Critical Incident Management Part 2

Critical Incident Management Part 2 by Steve Krile

In my last article, I talked about the first step toward a harmonized Critical Incident Management system that would allow you to investigate the causes and results of all your cases – regardless of when they were reported or in what country. The main concept that will drive the rest of your analysis is the idea of defining a Most Serious Result. In this article we will dive in to just what the Most Serious Result is, and why it is so important.

It is typical in industry to have 10 percent of the workforce experience some sort of unsafe critical incident management act or condition. In a business of 500 people, this represents 50 “cases” a year. If your business has 10 facilities each with 500 people then you can be looking at over 500 cases per year. From a risk-management point of view, giving equal weight to all 500 cases can be at the best difficult, and at the worst, not possible. So, we as professionals perform a sort of injury analysis triage – where we look at the cases and decide how “bad” they were, then carry on with the level of investigation we believe is necessary.

Creating a standard coding system that would act as a formal evaluation of result gives you the context needed to cross country lines, and indeed go back in time. For instance, if one of the countries you have operations in decides that a particular type of injury needs to be reported – say musculoskeletal disorders – you would feel the effect of these legislative changes in your long-range analysis.

You would find yourself explaining why this year your injury rates seemed to jump 40% because the government changed the rules. However, if you had been counting EVERYTHING in the same system and just weeding out the cases that the local government cared about for public reporting while examining all the Critical Incidents internally you would not (and indeed *will* not) have to make any corrections.

So, we need a coding system that can stand up to long range scrutiny. One that is not likely to change over time. The codes should adequately describe the seriousness of the injury in terms common concepts across all reporting regions, but not specific enough to force a choice of one over the other for legislative reasons. Here is the list we use today.

Fatality – Work-related injury that results in death.
Days Away From Work – Work-related injury on expert medical authority results in a person missing days at work.
Job Transfer or Restricted Duty – Work-related injury that on expert medical authority restricts the person from performing their normal duties.
Healthcare Incident – Work-related injury that requires expert medical treatment.
First aid – Work-related injury that treated by non-expert medical personnel.
Near Miss – Work-related incident that could have resulted in a serious injury.
Not Work Related – The reported injury was determined not to have been a result of our work environment.

This list has served us well. There are many concepts woven in to the words above and many tests that this list has survived – and believe me, when you start using a universal coding system rather than a government-based metric, your operations may have a few things to say about the approach. Specifically, if you have a facility that doesn’t “report” many incidents, but has a ton of non-government reportable incidents, they very much may not like this standard coding system. Notice nowhere in the list do we ask for whether the injury is reportable to the local government. For us, that is secondary to understanding our problems. What the government wants or needs to know is a statutory requirement. But when one of our workers is hurt, we need to understand the full impact to our business.

There are a few concepts in the above definitions that I’d like to break out for you. The first is the idea of “work-related”. Having this item in the list really helps narrow the field of possible events to only those that our business needs to consider for system improvement.

The second is the concept of “expert medical”. In some countries and locations there is an on-site physician that treats the employees for all sorts of medical concerns – work-related and not. These people are considered experts, and should be considered within the context of the above coding. Again, this is closing a loop hole that some of your operations may be using – treating injuries internally and ignoring the cause simply because the care was “free”.

Finally, there is the concept of “on medical authority” when deciding whether to count the Days Away or Job Transfer case. As long as a doctor has identified that the worker cannot perform certain functions – by body part with an identified time period – then the case should be considered a part of Lost Time. This forces our operations to actually ask the doctor to specifically tell us what the person can reasonably do and for how long those restrictions should last. This often closes the loophole of open-ended restrictions that seem to go on forever.

Do not underestimate the power of a stable coding base. With the above structure we can now start a true apples-to-apples comparison of performance across departments, plants, countries, and even years. And if we fold in the idea of business indexes (like hours worked, or sales volume for instance) we have the possibility to takes each of these Critical Incident Management items and turn them in rich business metrics.

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