Real leaders leave a legacy. They capture the hearts and minds of their teams. Their origin story puts the safety and wellbeing of their people first. Great companies, ubiquitously have safe yet productive operations. For those companies, safety is an investment, not a cost. For the C-suite, it’s a real topic of daily focus. This is The Safety Guru with your host, Eric Michrowski, a globally recognized ops and safety guru, public speaker, and author. Are you ready to leave a safety legacy? Your legacy success story begins now. 

Hi, and welcome to the Safety Guru. Today I’m very excited to have with me Rob Shaw, who’s a false prevention expert. Rob, welcome to the show. Really excited to get to know some really tangible ideas that you can share with their listeners around slips, trips and falls, maybe why don’t we get started with a little bit of your background? You have quite a unique background on a topic that often people don’t talk about or assume is I can’t change anything.

Very true, and thank you for having me, Eric. Yeah, my background is I’m now entering my 20th year working full time on slips, trips, and falls, which amazes me more than I think anybody else. You’d be surprised that you could work for this long on a topic that seems very simple on the surface. So, my background was 15 years with the UK health and safety regulator, the Health and Safety Executive, where I worked as a scientist, doing research into why people fall over, what can be done to prevent it, and helping the regulator write their policy documents and their guidance, helping them undertake slip, trip and fall accident investigations and helping clients commercially reduce their risk of slips, trips and falls. And I think when I started the job, I thought it would end up being a bit of an insurance gig and I’d do it for a little while and then I’d find something else. But actually, there’s a lot of science that underpins why people fall over. But once you apply that science, the solutions are quite simple. So, it’s a technical subject that also has direct, practical applications to help companies reduce risk.

And I found that to sort of take my interest for the last 20 plus years. So about five years ago, I started my own consultancy doing the same thing.

Really interesting because it’s a topic that a lot of organizations kind of assume it’s going to happen. So, what’s the size of the problem around slips, trips, and falls in the UK and worldwide?

I think that’s one of the big problems with slips and trips is it’s often seen as very minor something that you can’t do anything about, and there are bigger problems. Industry and organizations worldwide have a lot of safety risks to manage, and some of them are very tangible and could, if there’s a failure, result in serious injury to lots of people. But in reality, most organizations find that slips trips and falls are one of their highest causes of regular injury. So, in the UK, for example, the highest cause of non-fatal major injuries in the UK workplace are slips, trips, and falls every year, about a third of all the major injuries. So, things that require hospital visits, hospital stays, significant time off work result from a slip or a trip. The same is true worldwide. The last time I looked at the statistics in the US, for example, the CDC say that over a million Americans a year are injured following a slip, trip, and fall, including 17,000 fatalities, and they account for at least 15% of all workplace injuries in the US as well. So, they are quite serious.

And when you’re talking about the size of this problem, you’re talking about whether I’m slipping, tripping or falling from different heights or is its same level.

Typically, all those statistics relate to the same level. So, falls from height is its own category of risk, and we know that slips and trips are very closely linked to falls from height, but obviously the consequences are potentially more severe because the resulting fall is from a greater height. So those statistics don’t consider falls from height, falls from ladders, and so on. 

And I know when we spoke originally, one of the things that really struck me is a lot of organizations do root cause analysis around them, and the root cause analysis is very weak and essentially gets to I wasn’t aware of my environment. I slipped. I don’t know why, or I was new to this part of the job, C-Suite, et cetera. So, what are some of the myths that exist around slip, trips, and falls like that, that basically it’s not preventable?

I think that’s exactly the core of it. The common myths are that they’re not particularly serious. And we’ve made the point that actually they result in a lot of serious injuries every year and a large number of fatalities. Unfortunately, my 20-year career has been spent investigating the more serious end of slip strips and falls, and there are some very unpleasant ones. But the second point that you draw on there that they are seen as something that can’t really be prevented, they’re just part of the cost of doing business. People will find a way to fall on floors. And while that’s very true, people are very good at falling over. And walking as bipedal creatures is quite a challenging biomechanical task. It’s heavily influenced by environmental factors and by task factors. So, one of the big myths is that there isn’t really a lot you can do about it. And that’s typically because most root cause analysis, in my experience, tends to come down as far as human error and stop there. And if there has been a slip, trip or fall at some point, there must have been a human error. Somebody has failed to do the walking process properly, but that error is very heavily influenced by the environment, the design of the task, the individual’s capabilities, and so on. 

