Environmental conditions for safety work – Theoretical foundations

Safety Science 50 (2012) 1967–1976

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Environmental conditions for safety work – Theoretical foundations Ragnar Rosness a,⇑, Helene Cecilie Blakstad a, Ulla Forseth a, Irene B. Dahle b, Siri Wiig b,c a

SINTEF Technology and Society, P.O. Box 4760 Sluppen, NO-7465 Trondheim, Norway The Petroleum Safety Authority, P.O. Box 599, NO-4003 Stavanger, Norway c The University of Stavanger, Faculty of Social Sciences, Department of Heath, NO-4036 Stavanger, Norway b

a r t i c l e

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Article history: Available online 4 February 2012 Keywords: Environmental conditions Framework conditions Contingencies Contextual factors Safety work

a b s t r a c t This paper reviews literature on environmental conditions for safety work. By ‘‘environmental conditions for safety work’’, we refer to conditions that influence the opportunities an organisation, organisational unit, group, or individual has to control the risk of major accidents and working environment risk. The purpose of the review was to document how international safety science literature uses ‘‘environmental conditions’’ or synonymous concepts, to help build a common conceptualisation of environmental conditions for safety work, and to link environmental conditions to safety work and risks. We did not find a uniform and systematic approach to environmental conditions for safety work in the literature. We therefore turned to a broader range of organisational research literature, where we found a diversity of complementary answers to our research question aimed at investigating the ways in which environmental conditions may constrain or facilitate safety work and thus influence risks. Due to the diversity of these theoretical resources, we have refrained from trying to reduce them to a single model. Our conceptualisation of environmental conditions includes definitions, the ‘‘sender–receiver’’ metaphor, and a selection of theoretical resources. The ‘‘sender–receiver’’ metaphor may be used as a starting point for exploring the ways in which some actors influence the environmental conditions of other actors, and how actors may resist, co-create or re-create the environmental conditions for their own safety work. Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction The Norwegian petroleum industry is characterised by high-risk operations, complex and tightly coupled technologies and complex organisations with extensive outsourcing and subcontracting. Contractors and subcontractors work in an environment that is shaped to a significant extent by the operator, i.e., the oil company that is responsible for the daily management of the petroleum activities on behalf of the licensees or the owners of the production facility. This implies that the safety work of contractors and subcontractors may be constrained or facilitated by environmental conditions that are created and maintained by the operator or co-created by the operator and the contractor or subcontractor. By ‘‘safety work’’, we refer to all efforts to keep the risk of major accidents and work environment risk under control. According to this definition, safety work is not limited to tasks performed by safety professionals. A technician carrying out his/her daily work in a safe manner and a company board allocating adequate resources to safety critical investments are examples of safety work in action. By ‘‘environmental conditions for safety work’’, we refer to conditions that influence the opportunities an organisation, ⇑ Corresponding author. Address: SINTEF Technology and Society, P.O. Box 4760 Sluppen, NO-7465 Trondhem, Norway. Tel.: +47 73 59 27 53; fax: +47 73 59 28 96. E-mail address: [email protected] (R. Rosness). 0925-7535/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.ssci.2011.12.029

organisational unit, group, or individual has to control the risk of major accidents and work environment risk (Rosness et al., 2009). Different stakeholders, such as the government, regulators, researchers, and organisations claim that environmental conditions are important for organisational safety and working environment. The importance of environmental conditions related to risk management processes has also been demonstrated in accident investigations (Baker, 2007; Hopkins, 2008; Kletz, 2001, 2003; Starbuck and Farjoun, 2005; Vaughan, 1996). However, there is no consensus on how to operationalise ‘‘environmental conditions’’ and related terminologies co-exist in the literature, e.g., ‘‘environmental stressors’’ (Rasmussen, 1997), ‘‘constraints’’ (Leveson et al., 2005, 2006), and ‘‘context factors’’ (Øvretveit et al., 2011). In 2007, the Petroleum Safety Authority (PSA) Norway established a new strategic priority ‘‘groups exposed to risks’’. This strategic priority aimed at approaching risk from a holistic perspective and understanding the exposure of different groups of workers (e.g. drillers, wire line, process workers, climbers) within the petroleum industry to different types of risk. The holistic perspective focused on how a number of involved parties and the context these groups work within create these risks. The PSA found that incentives and economic frames established in contracts, communication, and collaboration between partners, and an understanding of roles and responsibilities were important factors in managing working environment risks and risk of major

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accidents at different levels in the contract chains. However, the connection of such environmental conditions with health, safety, and environment (HSE) performance in large companies as well as suppliers and sub-suppliers were poorly understood (Dahle et al., 2010). Few had considered measures to change environmental conditions in order to improve different parties’ ability to manage risk. The PSA identified a need to increase the knowledge and awareness of environmental conditions and their effect on the ability to control and manage risk. Moreover, internally, within the agency, the PSA did not have a shared understanding of environmental conditions for safety work. In some professions, environmental conditions are perceived as laws and regulations while other professions have a more comprehensive understanding that includes political climate, technological challenges, change management, and competence, among others. In sum, lack of knowledge about the impact of environmental conditions on safety work in the industry, lack of a common understanding within the agency, lack of tools to improve communication about environmental conditions, and a clear need for clarification and theoretical foundation of the concept led the PSA to initiate a collaborative project, hiring external scientists to perform a literature review. The purpose of the review was to document to what extent and how ‘‘environmental conditions’’ or synonymous concepts were used in international safety science research literature, to help build a common conceptualisation, and to link environmental conditions to safety work. The present paper provides the main results of this literature review. Researchers have proposed several lists of conditions or factors that may contribute to accidents or influence the risk level or the reliability of human performance in organisations, e.g. Generic Failure Types (Reason, 1997), Performance Shaping Factors (e.g. Swain and Guttmann, 1983), Error Producing Conditions (Williams, 1986), and Common Performance Conditions (Hollnagel, 2004). The purposes of such lists are typically to support identification of factors contributing to accidents, to support organisational safety reviews, or to support analyses of human reliability or accident prediction. The related terms ‘‘context’’ or ‘‘contextual factors’’ are mentioned frequently in analyses of patient safety interventions in conjunction with attempts to build more complete causal accounts for the effectiveness of safety interventions by including factors other than the intervention itself (Øvretveit et al., 2011; Taylor et al., 2011; Stevens and Shohanja, 2011). The purpose of the present work is not to compile another list of performance shaping factors or contextual factors in safety interventions, but rather to conceptualise the ways in which environmental conditions enhance or restrict the scope of action for individuals, groups, organisational units, and organisations to keep risks under control. In this sense, we attempt to adopt the viewpoint of the actors that strive to keep risk under control. This paper addresses the following research question: How can environmental conditions, including those created and maintained at different hierarchical levels within a contractor hierarchy, constrain or facilitate the efforts of individuals, groups, and organisations to keep work environment risk and major accident risk under control? We wanted to explore (1) whether there exists a systematic approach to environmental conditions for safety work in the literature, (2) whether it is possible to derive implications concerning environmental conditions for safety work from the literature on organisational accidents and organisational resilience, and (3) whether a uniform approach to environmental conditions can be identified in the audit reports and other documents issued by the PSA. The paper is organised as follows: In Section 2, we describe the process of literature search conducted through several databases using key words related to ‘‘environmental conditions’’. Furthermore, we present a review of the literature that was found most relevant for the purpose of the present study. Section 3 presents an

