Safety Science 50 (2012) 1333–1343

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Safety Science

journal homepage: www.elsevier .com/locate /ssc i

Review

Is it possible to influence safety in the building sector?

A literature review extending from 1980 until the present

Paul Swuste a,⇑, Adri Frijters b, Frank Guldenmund a

a Safety Science Group, Delft University of Technology, The Netherlandsb Arbouw, Harderwijk, The Netherlands

a r t i c l e i n f o

Article history:Received 1 August 2011Received in revised form 27 November 2011Accepted 30 December 2011Available online 10 February 2012

Keywords:SafetyConstruction industryReviewCauses of accidents

0925-7535/$ - see front matter � 2012 Elsevier Ltd. Adoi:10.1016/j.ssci.2011.12.036

⇑ Corresponding author. Address: Safety ScienceTechnology, Postbox 5015, 2600 GA Delft, The Nether

E-mail address: p.h.j.j.swuste@tudelft.nl (P. Swust

s u m m a r y

The available literature on construction safety is not very optimistic about the chances of evidence-basedsafety in the construction industry exerting a positive influence. Many articles indicate that the structuresand processes that are designed to ensure safety in the industry are poor. Safety management systems donot work, or are limited, the business processes executed are fragmentary, it is not clear who is respon-sible for safety and parties lower in the construction hierarchy tend to be saddled with the consequences.Safety detracts from the primary production process and is seen as a bureaucratic burden. But there aresome positive developments as well. Lists of prevalent accident scenarios and central events are availableand information is published on barrier failures. What is missing is a reliable exposure gauge of the rel-ative importance of scenarios and the identification of pivotal events. The more clearly the cause-effectchains of accident processes can be recorded, the more specific the measures, solutions and interventionscan be when it comes to avoiding or reducing the effects of accident scenarios. Audit methods have alsobeen developed, such as the Safety Index, which can be used to not only negatively but also positivelyassess safety. Finally an approach that can best be described as ‘frappez toujours’ seems to yield notice-able results. In such cases it does not really matter what safety intitatives are taken. Simply highlightingthe issue is a factor that can, in itself, have an effect.

� 2012 Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13342. Causes of accidents in the construction industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1335

2.1. The United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13352.2. Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1335

3. Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1336

3.1. Organic structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13363.2. Less successful examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13373.3. More successful examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13373.4. Laws and regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13383.5. Costs of accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13383.6. National campaigns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1338

4. Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1338

4.1. Classical psychological surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13384.2. Behavioral-based safety programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13394.3. Safety climate surveys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1339

5. Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1339

5.1. Design decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13405.2. Case study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13405.3. Techniques to predict accident scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1340

ll rights reserved.

Group, Delft University oflands. Tel.: +31 15 278 3820.e).

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1334 P. Swuste et al. / Safety Science 50 (2012) 1333–1343

6. Conclusions and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1340References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1341

Fig. 1. The Bowtie metaphor.

structure

1. Introduction

The building sector is a dangerous branch of industry.1 Fre-quently this is one of the first statements in many articles on con-struction safety. In the construction industry the same types ofaccident continue to occur time after time. Often building companymanagers point to major differences in the manufacturing and pro-cess industries, where safety programs seem to have an effect. Thesedifferences reveal the dynamic nature of the construction industry interms of planning, the population that is exposed, labor intensity andthe uniqueness of the final products.

This review focuses on the question of whether or not it is pos-sible to influence safety in the building sector. The building sectoris quite an extensive concept. The review will therefore confine it-self to the contract side, the design and the construction of buildingprojects and to parties involved. The various phases of the buildingprocess, such as demolition, implementation and conceptual de-sign will not be included in the review.

The Delft University of Technology library is an internationalrepository on the causes and prevention of accidents in theconstruction industry. Using such search terms as ‘construction’,‘safety’ and ‘accident’ its resources were consulted for the purposesof this study. That yielded tens of thousands of references, a numbersubsequently reduced to 130, on the basis of selection criteria suchas period (1980 and after) and type of journal (peer-reviewed).

Safety in the construction sector is dealing with accidents andaccident prevention. Accident analysis provides insight in hazardsand major accident scenarios, while prevention is related to safetyinterventions, ranging from the introduction of technical measures,design modifications, and organizational and behavioral interven-tions. To understand accidents and the influence of accident pre-vention programs, two metaphors are used in this review, thebowtie as a description of an accident process, and the organiza-tional triangle to relate behavior to other organizational forces.

There are a few theories, models and metaphors representingthe accident process (Gulijk et al., 2009; Swuste et al., 2010,2011). One such metaphor, the bowtie (Visser, 1998), a metaphorwhich is rather common in The Netherlands (Fig. 1).

The middle point of the metaphor is the ‘central event’. Acentral event is condition reached when one or more hazards arebecoming uncontrollable by following one or more scenario routes(left to right arrows). These scenarios represent conditions underwhich a hazard becomes a risk, thus leading to effects such as dam-age and to accidents. Barriers are physical entities that can stop orreduce the energy flow to and from the central event. The meta-phor also clarifies the relationship with safety managementthrough the arrows that go upwards. Management is responsiblefor identifying risks, scenarios and central events, for selectingand identifying barriers and for the various activities undertaken

1 In many articles from the US a comparison is made between the size of thenstruction sector in percentage of the total workforce, and the percentage of fatal

ccidents in construction. For instance, in 1996, 5% of the workforce accounts for 20%f all occupational deaths (Abdelhamid and Everett, 2000), and in 2004 these figuresecame 7% versus 23% (Behm, 2008). Information on mortality rates for the period980–2010 is not easy available. In the US the rate was 15.5 per 100.000 workers fore period 1980–1997 (CDC, 1998,2001) and 9.5 in 2010 (BLS, 2011). With these

gures US construction is the third most dangerous occupation, after mining (30/105)nd agriculture/fishing/forestry (20.5/105). European figures are comparable. Here thegures range from 14.7/105 (1994) to 10.4/105 (2001) (European Agency, 2004;enavides et al., 2003). In Europe, construction is the second most dangerous sectors,st after fishing.

to ensure and optimize the quality of barriers, such as mainte-nance, inspection, training for use and the rules surrounding con-flicts between safety and other business objectives. Apart fromthe barrier choice, these management factors will have no directeffect on scenarios, but they will determine the effectiveness ofthe barriers (Guldenmund et al., 2006).

