How strong a role does evidence play in decision-making within OSH?

Does evidence really improve safety? The number of academic papers in occupational safety and health (OSH) has steadily increased over time going from about a dozen articles published in 1910, to 26,000 published in 2010, to more than 80,000 published in 2020[1]. The increase in evidence occurred at the same time as a wider societal change in awareness of health and safety in the workplace, and throughout the 20^th century the number of occupational deaths, injuries and illnesses steadily decreased[2].

Recently, in high-income countries at least, the number of occupational accidents and deaths have reached a plateau and in many low- and middle-income countries levels remain high[3]. This suggests that more evidence does not automatically lead to increased safety. So, what is the role of evidence within OSH?

RAND Europe, commissioned by Lloyd’s Register Foundation in partnership with the National Safety Council, explored this question by conducting a study consisting of a rapid evidence assessment and engagement with stakeholders (see full report). This study investigated the role played by evidence in the decision making processes in OSH within organisations, globally and across all sectors.

Given the complexity of this issue, this study aimed to provide a high-level picture of the ecosystem around evidence in OSH. The research team identified the agents involved in the production and sharing of evidence, as well as some of the enablers, barriers, and principal mechanisms of evidence use.

Some of the key findings are summarised below.

• We found no single definition of what constitutes evidence within OSH. However, there is consensus amongst stakeholders on what can be considered evidence-based, such as ‘something that has a solid body of research and practice’ and that it is ‘observable, repeatable, and independent’.
• There are many different types of available evidence; these are highly fragmented and disconnected, reflecting the complex and sectorial nature of the OSH space.
• Evidence needs to be produced, shared, and translated before it can be used and each phase comes with challenges. There are several players involved in each step of this life cycle, as illustrated in the figure below.

• Evidence is far from being the only information used to support OSH related decision making within organisations. There are many factors that influence whether decisions are evidence-based or not, including:
  • Laws and regulations: many organisations implement health and safety practices only if these are mandated and enforced by the law. Regulations are country-specific, and there is high variability between countries.
  • Size and internal capability of the organisation: small and medium enterprises do not often possess the resources and internal expertise necessary to incorporate evidence within their health and safety practice.
  • Business case for safety: many decision makers within organisations overestimate the cost of implementing evidence-based safety practices and underestimate the risks of not doing so.
  • Safety culture: the opinions, expectations, and priorities of the duty-holders, as well as the wider culture and context of the organisation influence the extent in which evidence is put into practice.

The role of evidence in occupational safety and health is therefore certainly important, but it is only one part of a complex ecosystem of information and decision-making that ultimately shapes occupational safety and health.

So, does evidence really improve safety? The short answer is yes, but not on its own; evidence just existing ‘somewhere’ is not enough. Researchers and knowledge sharers could do more to help duty-holders identify and implement relevant evidence into their practice. For example, translating evidence into easy-to-digest formats (such as infographics) that can be shared via professional networks makes it more likely that evidence is accessed and understood by its intended audience. Furthermore, duty-holders might be more inclined to integrate evidence in their decision making if they could see the value and applicability of learning from other sectors, and the financial value of evidence-based safety interventions. Further research on the cost/benefit of evidence-based practice might help address the perception that evidence-based practice is costly. So, maximising effective evidence use and thus improving safety for all also depends on tailoring the production and translation of evidence to the needs of its end-users and making evidence accessible.

One approach to this is to use ‘what works’ methods, which the Foundation are exploring further.  More information on this will be posted on the website shortly.

[1] Dimensions data and solutions for discovery and analytics web app.

[2] Tupy, M (2018). “Workplace Fatalities Fell 95% in the 20th Century. Who Deserves the Credit? FEE Stories

[3] Hämäläinen, P et al (2017) Global Estimates of Occupational Accidents and Work-related Illnesses WSH Institute, Singapore & Ministry of Social Affairs and Health, Finland