And I think in root cause analysis, what we do is we get to human error, and it’s a very convenient process, root cause, because we can say, well, there’s nothing else we could have done. The individual needs to pay more attention. We will focus on training, we’ll focus on awareness, but it doesn’t help in managing further risk. If somebody slipped on a wet floor or tripped over an obstacle by not getting down to the root cause of how slippery that floor is when it’s wet, how it was wet in the first place. Why the obstacle? Came to be there, how you would prevent it. Again, it relies on the next individual using that area to do a better job of navigating the hazard rather than proving the underlying hazard. So, I think those are the problems. The three big myths and issues are the perception that they’re not serious, the perception that there’s nothing that you can do about them, and then the poor root cause analysis. And as we will go on to talk about, there are lots of very simple solutions to slips, trips, and falls, but they’re rarely based on good evidence, they’re rarely based on a good root cause analysis and an appropriate scientific selection of an intervention.

And that gives us lots of problems. Because organizations often will have put lots of time, effort, and money into a solution to what they see as the problem. And if it’s not the right solution, it doesn’t work. And that reinforces the opinion that you can’t do anything about them. We’ve invested this time, this money, we bought shoes, we’ve changed the floor, and it didn’t reduce the risk. We still had slips, and that’s likely to be because they didn’t get down to good quality scientific evidence.

So, before we get to some of the drivers and some of the solutions, what would you advise organizations or leaders when they’re looking at root cause analysis? What should they be expecting to see?

I think one of the things that I see routinely with client’s information, and normally, if I’m working with a new client, the first thing I’ll recommend is that we look at their data and look at it from the point of view of an expert. Because one of the most common mistakes is that slips, trips, and falls, particularly in workplace risk assessments, are sort of thought about as a single word, a single line on a risk assessment. Slips, trips, and falls. And often when you break down the issues that there have been, you find that the idea of slips and trips are considered completely within the same category, where the root causes are very different from a slip or a trip, and your solutions are different. And the way that people go about reporting and their engagement with the process is also very important. So, we work with a partner who has a software tool for any data analysis. It’s not just risk data, but it has a really nice feedback loop and a very quick and easy way to go. And so, gathering better quality data is very important, but also querying that data for common themes, common issues, not only between incidents, but across sites, which are your high-risk areas commonly in different sites?

Are they internal versus external? Maybe the kitchen or the toilet environments? And, looking at where perhaps the best effort would be spent in reducing that risk.

Sure. Okay, so really looking at themes and trending to understand where should I go fix first? But should there be something if I’m an executive looking at root cause analysis, should I be challenging my team? If the root cause that’s identified is human error situational awareness or should I accept that?

That’s a very good question and I think I generally say challenge. It doesn’t mean that the wrong root cause has been identified. There will be situations under which human error has occurred. Distraction is an obvious example. You know, if people are on a mobile phone whilst they’re completing a task, we know from the research, and some very good and interesting research was done many years ago. I wasn’t allowed to take part, but it sounds very good fun. That showed that if you were holding an in-depth conversation on a mobile phone whilst walking, the level of distraction was something similar to six shots of whiskey. So, who the control group were for? That I don’t know. Very interesting science, but it does have a significant cognitive load, so it requires you to focus on the conversation, you’re less aware of your environment. So, it doesn’t mean that human error is not a valid part of that root cause analysis. But if it’s the only issue identified, it doesn’t put the organization in a position to do anything positive to reduce that risk in future. So, I would challenge that more should be looked at. And in many cases what we advise is for the investigators.

