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Should we hold the handrail? Risk and Safety in COVID times

 

“The greatest enemy of truth is very often not the lie – deliberate, contrived, and dishonest – but the myth – persistent, persuasive, and unrealistic.” 

– J.F. Kennedy

“OK, stay safe, look after yourself and as you go down, be careful, don’t touch the handrails.” Those were the words of a ship manager whom I visited in my hometown just a few week ago. Hearing this for the first time, I felt a sense of utter disbelief. “What did you just say”, I asked the manager. “You heard it right. Don’t hold that rail, it could carry infection” he repeated.

It was a telling example of how our priorities have shifted so much within weeks. Lifesaving rules have now become life threatening. I took the message on LinkedIn and the post received more than 15K viewings in a matter of few days. But there’s a bigger question to be asked here. What can the example of handrails teach us about human nature in the face of uncertainty? I will offer some reflections in this short write-up.

Can handrails save lives?

While not central to the topic, do handrails really save lives or prevent people from falling from staircases is a good place to start. There has been an extensive body of research on handrails and staircase related accidents. According to one study by Miller and Esmay in 1958, 75% of stair falls happened where no handrails were present.  In another case in 1971, McGuire found that 16% of accidents were due to missing handrails. In the early 1960s Sheldon’s study found that 44% of stair accidents amongst elderly people could be avoided with handrails on staircases. The same study also showed that on staircases with no handrails people aged over 60 experienced twice as many accidents as those less than 60. Research conducted by Carson in 1978 showed that stairway incidents where no injuries were sustained were four times more with handrails than without handrails. Carson’s also found that where serious injuries are sustained, it made no difference whether handrails were present or not. But if handrails were made available injuries were less severe.

John Templer’s study in 1985 revealed that the rate of incidents was higher where people actually used handrails to pull themselves up in ascent or for guidance and balance in descent. Templer concluded that people who “used handrails to pull themselves up may initially have been more vulnerable and thus had more incidents” (i.e. elder people). The same study concluded that “those who merely used the handrail for guidance and balance may have been lulled into a sense of security that masked some of the risks involved in descending stairs.”

Templer suggested that for someone who uses the handrail has a ‘fair but not certain chance’ of preventing a fall and avoiding an injury but there are two further complications.

If you were holding the handrail from the outset of the fall, it depends upon:

  1.  The ability to maintain grip as against the magnitude of the fall
  2.  Twisting motion that may damage the wrist
  3. Reaction time after the onset of the balance loss

If you were not holding the handrail at the onset, the chances of falling will depend upon:

  1. The ability to reach the handrail (handrail design, height of rail)
  2. The ability to grasp the handrail (agility, distance of handrail from wall, shape of handrail)
  3. The ability to maintain grip on the rail (magnitude of forces, body attitude, twisting of wrist, handrail shape, handrail height, material and make, slip resistance, friction, nosing of staircases, maintenance of stairs)

The UK’s Health and Safety Executive puts it in clear terms:

“Whilst it is true that slips and trips on stairs are a common cause of injuries at work, there is no mandatory requirement to “hold the handrails”. Research actually suggests that the key requirement is for handrails to be available, visible, and at the right height so that they can be grasped in the event of a slip or trip rather than be continuously held.” (HSE, UK)

What we know so far is that there is more to staircase accidents than just holding the handrails. There are many variables (including physiological state) that may influence the potential for an injury and we rarely discuss these with the workers. It is also clear that the design and construction of staircases and handrails play a crucial role in improving safety. The perceptive traveller amongst us would know that we are rarely reminded to grab the rails when we board or disembark an aircraft. It follows that mature industries and forward-thinking organisations prefer focusing on meaningful design improvements. (By the way you should watch President Obama getting on and off the Air Force One – a point beautifully articulated by Dr. Robert Long in one of his articles). Templer concluded that the most effective solution is to minimise the impact of injuries by designing soft stairs. That was 1985. If we went back in time with what we know today, we would have no hesitation in calling Templer’s idea of soft stairs a ‘fail-safe’ design in scientific terms.

Can handrails also threaten lives?

We are in a very different place from where we were a few weeks ago. The notion of safe and unsafe, good and bad, compliant and non-compliant, and legal and illegal has turned upside down with little pre-warning. Doorknobs and door handles were meant to provide security; handrails were meant to improve safety. We now view these artefacts as carriers of life-threatening illnesses. The control panel on elevators were meant to provide access and mobility, now we fear to even enter the elevators let alone touch the panel. In many parts of the world, people are starting to use toothpicks to activate elevator controls and then dump the toothpick into waste bins and plastic bottles. These are local solutions to problems that couldn’t possibly be contemplated in design stages at least when viewed through the principles of ALARP (as low as reasonably practicable).

What can handrails tell us about the nature of risk and safety in a post COVID world?

As someone commented on my LinkedIn post – it’s quite simple, use hand gloves and hold the rails. And then someone else added, it’s simple, dispose the gloves and wash your hands. But is it really that simple? Because now we have to ensure that we make the right gloves available, people use the right gloves, we train people to wear and remove the gloves so they don’t spread infection, segregate the gloves in a safe manner, follow environmental policies, consider an audit trail to demonstrate compliance. Risk is no longer as linear and predictable as we are made to believe in our risk models. Each control that we introduce opens up possibilities for surprises in unimaginable ways. And this is just handrails. How much more if we talk about flying planes or navigating ships? It turns out that the world we have created is not as predictable and simple as we thought it would be.

The conundrum of keeping things simple

Simplicity gives us a sense of order and control. Here’s the rule, follow it and you will be fine. In an attempt to simplify things, we are mindlessly applying rules without engaging with the context for instance the famous take fives, lifesaving rules and so on. We have created libraries of rules within our organisations and assigned dedicated departments to maintain those libraries. But we spend little time thinking and observing people on the front-line applying those rules in varying situations. Unfortunately, recalling rules has taken precedence over the ability to apply rules in the face of diversity and uncertainty.

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One can understand the need to hold a handrail on an unstable platform (i.e. ships and oil rigs) but why do we need to apply the same set of rules in a stable office environment? Prestigious institutions and reputed organisations (even those selling risk management services) seem convinced that we should keep things simple. Some companies even have such simple rules embedded in induction and training programs for employees and visitors. What sense does it make I wonder? This is dumbing down safety to control people, it reaches the point that people disengage and do as they are told or even more, tell us what they think we would like to hear. All this takes organisations away from the realities of front-line operations towards unrealistic goals and mindless administrative exercises.

The irony of understanding

Let’s return to the original question. What can handrails tell us about human nature in this post-COVID world? This is the great irony of understanding. At one level, I am beginning to better understand the role of handrails in improving safety. In that sense knowing is liberating as knowledge puts me in control. On the other hand, I am beginning to realise that risk and safety management systems of today are based on retrospective knowledge and past experience. Whether or not past knowledge will be useful to solve problems of the future is questionable. An organisation that genuinely aims to learn and improve will always have to stay curious and constantly question the validity of rules and plans in the face of uncertainty. But this is a deeply uncomfortable space for many leaders. Not surprising that in the face of uncertainty we choose to hold the handrail.

The article was first published in the Seaways Journal of the Nautical Institute (May 2019 edition)

A podcast on the topic is available at https://preaccidentpodcast.podbean.com/e/papod-272-when-life-saving-rules-become-life-threatening-hazards-nippin-anand-talks-about-his-most-popular-social-media-post-ever/

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