安全健康恢复的现实性

The reality of ‘‘Revitalizing Health and Safety’’ Clive Smallman* Judge Institute of Management Studies, University of Cambridge, Trumpington Street, Cambridge CB2 1AG, UK Received 13 November 2000; received in revised form 30 April 2001; accepted 15 June 2001 Abstract Problem: Workplace health and safety remains an important international socio- economic issue, but the progressive declines in reported incidents may be slowing. The British Government has responded by launching a new policy initiative aimed at ‘‘Revitalizing Health and Safety’’ by establishing targets for improvement, strategies, and a series of action points, mainly targeting employers and organizational issues. This paper critically assesses the realities of implementing this policy with respect to the scientific base for each of the strategies. Method: Literature meta-analysis; analysis of policy. Results: Empirically proven determinants of workplace health and safety provide baselines for compensation and conditions of work, workforce characteristics, workplace characteristics, health and safety environment, political and economic factors, and industry characteristics. Support for different policy elements is varied and there are some significant gaps. Summary: An impressive body of research was found that offers a firm foundation for future developments. However, the need for work that is interdisciplinary, ordered, and collaborative is pressing. The need to move away from elegant but simplistic pictures of occupational health and safety (OHS) management practice, and to reflect true complexity is imperative. The reality of health and safety at work is that it is an issue that is taken lightly by those who do not practice or research safe and healthy working, and a serious issue for victims or relatives of victims of shoddy management. It remains one of the bastions of inequality of work worldwide. Impact on industry: The intent of governments in attempting to reinvigorate the suppression of workplace injury and illness is motivated by both social and economic imperatives. Motivation for organizations is not fully understood as there is no obvious business imperative. If organizations can further understand and provide a scientific justification for investment in OHS management, then governments’ task will be made easier. By proving the value of OHS to management, we will demonstrate that 0022-4375/01/$ – see front matter D 2001 National Safety Council and Elsevier Science Ltd. All rights reserved. PII: S0022 -4375 (01 )00065 -2 * Tel.: +44-1223-766592; fax: +44-1223-339701. E-mail address: c.smallman@jims.cam.ac.uk (C. Smallman). www.elsevier.com/locate/jsr Journal of Safety Research 32 (2001) 391–439 organizations continue to present considerable hazards to their employees. D 2001 National Safety Council and Elsevier Science Ltd. All rights reserved. Keywords: Health and safety policy; Literature review; Research agenda 1. Introduction Workplace injury and illness is an international economic issue. In the United States and in Britain there is statistical and anecdotal evidence to suggest that the long-term 20th century trend toward safer workplaces has slowed and may have reached a plateau (Dorman, 1996; Fairris, 1998; Health and Safety Commission, 2000). Notwithstanding the severe social implications of this stagnation, the economic cost is considerable, and in 1998 work-related injuries cost the United States US$125.1 billion (1.5% of GDP—National Safety Council, 1999). By comparison, annual costs to the British economy are between £14.5 and £18 billion (2.1% and 2.6% of GDP—Health & Safety Executive, 1999). The British Government’s solution to tackling this issue was to announce the Revitalizing Health and Safety initiative in March 1999. The government’s aims were to reinvigorate the health and safety agenda, to identify new approaches to improving workplace health and safety performance (particu- larly in smaller employers), to ensure that health and safety regulation remains compatible with trends in the development of industry and com- merce, and to ensure coherence between health and safety legislation and other government programs. At the heart of occupational health and safety (OHS) policy in Britain sits the Health and Safety at Work etc. Act 1974 (HSWA). This body of law: . . .provides for goal setting law, taking account of levels of risk and what is ‘‘reasonably practicable,’’ with the overriding aim of delivering good regulations that secures decent standards and protection for everyone. Health and Safety Commission, 2000, p. 8 The Act effectively delegates responsibility for proposing new law and standards to the Health and Safety Commission to the Health and Safety Executive, the Act delegates responsibility for enforcing health and safety legislation, investigating accidents and complaints, conducting research, and providing information