If you want to prevent accidents at work – then think about social, cultural or organizational aspects – before the individual.

Accidents at work are estimated to kill more than 380,000 workers worldwide every year (Concha-Barrientos et al., 2005; EU-OSHA, 2017). Although the risks of accidents at work have been reduced over the last about 30 years, the increased complexity and multidimensional characteristics of risk to workers have challenged the existing approaches to accident prevention. In recent years social, cultural and organizational aspects have become important additional perspectives included in accident prevention programs at work, and referred to as the “third age of safety” (Rasmussen, 1997; Hale & Hovden, 1998).

A Campbell systematic review that we have just published contributes to pointing out the most effective forms of prevention for accidents at work, which can provide some important prevention principles. The day-to-day practical efforts to prevent accidents at work are too often focused on measures directed at the individual level (as opposed to the group or organizational level), which provides limited protection against having an accident at work, according to this systematic review. These empirical results are in fact also reflected in theoretical development, where individual level approaches to accident prevention move towards including social and organizational level factors in the prevention models.

At the individual level, we identified physiological approaches, attitudinal approaches, and behavioural approaches to prevention of accidents at work. The physiological approaches are usually directed at individual workers, and are intended to increase workers’ mobility and agility through various training methods. The underlying assumption of these training methods is that a stronger or more flexible body can better withstand loads and thus avoid a potential accidental injury.

The effect of the physiological approach could not be supported by this review.

Another line of approaches is about attitude and belief modifications, in order to increase knowledge and awareness of safety risks at the workplace. The theoretical or conceptual support of such approaches is the KAP (Knowledge-Attitudes-Practices) model (Lund & Aarø, 2004). According to this model, safety-related practices are determined by an individual’s beliefs and attitudes.

Social psychology research has provided theoretical knowledge of the relationships between attitudes and beliefs and human behaviour (Hofmann & Tetrick, 2003). These attitude–behaviour relationships have provided the basis for a number of practical approaches for the prevention of accidents at work, where knowledge and information related to risk and safety at work have been disseminated or taught to workers with the intention of modifying their attitudes and beliefs, and in turn promote safer behaviour (Burke et al., 2006).

Wicker (1969) reviewed research on the relationship between attitudes and behaviour, and concluded that attitudes or beliefs probably do not predict behaviour. Since this review, social psychology researchers have sought to develop more elaborate models to increase the predictive power of attitudes. The two most known models are the Theories of Reasoned Action (TRA) (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975) and the Theory of Planned Behaviour (TPB) (Ajzen, 2012). The assumption is that behavioural intention is the best predictor of behaviour. Behavioural intention is regarded as a result, not only of attitudes, but also of social influences (including social norms) and self-efficacy (or perceived behavioural control).

While attitude modification approaches mainly explain behaviour in terms of internal mental states and cognitive processes (e.g., knowledge-attitudes-behaviour), the individual behaviour modification approaches represent an external focus that explains behaviour in the form of environmental consequences, such as incentives for safe performance or punishment for unsafe performance (Luthans & Kreitner, 1985).

The theoretical framework for the individual level behaviour modification programs is based on behaviourism that can be traced back to B. F. Skinner (1969), who suggested that humans choose various responses to receive a particular consequence. This contingency is framed as the Antecedent-Behaviour-Consequence (A-B-C) model, where both antecedents and consequences are responsible for influencing the behaviour of an individual. Where antecedents serve to define or signal the desired behaviour, the consequences of behaviour serve in influencing and reinforcing the behaviour more directly, and encourage the occurrence of a desired behaviour (Krause et al., 1999). Skinner’s theoretical framework has been expanded by inclusion of the mediating role of cognition, and the term ‘organizational behaviour modification’ has been suggested for this approach (Luthans & Kreitner, 1985).

Another important expansion of the Skinnerian approach is the social learning theory (Bandura, 1971). Together with the A-B-C model, these theoretical frameworks have informed safety intervention research and practice. Some commonly used components in behaviour-based safety (BBS) interventions are safety training, goal setting and feedback, observation and feedback. One drawback is that the possible effect of behaviour-based approaches seems to disappear when the incentives are no longer present. When work is performed in dynamic and complex work situation, and with transient workforces, this can further challenge the sustainability of prevention measures.

Overall, we only found a weak link between individual level approaches and reducing accidents at work. It seems that knowledge and attitudes are overruled by the social or organisational practices at the workplace.

Nevertheless, could we somehow incorporate sustainability into the social structure? In the areas of social science and organizational psychology, safety climate and culture have been proposed for such a social structure that can help make safety interventions more sustainable. With this, we leave approaches to prevention of accidents directed at the individual level and turn to the group level approaches.

Since the seminal safety climate article by Zohar (1980), safety climate changes have emerged as an important safety prevention approach. The safety climate of a group can be understood as a socially constructed phenomenon, as it emerges as a group-level property through shared cognitions and social consensus. Thus, safety climate informs workers on how they are expected to act under different circumstances, and reflects the shared priority of safety in a group compared to other competing goals, such as productivity or quality. Safety climate approaches include, for example, leadership based safety interventions, as leadership is seen as a safety climate antecedent, which has consequences for safety behaviour and safety at work (Kines et al., 2010; Zohar & Luria, 2003).

Safety climate interventions is about modifying the shared perceptions among employees in an organization or group to influence the relative priority of safety enacted within the organization or the group, for example, what kinds of behaviour are being rewarded and supported with regard to safety at work.

