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Safety Science 130 (2020) 104890

Contents lists available at

ScienceDirect

Safety Science

journal homepage:

www.elsevier.com/locate/safety

Vision zero: Developing proactive leading indicators for safety, health and

wellbeing at work

Gerard Zwetsloot

, Stavroula Leka

b,c,⁎

, Pete Kines

, Aditya Jain

Gerard Zwetsloot Research & Consultancy, the Netherlands

Cork University Business School, University College Cork, Ireland

Centre for Organizational Health & Development, School of Medicine, University of Nottingham, UK

The National Research Centre for the Working Environment, Denmark

Nottingham University Business School, University of Nottingham, UK

A R TICL E INFO

Keywords:

Benchmarking

International Social Security Association

Knowledge transfer and exchange

Research to practice

Prevention culture

Key performance indicator

A BSTR A CT

The importance of leading occupational safety and health (OSH) indicators in complementing lagging indicators

is an emerging topic for the promotion of a prevention culture in organizations. The purpose of this paper is to

describe the development process of a set of proactive leading indicators for safety, health and wellbeing (SHW)

at work, which was carried out as part of the International Social Security Association’s (ISSA) Vision Zero

strategy. Principles of integrated knowledge transfer and exchange between research, policy and practice were

followed in both the conception and development phases, and a mixed methods approach was applied across

four stages consisting of: a literature review and input from industry; a quantitative evaluation through an online

survey; a qualitative evaluation through feedback from organizational representatives and key stakeholders; and

a consensus building workshop with the ISSA Steering Committee. A set of fourteen indicators was developed to

complement the ISSA Vision Zero strategy, two in relation to each of its seven golden rules for promoting SHW at

work. The indicators deal with integrating each aspect of SHW in e.g. visible and competent leadership, pro-

curement, pre-work brieﬁngs, evaluating risk management and targeted programmes, learning from unplanned

events, innovation and change, work organization, onboarding and refresher training. Results can be presented

qualitatively and quantitatively as e.g. ‘yes’ or ‘no’ responses, on a Likert or continuum (ﬁve–point) scale, or with

frequencies and percentages. The indicators are designed for use by both small and large organizations across all

sectors, and can be used for benchmarking and as key performance indicators. They are not only intended to

better direct and control SHW processes, but also to support the development of a prevention culture.

Recommendations are provided on how the indicators can be reﬁned and improved through future research.

1. Introduction

‘Vision Zero’ (VZ) at work is a transformational approach to pre-

vention that integrates the three aspects of safety, health and well-being

(SHW). It is based on the assumption that all accidents, harm and work-

related ill-health are preventable. VZ is 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 SHW.

VZ should be understood as a journey, a process towards the ideal. It is

also a value-based vision implying that work should not negatively

aﬀect workers’ SHW, and if possible, should help them maintain or

improve their SHW and develop their self-conﬁdence, competences and

employability (Zwetsloot

et al., 2017b).

VZ is regarded as a commit-

ment strategy (Zwetsloot

et al., 2013a; Zwetsloot et al., 2017a),

which

implies that the process of continual improvement is driven by the

commitment of both (top) leaders and workers. In the implementation

of VZ commitment, communication, culture, and learning, are key as-

pects (Zwetsloot

et al., 2017a).

A commitment strategy can start at any

level of SHW performance, and trigger a continual improvement pro-

cess. This implies that VZ is relevant for a large variety of organizations

(not only for the well-known frontrunners, but also for small organi-

zations).

This paper describes the development of a set of proactive leading

indicators for SHW for the International Social Security Association

(ISSA). ISSA and its fourteen sections for prevention launched their VZ

strategy and the ISSA Global VZ Campaign in September 2017 at the

XXI World Congress on Safety and Health at Work in Singapore. The

strategy and campaign are run by ISSA partners in more than 80

⁎

Corresponding author at: Cork University Business School, University College Cork, College Road, T12 K8AF Cork, Ireland.