and advice. Local government also shares some measure of responsibility for the enforcement of health and safety law in retail, entertainment, and office premises. In July 1999, the government and the Health and Safety Commission initiated a consultation on the subject of health and safety, seeking contribu- tions from stakeholders. From the 1,500 responses, the Health and Safety Commission developed the Revitalizing Health and Safety Strategy Statement, which is the first major policy statement on workplace health and safety in C. Smallman / Journal of Safety Research 32 (2001) 391–439392 Britain since the HSWA over 25 years ago. The stated aim of this new approach was to exploit innovations in pursuit of ‘‘adding value’’ to the current system, while not threatening its overall balance. For example, the strategy presents the first ever health and safety targets for Britain (Health and Safety Commission, 2000, p. 8): � to reduce the number of lost workdays due to work-related injury and illness by 30% per 100,000 workers by 2010; � to reduce the incidence rate of fatal and major injury accidents by 10% by 2010; � to reduce the incidence rate of cases of work-related illness by 20% by 2010; � to achieve half of the improvement under each target by 2004. These objectives are operationalized in a 10-point strategy statement. The emphasis throughout is that improving workplace health and safety makes good business sense. The government aims to lead by example through demonstrating its own commitment to health and safety in the public sector. Furthermore, in attributing health and safety failures largely to ‘‘poor management and ignorance of good practices’’ (Health and Safety Commission, 2000, p. 19), the essential role of education at all levels is stressed most strongly. The strategies are supported by 44 action points focused around the themes of the business case, leadership, partnership, and dealing with failures (Rose, 2000). This paper critically assesses this policy with respect to empirical research on health and safety management. The aim is to evaluate the extent of the theoretical base that will support the implementation of the policy and to propose a research agenda that will fill revealed gaps. While this work is orientated around Britain, it is germane elsewhere, since Britain has had considerable success in reducing OHS incidents in comparison with other developed countries.1 The successful implementation of the British Government’s policy should offer lessons for other nations, as will a science- based critique of this policy and the literature. The study begins by outlining the method used and then moves on to a meta-analysis of past research on workplace health and safety, synthesizing a composite model of the current orthodoxy. The policy implications of this 1 One study found that, over the period 1991–1995, fatality rates in Denmark, Finland, and the Netherlands were greater than that in Britain, but less than that in the USA (Government Statistical Service, 1997). Germany’s rate equaled America’s, but France, Belgium, Ireland, Spain, Italy, and Portugal (in ascending order) killed more workers per 100,000 employees or self-employed than the USA. Sweden and Ireland had lower nonfatal injury rates than Britain in 1993–1994. Denmark was marginally worse than Britain and better than the USA. Each of the remaining major (and lesser) European states has a worse rate than America. Portugal again had the worst rate. Whatever the weaknesses of comparing this data, the picture of fatality, injury, and illness across Europe strongly suggests the presence of a marked economic, not to say social, impact. The picture in the developing world is worse and almost certainly understated (Jeyaratnam, 1992; Shrivastava, 1992, pp. 20–28). C. Smallman / Journal of Safety Research 32 (2001) 391–439 393 model are then evaluated; leading to the conclusion with a critique of the literature and the policy and by proposing a research agenda, which addresses the shortfall between the current policy and the reality of revitalizing work- place health and safety. 2. Method In order to facilitate the policy analysis, a model was developed of the theoretical determinants of OHS performance from the literature. An analysis of the British Government’s Revitalizing Health and Safety Strategy Statement against this framework is then presented. In both phases of the study, content analysis was employed in order to draw out essential issues. 