Significant Injury or Fatality potential, or SIF potential, has ties to the ubiquitous Heinrich pyramid in safety management.

Since its creation in 1931 by William Heinrich, the Heinrich pyramid infiltrated health and safety procedures.

However, it’s faced harsh criticism. Some safety professionals claim it oversimplifies the relationship between near misses and serious incidents. Others protest it puts too much blame on the worker.

Now, most modern enterprises use safety software to record near misses and incidents. Therefore, with this wealth of data at our fingertips, the question is: how can we use it better?

Should safety professionals throw out the Heinrich pyramid altogether?

In short: not necessarily. Instead, here’s how to slice the pyramid for significant injury or fatality (SIF) potential.

Problems with the Heinrich pyramid

Heinrich’s pyramid was first released in his book Industrial Accident Prevention: A Scientific Approach.

Fundamentally, the pyramid claims that focusing on near misses and first aid incidents (bottom of the pyramid) leads to a reduction of fatalities and lost time injuries (top of the pyramid).

A diagram of the Heinrich pyramid.Heinrich wrote that the root of 88% of incidents is ‘unsafe acts of persons’. According to the pyramid, for every 300 accidents, 300 are no injury, 30 are minor injury and one is a major injury.

Years after Heinrich put forward the pyramid, Frank E Bird developed it into the accident triangle commonly seen today.

In the 1970s, drawing data from the large insurance company he worked for, Bird concluded the relationship between workplace fatalities, serious injuries, minor accidents and near misses is ratio of 1:10:30:600.

In other words, there is one workplace fatality for every 600 minor incidents.

However, safety leaders of today recognize this is flawed—or, at least, that the theory is often applied incorrectly.

If Heinrich’s ratio is correct, how can it be that injuries and illnesses have decreased over the past five years, but fatalities have increased?

Let’s take a look.

Too much blame on the worker

One of the most cited problems with the Heinrich pyramid is that it puts too much blame on the individual.

In his paper Influencing Behaviors for Better Safety Performance, Keith D. Robinson, CSP, CHMM, former Director of HSE at Stantec Consulting Services, argues:

“…by claiming that 88% of all injuries are the result of unsafe acts, Heinrich is putting all blame on the employee, without recognition of the interplay of root causes, including system failures.”

In other words, investigations underpinned by this bias can miss what’s really going on.

Safety professionals protest that Heinrich’s model pedals a culture where employees fear they will be seen at fault. Fear leads to cover ups, or incidents not getting reported in the first place.

Of course, human factors contribute to safety incidents. In this case, Robinson explains the question should be “What can managers do to influence their employees to make better choices?”

Misleads on the relationship between near misses and fatalities

The other problem with the Heinrich pyramid is that it overstates the relationship between near misses and fatalities.

In this sense, researchers at The Campbell Institute, part of the National Safety Council, argue the pyramid has been misused.

Mark Paradies of TapRooT agrees. Paradies writes that after it was adapted by Frank Bird, Heinrich’s pyramid became misunderstood.

People interpreted the new graph as meaning that for every major injury there would be 600 unsafe acts—without specifying that these unsafe acts must have the potential to cause major harm.

As Paradies puts it, “stopping paper cuts won’t prevent major process safety related accidents or industrial safety fatalities.”

Therefore, a better way to use Heinrich’s pyramid is through the prism of SIF potential.

What is Significant Injury or Fatality (SIF) potential?

To prevent serious harm, safety professionals must concentrate on the portion of near misses with SIF potential.

Near misses with SIF potential are situations that could have caused major harm if conditions, systems, or acts were slightly different.

For example, a back strain from manual handling has little SIF potential, while an elevated fall has high SIF potential. Each require a unique response.

Crucially, the contributing factors of SIFs are different to those behind non-SIFs.

A study by DEKRA Insight looked at several contributing factor themes. Researchers found that the top theme behind SIFs, breakdowns in the processes surrounding Life-Saving policies and programs (42%), related to 0% of non-SIFs.

As The Campbell Institute puts it, “[organizations] have to isolate that part of the triangle with the potential or SIF and prevent those incidents from occurring.”

So, how do you achieve that?

Enter safety software. Namely, Incident Management and Permit to Work.

Managing SIF potential with safety software

Safety personnel require a systematic approach to record SIF potential and do something about it.

In enterprises, this process is supported by powerful safety software, like Pro-Sapien.

Investigate the right events

Organizations must focus on SIF potential near misses and incidents, rather than the flawed belief that reducing near misses overall will reduce serious injuries.

Using Incident Management Software (IMS), this starts with an appropriately trained person categorizing near miss and incident reports.

Not just by type, but by severity.

Several Pro-Sapien clients also capture potential severity, to further inform the follow up process.

This is based on the premise that events leading up to a near miss / incident are what hold the SIF potential or non-potential, not necessarily the outcome.

For example, as DEKRA Insight explains, “a broken foot caused by stepping on a rock in the parking lot has significantly less SIF exposure than a broken foot that was driven over by a forklift.”

LBC Tank Terminals implemented this approach to shift to a proactive culture, and their success won them an EHS Innovation Award from Verdantix.

Therefore, by providing the tools to carry out a methodical investigation, IMS helps to slice the Heinrich pyramid to properly manage SIF exposure events.

This is required as, often, SIFs are the result of a complex series of mechanical, operational, engineering, and human failures. Not just unsafe acts alone, despite Heinrich’s 88% claim.

Furthermore, IMS solutions like Pro-Sapien also come with the ability to manage corrective actions, which are pivotal in avoiding recurrence.

Identify SIF exposure before an incident

You can identify SIF exposure or potential by considering the kind of activity that is happening. For example, does the event involve:

  • Lockout tagout (LOTO)?
  • Confined space entry?
  • Barricades/machine guards?

This is a process Permit to Work (PTW) software helps to manage.

If the answer to any of the qualifying questions is Yes, there is SIF exposure potential—and a permit to work should be required to manage that risk.

The purpose of PTW is to understand the precautions required to carry out a specific task safely.

It lets managers approve dangerous work with verification that additional controls are in place, to minimize the risk of SIF.

For example, confined space entry should require a permit to work. Approval would be issued after atmospheric testing returns safe results for oxygen, combustible, and toxic gases, among other controls.

However, in large companies the PTW process can slow down operations, therefore software helps ensure a smooth, transparent, and timely lifecycle.

Putting in place a PTW system like this helps prevent SIFs by giving high-exposure tasks the due diligence they deserve.

Heinrich pyramid vs. SIF potential

In summary, it can be said that the Heinrich pyramid is accurate, but only at a very high level.

Lots of near misses do not mean a fatality is imminent and solving lots of near misses does not mean a fatality is avoided.

Safety managers must go deeper than the triangle, to unveil the portion of near misses with SIF potential. Then they must implement corrective actions to combat precursor events, and controls to manage ongoing risk, like through Permit to Work.

That may be daunting, but the good news is, safety software is here to help.

Keep reading: It’s Time to Stop Playing the Name, Blame and Shame Game →

Hannah Stewart manages the Digital Marketing team at Pro-Sapien, and has been with the company since graduating with a BA Hons in Communications in 2015. Hannah has a keen interest in technology advancements and enjoys engaging EHS professionals in conversations about how the profession will be affected by such changes. At Pro-Sapien, Hannah manages all things marketing and works closely with the Sales team on business development.

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