Safety Triad

This triangle of safety-related factors has been termed "The Safety Triad" (Geller, 1989 Geller et al., 1989) and is illustrated in Pigure 2.3. 

Consider the three sides of "The Safety Triad" I introduced in Chapter 2 (see Figure 2.2). One side is for environment, including tools, equipment, engineering design, climate, and housekeeping factors. Another side of this triangle stands for behavior, the actions everyone did or did not perform related to an incident. The third side represents person factors, or the internal feeling states of the people involved in the incident—their attitudes, perceptions, and personality characteristics. 

This is the Safety Triad" (Geller et al., 1989) introduced in Chapter 2. The most common reaction to an injury is to correct something about the environment—modify or fix equipment, tools, housekeeping, or an environmental hazard. 

This kind of vague attention to critical human aspects of a work injury shows how frustrating and difficult it is to deal with the psychology of safety—the personal and behavioral sides of the Safety Triad. The human factors contributing to injury are indeed complex, often unpredictable and uncontrollable. This justifies my conclusion that all injuries cannot be prevented. 

If you recall, our overall map or guiding principle is represented by the Safety Triad (Figure 2.3). Its reference points are the three primary determinants of safety performance—environment, person, and behavior factors. To achieve a Total Safety Culture, we need to understand and pay attention to each. 

Let us keep in mind that people operate within a context of environmental factors that have complex and often unmeasurable effects on perceptions, intentions, beliefs, attitudes, values, and behaviors. This is represented by the environment side of The Safety Triad (Geller, 1989) and the "environment" designation in Figure 15.2. Such complex interactions among person, behavior, and environment dimensions of everyday existence often make it extremely difficult—sometimes impossible—to predict or influence what people will do. However, certain changes in external and internal condihons can influence people s behaviors consistently and substantially. 

Figure 18.2 also reflects the three basic areas requiring attention for injury prevention— environment, behavior, and person. This is, of course, the Safety Triad (Geller, 1989b) introduced in Chapter 2 to categorize intervention strategies and referred to later in Chapter 14... 

Only 10 firms account for 75% of agrochemicals sales, while the 15 largest drug companies have a market share of only 33% (Stinson, 1995). About 85% of fine chemicals are manufactured by companies of the triad the United States (28%), Western Europe (39%), and Japan (17%). Italy, with 4.0 million litres reactor capacity and 71 manufacturers, topped the European fine chemicals industry (Layman, 1993). Recently India, China, and Eastern-Central European countries have gained a significant proportion of the market, as a result of the lower direct labour costs and the more relaxed environmental and safety standards. It is fair to state that the high quality of chemists in these countries has also contributed to this development. In 1993, the cost of producing fine chemicals in India was 12% below that in Europe (Layman, 1993). 

The Merck group s efforts to find a more stable substitute for the DKA pharmacophore resulted in the design of 8-hydroxy-[l,6]naphthyridines such as compound 10,19 wherein the keto-enol-acid triad was replaced with a 1,6-naphthyridine ketone bearing a phenolic hydroxyl group. Further refinement of compound 10—replacement of the naphthyridine phenyl ketone with a 4-fluorobenzyl carboxamide and addition of a six-membered sulfonamide at the 5-position of the naphthyridine core—resulted in compound 11, the second IN inhibitor to reach the clinic.20 The discovery of liver toxicity in long-term safety studies of compound 11 in dogs led to the suspension of clinical development21 of this compound. 

It is these data that justify approval and continued marketing of a drug that complies with the quality criterion of the oft-quoted triad safety, efficacy, quality . This is usually not a trivial exercise. 

Effectiveness amd saifety in Phase II trials, aind safety in Phase I, aire necessary but not sufficient for regulatory approvad. They do allow the project to advance, and the decision to proceed with development often follows a successful, rigorous Phase II triad. 

The final element of the triad is accountability, which activates responsibility and authority. Without accountability, even if authority is granted and responsibility delegated, nothing may happen, actions may or may not be taken, nobody may care about results, and the safety management system fails. 

This complexity has been reflected in the approach taken by two schools Of research. In the first, Morton started with a great deal of data on the epidemiology of cancer. She took these results and showed the importance of tannin in this effect. Much research resulted from her studies, and the effects (both pro and con) of specific polyphenols on these cancers was undeniable. The work of the second researcher. Hausen, has proven the effects of a wide variety of quinones on the above triad of effects. The quinones themselves and their mechanisms of action have been clearly delineated. The health and safety aspects of his book make it indispensable. 

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