E-mail address:

[email protected]

(S. Leka).

https://doi.org/10.1016/j.ssci.2020.104890

Received 12 May 2020; Accepted 14 June 2020

(http://creativecommons.org/licenses/BY-NC-ND/4.0/).

BEU, Alm.del - 2020-21 - Bilag 26: Orientering om rapport og artikel fra NFA om proaktive arbejdsmiljømål til arbejdspladsernes forebyggelsesarbejde, fra beskæftigelsesministeren

G. Zwetsloot, et al.

Safety Science 130 (2020) 104890

countries, and by the spring of 2020 more than 11,000 organizations

had associated themselves with the VZ campaign, as did more than

1000 trainers (Treichel,

2020).

ISSA’s VZ concept incorporates seven

‘Golden Rules’ for prevention (ISSA,

2017).

The concept is ﬂexible, and

can be adjusted to the speciﬁc SHW priorities for prevention in any

given context.

Collaboration between organizations, companies and researchers in

the research process has shown to be conducive to integrated knowl-

edge transfer and exchange (KTE) in promoting occupational safety and

health (OSH) (Van

Eerd, 2019; Van Eerd & Saunders, 2017).

The de-

velopment of the proactive leading indicators described in this paper

reﬂects this integrated KTE process, as it was carried out in response to

suggestions from, and in collaboration with companies and other or-

ganizations that have associated themselves with the ISSA VZ strategy.

They suggested the development of a common set of leading indicators

in order to be able to benchmark globally and organize mutual learning.

For ISSA it was important that the indicators are not only theoretically

sound, but that they are recognized as useful by many organizations

participating in their VZ strategy. This implies that the user friendliness

of the indicators was considered from the start as an important condi-

tion. The seven Golden Rules (ISSA,

2017)

formed the framework for

the indicators, with two indicators being developed for each Golden

Rule.

The focus was on developing indicators that were both ‘proactive’

and ‘leading’, recognizing that current indicators of SHW at work are

often reactive, and do not provide directions for improvement e.g. ac-

cidents, injuries, sickness absence, and ill health. Leading indicators

that are used by organizations are often related to aspects of good OSH

management and are in line with ISO 45,001 (ISO,

2018),

e.g. the time

needed to close improvement actions or non-compliances. Proactive

management of SHW requires new types of performance indicators,

with an emphasis on proactive or primary prevention. However, there is

currently no broadly accepted set of SHW leading indicators, and as a

result, proactive companies often deﬁne their own sets of leading in-

dicators. The variety of indicators used in practice hinders bench-

marking and mutual learning.

Furthermore, it was recognized that most organizational practices

tend to focus more on safety and to some extent health aspects, with

less focus on wellbeing at work. Additionally, attention to work-related

health and wellbeing is often limited to hazards and associated risks

that stem, like safety risks, predominantly from technology-related as-

pects of production processes, such as the design of technical installa-

tions and workplaces. Often there is less organizational and systematic

attention paid to health compared to safety, while psychosocial risks

and wellbeing at work often remain out of scope (Bergh

et al., 2014b;

Leka et al., 2015).

However, SHW have more in common than many would expect

(Zwetsloot

et al., 2017b).

SHW represent similar human and social

values, and each is based on valuing people. There are also common

‘supporting values’ that are relevant for all three aspects (Zwetsloot

et al., 2013b; Zwetsloot, 2019),

e.g. trust is important for wellbeing,

and it is important for a culture wherein people feel free to report in-

cidents and near misses, or which address the health problems they may

encounter. Being ‘ﬁt for work’ physically and mentally is important for

managing safety. In both areas, the following issues are important: (1)

design and management challenges; (2) control of (work) processes and

dealing with deviations; (3) improving accuracy and human behavior;

and (4) proactive approaches to new developments, including re-

organizations and outsourcing, increasing ﬂexibility, job insecurity, etc.