So, whether it be the safety teams or the facilities management teams, a little bit of training on the risks and the root causes of slips, trips and falls is very valuable because a lot of people don’t know what they don’t know. And the problem with slips and trips is we’ve all had one, and most of us are lucky enough to have had one that we got away from without significant injury. So, we’ve got some predetermined ideas of how it happened. And as humans were also very good at blaming ourselves, it’s very embarrassing when you fall over, particularly if you didn’t injure yourself severely. And so, the first thing we do tend to do is internalize and say, oh, I should have been paying attention. Oh, I’m fine. No. So it might even be that the injured party is saying, no, there was nothing wrong with the environment. I just wasn’t paying attention, because once you’ve lost your balance, either from a slip or a trip, the fall is very, very fast. You hit the ground so quickly, it can be difficult to unpack what happened. So even the language from the reports of the injured party or the immediate investigators might be difficult to rely on, and the actual mechanics of the form might be more informative as to what is likely to have happened. 

Interesting. So, let’s get to some of the drivers and then some of the solutions, because I think ultimately that’s really interesting in terms of how you can make a tangible impact in these areas. So first, drivers around slips, trips, and falls. And you said that the drivers typically are different one from the other. 

Absolutely. Trips in terms of initiating factors, trips are where you catch your foot on something and fall over. So typically, they result from housekeeping issues or maintenance issues, so something that’s underfoot that shouldn’t be there, or something that’s become damaged and is standing proud. But also, trips can happen over permanent obstacles in an environment. So single steps between levels, bunding around machinery, anything that causes a change in level underfoot, particularly if it’s quite hard to see, it gives you the opportunity for your foot to contact that object and cause you to trip. And it doesn’t have to be a solid object or a square edge. You know, it could be a trailing cable or a flap of carpet, something we’ve all encountered. When it comes to slips, they tend to be a little bit more complicated. And this is where the science sort of hooked me in and has kept me interested in 20 plus years. It’s a combination of the floor material you’re walking on, and that could be a carpeted office, but it could also be an access platform in an industrial environment. It could be the back of a vehicle. So, any surface that you’re walking on, the footwear that you have on your feet or not.

We investigate a lot of barefoot slips in leisure environments, in changing rooms and so on, and the contamination present between the two. So those three factors will have a significant determination as to how much grip is available. And then depending on the task you’re trying to achieve, whether you’re walking from a to b, or whether you’re actually pushing and pulling a load, moving some objects, that will all influence how much friction you need to safely complete that task. And all those factors need to be considered when you’re looking at the risk of a slip. So, we tend to gravitate to one issue or another where we’ll replace the floor with a better floor, and that’s a very good collective control, but it may not address some of the other issues around the task and so on.

Interesting. And so, let’s dive a little bit deeper into some of the solutions to it. You talked about changing the floor being one option. One thing that intrigued me was an experiment that you talked about between two fast food companies, one that focused on footwear and then one that focused on the surface that people are walking in. So, tell me a little bit about some of the solutions that exist to address slip strips and falls.

Yeah, so when it comes to slips, and I tend to focus most of my efforts on slips because that’s where the technical issues are. Organizations are generally better at addressing trips because they’re more obvious in terms of hazards, although that does give us some issues. But in terms of slips, the big issues are obviously the flooring, the footwear, and any contamination present. Now, there’s very, very good slip resistant flooring out there. There’s very, very good slip resistant footwear, both of which can essentially eliminate the risk of slips in most typical environments. If we think about outdoor surfaces, outdoor slips tend to be less frequent, and they tend to happen on more challenging surfaces, where you’re walking on grass or mud or something that’s very heavily contaminated with something solid. But typically, walking across a sidewalk or a pavement, we don’t see lots and lots and lots of slips in normal wet conditions. Very normal anyway for our part of the world. So, there’s very good slip resistant surfaces out there and very good slip resistant footwear. The big challenge is identifying something appropriate for your workplace or your organization or your public space is very difficult because there are hundreds and hundreds of different test methods, all of which purport to test slip resistance.

But in reality, what we’re interested in is how slippery is this surface when a person walks on it. Not when moving a car tire at 10 miles an hour at 30 degrees, not when trying to break a rubber sled. There’s lots of different methods, but they need to simulate the dynamic interaction of the pedestrian heel and the floor surface. And there’s only a very small number of tests that do that well. So, one of the challenges is that if you wish to specify a certain floor surface, you can almost certainly find a test somewhere that will tell you that it’s appropriate. But that doesn’t actually mean that when you’ve got it back into the workplace that it’s helping you manage the risk. And we see lots of issues with national standards. There are no agreed international standards on testing the slip resistance of flooring. It’s very different nation to nation, and the quality of the tests and the usefulness of the information varies. When it comes to managing the risk of footwear, the picture is a bit simpler in the test, methods are much more similar. So, there’s a single standard test for how slip resistant footwear is across Europe, and the same test method is used in an ASTM in the US.