2.1. Meta-analysis of the literature A significant issue for OHS researchers is the breadth and depth of the literature on the subject, which is spread across several disciplines.2 A search of the BIDS Social Science Citation Index, Proquest and Elsevier Direct databases revealed some 280 substantive journal publications relating to the management of OHS. For the purposes of this research, 55 articles from this literature were identified using the following criteria: (a) Articles had to present substantive, well-specified, and (above all else) empirical content focused upon workplace determinants of OHS; (b) They had to have been published in peer-reviewed journals or in a monograph regularly cited by other authorities (e.g., Dawson, Willman, Clinton, & Bamford, 1988a); (c) Be published after 1990, except (again) where they are regularly cited by other authorities. Of the 55 selected, 20 were published in various journals focused upon employee (industrial) relations or the economics of employee relations, 16 were published in the Journal of Safety Research,3 8 were published in Safety Science, and 5 were published in general management journals. Of the remainder, three 2 Studies of OHS fall broadly into ergonomics, law, sociology, occupational psychology, employee relations, safety management, and occupational medicine. In this piece, I do not deal with the occupational medicine (e.g., I deliberately excluded work-related stress from my searches, since an early search revealed that I would have been overwhelmed by studies in this area) or ‘‘technical’’ aspects of safety management (sometimes termed safety science, e.g., ergonomics). These literatures are highly technical and rarely report upon managerial or organizational behavior aspects of OHS. Nor do I deal with directly with law, although its effects upon behavior are an input to the development of models. 3 I should point out that the selection of articles was made before I had targeted any particular journal with a view to publishing my results! C. Smallman / Journal of Safety Research 32 (2001) 391–439394 articles were published in the same research monograph (Dawson et al., 1988a), and the other three were published in journals focused upon risk. A summary of these empirical studies is in Appendices A and B. The content of each study was analyzed, identifying the nature of sample, the country of origin, analytical techniques used, dependent variables, significant independent variables, and main findings. 2.2. Analysis of policy It is important to distinguish between policy analysis (the investigative and consultative processes that leads to the development of policy) and the analysis of policy (how effective is policy or how likely it is to be effective). This study falls into the latter category, although it may feed into the former. Each of the strategy points and their supporting actions were addressed, aligning them with the elements of the model derived in the first phase. The intent was to identify how much theoretical support for the strategies existed and to identify gaps in knowledge. 3. Past research 3.1. Nature of samples There is a bias toward the individual as the primary unit of analysis: � Thirty-four studies evaluate the health and safety risk of individual employees. � Three studies only mention interviewing managers. � The remaining studies focus on employee groups or are not specific. More particularly, the bias is toward employees (workers) and the identifica- tion of the factors that lead to their injury or illness. Apparently, very little work explores the attitudes of management or senior management to health and safety. Yet, Hayes, Perander, Smecko, and Trask (1998) find that improving the safety record of a firm should include attention to management’s role in safety (interestingly this researcher found no research that evaluates safety managers’ attitudes either). Fuller (1999) finds that managers’ responsibility for safety has to be fitted in with all of their other responsibilities. This aligns with Dawson et al.’s (1988a) finding that the problem associated with health and safety is that it must be traded off against other management matters. Gill (1993) finds that the push for improvement in safety is more likely to come from employee representatives than from management. Hofmann and Sletzer (1998) find that supervisors’ openness to upward communication about safety issues sends a strong signal to employees about the degree to which their organization values safety. Notwithstanding C. Smallman / Journal of Safety Research 32 (2001) 391–439 395 these findings, Smallman and John (in press) find broad (although not statistically representative) support in British senior management in large firms for linking health and safety with corporate performance. From the point of view of organizational effects upon health and safety, coverage has been effected at the work group, establishment (or workplace), the firm, and industry levels. However, these studies again concentrate solely upon the relationship between organizational structures and health and safety risk. They do not look at the broader strategic picture of the organization. Forty-four of the samples studied in the analyzed research do not specify the size of the workplaces upon which their analyses are based.4 Fifteen samples are taken from large organizations, and two each from medium-sized and small organizations. This suggests that our knowledge of OHS manage- ment in small and medium-sized enterprises is rather ‘‘thin.’’ The sectors from which samples are drawn are summarized in Table 1.5 Table 1 demonstrates a bias toward industry and manufacturing, particularly high-risk industries. While OHS in these sectors remains important, as we move to a different form of industrialization in the developed world, what are the OHS implications of the so-called ‘‘new economy’’? 3.2. Country of origin Of the examined studies, there are 27 US-based studies, 6 British, 6 Canadian, 4 Norwegian, 3 Australian, 3 Swedish, 1 German, 1 based in Hong Kong, 1 Indian, and 1 from Taiwan. Two comparative studies were evaluated, one covers Australia and Britain, and the other covers 12 countries in the European Union. The paucity of comparative work is probably attributable to differences in health and safety legislation, and much of the American work focuses upon the effects of the Occupational Safety and Health Act and its enforcement. None of the comparative studies takes a view on organizational determinants or ‘‘national’’ cultural effects. 3.3. Analytical and methodological approach In terms of dominant research design, there is a bias toward quantitative techniques, based upon cross-sectional and occasionally longitudinal surveys, and their evaluation through regression analysis and its variants. Of qualitative techniques, only ethnographic content analysis is used, and expressly in two studies only (Holmes, Gifford, & Triggs, 1998; Holmes, Lingard, Yesilyurt, & De Munk, 1999). Dawson et al. (1988a) also apparently make use of content analysis, but their formal approach is not specified. 4 The Commission of the European Communities identifies firms with less than 10 employees as microenterprises, those with between 10 and 100 employees as small firms, those with between 100 and 250 employees as medium sized, and those with more than 250 employees as large. 5 The number of samples exceeds 55 since several studies compared a number of sectors. C. Smallman / Journal of Safety Research 32 (2001) 391–439396 However, their development of case studies of health and safety, through a mixture of interviewing, observation, and survey, is a comparative rarity. Economic and psychological statistical modeling of individual behaviors, based almost exclusively on primary or secondary data from self-completion questionnaires, dominates the study of accident causation in the health and safety literature. With the exception of Dawson et al. (1988a) and Nichols (1997c), there is little in the way of a sociological study to fully explain organizational behaviors that contribute to workplace injury or illness. Yet, there is a lengthening strand of sociological and social psychological research that uses qualitative analysis of systems failures to explain the causal antecedents of disasters (e.g., Perrow, 1999; Sagan, 1993; Toft & Reynolds, 1997; Turner, 1976; Turner & Pidgeon, 1997). Nichols, albeit eloquently, dismisses this body of work as ‘‘accounts of disasters’’ rather than ‘‘a sociological theory of industrial injury,’’ on the grounds that it is too abstract in its use of systems theory. However, surely disasters are industrial accidents writ large? The organizational antecedents of both are similar; the outcomes differ in scale only. 3.4. Dependent variables Each of the empirical studies choose as their dependent variable full or partial measures of the risk of injury in the workplace; they measure the probability of injury, the severity of injury, some proxy for probability or severity, or both. For example, injury rate is a direct measure of the probability of injury; injury severity is a direct measure of severity; and refusal to work is a proxy for risk of injury. The most frequently used dependent variable is accident or injury rate (used in 26 studies), with safety behaviors (including safety culture) employed in 12 studies. No study ties safety with broader corporate performance. This study identified only one organizational study that dealt explicitly with ill health (James, Lovato, & Khoo, 1994). Table 1 Nature of samples: sector Sector Number of samples Representative of industry in country of origin 20 Primary or utility 9 Nonspecific manufacturing industry 10 Construction 7 Chemicals 5 Health care 3 Civil aviation 1 Distribution 1 Retail 1 Students 1 C. Smallman / Journal of Safety Research 32 (2001) 391–439 397 3.5. Determinants of health and safety risk The significant factors that influence injury risk, and to a much lesser extent health risk, are many and diverse (see Table 2) and discussion of the more significant issues follows. 3.5.1. Compensation and conditions of work Some ‘‘flexible’’ employment practices, in particular subcontracting, have been lin