Vision zero: from accident prevention to the promotion of health, safety and well-being at work

Abstract There is growing attention in industry for the Vision Zero strategy, which in terms of work-related health and safety is often labelled as Zero Accident Vision or Zero Harm. The consequences of a genuine commitment to Vision Zero for addressing health, safety and well-being and their synergies are discussed. The Vision Zero for work-related health, safety and well-being is based on the assumption that all accidents, harm and work-related diseases are preventable. Vision Zero for health, safety and well-being is then the ambition and commitment to create and ensure safe and healthy work and to prevent all accidents, harm and work-related diseases in order to achieve excellence in health, safety and well-being. Implementation of Vision Zero is a process – rather than a target, and healthy organizations make use of a wide range of options to facilitate this process. There is sufficient evidence that fatigue, stress and work organization factors are important determinants of safety behaviour and safety performance. Even with a focus on preventing accidents these additional factors should also be addressed. A relevant challenge is the integration of the Vision Zero into broader business policy and practice. There is a continued need for more empirical research in this area. Graphical Abstract


Introduction
The Zero Accident Vision (ZAV) is based on the assumption that all accidents are preventable. ZAV is then the ambition and commitment to create and ensure safe work and prevent all accidents in order to achieve safety excellence (Zwetsloot et al., 2017a,b). This is a high ambition and it sometimes gives rise to the misunderstanding that ZAV focuses on the 'goal' of zero accidents, rather than on a 'journey' and a 'process' of creating safe work (safety excellence). Zwetsloot et al. (2013a) called for more (empirical) research into the practices and perspectives of such commitments for improving safety. They stated that ZAV was developed in industry and needed more attention from safety researchers. In this paper, we want to focus on the broader Vision Zero (VZ), which addresses not only safety but also (occupational) health and well-being, which is often associated with the Zero Harm (ZH) concept. We also focus on the challenges companies may face to keep ZAV or VZ 'alive' in the long run, also when the need to improve health, safety and well-being (HSW) seems less urgent. The latter is closely related to the question of how to sustain VZ as part of the business strategy, in order to prevent it from becoming a new, broader occupational safety and health silo.
The expression 'health and safety', or Occupational Safety and Health (OSH) is often used by people and organizations to mainly address (occupational) safety concerns (Leka, Jain, Zwetsloot, Andreou, & Hollis, 2016); their attention to work-related health and well-being is often limited to hazards and associated risks that stem, like safety risks, predominantly from technology related aspects of production processes, such as the design of technical installations and workplaces. Often there is less organizational and systematic attention paid to health compared to safety, while psychosocial risks and well-being at work often remain out of scope (Bergh, Hinna & Leka, 2014a;Leka, Van Wassenhove & Jain, 2015). It is not known to what degree this bias towards safety is also found in companies that have committed themselves to ZH, which in principle seems to include health. The impression, however, is that many ZH companies that already have developed a high degree of risk control in the area of safety, still have much to gain in the areas of health and well-being.
In this paper, the Vision Zero for health, safety and well-being is based on the assumption that all accidents, harm and work-related diseases are preventable. VZ for HSW is then the ambition and commitment to create and ensure safe and healthy work and to prevent all accidents, harm and work-related diseases in order to achieve excellence in HSW. VZ should be understood as a journey, a process towards the ideal, which is usually expressed in the terms 'zero accidents' (for safety only) or ZH (ideally for safety, health and well-being). VZ is also a value-based vision implying that work should not negatively affect workers' HSW, and if possible, should help them maintain or improve their HSW and develop their selfconfidence, competences and employability.
The call for more research into ZAV (Zwetsloot et al., 2013a) generated enthusiasm and was followed up by the publication of some empirical research but also raised criticism. As there are many similarities between ZAV and VZ, part of the criticism explicitly refers to the broader concept of ZH. We will therefore first provide a concise overview and evaluation of raised criticism.

