Accident Imaging - Learn from what did not happen yet
Basically "accident imaging" is: imagine what can happen given in a given situation. When you do that, look at the
broad picture and include all possible unwanted events, not just accidents alone.
Accident imaging is answering the question "what if?", what could happen if the situation was different from what
it is now?
Accident imaging could provide important information to secure continued operation of your company or organization
and improve the management system.
Accident imaging can take place during design stages of installations, work environment and procedures. It can take
place during inspections and investigation of unwanted events. In fact it can take place during
all or most business processes. What if we would lose that particular supplier? What if the warehouse would
burn down? What if we would lose one of our key people? What if we loose our power supply, would we lose
clients? What if we would have a fire, how much would we loose? WHAT IF?
Two examples of "what if?" The most recent one was the fire at a chemical storage plant in Moerdijk, The
Netherlands, in January 2011. An employee used an open flame to defrost a pump with the end result that the
total plant burned down and went into bankruptcy later on; no injuries.
The Moerdijk Fire
In my own experience is a card board manufacturer in Belgium. This happened early seventies when I was
working as a technical representative for INA, the US insurance company. My job was to look at
factories to give my opinion about the insurability of the plant concerned. My advice in this case was
rather straightforward: not recommended for insurance with an estimated maximum property loss of 90% of sum
insured. Two months later, the plant burned down killing six people with a almost total property loss, saving
only the power plant representing 10% of sum insured.
Two examples what may happen when the unwanted - but foreseeable - event occurred.
The quality of the
management team is determined
knowing in advance what problems can occur in their
organization or unit
the number and size of problems that occur
knowing what the causes of those problems would be
Knowing the actions that should be taken to minimize the
A quality management team should only have known problems with limited
Accident Imaging - the process
The process of accident imaging would include the following steps and
description of a situation/deviation from existing circumstances - what adverse situation could happen?
how often could the unwanted situation or event occur?
what are be the likely or possible consequences of the situation or event?
what are the likely or possible causes that may lead to the unwanted event?
what preventive and contingency actions can be taken?
what would be the results of the actions?
what would be the costs of the actions?
who is going to do what and when?
Risk classification is important in this
process, to estimate event frequency and consequences in steps 2 and 3 as well as in step 6 and 7 when
considering potential action results and their costs.
Accident Imaging - remember Murphy's Law: "What can happen, will happen". A matter
of chance. Not doing anything is like Russian Roulette.
LMRA - Last Minute Risk Analysis
LMRA - "Last minute risk analysis" or "last minute risk assessment" is a "tool" to
assist in developing the habit of looking at the job environment prior to starting the work. It boils down
to the question: "can I carry out the job without unnecessary risks?"
LMRA and accident or incident imaging are closely related. The both are answering
the question: "what could happen go wrong in this situation?"
LMRA should take into account the working environment, materials and equipment
used and working procedures followed. This way they could provide relevant information to update the
management system elements such as design and change management (installations, workplace), purchasing
(materials, tools) and training (work procedures).
Behavior / observation programs such as Dupont's STOP, C.O.A.C.H.
(Constructive Observation And Coaching Habits) and others are directed at developing desired behavior by
observing actual behavior and correcting deviations through discussion with the people involved.
Those programs are related to accident imaging as they would/should also
consider the environment in which the behavior (the way the work is being done) takes place.
Behavior programs may be executed to stimulate management teams to visit the shop
floor. However, effective behavior programs will function at the level where the work is being done and involve
the people doing the actual work. The end results of such programs should encourage peer involvement as
part of a company culture in which people will share responsibility for work properly carried, without
undue risks and unwanted events leading to loss.
Behavior programs, like STOP, should also take into account the working
environment, materials and equipment used and working procedures and provide information to improve the
Accident imaging - key to problem based culture change
Accident imaging is essential in design and change management to prevent and eliminate problem sources before
unwanted events and their losses will occur.
Accident imaging in its various forms- including LMRA and behavior programs - can be an important aspect in
risk and problem control and will help stimulating based culture change.