Turning HOP Principles into Action: Learning is Vital

In this fourth blog of my series on the five Principles of Human and Organizational Performance (HOP), I will discuss the fourth principle. This series gives leaders practical actions they can take to put HOP into practice. My goal is to share daily and weekly behaviors leaders can use to apply these principles.

HOP Principle 4: Learning is Vital

Learning is Vital: Organizations must actively and continuously seek to understand how everyday work actually happens rather than just reacting when things go wrong. Learning is an intentional practice necessary to build resilient systems and prevent future failures.

Here are a few concepts to consider when pinpointing what leaders can do to put actions behind this principle. 

1. A serious near miss or injury highlights failure points inside the organization related to systems issues, process factors, poor design, or unintentional leadership tactics. Discovering and removing the failure points is a leadership responsibility.
2. Organizations do not need to wait around for an incident to occur. Proactive safety cultures look for and eliminate risk before incidents occur. 
3. Backward looking accountability rarely works and comes at a significant cost to the organization. The overuse of discipline is the enemy of learning as it leads to people hiding errors, mistakes, injuries, and the truth on what’s influencing their behavior. 
4. How the organization learns and improves matters. World-class safety organizations prioritize solutions that create the biggest benefit in reducing risk for the workforce.

Below are proactive behaviors or actions leaders should build into their daily/weekly habits to ensure their organization is living out this HOP principle. I specifically excluded recommendations around conducting an incident investigation. While this is a critical task, it is reactive by nature because it is triggered by an incident. 

Proactive Behaviors for HOP Principle 4

Explore and understand work-as-performed. Practitioners of HOP understand there is often a discrepancy between work-as-designed and work-as-performed. This makes sense when you consider who is designing the environment, procedures, and work schedules. It is typically not the people currently performing the work. As principle three discusses, people behave in context, and if the environment or the work as designed actively encourages at-risk behaviors. people will engage in them. Therefore, proactively identifying failure points and systems issues is a critical leadership task. 

Consider the following formula for conducting a work-as-performed gap analysis:

• Select meaningful work. Jobs that have high risk or SIF potential, have long or complicated processes or procedures, take a long time to complete, or require significant set-up or resource requirements are all ones in which gaps are likely to be found.
• Get eyes on the job. There are often differences between how people work and what they say they do. Getting eyes on work will give you the clearest picture of how work is actually done. 
• Focus on identifying the failure points in the systems, processes, resources, or work, rather than on performers finding workarounds. If leaders become accusatory or begin to point fingers at the people doing the job, those people will shut down.
• Ask those closest to the work what they would do to make the work easier, faster, or better. The workforce is a valuable asset in process and systems improvement. Anything that will make the work easier will also make it more positively reinforcing to follow.
• Ask the workforce what they would do to remove risk or make the job safer. A goal of this gap analysis is to remove risk and allow people to fail safely. Incorporating their ideas will build organizational resilience.
• Implement improvement ideas quickly and loudly inside the organization. Leaders should be visibly improving the organization. This recommendation will ensure the workforce feels listened to and understand that leaders care about their wellbeing. 

Shift from Discipline to Forward Looking Accountability. Sidney Dekker in Just Culture emphasizes that not all mistakes are created equal, and leaders need to be able to distinguish between human error, at-risk behavior, and what he called reckless behavior. He states that only one of these (reckless behavior) might justify disciplinary action, as the use of it leads to fear, underreporting, and diminished ability for organizational learning. Instead, organizations should shift to restorative justice or forward-looking accountability.

My colleague Bart Sevin and I have written about the differences between the typical view on accountability and forward-looking accountability here. To put this concept into action, consider the following recommendations: 

• Develop organizational definitions of human error, at-risk behavior, and reckless behavior for your organization based on trends and hazards. Include examples of each and use them for leadership alignment.
• Look for what has failed instead of who has failed.
• Ask and answer the question, “What is the goal of the goal here?” as the foundation to any incident or near miss investigation. Use this question to ensure any proposed solutions will create a return on investment for the organization.
• Focus on creating new or safe behaviors instead of suppressing at-risk behaviors. Create accountability systems around supporting any new behavior change. 

Track and Share Organizational Learning. Many organizations invest in environmental, resource, process, system, or work designs, but they often fail to communicate these improvements throughout the organization. When companies fail to communicate, the workforce often feels like leaders “never fix anything around here,” which can lead to an erosion of trust inside the culture. To improve visibility throughout the organization, leaders should track and share safety improvements and make them regular topics of discussion with the workforce. Leaders should consider:

• Making the work order system visible, easy-to-understand, and with and with safety-related initiatives highlighted. Visibility shows workforce what and how the company is investing in improving the organization. 
• Holding intentional conversations with the workforce to ‘close the loop’ and provide feedback on what insights you’ve gained, and how the organization has responded. Many client organizations utilize the, “You said, We did” pattern of sharing updates on the status of concerns raised or hazards identified by those doing the work.
• Providing regular status updates during meetings on long-term projects. 
• Keeping a rolling list of completed projects for 6 to 12 months. 

Prioritize Solutions that Produce the Biggest Organizational Improvement. We know that context drives behavior. However, when you look at remediation strategies for near miss and incident investigations, they often focus on the performer (e.g., re-training, reminders, and discipline). These rarely address the true root cause of the performance issue. 

At a HOP conference, I attended a talk that discussed how one organization was putting HOP principles into action. They created a rule inside the organization that stated, “If SIF potential has been identified during an incident investigation, all solutions must be at the engineering level or above using the hierarchy of controls.” They have had significant improvements in reducing SIF potential inside their organization. These strategies go after the failure points inside organizations. Organizations and leaders should use the hierarchy of controls during solution development and establish clear rules for incident investigations to ensure response plans produce the greatest possible reduction in risk.

Pinpointed leadership activities and behaviors turn principles into action. The fourth principle of HOP is focused on how organizations learn and adopt to support safe production. Once leaders shift towards a systems approach, forward looking accountability, and focus efforts on solutions that produce the biggest ROI, they will work to produce a safer and more resilient organization. Building leadership habits around these principles will build a safer organization.

References

Dekker, S. (2007). Just culture: Balancing safety and accountability. Aldershot, UK: Ashgate Publishing Co