From the perspective of credibility for the employees, SHW are also

closely associated. Credibility, taking care of the safety of people, im-

plies that people (and their health and wellbeing) are valued. Several

concepts and models that have been developed and are based on con-

siderable evidence in one area, also seem relevant for the other area, for

example, on job design and work organization (Leka

et al., 2008)

versus

management systems, increasing risk awareness and safety culture

(Clarke,

2006; Edwards et al., 2013).

There is increasing recognition in research and in practice of the

need to overcome sub-optimizations of SHW and develop approaches

and models that support the integration of the various specialist views

on SHW (Jain

et al., 2018).

There is also a need to eﬀectively combine

traditional OSH and workplace health promotion (NIOSH,

2020; Jain

et al., 2018).

The development of the set of proactive leading indicators

for SHW aims to provide organizations with a promising tool to mea-

sure the degree of proactivity of their SHW actions. The tool could

provide organizations with feedback on the strengths and weaknesses in

their eﬀorts, which is useful for the process of continual improvement.

In addition, the indicators can also facilitate internal and external

benchmarking. In this way organizations will be able to put in place

good practices that support the promotion of all three aspects of SHW in

an integrative way, and as an integrated part of the business processes.

At the same time, it is recognized that a full integration of SHW is likely

to undervalue the importance of the health and wellbeing aspects if

organizational focus has traditionally been on safety (Zwetsloot,

1994).

It is therefore just as important that the indicators can diﬀerentiate

between the three aspects of SHW.

Before the development process of the proactive leading indicators

is outlined in detail, it is important to ﬁrst consider the use of OSH

indicators, including the key concepts of leading and lagging indicators,

and the research and evidence base in this area.

1.1. The use of occupational safety and health indicators

OSH indicators should comprise condensed information on existing

and emerging risks, exposures, hazards, as well as on preventive ac-

tivities to (further) reduce the remaining hazards and risks (Alruqi

Hallowell, 2019).

At the same time, the data thus obtained should be

useful for evidence-based decision making. Proactive leading indicators

for SHW reﬂect the actionable, current and ongoing processes, activities

and performances that are doing more than merely controlling existing

risks and safeguarding the status quo, but focus on recognizing,

creating, using and evaluating opportunities for continual improve-

ment, both speciﬁc short term improvements and the process of con-

tinual improvement. In this way they have a great potential to generate

impact, both in the short and long term.

The performance indicators most frequently used by organizations

reﬂect the OSH performance of the past (e.g. number of accidents and

occupational diseases, lost time incidents or sickness absence). These

have been called ‘lagging indicators’, because the information is lagging

behind reality. They measure the ‘outcomes’ of the past OSH manage-

ment process, rather than the qualities of the presently existing OSH

management and leadership processes. ‘Leading indicators’ are com-

plementary to lagging indicators; and have predictive value; they are

valuable for improving SHW management and leadership, e.g. by in-

tervening in risky situations before safety or health is aﬀected (Jain

et al., 2018).

Leading indicators have been classiﬁed as active or passive

indicators (Hinze

et al., 2013).

Passive leading indicators are typically

implemented before work begins and remain relatively static once a

project has begun, e.g. number of workers with a speciﬁc certiﬁcation.

In contrast, active leading indicators can be readily changed during

work, e.g. pre-task planning meetings. These indicators are generally

continuous in that they occur at a frequency or are measures of quality

of implementation. However, not all leading indicators are by deﬁni-

tion, ‘proactive’ leading indicators as deﬁned above.

Using the bowtie metaphor,

Swuste et al. (2016)

provided a dis-

tinction for leading and lagging indicators, with leading indicators

providing information on the left-hand side of the central event, and the

lagging indicators on the right-hand side. Thus, leading indicators ba-

sically are proxies for hazards, for barriers, for scenarios and manage-

ment factors, while lagging indicators are proxies of the central event,

of 'loss of control' and of consequences (Grabowski

et al., 2007; Øien

et al., 2011).

According to this approach, leading indicators provide

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G. Zwetsloot, et al.