analysis of five different perspectives on organisational accidents and resilient organisations with regard to implications concerning environmental conditions for safety work. In Section 4, we summarise the results of a survey of recent inspection and audit reports from the PSA addressing environmental conditions for safety work. Section 5 presents a conceptualisation of ‘‘environmental conditions for safety work’’, which includes a selection of theoretical resources for understanding and analysing environmental conditions. The discussion in Section 6 reviews implications for safety management and challenges for regulatory practice. 2. Literature survey 2.1. Literature search and analysis The databases used to conduct the literature search included ISI Web of Science, Sage, ABI/Inform (Pro Quest), and Google Scholar. The searches were limited to the publications published between 1980 and 2010. The following key words were used:       

External conditions Contingencies Context Constraints Environmental stressors External stressors Influencing factors

These key words were used in combination with other key words that helped to restrict the search. These words were ‘‘HSE’’, ‘‘SHE’’, ‘‘OHS’’, ‘‘work environment’’, ‘‘working environment’’, ‘‘health’’, ‘‘environment’’, ‘‘safety’’, ‘‘occupational health’’, and ‘‘work conditions’’. The literature captured by the search covered many topics without clear relevance to the present study, such as education, feminism, political liberation, economic growth, psychological conditions, art, medicine and urban planning. The number of hits was in many cases excessive. The searches were then restricted to abstracts, and, if necessary, further restrictions were placed to encompass only ‘‘citations’’ and ‘‘key words’’ with the aim to capture the most relevant articles. When the searches resulted in less than 50 hits, the content of the hits were reviewed. The most relevant publications were selected for further analysis with respect to their potential contribution to a conceptualisation of environmental conditions for safety. We did not find any uniform or systematic approach to environmental conditions for safety work in the literature reviewed. We did find proposals for structures or taxonomies for grouping contextual factors in conjunction with patient safety interventions (Hattrup and Jackson, 1996; Taylor et al., 2011). A great number of specific environmental conditions were discussed, including political climate and public awareness; social systems with relevance for safety systems; health, safety and environment (HSE) regulations and their interpretation and relevance for existing conditions; relationship between employer and employee; organisational structures; economical conditions and development; competence and education; technological change; culture, especially with respect to cooperation; and incentives related to contracts between oil companies and contractors. Several publications drew attention to changes in environmental conditions for safety work, such as changes in the labour market with consequences for employee participation (Johnstone et al., 2005), subcontracting and precarious work (De Beeck et al., 2002; Robinson and Smallman, 2006), changing employment conditions associated with complex contractual processes and dilemmas of loyalty (Marchington et al., 2005), a political climate that is unfavourable to HSE regulation (Bluff et al., 2004), weakening

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of trade unions (Bluff et al., 2004) and developments of transnational rules and governance (Djelic and Sahlin-Andersson, 2006). Several authors discussed relations between environmental conditions and risks. Johnstone et al. (2005) identified positive relations between employee participation and health and safety. Marchington et al. (2005) found that new ways of organising work led to erosion of traditional forms of worker participation, reduced job security, and individualisation of work, as well as to new forms of empowerment. Robinson and Smallman (2006) found a positive association between use of subcontractors and injury rate and prevalence of illness. Rasmussen (1997) suggested that a broad range of environmental stressors acting at different system levels influence the capacity of socio-technical systems to keep physical processes under control. Furthermore, Osmundsen et al. (2006, 2008) identified possible unwanted effects of incentives related to contracts between oil companies and contractors. The reviewed literature also gives suggestions on the methods and means to control, influence or monitor environmental conditions. These include close follow up of conditions for employee participation and evaluation of the relevance of regulatory approaches for the current situation (Johnstone et al., 2005). Rasmussen (1997) suggested applying different strategies for risk control, depending of frequency and the seriousness of potential unwanted events. The reviewed literature provided valuable insight into some environmental conditions for safety work, in particular, into conditions that are in transition. However, it did not provide a conceptualisation of environmental conditions in accordance with the objectives of our study. We therefore decided to supplement the literature captured by the literature search with other literature that was known to the authors and considered relevant for the purpose of the study. The resulting body of literature was systematised with regard to the proposed relations between environmental conditions and risk. The results of this systematisation are presented in the following subsections. 2.2. ‘‘Efficiency-Thoroughness Trade-Off’’ and ‘‘Functional Resonance’’ Hollnagel (2004, 2009) outlined a systems view of the emergence, propagation and interaction of variability and disturbances in socio-technical systems. The metaphor ‘‘Efficiency-Thoroughness Trade-Off’’ (ETTO) suggests that actors have to balance efficiency requirements and quality requirements. The output of this balancing act will display some variability, and this variability may become part of the environmental conditions of actors further down in the production sequence or command chain. The metaphor ‘‘Functional Resonance’’ suggests that such variability from different sources may interact and that system properties may cause such variability to increase in an uncontrolled manner (‘‘resonate’’). This process may occasionally lead to an accident. Hollnagel thus draws attention to conflicting demands and variability of input from other actors as environmental conditions for safety work. There is a need to be explicit about situations were actors have to make efficiency-thoroughness trade-offs that may have an effect on safety. In particular, there is a need to identify situations where variations in the output (e.g., decisions, budgets, plans) from one actor may negatively affect the environmental conditions of other actors. 2.3. A contingency model of decision-making Rosness (2009) outlined how decision-makers may adapt to the constraints of the decision setting and how such adaptation may affect the outcome of the decision process. He identified five types of decision settings with associated constraints, dominant decision criteria, representative decision modes, and potential safety problems related to the decision process and its outcome:

    

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Operations Business management Administrative and technical support functions Political arenas Crisis handling

This perspective draws attention to the differences between, e.g., decision-making in a control room and decision-making in a boardroom or a parliament. The model may help us identify the constraints and challenges related to specific decision contexts. The model also has implications concerning how decision-makers may be helped to overcome the potential safety problems associated with each decision setting. 2.4. Discourses on environmental conditions The term discourse (Foucault, 1972) contributed to a shift in focus in research on power from actors to social institutions and domains. This perspective illustrates how power and specific interests are constituted though language, symbols and discourse, with a constant struggle between competing discourses. An example of this can be behaviour based versus technical perspectives on safety. In a historic study, Olien and Olien (2000) analysed how ideology, both its formation and development, served as contingencies that influenced the development of the American petroleum industry in the period between 1859 and 1945. They illustrated how the public discourse was reflected in policymaking and regulation. Based on a rich data set, the authors identified key actors and stakeholders, and the arguments they used to strengthen their views. The authors also tracked the manifestation of competing discourses and their effect on oil policy, identifying five discourses: operational, technological, economic, political, and normative/ moral. This contribution demonstrates the ways in which environmental conditions are socially constructed and subject to interpretation, sense-making (Weick, 1995), and power struggles. In an intra-organisational setting, the willingness to spend resources on ameliorating an HSE problem may increase if that problem is accepted as constituting a violation of laws and regulations. 2.5. Resource dependency Pfeffer and Salancik (2003) suggested that organisations face conflicting demands from other organisations in their environment. Pfeffer and Salancik explicated how an organisation may handle influence attempts of other organisations that control resources that are vital to the focal organisation. This perspective reminds us that the handling of environmental conditions also concerns power relations between organisations and the strategies and tactics that organisations may use to manoeuvre in a field of conflicting demands from other organisations. Some of these demands may concern compliance with safety requirements. Other demands may conflict with the compliance with safety requirements. At the root of this perspective is the awareness that organisations face conflicting demands from other organisations and institutions in their environment. Organisations need to devise strategies that enable them to prioritise safety requirements when such conflicts occur. One such strategy may be to convince other organisations that the two organisations have a strong common interest in meeting safety objectives. 2.6. Normalisation of deviance In an ethnographic-historic study of the Challenger disaster, Vaughan (1996) proposed that a culture of deviance had developed

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because of the environmental conditions that faced NASA and its contractors during the space shuttle programme. Repeated signals of potential danger occurred as tests or flight experiences produced anomalies. These signals were processed in accordance with the formal rules, each time leading to the acceptance of the risk and a new shuttle launch. However, the repeated acceptance of anomalies led engineers and managers to develop and institutionalise a cultural construction of the risk as acceptable. It was considered safe to fly in spite of increasingly serious signs that the O-rings might fail to contain the burning gases inside the solid rocket boosters. Vaughan argued that the production pressures that the space shuttle project faced strongly contributed to this process, which she labelled ‘‘normalisation of deviance’’. This perspective reflects the processes within an organisation that may gradually come to accept serious anomalies as ‘‘normal’’ and acceptable while complying with formal safety management requirements. This perspective emphasises the need to introduce outsiders who may challenge the assumptions and norms ingrained in the culture. 2.7. Circuits of power Clegg (1989, see also Clegg et al., 2006) proposed that the interplay between different forms of power may be represented by interacting circuits of power. Episodic power is applied when actors involved in arenas of struggle try to get others to do something they would not otherwise do. Here, ‘‘standing conditions’’ refer to circumstances that enable or restrict the exertion of power and opportunities to resist in specific episodes of struggle. Clegg (1989) called the two other circuits of power ‘‘dispositional’’ and ‘‘facilitative’’. These circuits can provide underlying premises for episodic power and can be influenced by environmental conditions that Clegg labelled ‘‘exogenous environmental contingencies’’. In circuits of dispositional power, exogenous environmental contingencies can interrupt and disturb existing rules that fix the relations of meaning and membership, i.e. rules that determine how things are understood and who may gain access to positions or settings associated with power. Fundamental rules for understanding safety and access to involvement in safety work, i.e., ‘‘the rules of the game’’ for safety work, are created, maintained and changed within this circuit. In the circuit of facilitative power, exogenous environmental contingencies may stimulate or restrict innovation in techniques of discipline and production. Examples of this can be the introduction of Behaviour Based Safety programmes or new ways of organising offshore petroleum operations based on extensive use of information and communication technology (‘‘integrated operations’’). Innovation in techniques of discipline and production may in turn change the standing conditions for episodic struggles, for instance by changing the roles of involved actors. The circuits of power model sensitises us to the diversity of mechanisms by which environmental conditions may facilitate or restrict the scope of actors to keep risks under control. The efforts to improve the scope of actors to keep risks under control may target the standing conditions that influence the outcome of specific episodes as well as exogenous environmental contingencies that influence dispositional and facilitative aspects of power. 2.8. The notion of ’’context’’ in patient safety research Environmental conditions for safety work may be regarded as part of the context within which actors strive to keep risks under control. Definitions of the term ‘‘context’’ are diverse (e.g., Cappelli and Sheer, 1991; Hattrup and Jackson, 1996; Johns, 2001). Contextualising entails linking observations to a set of relevant facts, events, or points of view that make possible research and theory that captures a larger whole (Rousseau and Fried, 2001). Contextualisation has become

