quality or employee safety and health. It is also the consistent characteristic that marks all successful safety programmes, no matter how much their specifics differ.

Employee Motivation

Safety promotion relates directly to the concept of motivation, which has been the subject of a great deal of research. There is controversy about how and why people are “motivated” either to adopt new behaviours or change old ones. A central issue concerns the relation between attitudes and behaviour. Must attitude change come before behaviour change? Can behaviour change exist without attitude change? Does attitude change predict behaviour change? Does behaviour change cause attitude change?

Answers to these questions are uncertain. There are those who insist that motivation is best achieved by changing external behaviour alone, while others feel that internal attitude or cognitive change must be part of the behaviour change process. Both of these viewpoints have influenced the conduct of safety promotion.

Although not directly observable, motivation can be inferred from changes in behaviour and attitudes. Three variables that define motivation are as follows:

• Direction of behaviour requires the specification of objectives and the provision of the necessary training or education to achieve them.
• Intensity of action involves the realization and strengthening of behaviour and attitude change primarily through reinforcement and feedback.
• Persistence of effort involves making the desired behaviour and attitude changes permanent in all facets of employee performance.

Safety Promotion Models

The safety literature describes a variety of safety promotion theories and methods that address each of the motivational variables; among these, two models have shown the capacity to improve safety performance. One, organization behaviour management (OBM), focuses on behaviour modification and the application of behaviour control methods developed by B.F. Skinner. The other, total quality management (TQM), focuses on process modification and the application of quality control principles developed by W.E. Demming.

Behaviour modification is founded on the premise that the causes of behaviour are environmental in nature. Accordingly, one can predict and control behaviour by studying the interaction between individuals and their environments. This knowledge requires the specification of three conditions:

1. the antecedents of behaviour—that is, the occasion on which a response occurs
2. the behaviour or action that occurs
3. the consequences that reinforce the behaviour or action.

Quality improvement requires a “constancy of purpose” or commitment by both employees and management to make improved product and service quality a corporate priority. This attitude adjustment rests on a conscious management decision to do whatever it takes to make the quality improvement vision a reality. Quality improvement objectives are broader in scope and the methods for their achievement are less uniform than those of behaviour modification. They are more concerned with changing or even eliminating total processes than with modifying individual behaviours.

As shown in table 1, both models are responsive to the variables and supporting actions that motivation requires. The models differ, however, on the safety emphases used to motivate employees. As a result, they differ in terms of their efficiency in satisfying the requirements of the three motivational variables.

Table 1. OBM vs. TQM models of employee motivation

OBM Model

Direction of behaviour

OBM safety objectives are usually narrow in scope and focus on increasing the occurrence of specific safe behaviours, thereby decreasing the incidence of unsafe acts. The following sources can be used to select unsafe acts or behaviours as targets for observation and eventual reduction:

• analysis of incident investigations and related safety records
• interviews with employees at all levels to obtain data on unreported events, hazards and so forth
• observation of in-house safety inspections.

Based on information from these sources, employees are asked to assist in establishing a list of priority behaviours judged to be critical to improved safety performance. An observation system to track the occurrence of these critical behaviours is established, observers are trained and an observation schedule is set. The incidence of priority behaviours is then observed during a pre-intervention period. This phase of the problem definition process provides baseline data against which to measure the success of the behaviour modification process. These data also alert employees to the presence of unsafe behaviour in the workplace.

Employees are then exposed to training that covers the behaviours to be practised, offers safe behaviour performance guidelines, and allows for behavioural feedback. For example, workers are sometimes shown slides or videotapes of safe and unsafe practices, followed by discussion. At this time they are also shown baseline data and encouraged to improve their performance of critical safe behaviours. The data, often in chart form, are posted in the plant to prepare for the subsequent phases of the OBM programme. The activities of observation and recognition are performed on a continuing basis by supervisors or trained co-workers. As appropriate, new job safety performance elements are added to the training and become part of the programme.

Intensity of action

OBM uses both individual reinforcement and group feedback to modify behaviour. Reinforcement occurs at the individual employee level in the form of verbal praise or other sorts of recognition when a display of safety behaviour is seen in the workplace. Feedback about the level of safety behaviour exhibited by the group is also communicated throughout the programme.

Various types of rewards can be used to reinforce behaviour, such as the following:

• individual monetary incentives (e.g., cash awards and tokens for the purchase of consumer goods)
• praise and feedback (e.g., knowledge of results, congratulatory notes and positive comments)
• team competitions, which may involve the use of cash awards.