Safety Science 130 (2020) 104890

information on distortions of processes, and thus on the stability of a

system. Furthermore, being achievable, meaningful, transparent, easy

to communicate, valid, useful, and timely were identiﬁed as some of the

valuable qualities of leading metrics. But perhaps most importantly,

leading indicators should be actionable, that is, they can be utilized to

identify and implement steps intended to reduce or eliminate risk

(Sinelnikov

et al., 2013).

It should also be highlighted that both in the literature and in

practice, there are blurry delineations among OSH risk analysis, safety

climate, and leading indicators, and it has been highlighted that the

diﬀerences between these concepts might be merely theoretical and

ideological (Alruqi

& Hallowell, 2019).

Due to this ambiguity, a more

general terminology has also been suggested, such as key indicator,

performance indicator, or key performance indicator (Eriksen,

2009;

Grote, 2009; Guldenmund & Booster, 2005; Mearns, 2009; Øien et al.,

2011; Saqib & Siddiqi, 2008).

Some authors prefer the term ‘positive

indicators’ to leading indicators (e.g.

Podgórski, 2015),

while the

OECD

(2008)

uses the term ‘activities indicators’ to refer to (proactive)

leading indicators, and ‘results indicators’ for lagging indicators. What

is important to highlight is that irrespective of the term used, these

concepts aim at developing a prevention culture (Bollman

& Boustras,

2020; Kim et al., 2006).

The appeal of leading metrics is in their potential to predict and

prevent adverse outcomes by giving organizational leaders an addi-

tional set of forward-looking OSH targets for improvement.

Organizations also use leading metrics to support communication and

employee morale building strategies aimed at transforming organiza-

tional culture from being passive and problem focused to being

proactive and solution driven. A meta-analysis by

Alruqi and Hallowell

(2019)

highlighted that nine common leading indicators are sig-

niﬁcantly correlated with worksite injuries: safety record, safety re-

source, staﬃng for safety, owner/leader involvement, safety training/

orientation, personal protective equipment, safety incentives program,

safety inspections/observations and evaluations, and pre-task safety

meetings. The authors concluded that that these indicators are valid

and generalizable across geographies, industry sectors, company types,

and safety cultures.

While some recent research has shown that some safety leading

indicators are predictive (Salas

& Hallowell, 2016),

provide early

warnings of potential hazards (Guo

& Yiu, 2015),

and can be used as

levers to improve future performance (Lingard

et al., 2017),

there is still

limited scientiﬁc evidence currently available to indicate which leading

indicators for OSH promotion should be used (Amick

& Saunders,

2013). Hallowell et al. (2013)

identiﬁed 13 proactive safety indicators

that improve safety performance, including: near-miss reporting, safety

observation, auditing program, pre-task safety meeting, housekeeping

program, and worker involvement. Later, in a study of 261 contractors,

Salas and Hallowell (2016)

found evidence that empirically supported

the following as predictive of improving safety performance: near-miss

reporting, stop-work authority, upper-management engagement in

safety activities, worker involvement, owner involvement, safety au-

diting and observation, and safety risk assessment.

Another prominent example for leading indicators developed in the

area of OSH comes from the Ontario Leading Indicators Project, which

the Canadian Institute for Work & Health has been running since 2008.

The Organizational Performance Metric–Monash University (OPM-MU)

has been reported to be a reliable and valid measure of leading in-

dicators in OSH (Shea

et al., 2016),

and useful for not only safety but

also health outcomes (Amick

& Saunders, 2013).

The OPM-MU has

been associated with fewer incidents and fewer near misses. Aggregated

OPM-MU scores have also been associated with lost-time and medical-

treatment injury rates (De

Cieri et al., 2016).

This tool is similar to the

Prevention Culture Index developed by IOSH-UK which consists of 10

indicators: management commitment and visibility; communication

including feedback loops; productivity versus safety; information, in-

struction and training; safety resources; participation; shared

perceptions about safety and risk; trust; autonomy; incentives; and re-

porting accidents and near misses, investigations and controls (White,

2015).