The organizational triangle (Hoewijk, 1988) is a metaphordepicting three major forces which are operating at the same timeon the behavior of the people who work there. These generic forcesare structure, culture and processes and they are dynamicallyinterrelated, that is, the particular strength of each force is deter-mined by the other two (Fig. 2).

This actually means that these forces are also functionally re-lated in that their particular strengths are both meaningful and sig-nificant with regard to each other and, hence, with regard to theorganization. Together they shape the context in which behavior,and therefore also safety related behavior, takes place. The struc-ture is primarily the formal framework of an organization, i.e. theproposed allocation of power and responsibilities and the mecha-nisms of communication, coordination and control. This defineshow the organizational mission should be accomplished and by

culture processes

behaviour

Fig. 2. The organizational triangle.

Table 1The hierarchy of the major events in plant construction.

Central eventsFalling from a heightContact with falling or collapsing objectsContact with electricityContact with moving machinery partsFalling from a moving platformContact with hoisted, hanging, swinging objectsHit by a vehicleSqueezed between or against somethingContact with objects thrown from a machine

P. Swuste et al. / Safety Science 50 (2012) 1333–1343 1335

whom. The culture is the basic assumptions, the underlying tacitconvictions of an organization. The processes are the patterns ofactivity taking place throughout an organization; the actualprimary processes, which deal with the main output(s) of an orga-nization; the secondary processes which support the primary ones,e.g. management, quality control; and the tertiary processes, e.g.formulations of policies and strategies. One important implicationof the figure is that (safe) behavior cannot be isolated from itsstructure, processes, or culture (Guldenmund, 2007, 2010).

These two metaphors describe topics which are repeatedlymentioned in the literature reviewed. The first one are causes ofconstruction accidents, including hazards, scenarios, barriers cen-tral events, and different methods to analyze accidents. The secondtopic is the influence of management on accidents and accidentprevention, and the third one is focusing on safe behavior, andthe influence of organizational climate and culture. These threetopics will appear in this article as main paragraphs. Because thedesign of a building structure is often mentioned in articles as amain source of various hazards during construction, a last para-graph is devoted to this topic.

2. Causes of accidents in the construction industry

Descriptive epidemiology is an often-used method in the inves-tigation of construction accidents, which draws on national, regio-nal, company or project records of accidents or deaths. It is a typeof research that is most prevalent in the United States. The resultsprovide information on the hierarchy of central events, on barrierfailures, on the general determinants of accidents, or on the spe-cific determinants of accident scenarios. In Europe, alongside re-sults of descriptive epidemiology methods for accident analysishave also been developed, as well as audits to ‘measure’ safety atconstruction sites.

2.1. The United States

For a long time it was the case that in many publications of epi-demiological studies the hierarchy of central events in the con-struction industry remained unchanged, based upon mortalitydata (Baradan et al., 2006; CPWR (Centre to Protect Workers’Rights), 2007; Hinze et al., 1998; Horwitz and McCall, 2004; Huangand Hinze, 2003; Hunting et al., 1999; Lipscomb et al., 2000; Löpezet al., 2008; Wang et al., 1999) (see Table 1).

This hierarchy resembles the results obtained from Dutchresearch (Ale et al., 2008; Aneziris et al., 2008). However, it is theposition of the central event ‘contact with electricity’ scores rela-tively high in the United States, because of the presence of overheadpower lines in many urban areas. The contribution made by the dif-ferent central events is presented in absolute figures or percent-ages. This demonstrates a major weakness in the safety domain.While national figures are presented as rates by standardizing thehours worked or the total population of construction workers, thisis not an option for specific scenarios. Information is not yet avail-

able on the degree of exposure to specific scenarios. In the relateddiscipline of ergonomics this problem is also identified (Schneideret al., 1998).

Already for decades, the central event ‘falling from a height’ hastopped the list. On the basis of national accident records, Americanresearch into construction safety publishes lists of failing accidentbarriers involving scaffolding, ladders and working on roofs (Cattl-edge et al., 1996; Halperin and McCann, 2004; Helander, 1991;Hsiao and Simeonov, 2001).

An accident analysis based upon morbidity data was conductedin Denver, Colorado. Starting in the late 1980s and continuing tillthe early 1990s, an airport was constructed with more than30,000 construction workers and 800 contractors (Lipscombet al., 2006). Accident records of insurance companies were used,concerning slipping and tripping accidents, a central event notlisted in Table 1. This scenario frequently occurs on constructionsites, but the registration of such accidents is usually inaccurate,because often the consequences are not serious. For the analysisof accidents the ‘epidemiological triangle’ was used (Gordon,1949; Haddon, 1968). This triangle was introduced to the safetydomain by physicians, and serves to divide the causes of accidentsinto source factors (material, equipment), environmental factors(weather conditions, the conditions of walkways) and factors re-lated to victims (behavior, fatigue, rule violation). Organizationalfactors were added as a fourth element, and included issues suchas tidiness around the workplace. Often this factor scores low sinceconstruction workplaces tend to be dirty and messy. The case anal-ysis only provided a limited impression of accidents causes. Onlyenvironmental factors were consistently recorded together withthe victim’s behavior. The majority of the accidents did not occurduring work periods but rather when moving from one workplaceto another. Logically, the authors did emphasize the importance ofmaintaining clean and safe walkways.

Research into the general determinants of accidents has deter-mined the influence of race and age. For example, in North Carolinano difference in the incidences of accidents was found betweenAfrican American and white workers (Wang et al., 1999). This re-search as well as that carried out by Lipscomb et al. (2000) fromthe same state indicated that living conditions do contribute toaccidents, including alcohol and drug use. The age distribution ofvictims led to a subtle conclusion. Typically, the accident ratesproved to be inversely proportional to the age of the victims: theyounger group had more accidents. However, a closer analysis ofthe type of accidents showed reduced accident incidence withgrowing age but revealed also that younger workers are involvedin significantly fewer serious accidents than older workers(Horwitz and McCall, 2004). According to these authors, youngerconstruction workers will have a lower exposure to high hazardsand thus a smaller chance of incurring more serious accidents.