Rewards are often used in combination, so it is very difficult to isolate the impact of any individual type of reinforcement. Nevertheless, it is clear that positive responses to safe behaviour do increase its occurrence.

Reinforcement also includes group feedback about safety performance, which frequently takes the form of learning curves or bar charts tracking the percentage of safe behaviours that are observed during the intervention period. This information is displayed prominently so that the work group is aware of progress. This knowledge tends to maintain safe work group performance and stimulate future efforts at improvement.

In the OBM paradigm, reinforcement and feedback require a continuing programme of behavioural observation. This condition enables positive communication to occur on the spot when safe behaviours are seen or when unsafe practices require correction. Although behaviour modification emphasizes positive reinforcement rather than discipline, its proponents recognize that reprimands or other aversive actions may be necessary in certain situations. Whenever possible, however, these steps should be avoided because their effects are usually short-lived and may diminish employee commitment to the total programme.

Persistence of effort

OBM effectiveness in sustaining behaviour change depends on continuous observation and reinforcement of specific safe behaviours until they become self-reinforcing and a habitual part of an employee’s job activity. The strength of OBM rests in the creation of a measurement system that allows a company to continually monitor and control critical behaviours. To achieve long-term success, use of this measurement system must become part of an organization’s management style.

There is little doubt that the OBM approach produces positive results and does so relatively quickly. Most studies show that the use of positive reinforcement, in the form of incentives or feedback, enhances safety and/or reduces accidents in the workplace, at least over the short term. In contrast, longevity of behaviour change as produced by OBM procedures has not been fully demonstrated by research. In fact, most of the studies conducted are short-term in duration (less than one year). This situation has raised questions about the permanence of OBM treatment effects, although two studies of OBM techniques, one conducted in the United States and the other in Finland, have reported some long-term positive effects.

In the United States, the use of a trading stamp award system improved safety performance in two coal mines for more than ten years. In this study, employees earned stamps for working without lost-time injuries, for being in no lost-time injury work groups, for not being involved in equipment-damaging incidents, for making safety suggestions that were adopted, and for unusual incident or injury prevention behaviour. Besides the token award system, workers received extensive training during the baseline period, intended to prompt safe behaviour and to maintain safe work conditions. This training activity was regarded as very important to the improvements obtained.

In Finland, significant housekeeping improvements in a shipyard were achieved during a three-phase programme featuring feedback to foremen and workers following baseline measurement and employee training. These improvements, expressed as higher housekeeping indices, continued to be observed at the new high level throughout a two-year follow-up period during which no feedback was given. Significant accident reductions were also noted throughout the project’s duration. The long-term effects of this programme were attributed to reinforcement that concentrates on the outcome of behaviour and persists in the environment (as housekeeping changes do), rather than simply on a behaviour, which influences workers for only seconds.

These studies notwithstanding, it is difficult to determine the long-term efficacy of OBM approaches in maintaining safety performance improvements. In the US study, the use of tokens evidently became an accepted part of the mines’ management style, but there was also a strong emphasis on training. Learned feedback from environmental changes that are an outcome of behaviour, as reported in the Finnish study, looks promising. Here too, however, there is some indication that other factors may have been operative to influence shipyard employees during the follow-up “no feedback” period.

With these observations in mind, the bulk of research suggests that feedback must be maintained if OBM programmes are to achieve lasting success, and that this process must be accompanied by a management style that permits it. When these conditions are absent, positive behaviour change effects diminish rapidly and revert to previous levels. Where housekeeping improvements are involved, there is some evidence that the higher performance levels continue for a relatively long period, but the reasons for this remain to be determined.

TQM Model

Direction of behaviour

TQM goals are broad in scope and centre on creating improved processes. There is an emphasis on discovering and eliminating the conditions that cause or support the existence of unsafe behaviours, as opposed to a concentration on unsafe acts as the cause of injuries.

The TQM approach uses many of the same methods as OBM to uncover safety performance deficiencies that are to become targets for improvement. Additionally, it concentrates on the management systems and practices that contribute to these problems. These conditions may appear in all functions, from planning, through organizing and decision making, to evaluating cost-effectiveness. They also include the presence or absence of practices that incorporate employee safety considerations into everyday business processes such as the application of ergonomic principles to workplace and equipment design, review of purchasing specifications by safety and health professionals, and timely correction of reported hazards. Operational indicators such as the lattermost, combined with injury, downtime and employee absence records, provide baseline information on how well the management system supports the safety function.

