Safety leadership guide:

How listening and learning

are our best defence
Safety leadership guide: How listening and learning are our best defence

Foreword

This guide has been produced for leaders at all levels in Defence. You could use it as an
informal guide or a briefing sheet for your teams, or use it to develop your own material and
literature (for example, a Commander’s Guide).

If you develop your own version of this document, you must report this to Director HS&EP to
make sure a consistent message is maintained.

Document contact: [email protected]

1
 Safety leadership guide: How listening and learning are our best defence

‘The safety performance of Defence is influenced by our collective behaviours and leadership, and as leaders we
need to communicate the safety behaviours we expect of our ourselves and those we lead. A safety culture builds
slowly, but behaviours are influenced quickly through strong leadership, messaging, expectations, and examples.
We call this the ‘tone from the top’.

‘At the same time we need to do more to listen and support our people. We are aiming to build an organisation
where we are always learning and always getting ahead of incidents – an organisation that recognises people
make mistakes, encourages learning from these mistakes and balances the impact of organisational factors
against individual actions. This short guide has been written to help you lead safety from the front and to set the
‘tone for the top’ that will allow us to improve safety through learning’ in Defence.’

David King, Director Health, Safety & Environmental Protection

The importance of listening

In Defence, our people are involved in some
and learning of the most pressurised and constantly
When an organisation is listening and changing situations it’s possible to be in.
learning in relation to safety, the following are They have to adapt and be flexible in
true. complex situations. It can be tempting to
interpret mistakes as rule-breaking, or a
• Leaders support fairness, openness and problem with a person’s capability. However,
learning by making personnel feel when we blame individuals, three things
confident to speak up when things go happen.
wrong, rather than fearing blame.
• We fail to learn why a person made a
• Actions and decisions are understood particular decision or had to adapt a task
before they are judged, and people are based on circumstances.
supported to learn from their actions.
• We put people off speaking up about
• People are asked for their advice to help safety and risk-related issues.
with designing the systems that could help
change things for the better. • We do people a disservice by not
supporting them to be successful in
• Those responsible for managing incidents difficult situations.
draw on human factors (things which
influence people’s actions and decisions)
investigations, skills and expertise to fully “These people are closer to the action. They're the
ones standing on the deck, feeling the vibration in their
understand how an incident happened, shoes. Whatever it happens to be, they're closer to the
the lessons that can be learned and how problem. They know something you don't know, and
to adapt in the future. your job at that point is to make it easy for them to tell
you what that is. If you want a resilient system where
Everybody makes mistakes. Decisions and errors don't get propagated through the system, you
really need to create an environment where it's okay for
actions that seem irrational now probably people to tell you you're wrong.”
made sense to people in the circumstances David Marquet, US Submarine Commander
they were in at the time.

2
Safety leadership guide: How listening and learning are our best defence

An organisation that listens to and learns

from its people is one that is constantly • It boosts motivation, morale and
improving, understands that mistakes, retention
misjudgements and the need to adapt are Being open about events, and learning
normal. Evidence from many industries from them, is associated with increased
shows that most accidents are due to errors, trust between all levels of an organisation,
and are influenced by poorly designed and higher motivation and morale within a
equipment and procedures, unhelpful workforce.
pressures and not preparing people for • It will help us to take advantage of new
situations they find themselves in. technology
We recognise that the people who know the The development of effective and
most about equipment, tasks and systems innovative new technology relies on
are the people who do the work. We want to constant feedback from those who have to
encourage our people to speak up about use it, so that potential mistakes and
mistakes, and the conditions that make issues can be recognised and addressed.
mistakes more likely, so we can learn from
them.
Within a listening and learning organisation,
people still take responsibility for their "Survival from major injury of British military personnel
has improved every year since 2002. Lessons learned by
actions. We tackle the workplace situations the Defence Medical Services over the last decade of
that influence people’s actions and decisions, conflict were not just about how to resuscitate better or
as well as supporting people to be equipped debride wounds more thoroughly but also how to tease
out the very best human factors from the teams on the
to deal with situations they find themselves in. ground. Much of this evolved seamlessly by multiple
personnel suggesting multiple solutions and the
Why we need openness headquarters having the confidence to listen and allow
changes to happen.”
and transparency in safety Members of the Defence Medical Service explaining
rapid improvement in treating severely injured in Iraq
• It makes systems robust and resilient and Afghanistan
when it matters
When people speak up about mistakes
and conditions that make tasks difficult,
we can make improvements so that Defence Organisational Learning Strategy (DOLS)
systems work when they are really The Defence Organisational Learning Strategy
needed. (DOLS) aims to make Defence a ‘learning
organisation’, where knowledge and experience
• It helps personnel to be successful are readily accessible, and where learning, and
We value the ability to adapt and need to passing on learning, become routine.
understand what trips people up, or helps Defence learns best through:
them, so their work can be successful.
• people who are open to sharing and learning
• It will help us achieve the highest from experience;
possible standards of safety and • processes that help us learn from experience;
effectiveness and
Evidence shows that an environment
• tools that enable learning processes.
which promotes learning leads to
increased reporting of unsafe conditions,
incidents and accidents, and provides
greater opportunities to tackle issues
before problems develop.

3
Safety leadership guide: How listening and learning are our best defence

Below is a brief checklist that you can use to

What leaders can do to prompt responses to situations you may find
promote openness in yourself dealing with.

safety A checklist for leaders

To make sure Defence listens to its people, 1. People will make mistakes.
and learns from safety events, you should: 2. People's actions are rarely malicious and
usually make sense to them at the time.
• talk about how you recognise that 3. Mistakes are typically due to underlying
mistakes, and the need to adapt, are conditions and systems.
normal; and 4. Understanding why mistakes happen can help
us prevent or correct them.
• encourage people to speak about 5. Plant, tools and activities can be designed to
mistakes and the conditions that cause reduce mistakes and manage risk better.
them. 6. Leaders help shape the conditions that
influence what people do.
It especially matters how you respond when 7. It matters how leaders respond when things go
things go wrong, or you receive bad news. wrong. Take the opportunity to learn

• Assume good intent

Assume that those involved are doing
their best and respond without blame.
When you can respond in a way that Accountability
avoids blame and promotes learning, Taking time to learn from safety mistakes
people will continue to feel confident to does not mean there is no accountability. We
speak up. aim to continually improve and develop our
• Learn from those who do the work processes to help with our decision making
Work with those who are most familiar abilities and to make sure our people are
with the equipment or tasks. They can better equipped to deal with situations they
help you understand the conditions that find themselves in.
lead to mistakes or misjudgements. Leaders have an important part to play in
helping to identify errors, and it’s important to
• Understand and address the factors
acknowledge that you are part of a chain.
that make mistakes more likely
If an incident needs to be investigated, On the rare occasion that someone intends
ask what happened and why, and what harm, normal disciplinary processes apply.
can be learned. Take action to tackle the However, even in these situations we have a
conditions that make mistakes more likely. duty to understand the conditions that
influenced the person’s actions. Harmful acts
can result from issues that an organisation
must tackle (such as frustration with
dangerous equipment or a communication
breakdown) or circumstances where people
need support.