In 2015, an online survey was conducted to explore whether the

indicators included in the IOSH Prevention Culture Index are suitable

for measuring a culture of prevention at company level. The survey was

sent to senior OSH practitioners who are members of IOSH, of whom

840 completed the survey. The survey asked respondents to assess the

importance of the indicators for an eﬀective prevention culture and

whether the proposed options are the right ones for measuring a culture

of prevention. It also asked whether the maturity model is suitable for

making statements regarding how each indicator contributes to im-

proving the culture of prevention. The indicators rated as being the

most eﬀective were: management commitment and visibility, commu-

nication, and participation. The indicators rated as being the least ef-

fective were: safety resources (PPE available, posters etc.), productivity

versus safety (time and pressure), and reporting (accidents and near

misses, investigations and controls) (White,

2015).

Leading indicators for wellbeing at work have also been developed

in the area of occupational health psychology. For instance, Bergh and

colleagues developed a leading indicator for psychosocial risk (PRI) in

the oil and gas industry, consisting of a condensed set of 11 items,

addressing job demands, role clarity, relationships, job control and

support (Bergh

et al., 2014b).

The PRI has been shown to eﬀectively

predict both near misses in terms of safety (hydrocarbon leaks) (Bergh

et al., 2014a),

and well-being at work (Bergh

et al., 2018).

The literature on leading indicators also indicates some challenges

in their development: conceptual clarity, whether to measure work-

place policies and practices through self-assessment or external audit,

how to interpret changes in scores, how to use indicators to improve

prevention, and how much to tailor indicators to speciﬁc workplace

contexts (Amick

& Saunders, 2013).

There is also little consensus on

which methods should be used for identifying leading indicators (Raben

et al., 2018).

Another issue being discussed is whether there can be a

common set of leading indicators at a “high level” across industries and

organizational contexts within a country or internationally (Shea

et al.,

2016).

Recognizing these challenges, we adopted a mixed methods ap-

proach for the development of the proactive leading indicators for

SHW, with stakeholder input and feedback throughout the KTE devel-

opment process. The aim of this paper is to describe this development

process which was implemented in four stages as detailed next.

2. Method

A mixed methods approach was applied for the indicator develop-

ment process that included four stages: (1) a review of literature and

input from industry; (2) a quantitative evaluation of a draft set of in-

dicators through an online survey; (3) a qualitative evaluation through

feedback from organizational representatives and key stakeholders; and

(4) a consensus building workshop with the ISSA Steering Committee.

2.1. Stage 1: Review of literature and industry input

First, a literature review of the academic and grey literature was

conducted on OSH/SHW indicators with a speciﬁc focus on leading

indicators. The literature review process began with seeking familiar-

ization with the range and diversity of data in this domain, and gaining

an overview of the body of material gathered to be reviewed. This was

primarily achieved through running preliminary searches of the (aca-

demic and grey) literature, and by sifting and sorting through identiﬁed

sources of information. The following search terms were used:

a. Indicator OR measure OR benchmark OR precursor

AND

b. Leading OR lagging OR proactive OR positive performance OR key

performance

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G. Zwetsloot, et al.

Safety Science 130 (2020) 104890

AND

c. Occupation OR work OR business

AND

d. Safety OR health OR wellbeing OR prevention culture OR zero OR

vision zero OR zero accident vision OR anticipation OR weak signals

OR procurement OR innovation OR restructuring OR reorganiza-

tion.

Our systematic search of databases, Pubmed and Web of Science,

provided 5218 hits. A search on Google Scholar provided 18,000 hits –

and we took the ﬁrst 150 (to get 100 unique hits, removing doubles)

which were ranked by Google by ‘relevance’. After reviewing the ab-

stracts of these publications for relevance and avoiding duplication, 92

publications were included in our ﬁnal literature database. The review

focused primarily on studies published between 2014 and 2019.

However, earlier studies were also reviewed with 17 of the 92 studies

being from pre-2014. Most studies were published in the journal Safety

Science (nearly 25%).