Slightly different interpretation of those results, but the same test method. The inherent problem with that is that that test method itself is flawed. It doesn’t test the bit of the interaction we’re interested in, which is at what point does this shoe fail in a challenging environment? It doesn’t challenge the footwear, what it does is forces it to fail and then measures how much friction is generated during the slip, which is a very different question. Those are some of the challenges around slips and then there are lots of issues around human factors and they particularly come into play around the cleaning process. So many floors that are smooth and shiny, for example, will be very slippery when they’re wet, but they’ll offer excellent friction when clean and dry, because you’ve got very good material contact between the footwear and the floor. So, it’s not necessarily the case that having a smooth, shiny floor is always bad, or that any floor is inherently slippery. It’s about managing risk. But one of the big challenges is if those floors do get wet, then you’ve got to be able to manage that very carefully because the risk changes quite dramatically from the dry condition.

So, what we find is that by managing the cleaning both how effective the cleaning is at removing contaminants from the floor and how well managed the cleaning process is itself. So that during any wet part of the cleaning process people are not accessing that floor other than the cleaning staff who need to be considered, then that can also help improve the management of risk. So, the example you talked about with the fast-food restaurants, there are two well-known fast-food brands internationally, but within the UK. Their representatives were members of a food group with the Health and Safety Executive, with the Regulator, and about 20 years ago, we sort of came together with that group and said, right, these are some of the root cause issues, these are the some of the things that we could be doing. And they both decided to go in very different directions with their solutions for preventing slips in their kitchen environments. So, one focused very much on their floor specification and the way they cleaned that floor didn’t do anything about footwear. And the other one moved very much into specifying good slip resistant footwear for all staff and put less emphasis on what the floor was in the kitchen and how often and how well they cleaned it.

And they both had significant reductions in injury rates, I believe about 65% each. It was completely comparable. Two very different solutions, but both worked to control the risk. Now, as those two organizations have matured, they’re now looking at it more holistically. Each one is now looking at flooring footwear and cleaning as they’ve grown into that. But in the first instance, two different solutions, but both appropriate, both selected using relevant science, and both organizations saw a significant reduction in the injuries that they were having in those kitchens.

So, you talked about the regulatory side, regulatory or standard side, where there isn’t a common standard that really addresses the need for slip resistant floors or footwear. How can people navigate around it in the absence of a clean standard that really helps solve that problem?

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It is a real challenge. And what I would say is that you need somebody who is an expert in slip resistance, which sounds very much like a sales pitch and will sound more like a sales pitch when I say that’s quite difficult to do. Because one of the challenges in our industry is there’s a lot of vested interest and a lot of false expertise. So, for example, when it comes to testing flooring, within the UK, especially, there are a lot of people who offer free flooring tests or very, very cheap flooring tests and they will come out and test your floor. It will always say the floor is bad and they will have in the van something you can put on the floor that will make it better and then they’ll sell that to you. And it’s not to say those products don’t work. There are ways of modifying existing floors that improve the slip resistance and improve safety, but the vested interest is always going to be in selling that product and applying that product, when actually in that environment, the floor may not be the key factor that’s going wrong. It may be the management of contamination, it may be the footwear the individuals are wearing, all the tasks they’re being asked to do.

So, it’s really about finding sort of independent advice and guidance. And in the UK, that has always been through the regulator. Now the regulator in the UK has changed the way they do their science a little bit. And slips, trips, and falls is not currently a topic that’s emphasized, it’s a hibernated topic. So, they’re not proactively enforcing on it and working on it, which is why we went independent, because when that happened, I was sort of given the choice of retraining and learning a new safety discipline or carrying on doing what we were doing. And we’ve not fixed slip strips and falls yet. So, yeah, independent expertise. I’m currently the lead for preventing workplace falls for the International Ergonomics Association slips, Trips and Falls Technical Committee. And that technical committee has a wide membership from across the world, lots of scientists and academics from different universities, different commercial organizations, and they host conferences every year and so on. So, this year’s conference is in Toronto, and that sort of organization of independent researchers and consultants and so on is a good place to start.

