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Abstract
Safety hazards and health risks are important factors that contribute to the occurrence of accidents in the workplace. To understand the factors that underline the occurrence of accidents, different disaster causation theories have been developed. The theories explain linearly and/or non-linearly the condition that initiates accidents or causes the escalation of the level of injury or damage following any unsafe act.
The implementation of any of these models in an organizational setting or even through legislation such as the OHS that seeks to reduce hazards or ensure the safety of workers requires the understanding of differences and similarities of various accident causation models. After discussing the Swiss Cheese Model and the Gordon Multiple Causation framework, the paper finds the two systems different. However, they are similarly based on their theoretical foundation.
Introduction
Safety hazards together with health risks are contributory factors to accidents. These risks entail unplanned events that translate into injuries or causes of some unexpected outcomes. Since the industrialization era, people have been working under environments that involve interactions with machinery and hazardous working conditions as witnessed in chemical-processing industries. Winder (2009) reveals how the early industrialization led to the development of production approaches that were new to workers. A review of any of the two accident causation models entails making a comparison of the proposed theoretical facets of the models. This paper discusses the differences together with similarities of the Gordon Multiple Causation Model and the Swiss Cheese Framework.
Background
The Gordon Multiple Causation Model
The Gordon Multiple Causation Model proposes that accidents occur following the contact of not only complex but also randomly interacting factors that play out between victims, agents, and the environment. Its development is epidemiological in nature since it involves studying accidents from the approach of cause-effect relationships. It suggests a predisposition of various traits in any situation likely to cause injury.
Without negating environmental factors, individuals’ susceptibility and perceptions interact in a complex manner with a myriad of situational traits to cause accidents. Gordon suggested that accidents causative factors are unlimited in nature. Therefore, he only suggested some strategies that prevent the occurrence of accidents. Central to the work of Gordon was that machines’ capacity to design a structure that suits the usability of their clients (Ergonomics) was important in helping to reduce the occurrence of injuries that related to fatigue and errors in machine utilization. Gordon’s theory suggests that accidents could be prevented through the appropriate modification of the host, the agent, and the environment in which an accident occurs or is likely to occur.
The Swiss Cheese Model
The Swiss Cheese Model of accident causation is employed widely in engineering (Leveson, 2004), in healthcare settings (Bayley, 2004), and in the aviation industry. The framework is used in risk analysis where layered security systems are deployed. For example, the model finds application in the analysis of computer defense systems. The theory holds that any security or incident that can potentially cause an accident behaves as multiple Swiss cheese slices when they are joined side by side.
These layers prevent risks from occurring or from being actualized through the layered defenses. In theory, any lapse and/or weakness in one layer does not lead to the actualization of the risk since the next layer behind it helps to overcome that limitation or drift. However, in practice, layers that act as the defense mechanism may have their flaws aligned to the extent of leading to an accident. Therefore, in the Swiss Cheese Model, accidents are preventable if point flaws in each layer are arranged in a manner that no alignment occurs at any time.
Differences between the Swiss Cheese and the Gordon Multiple Accident Causation Theories
Theoretical Foundations
The Swiss Cheese Model and the Gordon Multiple Causation framework are different in terms of their theoretical formulation. Gordon’s theory endeavors to identify different factors that are responsible for accident causation. It also reveals how these factors interact in the process of causing accidents. The model postulates that a single accident occurs following the complex interaction of different factors. It compares accidents to the processes of the causation of infectious diseases. To this extent, the model insists that accidents are fully understood after investigating their causal-and-effect relationships in the presence of the interplay of various complex factors (Svenson, 2001).
Gordon’s Multiple Causation theory differs from the Swiss Cheese Model, which mainly considers the process of propagating an unsafe act through a series of shields. The Swiss Cheese Model mainly focuses on propagating unsafe acts through defensive mechanisms. It blames accident occurrence to people’s forgetfulness, lack of attention, and/or their moral weaknesses. It also assumes a system approach to accident causation. From this paradigm, it allocates blame to accident causation to working conditions. Therefore, the model focuses on erecting defenses to counter the errors or mitigate their effects.
The cheese model describes latent and active errors as the two major blunders that lead to the occurrence of accidents. Active errors occur when the impact of an error is immediately felt. In comparison, OHS Body of Knowledge (2012) posits that latent errors “tend to lie dormant in the system largely undetected until they are combined with other factors to breach system defenses” (p.12). The cheese model suggests that human errors arise from latent conditions that are found in a system.
The Nature of Causation and Prevention of Accidents
Accident prevention is a major issue of concern in all work environments. Winder (2009) asserts that since the 1940s, efforts to integrate safety and the health of works led to increased efforts to prevent accidents (p.284). This observation underlines the need to differentiate accident causation theories from the paradigms of their accident prevention approaches. The Gordon Multiple Causation Theory does not accept any simplistic interpretation of accident causation.