Criticism of the zero accident vision and zero harm
Several critical papers on ZAV or ZH have been published since 2013. The main criticisms are as follows: (1) that ZAV is unrealistic and naïve and denies the realities of risk (implying uncertainties, human limitation and learning by mistake, Long, 2012;Sharman, 2014); (2) ZAV leads to more bureaucratic safety systems and bureaucratic accountability (Dekker, 2014a,b,d); and (3) ZAV leads to a focus on very minor risks (Sharman, 2014), associated with overspending of investigation resources (Dekker, 2014b). The critics also state that ZAV leads to a safety culture of scepticism, cynicism, underreporting, lack of debate, fear of openness, a non-learning climate (Long, 2012), intolerance (Sharman, 2014), stigmatization of workers involved in incidents (Dekker, 2014b) and a punitive mindset (Long, 2012). According to the critics, the focus in ZAV is on attaining zero injury rates, which may lead to underreporting (Sharman, 2014) and trickery and fraud with numbers (Dekker, 2015;Dekker & Pitzer, 2016;Dekker, 2014b). For a more indepth overview, see Zwetsloot et al. (2017a).
According to Zwetsloot et al. (2017a), part of the criticism seems to be based on the assumption that ZAV committed companies are trying harder to do the same old safety things, that is, to make more safety procedures (systems associated with greater bureaucracy) and to be stricter and more punitive towards unsafe behaviour. If that assumption is right, the critics are right. But this is not what the empirical studies of VZ committed companies published so far confirm (Twaalfhoven & Kortleven, 2016;Young, 2012;Zwetsloot et al., 2017b).
The critics assume that ZAV (or ZH) companies have only three options to realize their ambition: stricter control through (bureaucratic) procedures, stricter behavioural control (or error prevention), and fraud with numbers (Dekker, 2014a, c;Long, 2012;Sharman, 2014). In reality, the limited empirical research into ZAV/VZ companies clarified that these companies realize that ZAV is based on a different mindset, requiring a long-term process, and that healthy organizations make use of a wide range of traditional and innovative options to facilitate the ZAV process (Zwetsloot et al., 2017a,b). For instance, developing a 'commitment strategy' for safety, integrating it into business development, using technological and social innovations, developing a learning safety culture.
ZAV committed companies explored innovative ways to improve safety (Young, 2014) and endeavoured to develop a learning-driven safety culture. Instead of stricter control and more sanctions towards unsafe behaviour, there was more empowerment than in other safety frontrunner firms. Managers asked questions in order to trigger reflection and dialogue, instead of giving orders and referring to existing procedures (Zwetsloot et al., 2017a,b).
The empirical results so far show that ZAV implementation often leads to significant safety improvements (Young, 2014;Zwetsloot et al., 2017a), thereby being keen to make use of technical and social innovations (Young, 2014). Companies and their personnel see ZAV as a journey driven by genuine long-term commitment (Koivupalo, Sulasalmi, Rodrigo, & V€ ayrinen, 2015;Twaalfhoven & Kortleven, 2016;Young, 2014;Zwetsloot et al., 2017a) that does not lead to more bureaucracy. Instead, it leads to higher worker commitment and more empowerment (Zwetsloot et al., 2017b), to managers giving safety very high priority in daily practice, to the encouragement of participation and learning, and a culture that has more characteristics of a 'just culture' than is found in non-ZAV frontrunner firms (Zwetsloot et al., 2017b).
In any case, criticism should not overshadow the many good practices found in the empirical studies so far. All in all, an evaluation of the criticism published so far underlines the earlier Zwetsloot et al. (2013a) call for more research into the industrial practice of ZAV (or ZH) implementation.
It is to be noted that the critics of ZAV and ZH seem to have a very strong bias towards safety. In fact, in their publications, ZH is almost equal to zero accidents (e.g. Dekker, 2014a,b,c;Long, 2012). They assume that the only reason for adopting zero accidents or harm is to reduce loss time incidents (LTI's) to zero (they see it as a goal, not as a process), which is a very limited interpretation of ZH. In addition, they have not seriously addressed the ambitions in the areas of health and well-being.
The critics might be particularly negative about VZ, as they focus only on the unproductive impacts of approaches that are based on a misunderstanding of VZ. However, the criticisms they offer are helpful for understanding the pitfalls of VZ when applied incorrectly. Table 1 provides an overview of some potential pitfalls for companies that strive to achieve zero accidents.
We consider ZAV and ZH companies as companies that are 'innovating' their approaches with the intention to achieve excellence in safety or in HSW. This paper will therefore discuss the consequences of a genuine commitment to ZH for developing an integrated, balanced approach to HSW at work, realizing synergies in HSW.
Vision zero for health, safety and well-being at work HSW at work are often parallel silos both in organizational practice, and in research communities. There are different foci that have emerged in the various silos, as well as several frequently found misunderstandings, which hinder mutual understanding and cooperation in these key areas. Safety experts tend to regard psychosocial risks (let alone positive psychology) as not very relevant for safety and as a 'very soft' area with a lack of hard evidence. A topic like 'personal resources' (an important area in the Job Demands and Resources model referring to self-efficacy, self-esteem and optimism) is likely to be associated by safety experts with the 'accident prone' theory (referring to personal characteristics in general) (Dahlb€ ack, 1991), which goes back to 1926, but which still remains controversial (Burnham, 2009). See also Christian, Bradley, Wallace, & Burke (2009) for a good meta-analysis of the role of personal factors in workplace safety.
Experts in well-being at work tend to think that safety is a 'hard', technology dominated area, where simple 'mono-causal' factors lead to incidents (well-being being multicausal). However, many safety experts nowadays focus strongly on safety culture and/or safety climate (Griffin & Curcuruto, 2016;Leitão et al., 2016;Petitta, Probst, Barbaranelli, & Ghezzi, 2017;Zohar, 2014), and on interventions to improve safety awareness and organizational and behavioural change, subjects that are certainly not 'hard' nor 'mono-causal'.
It is important to note that ZH implies the control (or reduction) of occupational risks stemming from different types of hazards. Safety hazards stem mainly from energy-intensive processes or products that imply the potential of acute liberation of energy injuring people and damaging the work environment, or they stem from the potential of loss of containment of (acute) toxic materials. Traditional occupational health hazards stem from various (chronic) exposures to physical, chemical and biological agents, as well to physical strain and the burden of unfavourable postures, movements. Psychosocial hazards stem from work organization or negative interpersonal interactions. Although there are many interrelationships between these various types of hazards, the different types of hazards require also different methods for risk assessment and different types of control measures. This is also true within the safety domain, as we now know that a focus on prevention of personal risks does not help to reduce process safety risks (Baker, 2007) and a focus on minor personal safety risks does not automatically help reduce severe personal risks (Mendeloff & Burns, 2013).
While the focus in the area of psychosocial risks, or positively formulated well-being at work, is strongly on work organization and interpersonal interactions, in the area of safety there is little empirical evidence regarding work organization (some exceptions are Laschinger, Heather, Leiter, & Michael, 2006;Parker, Axtell, & Turner, 2001). The psychological perspective on safety seems to be dominated by (safe and unsafe) behaviour and safety culture/climate. While in the area of well-being, growing attention has been placed on the importance of organizational culture (Dollard & Bakker, 2010;Dollard, 2007;Zwetsloot & Leka, 2010).