We’ve touched on the topic of select, how about trips?

So, for trips, the first thing is good risk assessment for the environment. So, identifying low lying hazards, trailing cables for the maintenance defects, damaged tiling or cracked floor surfaces, you know, drain covers that are not sitting properly. A good reporting system is key because the individuals who work in those areas day after day will be very familiar with those hazards, will likely have had near misses around them, or will have spotted them, and you can almost crowdsource your risk assessment if you have a very good reporting process that’s very quick and easy to do. But critically, that reporting process needs some feedback in it. So, if an individual reports are damaged, great, it may not be possible to fix it the following day. You need to get an engineering, you need to find budget for that, and so on. But if nothing at all is done following the report for two months, the individual sort of feels like they’re not being listened to. So, it’s really important that you’re able to go back to them straight away and say, we appreciate that report. We’ve received it. This is what we’re going to do about it and encourage engagement with that process when it comes to permanent trip hazards built into environments.

So single steps, curbs at crossings, bonding around machinery, that kind of thing, visibility is very, very important. And the same is true for navigating steps and stairs, which have their own set of challenges and hazards. So, the visibility of the obstacle is critical. The way that we navigate an environment is we tend to scan ahead of ourselves, not consciously. We subconsciously scan. And if something is visible, if it contrasts with its surroundings, we note it. And as we approach, we find a way to deal with that. And the obvious example I usually use is as you approach a flight of stairs, you don’t get to the bottom and stop, think about what you’re doing, and then place your foot onto the bottom step and start to use the stair. You just seamlessly walk up. Because as you’re scanning the environment, a flight of stairs ahead of you is a very obvious change in level and change in situation. Same is true of a well highlighted ramp. But if you come across a single step that you didn’t notice in your scanning, because it’s not a significant change in level, and it’s perhaps covered in the same-colored carpet or the same-colored floor material, that’s when people tend to trip.

And what the research has shown us, and there’s some great research out of Pittsburgh University that shows that as people approach a visible curb or step, they’ll do one of two things. They’ll take one longer step, so their next step is ready to go. Onto the rise, the change in height, or they’ll take one shorter step when they adjust their gait. But these are all subconscious decisions. Nobody’s thinking about this. So, you need to give people those correct physical and visual cues so that their subconscious processes are working properly. One of the challenges around a root cause analysis ending at human error is that you can’t reliably say to somebody well, be more observant, be more aware of your environment and stop falling over and expect them to do any of those things. Because we don’t consciously think about this as we walk. It’s very much a subconscious process.

Interesting. And how about in an uncontrolled environment? So, what I mean by this is if I’m a field worker as an example, and I’m not working in a natural environment or an environment that I get to control because it’s either third party or I’m outdoors climbing poles, what are some of the strategies in those instances?

It’s a very interesting situation where you’ve got peripatetic workers, for example, who are either out and about outdoors or out on other people’s sites or even contract cleaners who might be on their own sites or other people’s sites but have to access floors that are, for example, slippery when wet and then, as part of their work process, wet them. So, you’ve removed the level of control of the flooring. It may not be your site or your organization. It may be an outdoor surface that can’t be controlled. You’ve removed the element of contamination because of the weather outdoors or it’s somebody else again, somebody else’s site and processes. So, the key control in that situation is footwear. And it’s one that I recommend quite often for contract cleaners and for outdoor workers. And it’s one that we’ve had great success with peripatetic workers. I’ve done a lot of work with utilities companies, both water companies and electricity companies, maintenance engineers and even sales forces. People who are still doing door to door sales and are traveling, getting in and out of vehicles, accessing residential properties or without any control other than what’s on their feet. And a well specified slip resistant shoe can protect in those environments.