It notes that understanding accident causation requires an in-depth understanding of both technical issues and human-related issues that may lead to the occurrence of an accident. The model advocates people to understand accident causal series before taking remedies that can promptly counter any interacting factor in the accident causation process. Therefore, the primary focus of accident prevention should be on comprehending any deviation in an accident host, agent, and the surroundings.
In contrast, the Swiss Cheese Model insists that accidents can be prevented through the suppression of an identified cause through an array of defense layers. In this context, the model views accidents in a simplistic manner. It suggests that accident-causing factors are unavoidable. Therefore, successful propagation of any factor into an accident arises from failure in defensive layers as witnessed in case they are not intact. Unsafe acts are always in direct contact with a victim and/or the system (Reason, 2008). However, these unsafe acts develop into an accident due to various latent failures in the system. The failures emerge from poor decisions made by the system’s builders and application developers, residing pathogens, and those failures that have prevailed in a system for several years.
The Swiss Cheese Model takes a no-person-to-blame approach to accident prevention. This approach involves investigating accidents and incidents from latent error approaches, as opposed to active error strategies. Rather, contrary to Gordon’s, approach, the Swiss Cheese Model shifts the debate on accidents and incidents to concentrating on hazards and defenses (OHS Body of Knowledge, 2012).
The objective here entails conveying the message that hazards residing in a system are responsible for any unsafe acts that lead to accidents. This situation underlines the need to erect defenses to curtail the effects of such acts. The Swiss Cheese Model calls upon organizational managers to establish barriers that can catch errors as opposed to focusing on error eradication. The model suggests that the endeavor is impossible.
Similarities of the Swiss Cheese and Gordon Multiple Accident Causation Theories
The Swiss Cheese and Gordon Multiple Causation theories are similar in terms of their theoretical foundation to the extent that they regard human and system factors as important in the analysis of accident causation. For example, the Swiss Cheese Model takes a person-centric approach when positing that a tired driver is a dangerous and potential cause of an accident. From the Gordon Multiple Causation approach, a tired driver is prone to fatigue.
Consequently, the vehicle should be designed to suit the driver’s capability limits to ensure that he or she does not get tired. In both theories, human failure is an important amplifying factor for the injury suffered. Similar to Gordon’s model, the Cheese model accepts that individual errors made by operators do not explain or account for the occurrence of accidents or incidents independently (Reason, 2008). Rather, as witnessed in the case of Gordon Multiple Causation Model, accidents and incidents are explained by the collective organizational factors, which reside in the system.
Both Gordon and Swiss Cheese models establish theoretical approaches that can be instrumental in meeting the concerns of occupational health and safety (OHS). The OHS practice recognizes the importance of conceptual frameworks that inform any professional practice (Ridley, 2001). To this extent, both Swiss Cheese and Gordon Multiple Causation models establish an important theoretical framework that is pivotal in the OHS conceptualizations of a mental model, which explains accident causation. They both offer alternative theoretical models that OHS practitioners should consider in the evaluation of the occurrence of an accident.
For example, through the two models, OHS practitioners are put to task to work with organizations and environments in establishing limitations that permit the progress of unsafe act(s) into an incident or accident that may result in injury or damage. This plan creates a room for the evaluation of what takes place in any workplace and/or what should actually happen (Roelen, Lin, & Hale, 2011).
Conclusion
The Swiss Cheese Model shifted the focus of accident causation from a scenario where individuals took the blame for their occurrence to an approach where no person or a group of people would take the censure. While it accepts that people may engage in unsafe acts, it argues that accidents are caused by latent errors in the system. Gordon Multiple Causation Model differs from this approach since it proposes that accidents mainly occur through the interplay of host, agent, and environmental factors. In this approach, human errors are the principal causes of unsafe acts. When these acts interact with other factors, they cause injury or damage. The two models are similar to the extent that they play an important role in informing the OHS practice.
Reference List
Bayley, C. (2004). What medical errors can tell us about management mistakes? Cambridge: Cambridge University Press.
Leveson, N. (2004). A new accident model for engineering safer systems. Safety Science, 42(2), 237-270.
OHS Body of Knowledge. (2012). The core body of knowledge for generalist OHS professionals. Tullamarine, VIC: Safety Institute of Australia.
The reason, J. (2008). The human contribution: unsafe acts, accidents, and heroic recoveries. Surrey, Guildford: Ashgate.
Ridley, J. (2001). Health and Safety in Brief. Oxford, England: Butterworth Heinemann.
Roelen, A., Lin, P., & Hale, A. (2011). Accident models and organizational factors in air transport: The need for multi-method models. Safety Science, 49(1), 5-10.
Svenson, O. (2001). Accident and incident analysis based on accident evolution and barrier function (AEB) model. Cognition, Technology and Work, 3(1), 42-52.
Winder, C. (2009). The development of OHS legislation in Australia. Journal of Occupational Health and Safety, 25(4), 277-287.
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