Commonalities of safety and well-being
Safety and well-being likely have more in common than many would expect. In both areas, design and management challenges are important. The control of deviations in work processes is a shared interest. There are many similarities between the promotion of health and well-being and safety promotion. Business ethics are relevant for safety and for well-being, with many recent challenges, for example, the It is a process that requires commitment from all leaders and workers in an organization Focusing strongly on incident rates (and other lagging indicators) Using leading indicators Assuming that more safety rules, management systems and behavioural control will help to go from good to excellent safety performance Focus on leadership, being innovative and promoting (collective and individual) learning Assuming that one approach is able to improve different types of safety (e.g. process and personal safety) Using a variety of approaches and adapting them where appropriate impact of globalization on the (changing) workplace, the impacts of continuous cost reductions and the focus on core activities and outsourcing of all non-core activities. Positive psychology is not only relevant for 'work engagement' but is also likely to be relevant for safety promotion (Mathisen & Bergh, 2016;Nahrgang, Morgeson, & Hofmann, 2011). In the safety domain, the increasing attention to the concept of 'resilience' has also led to a positive safety concept 'Safety 2' (Hollnagel, 2014). In the area of resilience engineering, there is now a growing interest in how 'resources' help to master deviations (Grøtan, Waerø, Van der Vorm, Van der Beek, & Zuiderwijk, 2016). Other common bases for safety and well-being are as follows: (1) control of (work) processes and dealing with deviations, (2) improving accuracy, avoiding human error, and (3) proactive approaches to new developments, including reorganizations and outsourcing, increasing flexibility, job insecurity, etc. Fitness for the job is a concept that also bridges the two areas. The IAEA (2016) mentions 'fitness for duty' as one of the areas relevant for safety culture. The physical and mental fitness of the workforce is key to alertness and risk awareness. Traditional aspects thereof concern the (non) use of alcohol and drugs and fatigue, but increasingly this is seen in a broader perspective, paying also attention to the prevention of stress and burnout, and the promotion of healthy lifestyles.
Interfaces between steps in the production process are often problematic in safety (potentially causing communication problems and control challenges); in sociotechnical theories, these are known to be a source of production problems (quality), and to be a source of stress. The sociotechnical approach is therefore to reduce the division of labour as much as possible, preferring simple organizations with complex jobs, over complex organizations with simple jobs. See Kunzler (1996, 2000) for sociotechnical approaches to safety.
From the perspective of credibility for the employees, the two areas (safety and well-being) are also closely associated. Credibility, taking care of the safety of people also implies, often implicitly, taking care of their health and vice versa. The different traditions and foci imply complementarities and opportunities for synergies. Several concepts and models that have been developed and are based on considerable evidence in one area, also seem relevant for the other area, for example, on job design and work organization (well-being) (Leka, Cox, & Zwetsloot, 2008) versus management systems, increasing risk awareness and safety culture (Clarke, 2006;Edwards, Davey, & Armstrong, 2013). This is also evident in the content of developed standards like OHSAS (BSI, 2007) that focuses on OSH management systems, and PAS1010 (BSI, 2011) that focuses on the management of psychosocial risks in the workplace.
While safety experts focus on the organizational level for psychosocial aspects of safety (safety culture and climate), psychosocial experts in the areas of health and wellbeing at work focus on work organization, job content, demands and resources. These different traditions seem highly complementary and suggest a potential for important synergies.