Employee safety programme perception surveys have also become a popular tool for assessing the safety management system. Employees give their opinions about the effectiveness of the management practices and safety support activities that are present in their company. These data are gathered anonymously according to standard administrative procedures. Survey results help to set improvement priorities and provide another baseline against which to measure progress.

Just as TQM defines its performance objectives more broadly than OBM, it also makes a broader spectrum of training available to employees. TQM-based instruction teaches employees not only how to be safe but educates them about self-improvement and team-building methods that make possible ongoing contributions intended to increase safety throughout the organization.

The importance cannot be overstated of task planning at the systems level and providing sufficient safety training for employees whose jobs are expanded or enriched through process changes. There is some evidence indicating that as the number and variety of nonrepetitive tasks to which workers are exposed increases, so too does the frequency of accidents. It is not clear that this unwanted potential outcome has been recognized in the TQM literature.

Intensity of action

TQM uses various methods for reinforcing improved processes. These aim at creating an organizational culture that supports concerted employee effort to make process improvements. The mechanisms for behaviour change also incorporate reinforcement and feedback techniques to both recognize and reward performance improvement.

Several key conditions that support the development of improved processes are as follows:

• an open corporate climate with increased information sharing and removal of formal departmental barriers
• a focus on employee involvement, teamwork and training at all levels
• the removal of informal barriers to pride of workmanship
• a corporate culture that involves all employees in contributing to improvements
• follow-up to act upon or more fully develop new ideas for process improvement.

Adoption of these measures leads to higher employee morale and satisfaction that can increase the willingness to improve safety performance.

It should be noted that reinforcement at the employee level is regularly used in the TQM model. Rather than responding to specific critical behaviours, however, individuals receive praise for safe work at any phase of a process, with the goal being to encourage employees to internalize a process that incorporates improved safety performance.

Feedback about observed safety and health improvement results is also provided periodically through such media as meetings and newsletters, as well as through the conduct of follow-up surveys. These results are presented in the form of operating indicators. They may include such indices as lost workdays due to occupational injury and illness, number of safety and health improvement suggestions submitted, attendance levels, workers’ compensation costs and employee attitudes toward safety.

Persistence of behaviour

The long-term effectiveness of the TQM approach resides in its capacity to create or continuously improve processes that support safe job performance. These improvements require both attitude and behaviour change. They also must be endorsed at the deepest levels of management practice and philosophy if they are to last. That is, they must become part of an organization’s culture. For these reasons, positive results are not realized immediately. For example, successful users of TQM report an average of three years to achieve improved quality performance.

Evidence about the relationship between TQM and improved safety performance comes from two sources: the safety records of companies that have used TQM to successfully improve product and service quality, and the safety support processes used by companies with excellent safety records. Of 14 US companies receiving national recognition for excellence in quality management and achievement in the form of the Malcolm Baldrige National Quality Award, 12 had better lost-workday injury and illness rates than their industry average. Eleven of these companies also reported improved rates associated with the introduction of TQM practices, while only three companies had worse rates.

The efficacy of TQM techniques as applied to occupational safety is also exemplified by National Safety Council member companies with the most outstanding safety performance records in the United States. These successful programmes emphasize a “humanistic” approach to employee management, featuring less discipline, more active worker participation and better communication between workers and management.

Because TQM emphasizes employee involvement and empowerment in implementing system and process safety and health improvements, the potential for permanent change is maximized. Its emphasis on educating employees so that they are able to better contribute to future safety performance improvement also lays the groundwork for long-term effectiveness. Finally, TQM approaches visualize employees as active decision makers who are responsible for rather than simply responsive to the environment. These features make it highly likely that both employees and management will be committed to change produced through TQM on a long-term basis.

Comparison of OBM and TQM

OBM seeks to decrease specific unsafe practices and increase safe performance through a structured approach that defines critical behaviours, trains employees in safe/unsafe practices, establishes a system of behaviour observation, and uses a schedule of reinforcement and feedback to control employee behaviour. Its strengths are its emphasis on behaviour observation and results measurement, and the rapid production of positive results when the programme is present. Its weaknesses rest in its focus on specific behaviours that may not have been integrated with the need for management system changes, the use of an external control programme to maintain employee behaviour, and lack of demonstrated staying power.

