R-14 started when an accident occurred on one of my sites in the oilfield on a drilling rig.
A surface cement job was being performed, and returns being taken into the cellar. Cement got back to the surface and pumped out of the cellar. The cellar was then flushed with sugar water (sugar slows the process of cement setting up), and all of the water was pumped out leaving about 6 inches of water.
We then proceeded to attempt to skid the rig over to the next well. This is a lengthy process, with one step being to break the bolts on the BOP, pick it up, then skid the rig over. At this point however, the BOP bolts would not break for an unknown reason. What is normally a 15 minute process, had the guys beating on the bolts with a hammer for about 3 hours. During this process water proceeded to get into the boots of some of the men. This clean and clear looking water, had unknowingly to everyone on the crew, still had a high PH level due to the cement being in it at one point.
The bolts eventually broke, and the rig was skidded over. Some of the guys that got wet feet, went to change boots and socks other than one new worker. He chose to not change boots or socks. After the work day, he realized he had red feet that were mildly irritated, but chose not to seek any medical treatment.
The next morning, he woke up to second degree burns on his feet. A truly terrible, and unfortunate workplace incident. However, the worst part about all of this, was that a similar event occurred five years prior at the same company. No one on my site knew about it. To me this signified a severe lack of the right tools. We had to come up with a better system. All of the lessons learned software available was for people in the office, and only being used on desktops. Nothing being designed for the people in the field, this had to change, and it still needs to change.
R-14 is attempting to design software for the field hand, get the data into the hands of the men that do the work to keep them safe, and allow them to thrive at work.
Why Lessons Aren't Learned
And how we're solving it with 5 steps.
Collecting Data. No one likes to admit failure or admit to making a mistake, and this can deter people from submitting good lessons.
Take the barriers away that prevent people from submitting incidents.
The two best ways we've found is the small task of creating a non-punitive culture. (Kidding it's a bit of work).
The other way is making submission of incidents anonymous.
All Lessons Are Not Created Equal. In most databases all lessons are weighted evenly, leaving the user with many irrelevant lessons.
We rank our lessons, and allow you to do the same.
Quit filling your database with lessons where nothing can be learned or prevented.
Quality over Quantity.
Get Specific. Many lessons use non-actionable steps, and don't make for a good plan forward.
Do not use the words "Be safer", that helps no one.
Get Specific on what needs to happen to prevent the event. If you cannot. Get it out of there.
Think about what actions to take.
Avoid the Black Hole. It can be daunting to look for the specific lessons that apply to you.
Have a good filter system. Our system filters down by #tags. You can continue searching through #tags to find exactly what you're looking for.
Link to each lesson. When creating procedures you can link to each lesson and save it for later.
Put it in the hands of everyone, not just people in the office. Get our app and share lessons.
Truly Retain. Constantly review all of the lessons.
People need reminders more than being taught.
Gamify this process. It doesn't have to be a dread.
Daily lessons, and daily activities.
Reward the daily user.
Missions & Values
Reduce Injuries. Save Money. Equip teams.
We operate using these principles that have been proven to provide success in life and in business.
Deep Integrity - Doing the right thing even when no one else will know.
Create the future - Don't sit idly by waiting to safely arrive at death, accept the risk and get in the game.
Protect individual creativity and freedom - allow people to make mistakes, and have fun at work.
Action and Innovation - Constantly growing, improving and experimenting.
Excellent results - High performance. Not working for ourselves, but for the good of our fellow man.
Honesty and Open-mindedness - Telling each other the truth, even when it hurts; Then being willing to accept that criticism.