Other research into the general determinants of accident had amedical or an insurance bias, such as the research done on con-struction site eye injuries or accidents resulting from the centralevent ‘hit by’ (Hinze et al., 2005; Hinze and Giang, 2008). Resultsappear as overviews of victim age distribution, as various diagnos-tic categories of injuries, as points in time distributions or else theyrecord the months when the accidents occurred, or the costs in-volved in compensating the victims. These matters can be relevantwhen making various claim applications, but they are of minor rel-evance to the causes and prevention of accidents.

2.2. Europe

Striking epidemiological study results have emerged in Scotland(Cameron et al., 2008). Between 1997 and 2002 the Scottish fatalaccident rate among construction workers was 50% higher thanthat of England for the same period and the rate for major acci-

1336 P. Swuste et al. / Safety Science 50 (2012) 1333–1343

dents was 15% higher. The discrepancy can be explained by the dif-ferent building organization structure (Fig. 2). In England moremanagers and experts were involved in construction projectswhere there was little exposure to construction hazards. Scotland,however, had a much ‘flatter’ organization, thus making the popu-lation exposed to danger relatively large; in other words, the acci-dent rate denominator was very differently composed. An almostidentical investigation was conducted in Denmark, during the con-struction of the Øresund Link, the link between Denmark andSweden (Spangenberg et al., 2002, 2003). There too a remarkabledifference could be seen between the nationalities present. Theincidence of accidents leading to lost time among Swedish con-struction workers was a factor of four lower than that of Danishworkers. Here the way in which the building process was orga-nized was not the most likely explanation for the difference ob-served. The discrepancy was most probably attributable to thelower level of education of the Danish workers combined withthe higher unemployment level seen in the Swedish constructionindustry and the less generous Swedish sickness benefits.

What constitutes a Dutch example of descriptive epidemiologi-cal research is a survey that was conducted into crane safety (Paasand Swuste, 2006). There the instability of the load, the centralevent ‘contact with hoisted load, hanging, swinging objects’ wasby far the most dominant central event leading to accidents. Com-parable British research done on hoisting activities arrived at thesame conclusion (Sertyesilisik et al., 2010). It was not possible toestablish an estimation of the risk because of the absence of infor-mation on exposure and on populations at risk.

In Finland, the relationship between mechanization in construc-tion and the incidence of accidents was studied. No effect was ob-served (Laukkanen, 1999). This observation is consistent withergonomic research carried out in construction. Mechanizationintroduces task and productivity modifications but this does notnecessarily have a positive effect on the exposure to hazards(Burdorf et al., 2007).

The collection of articles focusing on control measures and solu-tions included the technical devices employed to warn construc-tion workers once the risk of falling from a height becomes a realrisk (see e.g. Lee et al., 2009), and research into the direct andunderlying factors of accidents.

The European studies of accidents occurring during construc-tion work were initially based upon a more complex accident pro-cess than that seen in the United States. A differentiation was madebetween the types of factors affecting the accident process. Alreadyin the 1980s research done in Finland correlated process distur-bance and accidents (Niskanen and Saarsalmi, 1983). Process dis-turbances may be an indication of material flow or machinerydisruptions during the construction process or of design adapta-tions that are only announced during construction. The SwedishAORU (Occupational Accident Research Unit) model is an exampleof such an approach. This model combines accident analysis withcontrol measures sessions and with structured decision-makingprocesses undertaken with stakeholders. The model was firstdeveloped in the early 1980s (Kjellén, 1983, 1984; Menckel andKullinger, 1996) and distinguishes between the direct and underly-ing causal factors of accidents. Direct factors were defined as thecombination of process disturbances, events and conditions thatdisrupted flawless and planned production, like interruptions inthe control exercised over materials, equipment, labor, technologyand direct supervision. The underlying factors were the character-istics of the production system that affect direct factors and wererelated to various immediate and long-term decisions concerningthe design and development of the production system with regardto all the physical, organizational and human resources. Theseunderlying factors resemble the management factors seen in thebowtie model (Fig. 1), and the process component of the organiza-

tional triangle (Fig. 2). The results of the accident analysis were dis-cussed in sessions with construction site foremen, safety people atthe construction site and the company’s safety officers. The infor-mation gathered during these sessions provided direct feedbackon all possible causes of accidents, which thus gave substance tothe company’s safety management system once this informationhad been linked to company decision-making processes. The ap-proach was tested in a number of companies. Unfortunately, thelimited scope of the investigation did not allow the impact toregister on accident figures.

In conclusion, most epidemiological research aimed at the con-struction sector takes place in the United States. The research ishampered by a lack of exposure measures, thus rendering soundstatistical assertions impossible. The hierarchy of central eventsand barrier failures is already known for some time. Europeanstudies into fatal and serious accidents in the construction industryare based on accident comparisons made between differentgroups. The way in which construction is organized or structuredis an important aspect. European accident analysis methods payspecific attention to process disturbances and management factors.

3. Management

Safety may be defined as an organizational guarantee that anacceptable level of safety will be secured for a specific process, orfor the duration of a project life cycle or organization. This meansthat certain measures need to be put in place such as the manage-ment activities outlined in Fig. 1. These activities are investigatedby various authors with the use of interview methods, question-naire surveys, focus groups and telephone interviews. In smallsamples face-to-face interviews are used as a method of investiga-tion. This paragraph will start with a general characterization ofthe structure and processes in construction companies, followedby an overview of less and more successful examples of manage-ment influence on safety. The paragraph will end with three moreexternal factors influencing management decisions; laws andregulations, costs of accidents, and national safety campaigns.