This type of intervention seems to be supported by a consistent theoretical framework, relating to organizational sensemaking processes (Weick, 1993, 1995; Zohar & Luria, 2004), social interactions (Morgeson & Hofmann, 1999), and social exchange and climate theory (Christian et al., 2009; Mearns et al., 2010; Nahrgang et al., 2007; Zohar, 2003; Zohar & Luria, 2004).

We found limited evidence for a little to moderate effect of leader-based safety climate and no effect of goal setting and feedback at group or organizational level.

It has been suggested that safety climate can be understood as a surface manifestation (espoused values) of deeper cultural levels (Guldenmund, 2000, 2010b; Schein, 2004). Furthermore, the culture and climate approaches have brought focus on the role of line managers in creating general organizational change, and in the prevention of accidents at work. These approaches are often centred on the commitment to and priority of safety demonstrated by supervisors and top management (Beus et al., 2010; Hofmann & Tetrick, 2003; Zohar, 2002).

Safety culture has long been a subject of interest for safety science, and particularly so following the Chernobyl nuclear meltdown in 1986. Safety culture leads us to the organizational approaches. The most elaborated theory of safety culture is based on Edgar Schein’s theory of organizational culture (Schein, 2004), where the essence of culture is its core of basic assumptions that manifest as values, and in turn defines behavioural norms, for example, norms that influence safety behaviour. The basic assumptions and values are taken for granted and maintained by members of a group, and are taught to new members as the correct way of thinking and feeling in relation to specific aspects, such as safety. Following this, safety culture may be defined as those aspects of the organizational culture that impact on attitudes and behaviours related to increasing or decreasing safety or risk (Guldenmund, 2010a). However, in this review we found no eligible safety culture studies. It may still be a new field, as well as possibly being more difficult to evaluate the preventive effect of such safety culture interventions.

Quite another line of organizational approaches is engineering control, for example, introduction of machine safeguards, walkways, elimination of hazardous substances or materials and other changes in the physical environment that directly influences individuals’ safety, without necessarily affecting their behaviour. In these cases, social influences are somehow minimized by the engineering approach, in the sense that the sociality or the safety practices usually do not affect the effectiveness of engineering approaches. Airbags in cars exemplify this – they work despite driver behaviour. 

Preference for engineering control is reflected in the public health hierarchy of hazard control (Lingard & Holmes, 2001). The approach follows the basic tenet of industrial hygiene, which is control of health hazards in working environments; it has been applied to the control of physical hazards responsible for energy transfer and subsequent accidents and injuries in the workplace. Emphasis in this model is given to the most effective and efficient preventive measures that eliminate risk at the source of the hazard, e.g. through elimination and substitution. Lower tiered approaches in the hierarchy of hazard control are through the use of personal protective equipment or training efforts, as discussed above under the individual approaches.

This review found that engineering controls overall provide moderate to strong effects on reducing accidents at work. Strong effects were in particular seen in cases where the safety intervention works independently of human decision making or work practices, or where the risks were “designed out.”

Multifaceted approaches usually integrate several components in the prevention of accidents at work, and are characterized as a complex intervention. Research has emphasized the importance of integrating various components to achieve a higher level of safety at work (DeJoy,2005). Such multifaceted efforts are often used in larger organizational efforts to prevent accidents at work, which usually require more resources and coordination in order to implement, maintain, and evaluate the effort over time.

This review shows that safety interventions combining group or organizational level components provide moderate evidence of a strong effect at medium‐term follow‐up, and limited evidence of moderate effect at long‐term follow‐up

A final important type of modification is societal control – such as safety rules and legislation, which introduces coercive power or incentives for people or organizations to change behaviour. Regulation may serve as a potentially powerful institutional force to promote the adoption of occupational health and safety policies and practices (Chambers et al., 2013). Such societal control can also be exerted on a voluntary basis, e.g., by use of marketing, economic incentives, reputations, and benchmarking, which involves a voluntary exchange, for example, insurance-related benefits for low risk companies. The basic idea is that such instruments provide an incentive for companies or people at work to stick to certain (legal) standards, either due to the risk of penalties in the case of noncompliance, or because a benefit can be achieved in exchange for an appropriate behaviour (Rothschild, 2000).

This review demonstrated that there are little to moderate effects of enforcements and legislation.

Even though effects are modest for legislation and enforcement, the population-based effects can potentially be quite large, as they are often applied to broader groups of workers.

As a researcher studying effects of safety intervention at work, and as the principal investigator of this systematic review, my hope is that this review can highlight which measures are more effective in reducing accidents at work, and that this can be used by stakeholders in making informed decisions in creating safer workplaces.

Overall, the results of this review support that occupational safety intervention efforts should focus on organizational level approaches, and foster safer working environments through designing and planning safer tools, machines, and working conditions – rather than focusing solely on how workers can mitigate the risks. Careful attention should also be given to the Public Health Hierarchy of Hazard Control, which emphasizes that more effective preventive measures involve eliminating risk at the source or separating workers from hazards.

The full systematic review is published in the open access journal Campbell Systematic Reviews. Dyreborg, J., Lipscomb, H. J., Nielsen, K., Törner, M., Rasmussen, K., Frydendall, K. B., Bay, H., Gensby, U., Bengtsen, E., Guldenmund, F., & Kines, P. (2022). Safety interventions for the prevention of accidents at work: A systematic review. Campbell Systematic Reviews, 18, e1234. https://doi.org/10.1002/cl2.1234

For the full list of references included in this article, please see the full open access Systematic Review.