Fatigue and safety
Irregular working hours and overtime work may result in chronic fatigue, which can lead to decreased concentration and cognitive failure during work (Akerstedt, Fredlund, & Jansson, 2002;Williamson et al., 2011). Dembe, Erickson, Delbos, and Banks (2005) report an increase in occurrence of occupational accidents by 23% among employees working at least 60 hours per week. Lamond and Dawson (1999) showed that that moderate levels of fatigue may produce performance impairment equivalent to or greater than those observed at levels of alcohol intoxication deemed unacceptable when driving, working and/or operating dangerous equipment. According to Chan (2011) fatigue is the most critical accident risk factor in oil and gas construction. Flin et al. (2008) described how stress can impact workers' performance negatively in terms of efficiency and accuracy, and it has also been associated with lower levels of work situation awareness for drilling personnel on oil and gas installations (Sneddon, Mearns, & Flin, 2013). Mathisen and Bergh (2016) found a positive association between emotional exhaustion and action errors/violations and a negative relationship between engagement and action errors/violations.

Stress and safety
Stress has been linked with poor sleep quality, excessive drinking, feeling depressed, feeling anxious, jittery, inattentive behaviour, which may result in momentarily distraction, human error and/or failure in normal activities (Leka & Jain, 2010;Mearns, Flin, Gordon, & Fleming, 2001). Larsson (2003) saw another synergy: according to him, prevention of accidents and injuries is also an important strategy to prevent post-traumatic stress. Mearns et al. (2001) showed that the variable most likely to predict accidents and near misses on an oil installation is 'unsafe work practices'. The number one predictor of 'unsafe work practices' was employees having a perception of 'high production pressure'. It was the feeling of stress that contributed to performance issues in safety critical operations. Stress as a result of high production pressure was directly related to work practices. It is therefore easy to see a correlation between being stressed as a result of perceived production pressures and making critical errors at work. Goldenhar, Williams, & Swanson (2003) showed a correlation between several stressors (e.g. job demands, job control, job uncertainty, training, exposure hours and job tenure) and safe work practices in construction, and Glasscock, Rasmussen, Carstensen, & Hansen (2006) found similar results in farming. Bergh, Ringstad, Leka, & Zwetsloot (2014b) found a correlation between psychosocial risk factors and hydrocarbon leaks on offshore platforms, whereas Ramvi (2003) showed a correlation between the quality of the psychosocial work environment and commitment to safety at work at two different oil installations in the North Sea.

