Injury rates tell an incomplete story, but a more complete measurement narrative may be possible

Introduction: Despite years of research challenging their validity, injury rate metrics continue to significantly influence decision-making in many organizations. In this paper, we argue that both the source of this problem and a solution rest in understanding the narrative power of these metrics. We explore this idea by developing and applying a set of alternative injury measurement tools specifically designed to provide more comprehensive and compelling narratives of injury performance. Comparing alternative measures with traditional stand-alone injury rates demonstrates how the overall narrative of injury performance changes through metric design. Our overall goal is not to fix the statistical validity of the metrics, but to improve safety decision-making through more complex discourse. Method: The analysis in this paper rests on three large organization case studies. In each case, study data from the organization was presented back to senior executives using: the injury rate alone; the average injury severity; and a weighted combination of rate and severity known as SAIF. The resultant conversations were then analyzed, supplemented by individual interviews with conversation participants. Results: This research highlights the importance of presenting injury rate and severity measures together and demonstrating their interplay, rather than as stand-alone metrics. Four guidelines are proposed for improving narratives and conversations based on injury metrics. The four guidelines are: pairing measures, continuous variability, a simple communication mechanism, and highlighting differences. Conclusions and Practical Applications: Together, these guidelines enable users of injury measures to generate more dynamic discussions from their metrics.