3.1. Organic structure

To understand the context of safety management in construc-tion, more information is required on the elements as given inFig. 2. In the literature, construction companies are characterizedas ones with an ‘organic’ structure. Such a structure is contrary tothe mechanistic structure of companies that have a highly stan-dardized production process, like manufacturing and processindustries. The organic structure of companies manifests itself inits processes. Generally, though, there is a low level of standardizedwork performance and a culture of aversion to rules, procedures.And decision-making on planning and executing - including safety– is conducted low in the organization. This characterization isdrawn from studies done on safety management in the constructionsector in Europe, America, the Middle East, Asia and Australia(Helander, 1980; Jong et al., 1989; Kartam et al., 2000; Lee andHalpin, 2003; Lingard and Rowlinson, 1998; Lingard and Holmes,2001; Loosemore and Tam, 2004; Pinto et al., 2011; Sawachaet al., 1999; Spangenberg, 2010; Tam et al., 2004; Teo et al., 2005;Wilson, 1989). The construction industry is a political and marketsensitive sector. The dynamics of the building process, the tempo-rary nature of projects and the physical distance from a centralorganization means that relatively few construction workers areable to receive (safety) training and so develop loyalty more to fel-low construction workers than to their company (Wilson, 1989).The keen competition between companies creates a conflictbetween the primary process and any activities that threaten to

P. Swuste et al. / Safety Science 50 (2012) 1333–1343 1337

cause delay. Safety is one of those activities and such factors as pro-duction bonuses, and danger money are thus counterproductive tosafety. In addition, the costs of lack of safety are always shifted tothe weakest party, the subcontractor (Jong et al., 1989; Donaghy,2009; Priemus and Ale, 2010). The sector adheres to a rather rigidseparation between design and implementation/construction,which is not conducive to safety. If an accident occurs and if acci-dent analysis is conducted (which is not always the case) then theresults are limited to one direct cause – that of human behavior(Donaghy, 2009; Jong et al., 1989; Sawacha et al., 1999). In such acomplex environment it is therefore certainly a challenge to im-prove safety. The literature on safety management in constructionprovides a number of successful and less successful examples.

3.2. Less successful examples

Research confirming the context of safety management, as pre-sented above, emerges from Great Britain. There the industry is gi-ven a negative image. Research conducted by the Health and SafetyExecutive is based upon a hierarchical model of accident causationin which a distinction is made between direct, or proximal factorsconcerning the workplace, the materials and equipment and thework team and distal factors which are either underlying or in-volve external influences (Haslam et al., 2005; Suraji et al., 2001).Distal factors, unlike proximal factors, do not directly cause acci-dents and so they resemble the underlying factors seen in theSwedish AORU model and the management activities projectedin Fig. 1. All the distal factors were listed for 100 different construc-tion accidents (HSE, 2003) and, to a large extent; they fell outsidethe realm of the safety chain. Additionally, there was a lack of anytype of safety management either among clients and their advisersor with the contracting companies. And the state of the materialand equipment was below standard as was the standard of main-tenance. In general there was a lack of interest in the topic ofsafety. Recently published research from Asia, Taiwan and Austra-lia confirms these research findings (Cheng et al., 2010a; Lingardand Holmes, 2001; Mohamed, 1999). Authors conclude that it isthe structure of business processes and operational levels thatforms the greatest barrier to effective risk management. Safetyhas become too bureaucratic. With the slogan ‘manage the risk,not the paper work’ HSE calls for a return to the controlling of haz-ards and risks at construction sites (HSE, 2009; Donaghy, 2009).

Recent research done by HSE defined these distal factors insomewhat broader terms, as characteristics of construction pro-jects; as the outcome of the wishes of the client and the deci-sion-making process during design and project management.Table 2 provides examples of distal and proximal factors that affectthe accident process (Manu et al., 2010).

3.3. More successful examples

Not every study exposes poor relationships between safety workand safety outcomes, and sub-adequate levels of safety manage-

Table 2Examples of distal and proximal factors in the accident process.

Distal factors Proximal factors

Nature of the project, new construction –renovation, demolition

Uncertainty, complexityof threats

Construction method, conventional – prefab Manual operationsConstruction site, restrictions CongestionProject duration Time pressureDesign complexity Construction complexitySub-contractors Fragmentation of

workforceHeight, low–high rise Working at a height

ment. For instance, an Australian research team reported positiverelations and presented detailed lists of what are termed micro-performance indicators, like the percentage of permits checked,the remedial actions completed on time and the degree of compli-ance to a planned inspection schedule (Trethewy, 2003). Otherexamples come from the United States and Denmark whereresearchers point to the positive role that stakeholders, and specif-ically clients, can play in ensuring that safety is observed during bycontractors construction (Huang and Hinze, 2006; Spangenberg,2010). In Korean and Southeast Asian research the emphasis ismore on the quality of information systems and the impact thishas on design aspects (Jung et al., 2008; Benjaoran and Bhokha,2010), or upon safety training and awareness (Jaselskis et al.,2008; Teo et al., 2005; Tam et al., 2004). This focus on the training,competence and awareness of construction workers, supervisors,foremen and the broader ‘management support’ team is a recurringtopic in a number of studies (Abdelhamid and Everett, 2000; Aksornand Hadikusumo, 2008; Baradan et al., 2006; Carter and Smith,2006; Kines et al., 2010; Lipscomb et al., 2000; Paas and Swuste,2006). Finnish and Danish studies go one step further. Generalsafety training has little effect, but job training and discipline tea-ches builders to consciously deal with specific work hazards andrisks (Laukkanen, 1999; Spangenberg, 2010).

Another example is the ‘zero accident’ approach as exemplifiedby a safety study from the United States carried out during the con-struction of a large biomedical research complex near Denver,Colorado (McDonald et al., 2009) and a Canadian study into large,long-term construction projects (Hinze and Raboud, 1988). In bothexamples, sufficient safety expertise was present, sub-contractorsreceived safety training, and both safety communication andbehavior modification programs were executed during construc-tion where order and cleanliness in the workplace were seen asimportant issues. Finally building sites were only accessible toauthorized personnel. Both studies showed an incidence of losttime accidents that was well below the national average. In theearly 1990s a similar approach was adopted in the process industryin the Netherlands when the phenomenon of Safety Health andEnvironmental Checklist Contractors was introduced (Veiligheidgezondheid en milieu Checklist Aannemers – VCA). VCA trainsand certifies contractors to conduct maintenance work and build-ing activities at sites in the chemical and oil industries. The certif-icate is compulsory for contractors and aims to guarantee anacceptable level of safety. The introduction of VCA has led to a dra-matic decrease in the number of reported accidents amongst con-tractors (Jeen and Swuste, 2009; Jongen and Swuste, 2008). TheRisk Management Toolbox for construction is aiming at a similareffect by giving safety is being given a more prominent positionduring managements’ decision-making (Zalk et al., 2011). Thismodel is based upon the principle of control banding, a principlefamiliar from the domain of occupational hygiene (Zalk, 2010),and it combines the results of a given risk analysis with possiblesolutions and control measures. It is especially the combinationof risk analysis and control measures that is a strong point of thismodel and which is thus also a support to management in the con-struction branch.