TQM seeks to improve processes within the management system that affect employee safety and health. It stresses both attitude and behaviour changes and relies on a broad range of employee involvement and training programmes to define both safety and health improvement objectives and the means to achieve them. It uses reinforcement and feedback aimed at recognizing process improvements and employees’ contribution to them. Its strengths are in its emphasis on employee participation and internal control (facilitating and reinforcing both attitude and behaviour change), its capacity to sustain safety and health improvements, and its integration within an organization’s total management effort. Its weaknesses rest in its dependence on: (1) high levels of management/employee involvement that take time to develop and show improved results, (2) new process measurement systems, and (3) management’s willingness to allot the time and resources it takes to produce positive results.

Safety Promotion Programmes and Practices

In what follows, the interaction between wage systems and safety will first be considered. Wage systems have a critical effect on employee motivation in general and have the potential to influence worker safety attitudes and behaviour in the context of job performance. Incentives, including both monetary and non-monetary rewards, will be examined in light of their debated value as a safety promotion tactic. Finally, the role of communications and campaigns in safety promotions will be described.

Wage systems and safety

Wage systems can affect safety indirectly when incentive compensation, gain-sharing or bonuses are established to increase production, or when piece-work pay structures are in effect. Each of these arrangements may motivate workers to sidestep safe work procedures in an effort to increase earnings. Also, wage systems can be directly tied to safety considerations in the form of compensating wages that are paid for work that involves above-average risk.

Incentive wages

Incentive compensation or gain-sharing programmes can be established for productivity; for safety records; for scrap, rework and return rates; and for a variety of other performance criteria, alone or in combination. Such programmes have the potential to communicate management strategy and priorities to employees. For this reason, the performance criteria that an organization includes in its incentive wage system are critical. If safety performance and related factors are part of the package, than employees are likely to perceive them as being important to management. If they are not, then an opposite message is sent.

There are situations where work performance is introduced as a wage incentive criterion to induce workers to put up with dangerous conditions, or to fail to report accidents. Some commentators have noted the increased occurrence of this abuse, particularly in enterprise bargaining agreements and in efforts to reduce workers’ compensation premiums. Obviously, this practice not only sends employees the wrong message but is counterproductive and will ultimately increase employer costs.

Although the theory behind incentive compensation appears to be strong, in practice its influence on worker productivity is far from certain. Research on the effects of financial incentive schemes on productivity shows extreme variability of results, indicating that naive approaches to the planning and implementation of incentive compensation programmes can lead to problems. However, when applied correctly, these programmes can have very positive effects on productivity, especially output.

A US investigation of the effects of bonus plans on accidents and productivity in 72 mines yielded little evidence that they had any significant impact either on improving safety or increasing production. Some 39% of these plans included safety in bonus calculations, while the rest did not. Within the study sample there was wide variability in the bonus payout frequency. Although the modal payout period was monthly, in many cases miners earned productivity bonuses only once or twice a year, or even less often. In such cases, the effect on production was negligible and, as might be expected, safety performance was not affected. Even among mines that paid production bonuses more than 80% of the time, no significant negative effects upon miner safety (i.e., increased lost-time accident frequency rates) were found. Mines that had monetary bonus plans directed solely at safety also failed to produce accident rate reductions. Most of these used lost-time accidents and violations as performance criteria, and experienced the same low payout problem that plagued many of the productivity-based plans.

The failure to find a clear-cut relationship between incentive compensation and productivity or safety in this study highlights the complexity of trying to conduct successful wage incentive programmes. Although increased wages are important, the perceived value of money varies among workers. There are also many other factors that can influence whether monetary incentives will have the desired motivational effect. Incentive or gain-sharing programmes often fail to produce expected results when employees think the programme is unfair. Actions that can be taken to help prevent this from happening and reinforce the motivational properties of an incentive programme include the following:

• Set a performance standard that employees perceive to be reasonable.
• Make bonus earning intervals short.
• Use multiple performance criteria.
• Include only performance objectives that employees can control.

Controversy also surrounds the use of piece-rate pay. It is, perhaps, the most direct way to relate pay to performance. Even so, the literature is full of studies that describe adverse behaviour that piece-rate plans produce. Piece-rate plans often create adversarial relationships between employees and employers in matters that are inherent to productivity. These involve the determination of production rates, the establishment of informal limits on production, and the negotiation of off-standard piece-rate plans. In some situations, performance may decline in spite of higher rates of payment.