increasingly more important in contemporary organisational behaviour research for two reasons. First, the domain of organisational research is becoming internationalised, giving rise to challenges in transposing social science models from one society to another. Second, the rapidly diversifying nature of work and work settings can substantially alter the underlying causal dynamics of workerorganisational relations (Rousseau and Fried, 2001). Diverse scientific traditions deal with context and link context to their research activities (e.g. anthropology, sociology, organisational behaviour). Our literature search revealed that the term ‘‘context’’ is not commonly used in the research literature on health, safety and environment at work. Weick and Sutcliffe (2007:90f) identify contexts where mindfulness can make a big difference. They use criteria derived from normal accident theory (Perrow, 1984), see Table 1 below. Within patient safety research, it has been argued that quality improvement efforts and interventions often fail due to inattention to key contextual factors (Pronovost, 2011; Stevens and Shohanja, 2011). This implies a lack of knowledge of contextual factors that are important determinants of safety intervention effectiveness, and a lack of consensus on taxonomy of relevant contextual factors. Taylor et al. (2011) proposed a taxonomy that categorises contextual factors that are important for implementing safety efforts into four broad domains: (1) safety culture, teamwork, and leadership involvement; (2) structural organisational characteristics (e.g., size, organisational complexity, or financial status); (3) external factors (e.g., financial or performance incentives, regulations); and (4) availability of implementation and management tools. Others categorise context into informational attributes (e.g., ambiguity), task attributes (e.g., autonomy), physical attributes (e.g., danger), and social attributes (e.g., norms) (Hattrup and Jackson, 1996). We agree with Taylor et al. (2011) that a taxonomy or set of categories can guide researchers and practitioners in incorporating contextual issues into research and practice. However, the efforts to create such taxonomies within patient safety research are at an early stage. We should also be sensitive to the difference between our focus on exploring the scope of action for actors facing risks and the focus of patient safety research on constructing more powerful causal models to account for the effectiveness of interventions. 2.9. Principal-agent-theory Principal-agent theory is a formal approach specifying how a principal (e.g., an oil company) hiring an agent (e.g., a drilling contractor) can design effective incentives under conditions of incomplete information about the agent’s behaviour (Eisenhardt, 1989). It is assumed that the principal and agent engaging in cooperative behaviour have different goals and/or different attitudes toward risk. The idea is to devise a contract that changes the rules of the game so that the self-interested, rational choices of the agent coincide with the desires of the principal. For instance, the principal may invest in information systems to monitor the behaviour of the agent or turn to outcome-based contracts to align the interests of the agent with those of the principal. Osmundsen et al. (2006, 2008) used principal-agent theory to analyse the incentives facing contractors and subcontractors in the Norwegian petroleum industry. Osmundsen et al. identified several possible challenges related to incentives in contracts between operators and contractors. Reduced or zero payment rate during downtime may cause stress or shortcuts at the sharp end and deferral of repair and maintenance work. Rewards attached to incident frequencies may promote under-reporting of unwanted events. Activities that produce easily measurable results may get disproportionately great attention at the expense of important activities that are more difficult to monitor. Analyses of major accidents, such as the explosions at the Esso gas plant at Longford (1998) and at the BP Texas City Refinery

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Table 1 Analysis of five perspectives on organisational accidents and resilient organisations. Perspectives and representative references

Environmental conditions implied or referred to

Relations between environmental conditions and risk

Energy and barrier Haddon (1970, 1980)

Conditions that influence the scope for eliminating or reducing dangerous energy forms or establishing barriers between dangerous energy sources and vulnerable objects

Normal accidents Perrow (1984)

Interactive complexity and coupling of the technical systems. Compatibility between technology and organisational structure

High reliability organisations LaPorte and Consolini (1991) Information Processing (‘‘Man-Made Disasters’’) Turner (1978) and Turner and Pidgeon (1997) Decision making and conflicting goals Rasmussen (1997) and Rosness (2009)

Instrumental and cultural preconditions for organisational redundancy. Preconditions affecting the capacity for spontaneous reconfiguration of organisations in situations of crisis or high demand

Environmental conditions may influence the scope for eliminating or reducing dangerous energy forms and for establishing, monitoring and maintaining barriers between dangerous sources and vulnerable objects. Many environmental conditions may be conceived as factors influencing barrier performance Technologies with high interactive complexity can only be effectively controlled by decentralised organisations with a capacity to improvise. Tightly coupled technologies can only be effectively controlled by centralised organisations capable of prompt and coordinated response to disturbances The reliability of safety critical operations may be improved by means of organisational redundancy. The capacity of organisations to cope with crises and high demand situations may be improved if the organisation has a capacity for spontaneous reconfiguration Major accidents have repeatedly been preceded by inadequate collection, sharing or interpretation of information about physical hazards. Such problems often arise at organisational interfaces

Conditions that facilitate or hamper adequate collection, sharing and interpretation of safety relevant information

Goals or demands that compete with safety. Conditions that affect explicit and implicit decision-making in the face conflicting objectives

(2005), indicate that reward structures based on lost-time incidents may divert attention from process safety to personal safety, and thus contribute to the occurrence of major accidents (Hopkins, 2000, 2008). This suggests that organisations should identify and remove or mitigate unwanted effects of current incentive systems. The idea that ‘‘what you measure is what you get’’ pervades management theory and practice (e.g., Kaplan and Norton, 1992) to the extent that it may suppress alternative views on what stimulates good performance. One may question whether the assumption that agent behaviour is opportunistic and driven by narrow self-interest turns into a self-fulfilling prophesy when principals behave in accordance with this assumption. Such concerns may be less pressing if principal-agent theory is used to identify and remove undesirable effects of incentive structures rather than using incentives as a source of power. 2.10. Weak ties and the bridging of networks Granovetter (1973) proposed that weak ties between persons can have an important role in bridging more extensive social networks. He defined the strength of an interpersonal tie as a combination of the amount of time, the emotional intensity, the intimacy, and the reciprocal services which characterise the tie (p. 1361). He hypothesised that the stronger the tie between two persons A and B, the greater is the degree of overlap between their friendship networks. Close friends tend to share most of their friends, so that their networks will include many of the same persons. Conversely, if A and B are attached by a weak tie, then they are more likely to have non-overlapping networks. According to this logic, weak ties may, in contrast to strong ties, serve as bridges between networks that are not otherwise connected. Weak ties may thus be crucial for connecting remote units of a large organisation. A causal analysis of a blowout on the Norwegian petroleum installation Snorre A (Schiefloe et al., 2005) indicates that weak ties may be important to the planning of complex operations. Snorre A had changed operator two times in less than four years. Personnel in an operating organisation depend on extensive networks with resource persons (e.g. technical experts) in other parts of the orga-

