This blog post is adapted from a presentation given by Charles Redinger, Fred Boelter, Mary O’Reilly, and Glenn Barbi at AIHce EXP 2020 and from conversations with the presenters that took place on September 15, 18, and 23, 2020.

As industrial hygienists collect more data and better understand the risks present at their employers’ organizations, they will need to find a method for evaluating and prioritizing risks before recommending health or safety interventions. However, navigating risk is not always clear. IHs will benefit from studying frameworks developed through the field of decision-making in managing risk (DMMR).

Navigating risk is most challenging in situations that sit at the area of overlap between three realms: that of national laws and industry-wide regulations; that of organizational missions, values, and core principles; and that of personal morals, codes of conduct, belief systems, and cognition. AIHA Fellow Charles Redinger, PhD, MPA, CIH, calls this area the risk decision-making triangle: it is fraught with tension between these competing sets of rules and beliefs, but navigating it is necessary to develop risk resilience.

If Total Worker Health is adopted as an organizational value, an IH can use TWH as a point of reference on which to base risk management decisions. In the meantime, it is useful to learn the basics of human decision-making before identifying aids for navigating it and then frameworks for managing risk.

Mental Models, Biases, and Decision Making

People’s mental models inform their conscious choices, often without their realizing so. Mental models are useful sets of beliefs for quick, easy decision-making, but they are not always correct and are rarely questioned by their users. Some mental models are unique to the individual and result from his or her own experiences, but shared experiences build shared mental models.

An IH can find mental models in use everywhere: in corporations that focus on shareholders and the financial bottom line at the expense of worker health, safety, and well-being; in IH colleagues who are extremely proficient in their field but may not immediately understand the points of view of outsiders; and in frontline workers who are most concerned with doing their job in the ways most familiar to them. All humans use mental models, which is not necessarily a problem. When organizations can successfully build a mental model shared by all stakeholders, they get more done. But unchecked reliance on mental models can cause people to fall prey to cognitive biases, which leads them to overlook the real causes of problems and productive solutions by turning to the familiar instead.

“We need to be aware of our own biases and mental models,” said Mary O’Reilly, PhD, AIHce EXP 2020 presenter and adjunct professor currently teaching at the School of Public Health of the State University of New York at Albany. “We all have them.”

There is no simple way to build a mental model shared throughout an organization. In the short term, IHs can learn to listen and communicate across different mental models, temporarily setting aside their own biases and perceptions to understand how non-IHs make decisions. A future blog post will delve into the complicated business of driving an organization toward shared values, such as TWH.

Navigational Aids for DMMR

Navigational aids help industrial hygienists make well-informed decisions without unrecognized mental models and biases unwittingly driving their decision-making processes. With the right navigational aids, IHs may become more effective leaders in their organizations.

One such aid, structured decision-making (SDM), was presented at AIHce EXP 2020 by Fred Boelter, CIH, PE, BCEE, FAIHA, who has worked in industrial hygiene, environmental engineering, and risk management for over 40 years. SDM, he said, is just as useful for minor, personal decisions as it is for complex public-sector issues involving multiple decision-makers, scientists, and stakeholders. Common steps found in SDM approaches are:

1. Define the problem; clarify the decision context.
2. Define objectives and measures.
3. Define a range of acceptable alternatives.
4. Analyze the consequences of different management actions.
5. Analyze the tradeoffs between alternatives and select acceptable alternatives.
6. Acknowledge the uncertainty of possible consequences.
7. Understand risk tolerance and be more objective-driven, transparent, and defensible.
8. Sequence linked decisions—resolve near-term issues and prepare for the future.
9. Implement, monitor, and learn.

These steps guide the IH through the process of making a risk management decision. Boelter cautions that the IH should not skip any step, particularly the first two—if the problem is incorrectly defined, the organization will waste time and money while addressing it. This tip will help IHs avoid their own confirmation biases regarding risk management. Boelter also emphasizes the importance of stakeholder involvement in DMMR.

The traditional hierarchy of controls, and the version of the hierarchy of controls modified for TWH (Figure 1), are also helpful to keep in mind when making risk management decisions. They assist the IH in prioritizing solutions. However, keep in mind that human behavior is difficult to change through workplace health and safety policies.

It is also important to note that no organization or undertaking will ever achieve zero risk—even if decision-making is free of bias and controls are in place at every level of the hierarchy, some residual risk will remain. If there is no risk, there is no benefit. IHs should be transparent to other stakeholders about the level of residual risk. In fact, transparency and honesty are necessary at all steps of the DMMR process. Mutual trust determines whether stakeholders and leadership will accept the risk along with the IH’s proposed solution.

Frameworks That Support DMMR

The ability to use a system, or a stepwise process, to make a decision is an essential concept for DMMR. SDM provides a straightforward DMMR framework. Systems thinking and formal management systems offer more complex approaches.

A management system is a set of policies, processes, and procedures that an organization codifies and uses to fulfill its goals. Among the most common and well-known of these are the ones created by the International Organization for Standardization (ISO) beginning in the 1980s, including the ISO 9000 family, used for quality assurance; ISO 31000, which is specific to risk management; and, more recently, ISO 45001, which is specific to occupational health and safety. Others include the Committee of Sponsoring Organizations of the Treadway Commission’s Enterprise Risk Management integrated framework and the ANSI Z10 OSH Management standard. These offer IHs a step-by-step process for doing their job and improving decision making.

Even if one or more of these management systems are in place, an IH should consider developing a DMMR “operating manual” specific to his or her organization’s needs to ensure that the decision-making process remains consistent.

Risk Communication to Decision Makers

After an IH makes a risk management decision, he or she will need to go to organizational leadership to present findings and recommend solutions. Presumably, the IH will have used the navigational aids and frameworks mentioned above to ensure that the recommended solution is correct. But when speaking to leadership, such as board members or executives, the IH should recall the section on mental models and biases.

Often, organizational leaders lack industrial hygiene training and use mental models different from those familiar to IHs. Likewise, IHs will have to be aware of their own biases when communicating risk to leaders. Glenn Barbi, MPH, CIH, CSP, FAIHA, formerly the chief ethics officer and the vice president of environmental health and safety at BD, cautioned that many IHs assume the importance of both their job and their recommendations to the organization are self-evident. While industrial hygiene and occupational health and safety are undoubtedly important, C-suite executives will have many other demands on their time and attention. Also, while IHs take comfort in data, board members may be more intuitive. When communicating risk to them, IHs should take care to remain humble—aware that they don’t know everything that’s going on in the organization—and do their homework on to whom they are talking and that person’s background. While the IH may not share the decision-makers’ mindset, the IH should at least respect it and try to understand their audience’s perspective.

In meetings with leadership, Barbi counsels that IHs should take care to stick to their purpose and build trust with the leadership. They should take care that everything they do during the meeting establishes their credibility, which, as mentioned previously, relies on transparency and honesty. Once IHs forge trust between them and their leadership, leaders are less likely to see IHs as subordinates and more as equals. Then the IH might occasionally question the leadership in turn, potentially nudging the organization in new directions.

While the information in this blog post is not exclusive to Total Worker Health, the contents help achieve TWH objectives. Knowledge of cognition and the mechanics of decision-making may help an IH discover why workers make choices that do not support their health, safety, or well-being, or why leadership may doubt solutions that will improve organizational health. The DMMR frameworks and navigational aids can help IHs identify the most significant areas of concern, address them properly, and communicate their solutions to board members and other leaders.