At the same time, input on SHW indicators and practical evidence

was sought by organizations participating in ISSA’s VZ network and the

business networks of the researchers. Input was received from 32 or-

ganizations and experts from a variety of countries (9 Germany, 6 the

Netherlands, 4 Finland, 3 Japan, 2 international, 1 Chile, 1 Costa Rica,

1 France, 1 Mexico, 1 Russia, 1 Switzerland, 1 UK, 1 Ukraine) and

sectors (e.g. automotive, chemical industry, construction, electrical

power, engineering, food processing, manufacturing, mining, and

trade).

The ﬁrst step was to identify what we regarded as a leading in-

dicator. Both in the literature and from the input received, several re-

ferred to what we regarded as ‘good practices’ (e.g. exemplary behavior

of leaders). We did not regard these as useful indicators, as these factors

are not easy to measure quantitatively, and therefore are less useful for

benchmarking. Such factors were therefore regarded by the project

team as ‘indications’, not as potentially relevant leading indicators.

We then reviewed, evaluated and synthesized the collected litera-

ture and industry input in an integrative way in order to identify the

focus and content of the identiﬁed indicators, and cluster them ac-

cording to the ISSA Golden Rule they were most closely associated with.

In the case where the indicators were relevant to more than one Golden

Rule, the authors clustered them by consensus according to the most

relevant Golden Rule.

In discussion with ISSA, six core criteria for the selection of proac-

tive leading indicators were applied, as well as six complementary

criteria. Each individual indicator had to fulﬁl the core criteria; the

complementary criteria were mainly relevant for a well-balanced set of

14 indicators (see

Table 1).

The four authors of this paper individually ranked each of the

identiﬁed indicators in terms of the core criteria, of which a comparison

of rankings indicated a high degree of agreement (80%). As a result,

two candidate proactive indicators were identiﬁed for each Golden

Rule. One proactive leading indicator was then selected for each of the

Golden Rules for the next stage: developing an associated factsheet, and

including the indicator /factsheets in the pilot.

2.2. Stage 2: Quantitative evaluation

The next stage in the indicator development process was piloting the

indicators through an online survey. A factsheet was ﬁrst developed per

indicator, with condensed information on one A4 page regarding: key

concepts, aims, how to measure, limitations, and ﬁve good practices.

The good practices were included to ensure a qualitative understanding

in addition to the quantitative targets included in the factsheets

(Oswald,

2020).

After discussion with the ISSA Steering Committee a

rating of the outcomes was added, with three options: excellent, on the

way to excellent, and needs improvement. The idea behind this was

ISSA’s desire to trigger organizations to aspire to the qualiﬁcation 'ex-

cellent'. The seven indicators that were included in the pilot are shown

Table 3.

The online pilot survey was conducted between September and the

ﬁrst week of December 2019. A website was developed where partici-

pants could access the survey that was hosted on Qualtrics. Information

on the pilot was disseminated through ISSA to their VZ network of

organizations and through the researchers to their business networks.

Participants were asked to provide feedback to the following questions

for each of the seven indicators:

1. Is this indicator relevant for your organization?

2. Is the indicator clearly understandable? If No/Not sure, why?

3. Does the factsheet provide clarity around the indicator’s: Aim? Use?

Good practices?

4. Is this indicator helpful to your organization as a part of your Vision

Zero strategy? If No/Not sure, why?

Descriptive analyses of the survey ﬁndings are presented in the

Results section. Additional open-ended questions were also included

where participants could provide further feedback on each indicator

and the set of indicators overall.

2.3. Stage 3: Qualitative evaluation

A qualitative evaluation of the indicators was conducted through

the open-ended questions included in the online survey as well as

feedback provided by key stakeholders and the ISSA Steering

Committee and organizational representatives. It also involved discus-

sions at international conferences such as: Working on Safety (Austria,

September 2019), APA/NIOSH Work Stress and Health (USA,

Table 1

Criteria for the selection of proactive leading indicators for safety, health and wellbeing at work.

