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Accident investigations improve safety, Part 1

January 27, 2015
by Steve Wilder, CHSP, STS
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What a perfect world it would be if accidents never happened and we never had to think about it. But sadly, they do happen, and even more sadly, we often seem to accept them as a part of doing business.

Accidents do occur in long-term care. We know that. We also know that the Bureau of Labor Statistics recognizes long-term care as one of the highest-rated industries for occupational injuries. And be that as it may, we often seem all too willing to view these accidents as unavoidable, even before we know anything about them. And that is where our safety program breakdowns start to occur.

Over the years, I have asked a lot of managerial employees why they investigate accidents. The common responses:

  • Exonerate individuals (or management);
  • Satisfy insurance requirements;
  • Defend a position for legal arguments; or
  • Determine blame/responsibility.

Whenever an occupational accident occurs, a basic investigation is necessary. Through the investigation, we learn about causation, and we can put improvements in place to reduce the chances of recurrence. I’m not talking about occupational accidents that result in injury; I am talking about all occupational accidents. Even if any injury didn’t occur this time, a catastrophic injury from the same event may occur next time. Don’t wait for that to happen.

First and foremost, we must remind ourselves why we investigate accidents. Too often, I see my clients investigating accidents with what seems like a hidden agenda to place blame. It’s almost as if the mindset is: “something happened, and someone has to be blamed.”

Forget it. That doesn’t work.


Accident investigations are done to identify contributing factors that led up to the event. The more we know about contributory causes, the better job we can do with our safety management program to lessen the chances of recurrence. Looking for that person to blame puts people on the defensive, resulting in a compromised investigation. When you create a culture that proves that your goal is to learn from every event to prevent a recurrence, then you already have won half the battle. Staff will be forthcoming, give honest answers and work with you to achieve the desired results.

First, what is an accident? In simple terms, I define an accident as “any unplanned and unwelcomed event that interrupts normal activity.” You will notice that I don’t talk about injuries or damages at all. That is an outcome of an accident, not an accident itself. 

Imagine driving home from work, and you are stopped at a traffic light when the vehicle behind you fails to stop and runs into you. Was it unplanned? Sure. Was it unwelcomed? Did it interrupt your normal activity (driving home)? It sure did. Can it be called an accident? You bet.


Every accident has outcomes. We typically think of outcomes as negatives, but we can make them something positive as well. Negative outcomes include death and injury disease, damage to equipment/property, litigation costs and lost productivity.

On the other hand, accidents can have positive outcomes: the learning of new information; improvements to the safety programs; a demonstration of the organization's commitment to safety and a training/teaching opportunity, which improves morale.           




[submitted on behalf of the reader named below]

Wilder believes that the worker’s supervisor is the person most qualified to conduct the accident investigation.[But] that’s like the proverbial fox guarding the hen house... an inherent conflict of interest. A worker’s own supervisor, by default, is inextricably ensnared in that accident. Be it the worker (unsafe acts), the work site (unsafe conditions), or the workplace (inadequate policies/training/supervision)--it's a “no-win” situation for that supervisor.

Very few healthcare safety officers that I know of, myself included, ever worked all frontline positions including caregiver, maintenance, housekeeping, food production, storeroom, etc. A better solution is to get a peer supervisor to conduct the investigation. i.e., Shift Safety Supervisors at the Alexandria, Va. Fire Department all worked the frontline positions that they are now investigating, but no longer supervising. A practical alternative would be to use consultants who are not adversely affected by the consequences of investigation findings.

Respectfully submitted,

Donald E. White, Healthcare Safety Officer
Falls Church, Va.

I think is a sense we are saying the same thing. I agree with you that most healthcare safety professionals, myself included, do not have the intricate knowledge of each position to conduct the INITIAL investigation.

I am also a strong advocate for accountability for safety management by supervisors. If occupational accidents / injuries are uncommon in a department, then a supervisor shouldn't feel threatened by an occasional one that he/she has to investigate. Conversely, if a supervisor "looks the other way" on workplace safety, and accidents and injuries are more frequent, then they would not only be the unfavorable candidate to investigate, but I would also question their safety management skills (or lack thereof).

Whether it was as a healthcare risk manager or as a fire chief, more often than not I found that the front line supervisor (department head, immediate supervisor, company officer, shift commander) was still the best suited to conduct the investigation, and the safety officer or risk manager could follow up as needed.


Steve Wilder

Steve Wilder


Steve Wilder, CHSP, STS, is president and chief operating officer of...