Work organization and safety
Given the relevance of stress (prevention) for safety, it is not surprising that there is also considerable evidence that work organization factors are important for safety. Deviations in production process are known to be a potential trigger for the causation of accidents. In psychosocial research, deviations are regarded as 'demands' on the worker to deal with (requiring sufficient autonomy/decision latitude) (Bergh, Hinna, Leka, & Zwetsloot, 2016;Karasek, 1979). Actions to prevent accidents go hand in hand with making operations more reliable, which also have an impact on workers' health and well-being.
The relevance of work organization factors for safety are also addressed in several accident investigation models and methods. For example, the TRIPOD methodology of incident investigation (Groeneweg, 1994) comprises 'error enforcing conditions' as one of the eleven basic risk factors that can underlie many accidents. The great body of knowledge on the importance of decision latitude (autonomy), social support, etc., that is available in the area of psychosocial risk management, has now also been proven to be relevant for safety (e.g. to reduce human error, etc.). A meta-analysis by Nahrgang et al. (2011) showed that job demands and resources relate to safety outcomes.

Broadening the six innovative perspectives
The application of presently available (evidence based) methods and tools can help most companies to realize important steps towards genuine Zero. However, VZ is also paradoxical, and it will also require organizations to explore and identify new paths. In the second ZAV discussion paper (Zwetsloot et al., 2017a), an important discussion is centred on a table that clarifies six innovative perspectives for ZAV. This Table can be adapted to VZ perspectives promoting ZH broadly, encompassing HSW. Table 2 is a first attempt towards this perspective.
The six innovative perspectives included in Table 2 can be further explored making use of several relevant concepts and theories. An overview thereof is provided in Table 3. Safety improvement is triggered also by learning from the experiences of others in and outside the organization HSW improvement is triggered also by learning from the experiences of others in and outside the organization Benchmarking on lagging indicators (like injury rates)

Benchmarking on leading indicators and good practices
Benchmarking on leading indicators and good practices Safety improvement is triggered by best practices in the sector Safety improvement is triggered by adopting and adapting good practices from other (ZAV) organizations and sectors HSW improvement is triggered by adopting or adapting good practices from other (VZ) organizations and sectors

Keeping the vision zero spirit alive
There are several challenges and strategies for keeping the spirit of VZ alive. Here, we will focus on three specific clusters of challenges. 1. The first of these is the impact of globalization and the changing world of work (ILO, 2016;James, 2006). More specifically, the global financial situation stemming from around 2008 implies that cost reduction is a dominant factor, leading to a trend towards higher workloads, smaller HSW margins, growing job insecurity (causing stress but also less ownership and commitment to HSW) and challenges in the production chain (with contractors etc.).
The changing world of work also implies a range of other general challenges to the area of HSW. There is growing diversity with workforce migration, often implying different cultural backgrounds, languages and cultures. In addition, work teams are often changing rapidly due to contingent work. At the same time, there are generational gaps between young and older workers. This diversity can have severe implications for communication, education and training, cooperation, culture, and for dealing with personal vulnerabilities. In addition, it implies new forms of risk to worker HSW that impact on company sustainability (EU-OSHA, 2015). It is therefore important the companies commit to a wider VZ that includes these emerging priorities.
2. An additional ongoing challenge is reaching and engaging the many small-and medium-sized enterprises that often do not have a long-term vision or policy in HSW. Larger VZ-committed companies can play an important role in this respect by increasing the general business attention to HSW, and by motivating and supporting smaller enterprises that are their suppliers, contractors, customers or neighbours to commit to HSW goals. As VZ companies are highly ambitious, they are likely to recognize these generic challenges at an early stage and to deal with them seriously and effectively. This is another reason why research into the practices of VZ companies is interesting and important.
3. Mainstreaming into business management is the third important challenge. The VZ message needs to go beyond individual HSW company departments, from the HSW community (including HSW policy makers) to business leaders. It is important in this respect to keep in mind that ZAV and ZH are usually part of a broader 'family of Vision Zero', for example, zero defects, zero waste and traffic accidents (Zwetsloot et al., 2013(Zwetsloot et al., ,2017a. Seeing ZAV, ZH and VZ in a broader setting was suggested also as an explanation for why ZAV was more easily accepted in industrial practice than in the safety science community (Zwetsloot et al., 2013a). These broader 'zero visions' often go beyond aspects of internal organization and may include the development of new products and services, for example, Volvo and General Motors both claim to work on the development of 'zero crash cars', and they see it as a marketing incentive to work safe and produce safe products (Avila & Hosford, 2012;Volvo, 2017). Singh (2012), an important business analyst, sees the broader VZ perspective, which he calls 'innovating to zero', as one of the 10 Mega Trends that will impact business and society globally in the coming decade. Singh emphasizes the innovative nature of VZ, its close relationship with running business and describes it as a journey generating many opportunities along the way to creating and ensuring safety.
'The most remarkable feature of this Mega vision is that the ultimate opportunity lies not in attaining the actual goal itself, but in capitalizing on the opportunities that would lead to it … … . It also needs a strong culture from people within that ecosystem' (Singh, 2012, p. 59).
Clearly, this implies several challenges not only for the industry, but also for the HSW community at large.