Actors may deliberately take a risk or inadvertently run a risk when making specific decisions. Safety margins may erode over time (‘‘drift into failure’’). Unexpected interactions may occur in situations with distributed decision-making

nisation. These networks had been uprooted twice as a consequence of the changes of operator. The weak ties with persons in the distant parts of the company were not fully re-established after the second change of operator. As a consequence employees in the Snorre A operating organisation did not often seek advice from technical experts in other parts of the oil company (Schiefloe et al., 2005, p. 36). According to Schiefloe et al., this state of affairs caused the informal, organisational safety barriers to be poorly developed. Weak ties can thus be critical for the mobilisation of knowledge, advice, support or other resources in a complex organisation or a network of organisations. They are critical because they may bridge otherwise unconnected networks. Organisations therefore need to spend resources on building and maintaining weak ties, in particular in periods of transition. Alternatively, organisations may choose to establish formal links, for instance by appointing liaison personnel.

3. Analysis of the literature on organisational accidents and resilient organisations During the last four decades, a rich literature on organisational accidents and organisational resilience has emerged. We wanted to explore whether implications for an understanding of environmental conditions for safety work could be derived from this literature. In order to make this task manageable, we chose to direct our analysis to five different perspectives on organisational accidents and resilient organisations identified by Rosness et al. (2010): 1. The energy and barrier perspective (e.g., Haddon, 1970, 1980). 2. The normal accident perspective (Perrow, 1984). 3. The high reliability organisations perspective (e.g., LaPorte and Consolini, 1991). 4. An information processing perspective (Turner, 1978; Turner and Pidgeon, 1997). 5. A decision-making perspective (e.g., Rasmussen, 1997; Rosness, 2009).

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Each perspective was analysed with regard to environmental conditions that were either implicit in the texts or referred to more directly and the relations that were proposed between environmental conditions and risk. The main results of the analysis are summarised in Table 1. This analysis revealed that each perspective contributes unique insights into what aspects of the environment may act as environmental conditions for safety work and possible relations between environmental conditions and risk. The perspectives provide complementary rather than competing accounts of the relations between environmental conditions and major accident risk (LaPorte and Rochlin, 1994). Therefore, the results of this analysis could not readily be reduced to a single model or theoretical formulation.

range of environmental conditions. Many of them related to the opportunities for contractors and subcontractors to attain a good work environment and avoid occupational injuries. Particular attention was given to the contracts made amongst operators, contractors and subcontractors, communication and collaboration between partners and the understanding of the roles and responsibilities. The analysis of audit reports and other documents from the PSA thus confirmed that the organisation utilised the term ‘‘environmental conditions’’ differently, depending on the context in which it was used. We found that one actor in a given situation had to relate to environmental conditions while other actors had the opportunity to influence those conditions. The actor could be an individual, a group, an organisation, an industry or the authorities. These findings were taken into account in our attempt to conceptualise the environmental conditions for safety work.

4. Analysis of audit reports and other documents from the PSA The background for the project was the concern of the PSA about the importance of environmental conditions for the safety work of the petroleum industry and the understanding of the term. As part of the study, we wanted to explore whether a consistent but non-formalised usage of the term ‘‘environmental conditions’’ had already been established in documents issued by the PSA. The task was approached in two ways by performing (1) a survey of documents from the homepage of the PSA and (2) a review of audit reports issued by the PSA. We searched the document database of the PSA using the key word ‘‘rammebetingelser’’, the Norwegian equivalent to ‘‘environmental conditions’’, focusing on the period between 2004.01.01 and 2008.12.08, which resulted in 41 hits. The hits included audit reports, speeches, conference presentations, and a publication about HSE-culture. We found that within the PSA, this particular term was used in various contexts, ranging from an individual workplace to the Norwegian petroleum industry as a whole. Consequently, the term was used to refer to a broad range of conditions. We did not find any definitions or other attempts to formalise the use of the term. The term ‘‘environmental conditions’’ was not used in the HSE regulations. The Guidelines to § 7 of the Framework regulations (Petroleum Safety Authority Norway, 2010) state that, ‘‘The licensee and the owner of the onshore facility are mainly responsible for facilitating the operator’s execution of its tasks’’. This may be interpreted as a requirement to provide favourable environmental conditions for the operator’s execution of its tasks. The Framework regulations § 10 also state that ‘‘The activities shall be prudent, based both on an individual and an overall assessment of all factors of relevance for planning and implementation of the activities as regards health, safety and the environment’’. This indicates that also factors that have an indirect impact on HSE work should be assessed. This is not however explicitly stated. According to the Framework regulations § 7, the operator has a ‘‘duty to ensure compliance’’, implying a duty to ensure that suppliers and sub-suppliers maintain prudent HSE standards. However, it is not explicitly stated that this ‘‘duty to ensure compliance’’ includes a duty to develop proper environmental conditions, such as contract clauses, that are not counterproductive to HSE work at lower hierarchical levels in the contract chain. The HSE regulations thus do not explicitly state a duty to ensure environmental conditions that are beneficial to HSE work further down in the contract hierarchies. On the other hand it is not allowed to have contract regulations that may conflict with regulatory requirements and principles. Four audit reports were chosen for a closer study of the usage of the term ‘‘environmental conditions’’. These reports were selected because they addressed the relationships and interactions among operators, contractors and subcontractors. The reports referred to a broad

