PART 1: PEARL HARBOUR SYNDROME
It is unfortunately the sad reality that the number of accidents on South Africa’s mines and other workplaces increases exponentially in the period leading up to year-end, commonly referred to as the “silly season”. This phenomenon occurs year-on-year and mining companies and other employers, with the support of the various regulators including the Department of Mineral Resources and Energy and the Department of Employment and Labour, implement focused campaigns in an attempt to halt the trend.
There are various reasons for the increase in the number of accidents over this period, including deep-seated fatigue which has accumulated, particularly, over the last few years as a result of the measures that were implemented in relation to Covid-19, concerns surrounding job and financial security, and general anxiety surrounding the socio-economic impacts. These factors cannot simply be left “at the gate” and naturally find their way into the workplace, sometimes with disastrous consequences. This is of course not the only reason for workplace accidents. There is also often a shift towards greater risk-taking behaviour as attitudes to risk tolerance change as a result of additional factors such as bonus participation, strikes, protests, and, in the case of the mining industry, illegal mining which often takes place on operational mines (illegal mining is not limited to old and abandoned mines). These factors, holistically, create an environment which, if not managed carefully, facilitates incidents and accidents.
In this, the first part in a series of “how to prevent mining and other workplace accidents”, we address one of the key factors which contribute to incidents and accidents, and what we call the “Pearl Harbour Syndrome”.
A surprise attack was carried out by the Japanese Navy Air Service on the United States Naval Base situated at Pearl Harbour on 7 December 1941. At the time, the United States was a neutral party in World War II, and this defining moment, brought the United States into the war. For years afterwards, one key question was asked namely “how could this happen?”. Objective observers acknowledged the strategic brilliance of the attack, by Japan at the time, but at the same time, considered how the attack could be carried out successfully despite resources available to the United States.
Within the context of mining and other workplace accidents, this is the same as a fatal accident occurring (the attack), and not seeing it coming (the surprise nature of the attack).
I was extremely fortunate in 2019, to visit the Pearl Harbour Museum and to hear a first-hand account from a guide who had witnessed the Pearl Harbour attack in 1941. It was an incredibly moving experience to hear his story and, after going through the museum, to understand some of the key moments and events which resulted in such a devastating attack.
Years later, after reading various accounts, and the outcome of various commissions of inquiry, three key lessons became clear to me, and they apply equally to workplace accidents, and for this reason, I have called it the “Pearl Harbour Syndrome”.
The three most basic reasons were, firstly, ignoring the warning signs that were received that an attack was imminent, secondly, complacency (this cannot happen to us), and thirdly, underestimating the risk (the perception was that because of the technology available to the United States in Pearl Harbour, an attack could not be carried out. Because the United States believed that such an attack could not be carried out, the perception was that Japan could also not carry out such an attack).
There were various warning signs including intelligence reports, radar reports (radar was of course, in its infancy in 1941 and open to some interpretation), personal sightings in Pearl Harbour and various other warning signs. These warning signs were ignored for various reasons including that the command of the United States forces in Hawaii was separated under different leadership, and there was an apparent lack of co-operation, co-ordination and communication between the various forces.
The strong belief that the attack wouldn’t happen was based on an unquestionable faith that the United States had in their defence system. As a result, the belief was that an attack could not happen in Pearl Harbour (a false sense of security).
Underestimation of the risk was an important factor and is the “mirroring principle” i.e. because we cannot do it nobody else can do it.
Translating these principles to workplace incidents and accidents, there are various key lessons. Firstly, there are always warning signs and trends which, if co-ordinated, considered, and assessed properly, will always give a good indication of an impending high-potential incident or fatal accident. These indicators are, unfortunately, often ignored or they are misunderstood. As the saying goes, if a large assumption is wrong, this will lead to wrong conclusions. Similarly, if a number of smaller assumptions are made which are wrong, this can also result in wrong conclusions. Proper gathering of information, assessment, and analysis by a multi-disciplinary team is vital to ensure proper identification of key areas of focus to prevent accidents.
Secondly, absolute faith in health and safety systems is misplaced. Things change, and change must be managed properly through appropriate hazard identification and risk assessments, taking into account all factors such as workplace changes, personnel and people changes, equipment changes, and changes to methods of work. The health and safety systems in place must be tested at regular intervals to ensure that they remain robust.
Thirdly, just because, for example a senior manager believes that something cannot be done, this does not mean that other persons, including persons at the workplace, cannot do it. For example, just because there is a small gap in the guards surrounding a conveyor belt motor, which would take exceptional motivation for one to put one’s hands through, this does not mean that employees, for whatever reason, will not actually put their hand through the small gap, and be caught up in the conveyor belt motor – our history is littered with such examples.
Fourthly, co-ordination and co-operation amongst the various departments at mines and other workplaces are vital to prevent accidents. There simply cannot be an “us and them” approach between various departments including, between the primary employer / client and service providers (contractors).
What is clear, is that a co-ordinated, co-operative and holistic approach (with all stakeholders, including trade unions) must be adopted to prevent accidents over the next few weeks. Pulling out previous “silly season plans and campaigns” are only a starting point – managing change in the workplace must be the focus to ensure that all factors that may have changed during the course of the year are properly considered, and that the health and safety programmes and plans that were implemented in the past, have remained relevant, and robust.
For more information, please contact Warren Beech at warren@bv-inc.co.za.