Developing a full zero harm culture
Genuine commitment to zero accidents or harm is a value-laden commitment that has many implications for organizational culture. In the safety literature, there continues to be a lot of attention to safety culture and climate and safety leadership (Clarke, 2006(Clarke, , 2013Leitão & Greiner, 2016;Petitta et al., 2017), and there is growing attention to safety as a value (Cooper, 2001;Ratilainen et al., 2016). In the area of health and well-being, there is a growing interest in organizational values, culture and leadership (National Institute for Health and Care Excellence (NICE), 2015).
Organizations increasingly define core values to give meaning to the companies' existence and their value for society. When core values are more than a public relations instrument, they are important for the identity and cohesion of organizations. Core values have the potential to guide the practices and behaviours of managers, supervisors and workers.
From this perspective, it is logical that there is growing attention to values that support safety (Ratilainen et al., 2016) and to the value of HSW. Again there are several values that are supportive of HSW (Zwetsloot, van Scheppingen, Bos, Dijkman, & Starren, 2013b). In their broad literature review, Zwetsloot et al. (2013b) identified seven core values that are supportive to HSW, which could be clustered into three groups: (1) a value cluster characterized by a positive attitude towards people and their 'being' (comprising the core values of interconnectedness, participation and trust); (2) a value cluster relevant for organizational and individual 'doing' (comprising justice and responsibility); and (3) a value cluster relevant for 'becoming' which is characterized by the alignment of personal and organizational development (comprising the values of growth and resilience).
However, values can have a broader meaning related to work as well: values for doing 'meaningful' work (Milliman, Czaplewski, & Ferguson, 2003), and for being inspired, motivated and engaged through alignment of individual and organizational goals (Beer, 2009). These broader values also imply the development of a positive organizational culture, beyond safety culture. Olsen, Naess, & Høyland (2015) showed that a positive organizational climate (broader than safety climate) can also be relevant for safety on oil platforms.
Another challenge is the development and maintenance of a 'learning driven culture' for HSW (IAEA, 2016). This implies a learning attitude of management and workers, as well as a transition from 'We must work safe and healthy' to 'We want to work safe and healthy' (intrinsic motivation; Ryan & Deci, 2000).
One model that moves towards this more holistic HSW understanding is the 'Total Worker Health' approach which focuses on policies, programmes and practices that integrate both 'protection' from OSH hazards and 'promotion' of injury and illness prevention in furthering well-being for a globally competitive workforce (Schill & Chosewood, 2013). A review of Total Worker Health interventions has shown preliminary and promising results of the integration of HSW promotion activities (Anger et al., 2015).

Conclusions
There is a steadily growing attention in industry for VZ in terms of a long-term commitment process to strive for Zero Accidents and/or ZH. In most organizations, the attention for safety is dominant, while health and wellbeing at work still receive much less attention. VZ should be regarded as a holistic vision, wherein health, safety and wellbeing at work are all addressed, and synergies between these areas are recognized and utilized. There is already sufficient evidence to state that fatigue, stress, and work organization factors in general are important determinants of safety behaviour and performance. The broadening of ZAV to a ZH vision wherein wellbeing is addressed seriously is therefore an important challenge for many industries. The integration into business development and the development of a broader ZH culture (or prevention culture) are important challenges for VZ committed companies. There is a clear need for empirical research into this challenging area.