5. Conceptualisation of environmental conditions for safety work In order to support organisations, regulators and researchers in exploring how environmental conditions may constrain or facilitate safety work, we have proposed a conceptualisation which comprises (1) a definition of ’’environmental conditions for safety work’’, (2) the metaphors ’’senders’’ and ’’receivers’’, and (3) a set of theoretical resources for understanding environmental conditions for safety work. 5.1. Definition of ‘‘environmental conditions’’ The introduction section of this paper provided definitions of ‘‘safety work’’ and ‘‘environmental conditions for safety work’’. The definition of ‘‘environmental conditions for safety work’’ centres on an actor (individual, group, organisational unit or organisation) facing risk of major accidents or work environment risk. The concept comprises the conditions that facilitate or constrain the efforts of an actor to keep risks under control. It thus invites us to take the viewpoint of the actor, to be sensitive to the actor’s interpretation of the environmental conditions, and to consider the scope of actors to handle risks successfully in the face of those conditions. The broad definition of ‘‘safety work’’ reflects our assumption that a broad range of decisions, actions and practices, and not only formalised safety management activities, keep the risk of major accidents and working environment risks under control. The definition of ‘‘environmental conditions for safety work’’ refers to actors at different levels of analysis, ranging from an individual to an entire organisation. Consequently, ‘‘environmental conditions for safety work’’ is a broad and flexible concept that can refer to conditions ranging from the layout of an individual workplace to the demands for return on investments facing the executive management of an oil company. The term ‘‘environmental conditions’’ refers to conditions in the environment of the actor. The concept is thus compatible with an ergonomic perspective on performance when the actor is an individual or a work group. Correspondingly, the concept implies an open system perspective (e.g., Scott and Davis, 2007), when the actor is a group, an organisational unit or an organisation. 5.2. ‘‘Senders’’ and ‘‘receivers’’ The actions and practices of specific actors create, change and maintain many environmental conditions for safety work. For instance, higher management levels typically impose budget limits, whereas designers and decision makers may determine the layout of a workplace during the design of a production facility. The metaphors of ‘‘senders’’ and ‘‘receivers’’ convey the idea that some ac-

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tors (‘‘senders’’) exert a strong influence on environmental conditions that other actors (‘‘receivers’’) face when they strive to keep risks under control. The metaphor of ‘‘sender’’ can thus be used to highlight how decision-makers at the blunt end of organisations may enhance or restrict the scope for effective safety work at the sharp end. These metaphors can also be used to characterise the position of intermediate management levels. Middle managers are ‘‘receivers’’ of environmental conditions shaped by decisions at higher management levels (e.g., budget constraints, resource allocations and deadlines). At the same time, they are ‘‘senders’’ of many environmental conditions facing lower organisational levels. A middle manager facing a requirement to reduce her operating budget may for instance decide to postpone preventive maintenance work, and may thus cause operators to struggle with unreliable equipment and increased workload associated with handling of production disturbances. In the petroleum industry, where contractor hierarchies are a fundamental part of the value chain, the metaphor of ‘‘sender and receiver’’ can be used to illustrate the interactions among operators, entrepreneurs and subcontractors. This metaphor highlights a hierarchy and power relations among the actors. Some actors, such as major oil companies, are in a position to set the terms of an operation and renegotiate the terms of contracts if circumstances should change. This way, the ‘‘sender–receiver’’ metaphor evokes an asymmetric conception of power, where some agents are in a position to impose their will on other agents. However, where there is power there is also resistance, and there will often be room for interpretation, negotiation and power games between ‘‘sender’’ and ‘‘receiver’’. Another point has to do with how a literal interpretation of the concept ‘‘sender’’ and ‘‘receiver’’ might reduce power to a property of personal actors or companies. Power, however, is not only connected to agents, but represents a complex web of relations partially determined by the system of knowledge constituted in the discourse (Clegg et al., 2006). Used as a heuristic device in analyses of contractor hierarchies, the interpretation of ‘‘sender’’ and ‘‘receiver’’ is thus different from a causal relationship. The power of metaphors resides in their capacity to highlight specific aspects of reality and not in the capacity to cover all aspects and varieties of a phenomenon. The roles of ‘‘sender’’ and ‘‘receiver’’ should be seen as two ends of a continuum, and we emphasise the dynamic aspects of the relationship where the actors interact to create, co-create, contest and recreate their environmental conditions. Several environmental conditions, such as trust and mutual respect among operators, contractors, and subcontractors, can only be co-created. 5.3. Theoretical resources for understanding environmental conditions for safety work The literature search yielded diverse complementary answers to our research question concerning the ways in which environmental conditions constrain or facilitate safety work. This diversity reflects different basic assumptions about the nature of humans and organisations, different analysis levels, different theoretical interests and different practical concerns. We see no meaningful way in which this diversity can be reduced to a single model or theoretical formulation. We therefore propose that several theoretical resources need to be combined in order to gain a comprehensive understanding of environmental conditions and their effects on HSE. Each resource should convey a different way to make sense of environmental conditions, and thus point to new ways to diagnose a situation and new options for action with regard to environmental conditions. Textbooks on organisational theory by Morgan (1986) and Bolman and Deal (1984) inspired this approach to theory.