Safety audits as a management tool, focusing on barrier qualityare also examples of more successful approaches, like the CHASEaudit, and the ‘TR safety observation method on building construc-tion’. CHASE (Construction Hazard Assessment with Spatial andTemporal Exposure) is an example of an audit for construction jobsbased upon potential barrier failures (Rozenfeld et al., 2010). CHASEtakes into account the widely varying functions within the con-struction industry. It provides risk assessment by combining allpossible forms of loss of control during task execution, and linkingthat to the likelihood and severity of the consequences. Estimatesmade by experts are used to determine these parameters.

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The TR audit was developed by the Finnish Institute of Occupa-tional Health (Laitinen and Kiurula, 2002; Laitinen and Ruohomaki,1996; Laitinen et al., 1999; Mattila et al., 1994). The abbreviation‘TR’ is a Finnish acronym for construction site. The method wasintroduced in the Netherlands and termed ‘Safety Index’ (Frijterset al., 2008). It is an observation and evaluation method designedto determine the status of safety barriers at building sites, usinga scoring method. The Safety Index collects information on threecentral events outlined in Table 1, ‘falling from a height’, ‘contactwith moving machinery parts’, ‘contact with electricity’ and slip-ping and tripping scenarios. The TR-audit has the advantage ofnot addressing safety only as a list of negative reviews, and the re-sults of the TR-audit serves as a starting point for safety discussionswithin the company on items with a positive or negative score. Themethod has been tested and validated, and a high positive score onthe TR-audit is associated with a low accident rate on the respec-tive sites (Laitinen and Paivarinta, 2010).

3.4. Laws and regulations

According to Helander (1991), who reviewed the quality ofsafety barriers of scaffolds and ladders, procedures, laws and regu-lations are significant barriers conducive to reducing the centralevent of ‘falling from a height’. According to the author, ergonomicredesign could reduce many accidents. In line with Helander’sargument, OSHA introduced additional legislation in 1998. The rel-evant regulations relate to the special requirements concerning fallprotection and harness belts. An analysis of the fall accidents dur-ing the 1990–2001 period did not show that this legislation had ademonstrable effect, either in the numbers of accidents, or regard-ing the type fall scenarios (Halperin and McCann, 2004; Huang andHinze, 2003). To explain this, the authors pointed to the strong eco-nomic growth seen in the industry since 1995. This has led to a sig-nificant influx of unskilled construction workers. Before the effectsof legislation can be felt the authors state that more safety trainingand education is first needed. Another national study into the influ-ence that the OSHA has had on safety standards for scaffolding thatwas introduced 2 years earlier, in 1996, showed a different picture.The stipulations lay down requirements for the strength anddimensions of scaffolding and for fall protection. Both the fatalitylevel and the time lost due to accidents did decrease significantlyin the 5-year period after introduction (Yassin and Martonik,2004). A restrictive policy involving more frequent inspections,higher fines for non-compliance, and higher accident costs did leadto a better implementation of the standards.

3.5. Costs of accidents

In American publications the cost of accidents is often men-tioned as an argument to convince management of the importanceof safety on construction sites (see for instance Waehrer et al.,2007). Traditionally capitalizing on safety has been an importanttopic (see, for example, ⁄⁄⁄Van Gulijk et al., 2009; Swuste et al.,2010). Again in the 1980s it was seen as a major motivator foremployers in an industry where long-term safety problems tendedto be overshadowed by short-term technical problems (Helander,1980). Studies showed a direct relationship between projectfinancing and safety (Arboleda and Abraham, 2004; Hinze andRaboud, 1988). Big projects that were ‘under-budgeted’ had a high-er incidence of accident rate when compared to projects wherethese problems were not relevant. Similar results were also foundafter accidents reported by small contractors in Taiwan had beenanalyzed (Cheng et al., 2010b). However, for big contractors, thecosts of accidents are barely perceptible which means that thefinancial argument hardly enters into their decisions (Laufer,1987).

3.6. National campaigns

In the United States an extensive research program coupledwith a campaign to promote safety and health in constructionwas initiated, leading to the formation of the Center to ProtectWorkers’ Rights (CPWR) in 1990. To that end an extensive nationalinfrastructure was set up, including dozens of organizations de-signed to improve working conditions in construction. Regionaland national conferences brought together key decision-makersand initiated a comprehensive program with the appropriate fund-ing. Gradually the national rates of absenteeism and lost-time acci-dents were seen to decrease by 20% for no apparent reason, otherthan that this might well have been prompted by national initia-tives and a focus on the topic of construction safety (Ringen andStafford, 1996).

To conclude, safety management in the construction industry isa laborious process but, if in place, it would seem to correlate pos-itively with improved safety performance. Legislation only seemsto have a demonstrable effect in combination with a restrictivepolicy of inspection, as the American examples show. It is generallyassumed that in the construction sector financial arguments play amore important role than accident figures. It is still unclear howthe costs of lack of safety can be underlined but there are examplesof projects, and audit methods that place safety more at the heartof decision-making, like the zero-accident approaches, SafetyHealth and Environment Checklist Contractors, The Risk Manage-ment Toolbox, CHASE, the TR audit and Safety Index, or nationallymounted safety campaigns. These examples have reported positiveeffects on safety performance but not all have been able to provecausal relationships.

4. Behavior

A few distinct lines of research are evident in the central themeof Fig. 2 which focuses on studies carried out on the safe andunsafe behavior of construction workers. One line represents ‘clas-sical’ psychological surveys on the determinants of safe behavior,another surveys the effects of behavioral-based safety programs,and finally, there is a group of papers on safety climate.

