How to Use the Swiss Cheese Accident Causation Model

 

No matter how robust your safety procedures are, accidents inevitably happen.

But why do accidents occur? Where do they originate? And what can we do to stop them from happening?

These are the types of questions the swiss cheese accident causation model attempts to answer.

The video below walks through its definition and an example of the model in practice.

After watching the video, continue reading because we’ll expand the definition, discuss its origins and key concepts, and show you how to apply its insights to your organization.

What is the Swiss Cheese Accident Causation Model?

The swiss cheese accident causation model is a theoretical model used in risk analysis, risk management, and risk prevention.

As the video above points out, “any components of an organization is considered a slice [of cheese] in this model. Management is a slice. Allocation of resources is a slice. An effective safety program is a slice. Operational support is a slice.”

But if there are any deficiencies or flaws in any of these “slices” of your organization or agency, then you will have a hole in that slice. Hence, swiss cheese.

If holes within each slice of your organization line up, meaning one weakness carries over into another weakness and so on, it creates a single hole throughout your organization – causing an accident.

Who Invented the Swiss Cheese Accident Causation Model?

The swiss cheese accident causation model was invented by James T. Reason and was first described in his well-known book Human Error.

In this book, he describes several famous disasters including the Challenger space shuttle accident and instead of simply discussing various causes for the accidents, he proposes an integrated theory of accident causation now known as the swiss cheese model.

What are the Key Concepts of the Swiss Cheese Model?

Reason was able to construct his integrated theory of accident causation through in-depth research into the nature of accidents, leading him to the following insights:

• Accidents are often caused by the confluence of multiple factors.
• Factors can range from unsafe individual acts to organizational errors.
• Many contributing factors to an accident are latent errors – they’re lying dormant waiting to be triggered by any number of active errors.
• Humans are prone to operational errors which require properly designed systems to mitigate the errors humans inevitably commit.

These insights form the key concepts behind the swiss cheese accident causation model.

What are Active and Latent Errors in the Swiss Cheese Model?

According to the US National Library of Medicine, Nearly all adverse events involve a combination of these two sets of factors:

Active Failures

Active failures or active errors are the unsafe acts committed by people.

An example of an active failure would be an employee who chooses not to follow safety procedures like cleaning flammable debris from a machine.

But according to the swiss cheese model, their active failure was not the ultimate cause of the accident. There are other factors at play.

Latent Conditions

Latent conditions or latent errors are the failures built into procedures, systems, buildings, or machines by the designers, builders, writers, or management.

Latent conditions are failures waiting to be triggered by an active error.

An example of a latent condition would be faulty fire alarm systems that are inoperable.

If you combine this latent condition with our example of an active failure – failing to clean flammable debris from a machine – you get a serious fire accident.

How to Apply the Swiss Cheese Model

While the swiss cheese model isn’t prescriptive, you can use its insights to improve the overall safety of your organization.

One way to prevent active errors is to know the top OSHA violations in 2017 to ensure your safety procedures match OSHA’s standards so your employees don’t make these common mistakes.

One way to prevent latent errors is to know the Government facilities management trends of 2018 and keep up-to-date with the latest technologies and practices to ensure the safest environments for your employees.

Beyond those two suggestions, you’ll need to regularly provide in-depth safety training to your employees. That’s difficult to do on a tight budget and little time to set aside for a week or a weekend’s worth of training.

But instead of in-person training, you can use the effectiveness of eLearning to train your employees quickly and easily using nothing more than their computers and an internet connection.

But to get the right training, you need an eLearning platform that specializes in producing courses on Government safety training.

Lucky for you, Enterprise Training specializes in all forms of Government training, and we have plenty of programs to satisfy your safety training requirements.