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Based on the literature review, we have identified eight theoretical resources for understanding how environmental conditions may constrain or facilitate safety work. The theoretical resources are summarised in Table 2. Like most theoretical work, the selection of these perspectives was not a highly structured or reproducible process. We did not identify any finite, clearly delimited ‘‘population’’ of theoretical resources that would be most relevant to our purpose. However, at a heuristic level, several criteria guided our choice of theoretical resources: 1. In accordance with our definition of ‘‘environmental conditions for safety work’’, we wanted to capture several different analysis levels (individuals, groups, organisational units, organisations). 2. Some of the theoretical resources should capture sense-making processes, i.e., the capacity of different persons, organisations and cultures to attach different meanings to a given set of environmental conditions. 3. Some of the theoretical resources should capture power relations and the dynamics of power. 4. Theoretical resources that are restricted to psychological processes within individuals were not considered relevant to an understanding of environmental conditions for safety work. 5. The total set of theoretical resources should reflect, to a reasonable extent, the diversity of the relevant research literature. 6. Discussion and conclusions 6.1. Contributions of the present study Environmental conditions or contextual factors have typically been conceived as factors that contribute to accidents, influence the probability of erroneous actions, or explain variations in the effect of risk reducing measures. The dominating concern of researchers has thus been to quantify their influence on error rates, risk or on the effect of preventive interventions, often without specifying the mechanisms that lead to such effects. The present study identifies a set of theoretical resources that may help us explore the diversity of specific relations between environmental conditions and risk. Both the literature on organisational accidents and resilient organisations (Table 1) and the broader organisational theory (Table 2) proved relevant in this regard. The present study also expands the scope of common conceptualisations of environmental conditions and contextual factors by explicating sense-making processes. Actors interpret environmental conditions in different ways, and they influence the interpretations of other actors. Five of the theoretical resources summarised in Table 2 cover various aspects of sense-making (discourse, resource dependency, normalisation of deviance, and circuits of power). The present study also provides concepts and theoretical resources to highlight the processes through which decisions and practices of specific actors create, maintain and change environmental conditions. The metaphors of ‘‘senders’’ and ‘‘receivers’’ characterise the roles of actors in these processes. These metaphors should also be taken as an invitation to identify other possible roles that capture processes where environmental conditions are co-created. Relevant theoretical resources include Clegg’s concepts of ‘‘standing conditions’’ and ‘‘exogenous environmental contingencies’’ and Pfeffer and Salancik’s theory of resource dependency (Table 2). 6.2. Implications for HSE management and risk reduction In most cases, safety management theories or models outline how the ‘‘the management’’ or ‘‘the organisation’’ can manage risk. The petroleum industry is characterised by extensive outsourcing

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Table 2 Theoretical resources for understanding environmental conditions for safety work. Theoretical resource

Scope

Relations between environmental conditions and risk

Implications for safety work

Efficiencythoroughness trade-off Hollnagel (2004, 2009) Contingencies for decisionmaking Rosness (2009) Discourse Foucault (1972) Olien and Olien (2000) Resource dependency Pfeffer and Salancik (2003) Normalisation of deviance Vaughan (1996) Circuits of power Clegg (1989) and Clegg et al. (2006) Principal-agent theory Eisenhardt (1989) and Osmundsen et al. (2006, 2008) Weak ties and the bridging of networks Granovetter (1973)

How perturbations arise, propagate and interact at the level of socio-technical systems

Variability resulting from efficiencythoroughness trade-offs may cause adverse environmental conditions for other actors. Variability from different sources may ‘‘resonate’’ and trigger an accident Decision processes and their outcomes are influenced by constraints related to the decision setting and the way decision-makers adapt to such constraints

Identify situations where efficiencythoroughness-trade-offs may negatively affect the environmental conditions of other actors

How individuals, groups and organisations make sense of environmental conditions, and how they try to influence such sense-making processes.

The way actors deal with environmental conditions relates to the meaning they attach to those conditions. Discourses carry hidden assumptions that are often taken for granted.

Identify and question the hidden assumptions inherent in specific discourses.

Organisations dealing with conflicting demands from organisations in their environment

Some demands from an organisation’s environment may concern safety, whereas others may conflict with safety objectives

Devise strategies that enable the organisation to give priority to safety requirements when they face conflicting demands from their environment

Organisations facing a mismatch between resources and production demands

Adverse environmental conditions can lead an organisation to gradually accept serious anomalies as ‘‘normal’’

Seek help from outsiders to challenge assumptions and norms that are ingrained in the culture

Power mechanisms by which environmental conditions may influence the scope of actors to control risks

Environmental conditions can constitute standing conditions influencing episodic power or exogenous environmental contingencies influencing dispositional and facilitative power Reward structures may influence management attention, decision-making, and prioritisation of resources and efforts with regard to safety as well as reporting

Efforts to improve the scope of actors to keep risks under control may target the standing conditions well as exogenous environmental contingencies Remove or mitigate unwanted effects of current incentive systems

Weak ties can be critical for the mobilisation of knowledge and other resources because they bridge otherwise unconnected networks

Build and maintain weak ties when the linking of otherwise unconnected networks is critical to safety

Individual and group decision-making in the face of conflicting objectives

How to design effective incentives when principal and agent have different goals and agents have private information

The significance of weak interpersonal ties in more extensive social networks

and subcontracting. However, the management of inter-organisational and multi level environmental conditions for safety work is rarely an issue in the literature. We have outlined specific implications for safety work of each theoretical resource in the right column of Table 2. For instance, principal-agent theory calls for an examination of current incentive systems focusing on undesired effects on risks. We shall here consider more general implications of addressing environmental conditions for safety work. Our conceptualisation of environmental conditions for safety work implies that the distribution of power within and between organisations becomes an issue for safety management because a powerless actor is not in a position to actively take care of the safety of her or himself or others. It is also necessary to pay attention to the processes that shape the environmental conditions that specific actors have to face. Contractual clauses, for instance, may have a significant effect on contractors’ and subcontractors’ environmental conditions for safety work. This implies that the groups and organisational units whose safety work is affected by contractual clauses should have a fair opportunity to influence those contractual clauses. By introducing the concepts of ‘‘environmental conditions for safety work’’, ‘‘senders’’, and ‘‘receivers’’, we emphasise that the capacity of one actor to take care of safety issues often depends on the actions and practices of other actors. HSE management and risk reduction efforts should target both ‘‘senders’’ and ‘‘receivers’’, including the role of executive managers as ‘‘senders’’ and the

Allocate decisions to settings that are conducive to adequate processes and outcomes. Devise decision aids to counteract unwanted effects of situational constraints

dual role of middle managers as ‘‘receivers’’ of environmental conditions imposed by higher management levels and as ‘‘senders’’ of environmental conditions facing lower levels of the organisation. In conjunction with accident investigations, a careful examination of environmental conditions may help make sense of the actions of involved persons. This may counteract unjust attribution of blame and help the organisation identify a broader range of relevant risk reducing measures. 6.3. Challenges for regulatory practice Regulatory authorities such as the PSA may face several challenges when they try to address environmental conditions. The HSE regulations for the Norwegian petroleum sector mainly direct the responsibility to the company or employer to maintain prudent safety standards. We have argued that the HSE regulations, such as the operator’s duty to ensure compliance, do not explicitly state a duty to ensure environmental conditions that are beneficial to HSE work further down in the contract hierarchies. This, combined with lack of knowledge in the industry of possible implications of environmental conditions to safety work, has led the PSA to apply regulatory methods and tools beyond the traditional audits and use of sanctions in order to increase awareness of, and improve, environmental conditions for safety work. The PSA has emphasised a dialogue based regulatory strategy and has challenged the industry to reflect upon how environmental conditions, where the oil companies are the ‘‘senders’’,