4.1. Classical psychological surveys

Dutch psychological research on the determinants of behaviorand attitudes is founded on the assumption that behavior isreasoned and thus predictable. The study in question examinedthe extent to which the safe behavior of construction workers isinfluenced by their own views on safety, or by their social environ-ment (Urlings and Nijhuis, 1988). Workers’ own views were testedusing a series of slides presenting common situations on construc-tion sites. These slides showed the same central events as those re-corded in the Safety Index; falls from a height, contact with movingmachinery parts, contact with electricity, and tripping and slippingscenarios. All the situations were recognized as hazardous but ineach case construction workers provided different answers to thequestions posed on responsibility and on the matter of who shouldtake action. The questionnaire surveys managed to establish theinfluence of the social environment. The authors concluded that re-duced attention was paid to safe behavior whenever safety wasforced to compete with production. Furthermore, the social envi-ronment, colleagues, managers and supervisors, all played animportant role in safe behavior, both positively and negatively.So, if a construction worker works in an environment where safetyis positively evaluated he will behave in a safe way. The study con-cluded with the familiar example of positive feedback from and ofmanagers, the stressing of the need for regular safety meetings to

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influence the social environment, and clarity on responsibility. Ifthese topics are not properly managed then this will result inapathy towards safety. Twenty years later the negative effects ofthe social environment were addressed in a Hong Kong study(Choudhry and Fang, 2008; Tam and Fung, 2011). The roots of theunsafe behavior were determined through in-depth interviewswith victims. Hong Kong’s construction industry is a sector that re-wards unsafe behavior. Construction workers are viewed as ‘toughguys’ and safety rules and measures are for sissies. The companiesthere have introduced production bonuses. According to theauthors, the management has in that way promoted unsafebehavior. Supervisors were prepared to take big risks on the sitesif this provided the chance of gaining a higher position. All theparties involved in the construction industry displayed structuraldeficits when it came to the matter of basic safety knowledge.Language was a major problem too and designers seemed to largelyignore the physical limitations of laborers. Similar results have beenfound in Brazil, the United States, Australia and Europe (Arboledaand Abraham, 2004; Bust et al., 2008; Dong et al., 2009; Saurinet al., 2010; Trajkovski and Loosemore, 2006).

4.2. Behavioral-based safety programs

The impact of behavioral-based safety programs was measuredon a limited number of construction sites in England (6) and inHong Kong (7), using the same study approach (Duff et al., 1994;Lingard and Rowlinson, 1998). By staggering the introduction ofthe behavioral interventions the effect of the following four facetswas measured: working at height, orderliness and cleanliness, scaf-folding and the use of personal protective gear. Independent audi-tors who were not involved in construction reviewed the level ofsafety several times a week. Two interventions were implemented.First, a safety training course was given, using slides of unsafe situ-ations and explaining what amounts to desirable behavior accord-ing to a ‘not this way, but that way’ principle. The secondintervention involved providing continual graphical audit resultsfeedback depicting, per subject, the desired and actual safety scores.On English sites these interventions had a clear and significantlypositive effect on the audit scores but after the interventions endedthe effect disappeared. The results were less positive in Hong Kong.Only scores on order and cleanliness correlated positively withinterventions, as solutions for this scenario lay within the workers’ambit. Also here the effect rapidly disappeared after the interven-tion stopped. The authors attributed the temporary effect of theinterventions to the limited support from management.

4.3. Safety climate surveys

Once safe behavior becomes a topic, the safety culture, or safetyclimate of any given organization also receives frequent mention.These two concepts will sometimes give rise to some confusion.Safety culture and climate can be regarded as manifestations ofan organizational culture, or climate, that is focused on safety-re-lated matters. Organizational culture is defined as the shared basicassumptions of a group or an organization, the validity of which isnot disputed. These basic assumptions are implicit and thereforenot directly measurable. The basic assumptions are reflected inthe espoused values, formal statements or ambitions of an organi-zation, and through the artifacts, such as procedures, rules anddress codes. Organizational climate is perceived as a reflectionand manifestation of cultural assumptions and it is often equatedwith the espoused values. ‘Culture and climate are not differentorganizational phenomena but rather different interpretations ofthe same phenomenon. Culture places more emphasis on the his-tory and context of the organization. Climate highlights the existingsituation and its impact on employees’ (Guldenmund, 2010). In the

literature reviewed only safety climate surveys were reported, andthis was the topic of several studies.

Jorgensen et al. (2007) validated a questionnaire using a mixedpopulation of Spanish-American construction workers. Other stud-ies set out to characterize the safety climate or to investigate the‘good’ safety culture requirements. Dedobbelee and Béland (1991)found that the perception of safety among American constructionworkers revolved around one central theme: that of involvement,which applied both to management and to workers. Managementbecame involved whenever frequent attention was paid to safetyinstructions, meetings and providing safe equipment for the work-ers. The involvement of workers emerged from their participationin safety programs, auditing sessions and sessions designed to findsolutions to hazards and risks. Similar results were found in a num-ber of other studies, including in the surveys done by Dingsdag et al.(2008), Australia, Larsson et al. (2008) and Törner and Pousette,2009, Sweden, Mohamed et al. (2009), Pakistan and in the conclu-sions drawn by Meliá and colleagues (2008) when they comparedEngland, Spain and Hong Kong. The attention to the matter receivedfrom management and the way in which safety was organized in acompany had direct and positive impacts on supervisors and that,in turn, reflected on the workers. Subsequently the safety awarenessbehavior of individual construction workers is directly influenced bythe group. Hong Kong was the only place where this kind of correla-tion could not be established. According to the authors, the explana-tion lies in the turnover of contractors and sub-contractors, and thisis significantly higher in Hong Kong than in other countries.

The safety climate research discussed above was merely basedon questionnaires, and this method has some major disadvantages.Researchers made claims about behavior without presenting infor-mation on the two other aspects included in Fig. 2, those of struc-ture and processes. Frequently, researchers lack information onfieldwork and simply rely on databases or on questionnaires thathave been returned but fail to take note of other details aboutthe workplaces and companies. Another drawback is the question-naire itself, which often amounts to an evaluation of how the man-agement cares for its employees. This in itself may be interestingbut it says little about culture or climate (Guldenmund, 2007).