Unfortunately, the very existence of piece-rate plans, whether or not they have their intended effect in the form of increased productivity, creates an atmosphere that can be detrimental to safe job performance. For example, a study investigating the transition from piece-rate to time-based wages in the Swedish forestry industry found reduced accident frequency and severity. Following the wage system change, several hundred forestry workers were questioned about its effect on their job performance. They indicated three major reasons for the reduction, including:

• reduced pressure to work fast, take risks and ignore specific safety guidelines
• reduced stress, leading to fewer errors in judgement
• more time to consider safety matters, try new methods, and benefit from interactions with peers.

The Swedish experience was only partially corroborated by earlier research conducted in British Columbia in Canada. In this case, there were no differences in accident frequency between piece-work versus salaried “fallers” in the logging industry, although more severe accidents among piece-work fallers as compared with their salaried counterparts were reported.

In the final analysis, opinion remains divided as regards the potential uses and abuses of incentive wage systems, their contribution to increased productivity, and their effect on safety. Nevertheless, research supporting any of them is scarce, and what evidence exists certainly is not conclusive. Clearly, the effect of incentive compensation programmes on safety depends on their content, their mode of conduct, and the circumstances surrounding them.

Compensating wages

Economists have been studying the subject of extra pay for high-risk work in an effort to place an economic value on human life and to determine whether the marketplace already compensates for high-risk exposures. If so, it may be argued that government interventions to reduce risk in these areas are not cost-effective because workers are already being compensated for their exposure to increased hazards. Attempts to validate the compensatory wage theory have been made in the United States and England using available mortality estimates. At this time, it would appear that the compensatory wage theory has been supported to a degree in England but not in the United States.

Another problem that besets the compensatory wage theory is the fact that many workers are unaware of the true risks associated with their jobs, particularly occupational disease exposures. Surveys done in the United States suggest that large percentages of workers are not aware of their exposures to hazardous working conditions. Also, psychologically speaking, individuals have a tendency to minimize the importance of very low probabilities associated with their own death. As a result, even if workers were aware of the actual risks associated with their work, they would be willing to take those risks.

Although the issue of compensatory wages poses some intriguing theoretical questions which remain currently unresolved, the true danger of a compensatory wage structure relates to its underlying causes. When employers use extra pay in any form as an excuse for continuing a substandard safety and health programme, the practice is harmful and totally unacceptable.

Safety incentives

The term incentive can be defined as a reason for undertaking action with extra zeal in an effort to receive a reward. The use of incentives to motivate employees is a common practice throughout the world. Nevertheless, the value of incentive programmes is a subject of controversy among scientists and practitioners alike. Opinions range from the denial of any link between incentives and motivation to the contention that incentives are primary factors in the behaviour change process. Between these two extremes, there are those who see incentive programmes as a useful stimulus to improve productivity and those who see them as promoting the wrong sort of employee behaviour with results that are exactly the opposite of what is intended.

In the area of safety and health, opinions about the utility of incentive programmes are no less diverse. In some organizations, for example, management is reluctant to offer extra incentives for safety because it is already an integral part of job performance and needn’t be singled out for special emphasis. Another opinion suggests that offering incentives for improved safety performance diminishes the perceived intrinsic value of worker well-being on the job, which is, after all, the most important reason for emphasizing safety in the first place.

Along with the philosophical reasons for questioning the value of incentive programmes there are other issues that must be considered when discussing their merits or potential contributions as a safety promotion practice. These are problems related to the criteria upon which incentive programmes are based, the possibility for abuse of the programme by both employers and employees, and the maintenance of employee participation.

The criteria for awarding incentives are critical to the success of the programme. There are shortcomings attached to incentive programmes that are tied solely (1) to accumulating a certain number of safe days, (2) to lost-time injury rate (to workers’ compensation premium reduction), and (3) to some other accident-related measures. Accident criteria are not very sensitive. Success is measured negatively, by the reduction or non-occurrence of events. Because accidents are rare events, it can take a relatively long time for significant improvements to occur. Such indices do not assess an organization’s safety record but its reported accident record, which can be influenced by numerous factors not under the control of incentive programme participants.