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may affect the suppliers’ and sub-suppliers’ HSE work. The regulatory activities have revealed use of incentives that may have a negative impact on safety work, such as paying scaffolding companies according to volume of finished scaffold. This type of payment incentives may reduce time spent on planning of activities, including safety management. We have identified a need for a regulatory strategy and methods to increase understanding of the possible implications of environmental conditions for decision makers and decision-making processes at different levels within the petroleum industry – from the governments to the oil platform. Such decision-making processes may relate to regulations, contract processes, economic issues, and to the division of roles and responsibilities between different organisations and institutions, among others. Another important regulatory challenge is to contribute to increased awareness of goal conflicts and tradeoffs that may be under-communicated at different regulatory levels. Safety competing with production goals, conflicting Key Performance Indicators, and conflicts between other contractual agreements, such as compensation form and HSE, are examples of such conflicts or dilemmas that need to be managed. We have argued that environmental conditions are subject to interpretation, sense-making processes, and power struggles. Regulations and regulatory practices are interpreted and re-interpreted in a process in which different stakeholders participate. Regulatory initiatives may thus have consequences for HSE work that the regulator did not anticipate. Thus, the regulators’ ability to understand and consider the ‘‘discursive climate’’ in the industry is very important. With reference to Clegg (1989), we propose that regulatory agencies need to be aware of ‘‘standing conditions’’ that might come into play when actors in the regulated organisations strive to keep risks under control. Regulatory agencies also need to understand the effect of ‘‘exogenous environmental contingencies’’ when actors strive to improve their environmental conditions for safety work.

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and safety management literature. With reference to Table 2, the study thus draws on open systems theory (resource dependency, efficiency-thoroughness trade-off), theory of power (circuits of power), theory of discourse, theory of organisational decisionmaking (contingencies for decision-making), theory of culture (normalisation of deviance), economic theory (principal-agent theory) and theory of social networks (weak ties and the bridging of networks). Certain theories were deliberately excluded from the study. Psychodynamic accounts of behaviour, such as those reviewed by Morgan (1986) under the heading ‘‘Organisations as mental prisons’’, were excluded because they refer to personality traits and intra-individual processes rather than environmental conditions. Ecological theories of organisations, which seek to account for organisational properties by hypothesising different birth rates and survival rates for different populations of organisations, were excluded because their primary level of analysis, i.e., populations of organisations, was considered too aggregated for the purposes of this study. A major challenge for the present study was that the term ‘‘environmental conditions for safety work’’, was defined so broadly that it captures phenomena covered by several different disciplines. Environmental conditions facing an organisation may be different from those facing an individual; therefore, the strategies to cope with or change the environmental conditions may also be different. This diversity of phenomena led us to refrain from trying to devise a single model or theory to capture all aspects of environmental conditions for safety work. Due to the broadness of the notion of ‘‘environmental conditions for safety work’’, we were not able to find any obvious way to restrict our search to relevant literature. The results of this search should therefore not be considered exhaustive or complete. The authors hope to invite others to propose complementary perspectives on environmental conditions for safety work.

6.4. Research implications Empirical research is necessary in order to exploit the potential inherent in the proposed concepts and theoretical resources. Specific topics for research on environmental conditions for safety work may be derived from each of the theoretical resources outlined in Table 2. We will here consider methodological implications concerning how to study environmental conditions for safety work. Our conceptualisation of environmental conditions for safety work calls attention to the actors that face accident risks and working environment risks, and their scope for action. This implies a need for research strategies that are sensitive to sense-making processes and to the distribution and dynamics of power. Thus, there is a need for data collection strategies that are sensitive to sensemaking processes and discourses. In this regard, qualitative research methods are essential. There is also a need to capture the interaction between ‘‘senders’’ and ‘‘receivers’’. Appropriate analysis units could thus be pairs of ‘‘senders’’ and ‘‘receivers’’ studied in their natural environment. Finally, researchers should be sensitive to differences between regulatory regimes, organisations, organisational units and groups. For instance, the possibility of actors at the lower levels of organisations to influence their environmental conditions for safety work, and the appropriate means to do this, may be highly dependent on differences between national and organisational cultures. 6.5. Scope and limitations of the study This study covers established perspectives on organisational accidents and resilient organisations as well as theoretical resources that are not commonly referenced in the safety science

6.6. Conclusions An overall conclusion of the literature review is that we did not find any uniform or systematic approach to environmental conditions for safety work in the safety science literature. The study also revealed that the PSA does not use the term ‘‘environmental conditions’’ in a consistent manner. We identified a set of theoretical resources that may help us understand how environmental conditions may constrain or facilitate safety work. Due to the diversity of these theoretical resources, we have refrained from trying to reduce them to a single model. We propose that the metaphors ‘‘sender’’ and ‘‘receiver’’ may be used as a starting point for exploring how some actors influence the environmental conditions of other actors. HSE management and risk reduction efforts should pay attention to both ‘‘senders’’ and ‘‘receivers’’ of environmental conditions for safety work. It is necessary to pay attention to the processes that shape environmental conditions for safety work, for instance the preparation of contracts among operators, contractors and subcontractors. Regulatory bodies need to develop strategies for addressing environmental conditions for safety work, with special emphasis on groups that face unfavourable environmental conditions. The theoretical resources identified in this paper may be taken as a starting point for empirical research on the relations between environmental conditions and risks and how actors adapt to or try to influence the environmental conditions that they face. This calls for research approaches that are sensitive to sense-making processes and the distribution and dynamics of power.

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Acknowledgements The Petroleum Safety Authority, Norway initiated and funded this literature review. The writing of this article was funded by the Petroleum Safety Authority, the University of Stavanger, and by the Norwegian Research Council through the programme ‘‘Health, safety and environment in the petroleum sector’’, Grant Number 203317/S60.

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