To summarize, the matter of safety and behavior is a very com-plex issue. The focus on safety diminishes as soon as there is com-petition with other company goals, like production. Ultimatelythere will always be some form of competition but, as in the pre-vious chapter, the key concepts surrounding safety and safe behav-ior are training and involvement, both on the part of managers orsupervisors and workers. If involvement is lacking and if basicknowledge on safety is sparse the safety and safe behavior out-comes will be negative, as was for instance borne out by the HongKong example. This situation is not unique to the constructionindustry as it is also found in other industries.

5. Design

The relationship between design and safety is obvious. Consider-able attention has been given to this topic (see for instance Priemusand Ale, 2010; Spangenberg, 2010; Swuste et al., 2010). Perrow(1984) published one of the first systematic reviews on the relation-ship between design and accidents/disasters in high-risk systems. Ifsystems meet certain requirements, then accidents and disasterswill be inevitable and cynically these came to be termed ‘normalaccidents’. Such normal accidents continue to happen as, for in-stance, an accident analysis recently presented by the Dutch SafetyBoard of a normal accident involving a non-mobile, peak less trolleytower crane bears out (OVV, 2009; Swuste, submitted forpublication).

Literature on the impact that design and the design processhave on accidents in the construction industry has been rather

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sparse. The articles written can be divided into those that researchthe impact of design decisions on accidents, those presenting casestudies, and those introducing methods to assess and predict sce-narios and central events.

5.1. Design decisions

The first group of articles deals with the American proposals for‘Designing for Construction Worker Safety’ and ‘Prevention throughDesign’ (Behm, 2005, 2008; Gambatese et al., 2005, 2008). Deci-sions taken at the beginning of the construction process will havea major impact on construction site safety. Everyone will surelybe agreed on that point. There are however, according to authors,quite a few barriers that can frustrate the implementation of safetyin design. Laws and regulations are not really a stimulus and neitheris the insurance system. Architects and clients are not interested insuch matters and will even be put off by the prospect of potentialliability claims. Authors conclude that in general safety is seen asa topic for contractors and the construction team, and not fordesigners and clients. Another point concerns the tendering of pro-jects. If the lowest bidder gets the project, it is most likely thatsafety will be an afterthought. Furthermore, the collaboration be-tween designer and contractor will be limited in such cases andsafety will not be a topic of discussion. Finally the authors pointto the rather limited level of knowledge that architects and engi-neers have on safety.

Thankfully these barriers are not insurmountable. The potentialimpact that safety can have on the development of a project at thevarious construction stages is depicted in Fig. 3 (Szymberski, 1997).

The contribution that design can make to construction safetywas determined by taking a selection of 224 fatal constructionaccidents. Three categories were used to rate the accidents in ques-tion. First there were accidents that were caused by structure fail-ure because the structure was not designed for the load. Thesecond category involved accidents where the risk would havebeen significantly reduced if existing design suggestions had beenintroduced. The last category pertained to accidents which couldhave been prevented had the design been different. A group of ex-perts reviewed the accidents and concluded that 42% were causallyrelated to the design (Behm, 2005). This is a fairly high percentage.The relevant publications listed reviews of existing and potentialdesign suggestions aimed at improving safety on building sites.

5.2. Case study

In a Dutch study conducted by Frijters and Swuste (2008), theinfluence that different types of work floors have and how thiscan create hazards and risks during office complex constructionwas assessed. This concerned wide-slab flooring as opposed to hol-low-core beam flooring. The hollow-core beam floor plate is aready-made product whilst the wide-slab floor needs to be filledwith concrete after it has been put in position. On the basis ofthe tasks to be performed for both types of flooring, the hazardsand associated hazard scenarios were determined. The hours ofwork calculations were used to quantify the exposure to hazards.In this fairly simple comparative way, the safety implications ofvarious building systems can be revealed to the designer.

5.3. Techniques to predict accident scenarios

The application of a technique to predict accident scenarios andcentral events during building activities, originates from the pro-cess industry. Here the ‘Hazard and Operability Study (HAZOP)’ isa well-known technique which makes use of group sessions to de-tect all possible scenarios leading to the central event ‘loss of con-tainment’. Design drawings are routinely checked for relevant

combinations of guide words and process parameters. Guide wordsindicate possible malfunctions, such as no/not, more, fewer andsimultaneously. The process parameters are indications of poten-tial hazard, like those linked to pressure, flow or temperature.For the construction sector, loss of containment only has a limiteddegree of application and is replaced by ‘loss of control’ in relationto the central events given in Fig. 1. The technique can be used todetect all types of faults and disturbances in the material flow of abuilding site and to determine whether this can give rise to acci-dents. For this purpose the process parameters need to be adaptedto the research question. The technique was applied to road work-ers’ accidents during work (Swuste et al., 2000). The relevant tech-nology for the construction sector is still in its experimental stages.

A final example taken from this group concerns the applicationof design analysis to proposed design changes. The design analysisprovides a simple description of a manufacturing process – or aconstruction process – using three hierarchically ordered concepts:the production function, the production principle and the produc-tion form. The production function comes first and will answer the‘what’ question. What should be produced? In so doing, the con-struction process will be divided into its basic elements, such as‘receiving of material’, ‘material storage’, ‘transport and supply’.The second concern is the production principle, the ‘how’ question.How will the production function be executed? The productionprinciple still gives a general description, but it is already moreconcrete. Here the energy source used is determined, the opera-tional control method (also see Manu et al., 2010) – the distanceto the source – and the mechanical principle to be applied. The pro-duction form lies at the lowest level and answers the ‘in what way’question. The production form determines the actual detailed de-sign of the machinery in use, the installations or the tools. Thisall has to do with the dimensions and weights. The productionprinciple includes the key determinants of the potential accidentscenarios. This is not only important for the analysis phase but alsofor potential solutions. Scenarios and central events can be pre-dicted on the basis of information linked to the production princi-ple. This kind of design analysis has been successfully applied tohand operated pneumatic drills of the type used to remove con-crete from the heads of foundation piles. Alternative productionprinciples, like remote controlled cracking of piles have been suc-cessfully introduced, reducing scenarios related to hand-arm vibra-tions, to accidents and to dust and noise exposure to acceptablelevels (Swuste et al., 1997).