Both employers and workers can abuse safety incentive programmes. Employers sometimes use incentive programmes as a substitute for the establishment of a legitimate safety and health management system or as a short-term cure for long-standing safety and health deficiencies that require much different and more fundamental treatment than can be rendered by a promotion effort. At the employee level, the principal form of abuse appears to be the failure to report an injury or incident for fear that either an individual or work group will not receive an award. The chance of this problem occurring appears to be increased when monetary incentives are at stake or financial incentive plans for improved safety performance are written into labour contracts or agreements.

The success of an incentive programme is heavily influenced by the nature of employee participation and their perceptions about its fairness. If goals are set too high or if employees cannot perceive how their personal efforts can affect reaching the goals, then the programme is not going to be effective. Also, the longer the distance between safe job performance and reward reception, the less influence the incentive system is likely to have. It is difficult to maintain worker motivation with an incentive programme that won’t pay off for several months or longer, and even then only if things go well for the entire period.

Clearly the pitfalls that have been described help to explain why many organizations hesitate to use incentive programmes as a safety promotion device. It is easy to design an incentive programme that doesn’t work. But, there is a good deal of evidence, both quasi-experimental and anecdotal, that documents the contributions of incentives to the successful operation of safety and health programmes. The use of incentives, awards and recognitions to motivate employees to perform safely is an accepted feature of both the OBM and the TQM models. In the OBM model, use of incentives to reinforce employee behaviour is critical to programme success. With TQM, rewards, promotions and other incentives are used to recognize individuals for contributions to process improvement. Also, at the group, team or company level, special days or other functions are used to celebrate achievement.

Broadly speaking, the use of incentives may be viewed to have a positive influence on employee attitudes and behaviour. When evaluation of safety and health performance is made part of the decisions to increase an employee’s pay, these factors take on added significance as important job-related requirements. As indicated above, accident rate and related measures present significant problems when they are established as the sole incentive criteria. In contrast, the use of positive safety performance measures in the form of behavioural or process improvements provide specificity for employee action and create an opportunity for frequent feedback and incentive distribution. The characteristics of successful incentive programmes appear to remedy some of the problems associated with performance criteria, programme abuse and the nature of employee participation. Although the research into these areas is far from complete, sufficient data are available to provide guidance for organizations that want to make incentive programmes part of their safety and health management system.

Employer and employee abuses are largely circumstantial in nature. The reasons that incentive programmes are used to remedy safety management deficiencies largely determine whether the abuse can be corrected. If management sees employee safety and health as a low-priority concern, then such abuse is likely to continue until circumstances force a change in policy. In contrast, if management is committed to making safety and health improvements, then the need for a comprehensive approach to solving problems will be understood and accepted, and the support role played by incentive programmes will be recognized and valued. Similarly, the problem of employees not reporting accidents can be substantially reduced by changing the criteria that govern how incentives are awarded.

Research has shown that, to be effective in holding employee interest, rewards must be both frequent and tied to improved performance. If possible, to stimulate the feeling of participation in an incentive programme, employees should be involved in the selection of safety performance priorities. In this regard, it is necessary to insure that attention to priority behaviours does not lead employees to neglect other important job functions. Specific criteria and means for successful job performance should be clearly communicated and frequent progress reports given to programme participants.

There is also some evidence that distinguishes between the effects of rewards that are perceived as “controlling” and those that are viewed as “informational”. Studies of these differences have found that rewards for achievement that recognize personal competence are stronger than those that simply provide positive performance feedback. One explanation for this finding is that employees perceive informational rewards, which recognize achievement and personal competence, to be under their own control, rather than in the hands of another person who gives or withholds rewards based on the performance being observed. Accordingly, the focus for control of informational rewards is within the employee, or intrinsic, as opposed to being outside the employee, or extrinsic, as is the case of controlling rewards.

In summary, the appropriate use of incentives can play an important helping role for organizations that use them wisely. They can increase employee interest in safety and can stimulate enhanced self-protective actions by workers.

Communication in safety promotions

Communications of various kinds are used to enhance the effectiveness of any safety promotion effort. The communication process can be summed up by the following question: “Who says what in which channel, to whom, with what effect?” Accordingly, communication programmes usually involve a source, message, medium, target and objectives.

Communications vary in terms of their coverage and impact. Safety posters, banners and other mass media are high in coverage, because they are easily exposed to large number of people over time. They are generally considered to be low in impact, because it is unlikely that every exposure will produce the desired effect. Mass media or one-way communications are most effective in increasing general awareness about safety and health topics, and giving directives or safety reminders. They can also be a useful vehicle for making employees aware of management’s general interest in their welfare. In contrast, person-to-person or two-way communication, either through group discussions or individual contacts, though low in coverage value, can be high in impact and lead to decisions to change behaviour.