Core criteria

Proactivity

Relevance for each of the three aspects: safety, health, wellbeing

Evidence of eﬀectiveness

Complementary criteria

Complementarity and providing a good balance to lagging indicators

Ability to provide suﬃcient ‘communicative power’

Suitable for requiring good practices and a true prevention culture from contractors

and suppliers

Suitable for use by smaller organizations

Useful to improve the eﬀectiveness of existing management systems and for the

development of a prevention culture

Comprising a mix of traditional and innovative indicators

Relatively easy to measure quantitatively (no additional tools)

Identifying strengths and weaknesses – in key factors and processes that determine safety,

health and wellbeing performance

Allowing for benchmarking within and between organizations and sectors, nationally and

internationally

BEU, Alm.del - 2020-21 - Bilag 26: Orientering om rapport og artikel fra NFA om proaktive arbejdsmiljømål til arbejdspladsernes forebyggelsesarbejde, fra beskæftigelsesministeren

G. Zwetsloot, et al.

Safety Science 130 (2020) 104890

November 2019), Vision Zero Summit (Finland, November 2019), and

various ISSA network meetings.

Several interested organizations and individuals emailed more

comprehensive feedback directly to the project leader, e.g. the

Institution of Occupational Safety and Health (IOSH), The British Safety

Council, the (Canadian) Institute of Work & Health, the American

Industrial Hygiene Association (AIHA), and various organizations (e.g.

Siemens). The feedback was documented and thematic analysis (Braun

& Clarke, 2006)

was conducted on all qualitative input.

2.4. Stage 4: Consensus-building workshop

The ﬁnal stage in the development process involved a consensus-

building workshop with the ISSA Steering Committee in January 2020.

Six participants represented ﬁve ISSA sections for prevention:

Electricity, Information for prevention, Mining, Transport and Trade.

Consensus was reached on the following:

•

was to be explored further.

It was also agreed that it would be useful to provide guidance to

organizations that may begin with a limited set of indicators, de-

pending on their OSH situations and ambitions.

3. Results

3.1. Stage 1: Literature and industry input review ﬁndings

Table 2

presents a summary of the literature and industry input

review ﬁndings. Sixty-four leading indicators were identiﬁed in the

literature, and 72 in the input provided by industry. As shown, fewer

indicators were identiﬁed under ISSA’s Golden Rule 5, both through the

literature and the industry input. Several additional success factors

were identiﬁed; 39 in the literature review and 94 through industry

input. These were not taken into consideration further, as they were not

easy to measure quantitatively, and therefore were less useful for

benchmarking.

The next step was the selection of a draft set of seven proactive

leading indicators (Table

3).

An accompanying factsheet was developed

for each of these indicators, which then formed the input for the online

survey in stage 2.

3.2. Stage 2: Online survey results

Sixty organizations participated in the online survey, representing a

wide variety of sectors, and the majority of them were large (75%, with

250+ employees). The organizations operated in various countries,

while twenty were multinational. Eight organizations came from

Germany and seven from the UK, four each from the USA and Denmark,

three from Norway, and two each from the Netherlands and Poland -

thus the majority came from Europe. Most of the respondents were in-

company SHW professionals. A high drop-out of participants aﬀected

the survey, with 60 responses received in relation to questions on the

ﬁrst factsheet, and only 34 responses received on the last factsheet.

Table 4

presents an overview of the responses to the survey in relation

to the questions asked for each indicator.

The majority of respondents found the indicators to be clearly un-

derstandable and relevant for their organization. They also thought that

•

A ‘Guidance document’ for the leading indicators should be devel-

•

oped to accompany the factsheets. It should include ‘how to use the

leading indicators both for high-level companies and for those

starting with a VZ strategy. It should include suggestions on where

to start, in case using all indicators may not be relevant or be too

diﬃcult, and to provide guidance on how to present the outcomes of

using the indicators.

It was emphasized that the overwhelming majority of organizations

are small companies. Therefore, it was important to make the use of

the indicators as simple as possible for small organizations. This

would require diﬀerentiation in the options for using the indicators

(measurement options).

In line with the previous point, the titles of the indicators should be

short (preferably no more than three words) and to the point.