To summarize one might say that it is the design phase of anybuilding project that offers the greatest potential for safety to bepositively influenced. In practice, however, matters are more som-ber since decisions are left to the parties engaged in the constructionphase when all the choices and thus also the safety consequenceshave already been fixed. Expert opinion and one case study do con-firm the big influence that the design and the design process have onboth the safety of the worker and the finished product. The litera-ture gives a few examples of methods to assess prospectively sce-narios and central events, making design decisions in favor of safety.

6. Conclusions and discussion

Various authors have divided the development of theories,models and the safety science domain metaphors into time periods(see for example Hale and Hovden, 1998; Spangenberg, 2010).From 1980 onwards, the starting point of this review, a socio-cultural approach became dominant and so that was what servedto analyze and explain accidents from an interaction betweenman, machine, environment, organization and society angle. Theinvolvement of employees is one of the key features of this period,together with the norms and values of companies and societies.

Fig. 3. Potential opportunities to influence each stage in construction safety.

P. Swuste et al. / Safety Science 50 (2012) 1333–1343 1341

Is it possible to influence safety in the building sector? This isthe central question behind this survey. The main causes of acci-dents during construction, the central events, are known. Descrip-tive epidemiology has established a list giving a hierarchy ofcentral events (Table 1) and between countries there is consensuson this list. The available literature also provides insight into thebarrier failures that lead to accidents. With all this knowledgeavailable why, as many publications indicate, is it so difficult to im-prove safety in this particular industry and why do many construc-tion workers consider risk to be a natural occupational hazard?

The various studies often highlight the elements ‘structure’ and‘processes’ of the organizational triangle (Fig. 2). Generally theseelements of the management system are poorly developed interms of safety. ‘Construction is different’ is what is often stated.‘Different’ in this case is a reference to the special characteristicsof the construction and building process, all of which makes safetypast, present and future a rather complex issue. Business processesrelated to safety are conducted in a fragmentary fashion, it is notclear who should take responsibility for safety and parties lowerdown the hierarchy are saddled with the consequences. The thirdpoint of the Fig. 2 triangle, culture, has not been specifically inves-tigated. However, organizational climate assessments have beenmade and the central focus in these surveys was ‘managementcommitment to safety’. This is a phenomenon which is not peculiarto the construction industry. Management involvement means thatsafety is given a more prominent place in decision-making pro-cesses throughout the entire building process that responsibilitiesare made clear, that safety training, procedures and audits are ini-tiated and that management organizes maintenance activities forsafety–critical equipment so as to reduce process interruption dur-ing construction. Research shows that the focus on inadequatesafety training and hazard recognition has shifted from the con-struction worker to middle and top management and to the clientand designer. It is assumed that decisions concerning the design ofprojects will have a major impact on site safety (Fig. 3). In severalexamples it was shown that this focus on safety has a positive ef-fect on project safety outcomes.

There is always, however, the danger that companies will put alot of energy into programs designed to improve safety-consciousbehavior among workers without paying attention to the safetystructure and processes of the organization. This will inevitablylead to resistance. Often restricting people’s radius of action is asource of irritation, a thing that is particularly evident among expe-rienced workers, who can be frustrated by trivial rules that some-times interfere with their expertise (Hale and Swuste, 1998).

The review also shows some shortcomings in the research dis-cussed. First, research is often confined to serious and fatal acci-dents (Hinze et al., 2006). This preference is understandable,since the registering of these types of accidents will often be thor-ough, thus making it suitable for research purposes. Implicitly,there is the incorrect assumption that interventions undertaken

to prevent major accidents also have a positive impact on lesssevere accidents, an argument which resembles an inverted ver-sion of Heinrich’s iceberg. Major accidents present different sce-narios which is why such intervention has little effect on othertypes of accidents. This argument is consistent with earlier findings(Hale, 2002; Jeong, 1998; Saloniemi and Oksanen, 1998).

There is no tailor-made way to estimate the extent of the dan-ger, the energy involved and the length of time that a population atrisk will be exposed. This is a major shortcoming. The lack of dataon the common denominator makes the hierarchy of central eventsunreliable. This may have implications for the selection of and pri-ority given to the technical barriers set up to reduce or avoid therepercussions of scenarios.

Also the quality of the research done is sometimes questionable.This is particularly apparent in survey research carried out withquestionnaires, if this is the only source of information. The inter-pretation of results may be hampered if no information on the con-text is available. Poor quality research was also highlighted by aCochrane study done into the quality of safety interventions inthe construction industry (Molen et al., 2007). This survey showedthat research on quality and the effect of interventions was rarelycarried out and if it was only a few such studies were thorough en-ough to demonstrate the causal relationships between interven-tions and effects. The same survey noted that studies on theimpact of legislation had not provided conclusive evidence con-cerning measurable effects. Other factors affecting accident figureswere not monitored and it is not clear how legislation was intro-duced on the actual construction sites or how workers were moti-vated to comply with legislation. Other studies into the effects ofmultiple safety campaigns provide limited evidence of their effec-tiveness. This is because of the limited quality of the timeframeand the failure to compensate for other interfering factors.

Finally, there are roughly two different ways to bring safetyarguments more to the forefront of decision-making. The first ap-proach is a strict safety science route which presumes thatcause-effect chains should be clear, as well as the population atrisk, and should be the basis of targeted interventions directed atclients, designers, top managers at construction companies. Inthe literature researched, examples were found of Finnish, Swedishand Dutch ways and means of promoting safety by using scenarioanalyses and specific safety task training. A completely differentmethod is the approach known as ‘frappez toujours’ (be persistent)(Hale et al., 2010). It does not matter which initiative or interven-tion is adopted and its effectiveness is not an important point, aslong as the topic of safety intervention buzzes around long enough,including gaining media attention (Schneider and Check, 2010).The decrease in accident rates in the United States after the estab-lishment of the Center to Protect Workers’ Rights most probablydisplayed such an effect.

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