And there’s a perception that a lot of slip resistant footwear is developed for indoors and therefore really, it’s an indoor shoe. Actually, the principle works. It’s a very crude analogy, but similar to a car tire, a good piece of slip resistant footwear works by displacing the water or the oil or the contamination beneath the shoe and still giving you some contact between the rubber material of the shoe sole and the flooring. And it will do that in an internal and an external environment. And some of them will even work on snow and ice within certain tolerances. Very good. In the UK, where our freezing temperatures tend to be around about zero to minus five. I did do some work in the onshore Canadian oil fields where they get. Down to about -20 and the rubber properties change quite significantly then. So that has its own challenges, different.

Challenge in those cases, I think all you’re stuck with is metal grip in that case, right?

Yeah. Well, we found a piece of rubber footwear that really did not perform as well as the very top rubber footwear, but whose properties did not change as significantly during the temperature transition and so was still quite appropriate for the environment. So, there’s always something. But you do need to find your specific challenge and find your evidence to make sure you’ve got that correct solution.

It makes me wonder why, if we’re getting in a workplace boot as an example, why you wouldn’t have every workplace boot with that grip resistance as well as the composite toe, why are you solving for composite toe without the grip?

It’s something that I often talk about now within Europe, anything that has that composite toe tends to have a well rated, slip resistant sole on it. The problem is that it can be well rated in the standard test, but it may not offer the protection you need. There was some research done in California that showed that using that standard test, if you chose all the footwear that got the highest rating in that test, you could flip a coin and that’s your chance of getting a boot that’s appropriate for your environment. It was about 50 50. So, of those that passed the test, half of them were good and did offer protection, and half of them weren’t. Because the standard isn’t set up to challenge footwear and to give you a very challenging test method, it’s set up by manufacturers to pass the footwear they already make. Because that’s where the vested interest is and where a lot of people on the committee come from. So that’s a significant challenge.

And so, there’s no way around it for an individual even to figure out which footwear is better than tossing a.

Coin using the standard test. No, there are some better tests out there. So, the regulator in the UK has its own footwear test method, which isn’t set up as a standard, it’s set up as a voluntary scheme for manufacturers. It’s called the HSE Grip Scheme. And the way that works is it uses a biomechanically valid test to test when a piece of footwear fails, rather than how much grip it generates during sliding. But the power of that test is that the past thresholds, as you will, or the rating thresholds, are based on risk, not based on sort of an arbitrary how many pieces of footwear can pass this. And the idea is that you can use a risk assessment, then you don’t always need the best possible shoe, you need one that provides a suitable level of slip resistance as part of whatever else you have in your risk assessment. And the idea is that the manufacturers who already make excellent footwear. Their footwear will pass the standard tests, as the others do, but they can also demonstrate this additional level of performance in this test, almost as a marketing exercise, and it’s very effective. 

And there are two large scale clinical trials showing that this works. One was performed in the US, by Jennifer Bell, and one was in the UK, Mark Little and Co from the Health and Safety Executive. And there were large scale trials using footwear that had achieved a five-star grip rating, so sort of the highest rating on the HSE voluntary scheme. And one was done with hospitality workers in kitchens. That was the US study, and they found that it made a significant reduction in the number of claims and the number of injuries. And in the UK, it looked at healthcare workers. So, working in environments where quite often floors are very smooth and shiny for hygiene reasons, they often get wet, sometimes unpredictably, and asking the question whether if the National Health Service in the UK were to provide footwear for staff in these sorts of high-risk environments, which they don’t currently so it would be a significant financial outlay that they don’t currently undertake. Would it reduce the risk, and would there be a cost benefit? And the answer to that trial was also yes, it would be a significant reduction in risk, and it would be a cost benefit to do that, even though the footwear costs more that they’re not currently spending it’s saving a significant amount in injury, lost time, and claims.

And that was a statistically significant clinical trial of four and a half thousand health care workers. And so we’ve got some very good evidence that that intervention works.

So, thank you very much, Rob, for sharing all these themes. I think the main takeaway is we’re not doing enough around slips, trips, and falls. We’re accepting that there’s a high number and it’s hard to change, as opposed to really getting down to what’s the root cause and what are some potential solutions to addressing them. So, thank you for sharing all these insights. If somebody wants to get in touch with you, Rob, how can they do that?

The best way is by email. My email address is [email protected]. And as you’ve probably gathered, I’m quite happy to talk about slips, trips and falls until the cows come home.

Excellent. Thank you so much, Rob.

Thanks, Eric.

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