Credibility of source is very important in safety and health communications. In the workplace, for example, knowledge of a task and its hazards and the setting of a good example are important to making supervisors credible sources of safety and health information.

With regard to communication content, the use of fear has been a topic of research and controversy for years. Fear messages are used to change attitudes about the risks involved in hazardous behaviours by frightening the target audience. The message goes on to reduce the fear it has instilled by providing methods to prevent the danger or lower the risk. Workplace examples include campaigns to promote the use of personal protective equipment, while non-workplace examples include anti-smoking campaigns and auto seat-belt programmes. The main argument against using fear messages is the contention that receivers block out or suppress the message. Reactions such as these are likely to occur when the highly threatening communications fail to reduce the fear and individuals feel personally or situationally unable to handle the danger.

If fear messages are used, the following precautions should be taken:

• The message should attempt to evoke a high level of concern, and stress the positive benefits of the action to be taken.
• The suggested preventive actions should be concrete, relatively detailed, and specific.
• The guidelines for risk reduction should be presented, at one time, immediately after the fear response is evoked.
• The suggested preventive actions must be understandable and perceived by the target audience to be effective in preventing danger.
• The source of the communication should have high credibility.
• Use of statistics or risk data should be specific to the workplace or situation.

Finally, safety and health communications should consider the target groups at which messages are aimed. For example, research has shown that fear messages are more effective with new employees than with seasoned employees, who can use their experiences to discount the message. Additionally, fear messages have been found to be especially effective in influencing employees who are not under direct supervision and are thus expected to comply with safety regulations on their own.

As an aid both to defining targets and establishing objectives, the use of employee surveys is recommended to assess prevailing levels of safety and health knowledge, attitudes toward safety management programmes and practices, and compliance with rules and procedures. Such measurements assist in pinpointing education and persuasion priorities, and set a baseline for later evaluations of the effectiveness of communication efforts.

Safety campaigns

Safety campaigns usually are conducted to focus employee attention on a specific accident problem and are frequently associated with a particular slogan or theme to maintain interest and visibility. They use mass media such as posters, banners, videotapes, booklets and a variety of written or oral communications. Campaigns may be aimed at increasing awareness, conveying information, and changing attitudes in an effort to produce behaviour change.

The intended effect of safety campaigns is the same as that of behaviour modification and other programmes that attempt to get employees, supervisors and managers to make safety an integral feature of proficient job performance. Compared with behaviour modification programmes, however, safety campaigns are much less precise in defining target behaviours and outcomes, and less rigorous in the reinforcement of these behaviours. Even so, the major objective of both approaches is to emphasize the importance of safe work practices with the expectation that they will become habitual in nature.

Unfortunately, few studies have examined the effectiveness of safety campaigns in occupational settings. Case histories of successful efforts are frequently described in occupational safety publications, but these reports are seldom accompanied by convincing empirical evidence. Research has been done on the behavioural effects of specific media, such as posters, which indicates some positive results and provides a basis for guiding campaign communications, but meaningful research on safety campaign effectiveness in industry is simply not available. Rather, most of the useful information on the effectiveness of safety campaigns comes from the field of highway safety, particularly as reported in the United States and Australia.

Among the general recommendations that flow from anecdotal reports, the study of media effectiveness, and experience with highway safety promotion, the following can increase the power of any safety campaign and deserve special emphasis:

• Conduct needs studies to select campaign targets, using employee feedback to supplement data gathered from other sources.
• Assure employee involvement in campaign planning and materials selection.
• Pilot test the campaign theme and materials on the intended target groups.
• Involve all levels of management in the campaign from the top person to the lowest line supervisor.
• Use emotional/persuasive themes more than rational/informative ones.

Safety campaigns are intended to support an organization’s total safety programme. For this reason, it is usually preferable to judge their effectiveness by how well they attain defined support objectives. These include maintaining interest in safety, expressing management’s concern for employee safety, generating employee participation in safety activities, increasing morale and reminding employees to take special precautions.

Attempts to use accident reduction criteria to measure the effectiveness of campaigns, though seemingly appropriate, are usually confounded by the effects of the existing safety programme. Also, because accidents and injuries occur rarely, they are relatively insensitive criteria for evaluating the effects of specific safety programme changes that deal with the human or behavioural components of the safety system.

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