The factsheets should be made more attractive for smaller compa-

nies as well. They should start with the aims, while sections on

measurement should be moved to the end of the factsheets. The

ratings should move to the associated Guide. The ratings should

imply a possibility and trigger each company, also ‘beginners’, to go

to the next level. Suggestions to distinguish ﬁve development levels

were already received through organizational feedback, and this

Table 2

Proactive leading indicators for safety, health and wellbeing at work - outcome of literature and industry input review.

No.

International Social Security Association’s 7 Golden Rules for Vision Zero

Leading indicators

Literature

Total

Take leadership – demonstrate commitment

Identify hazards – control risks

Deﬁne targets – develop programmes

Ensure a safe and healthy system – be well-organized

Ensure safety and health in machines, equipment and workplaces

Improve qualiﬁcations – develop competence

Investing in people – motivating by participation

Industry

Success factors (indications)

Literature

Industry

Table 3

The pilot tested draft of proactive leading indicators for safety, health and wellbeing (SHW) at work.

No.

International Social Security Association’s 7 Golden Rules for Vision Zero

Take leadership – demonstrate commitment

Identify hazards – control risks

Deﬁne targets – develop programmes

Ensure a safe and healthy system – be well-organized

Ensure safety and health in machines, equipment and workplaces

Improve qualiﬁcations – develop competence

Investing in people – motivating by participation

Draft indicator

Frequency of pre-work SHW brieﬁngs

Percentage of evaluations after SHW risk assessments and actions

Percentage of inductions in which SHW are integrated part of the process

Number of leading SHW Key Performance Indicators (KPIs)

Percentage of innovations and changes used to reduce SHW hazards and risks in the design stage

Percentage of leaders and workers trained in SHW before they start their job

Percentage of adequate follow-ups on suggestions for SHW improvements

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G. Zwetsloot, et al.

Safety Science 130 (2020) 104890

Table 4

Online survey responses on proactive leading indicators for safety, health and wellbeing at work*.

Survey questions

Draft proactive leading indicator

Yes

Is this indicator relevant for your organization?

Is the indicator clearly understandable?

Does the factsheet provide clarity around the indicator’s aim?

Does the factsheet provide clarity around the indicator’s use?

Does the factsheet provide clarity around the indicator’s good practices?

Would this indicator be helpful to your organization as a part of your Vision Zero strategy?

Yes

*Diﬀerences in total numbers are due to non-completion of items.

the indicator factsheets overall provided clarity around their use and

good practices, and would be a helpful tool as part of their VZ Strategy.

3.3. Stage 3: Qualitative ﬁndings

The qualitative feedback received through the open-ended questions

included in the survey, key stakeholders from the ISSA Steering

Committee, and organizational representatives was analyzed themati-

cally, and the key issues (themes) that emerged are presented below.

Clarity

The majority of respondents highlighted the need for simplicity in

presenting and describing the indicators, in terms of short, clear titles,

deﬁnitions, use of examples, and measurement. They suggested looking

for ways to further simplify the factsheets.

In relation to indicator 2.1, some respondents mentioned that the target

of this indicator was unclear. It was suggested that it should more clearly

apply the hierarchy of controls. Furthermore, it was suggested that indicator

4.1 did not seem to trigger clear improvement actions the way it was pre-

sented. As one participant stated in relation to indicator 4.1:

“My company has “simplicity” as a value and having an indicator on

indicators is not compatible with this value” (medium sized orga-

nization).

Relevance to smaller organizations

Some participants from smaller organizations found the indicators

to be too high level for them. For example, in relation to indicator 2.1,

they felt it was not practical for a small company and highlighted the

need for some examples. The majority of respondents from smaller

organization found indicator 4.1 on SHW Key Performance Indicators

(KPIs) to be too general and not useful in their context.

For indicator 6.1 it was suggested that it is hard to do all training

before the start of a job. Therefore, this indicator is likely to be dis-

couraging, particularly for smaller organizations. As one respondent

from a small organization put it:

“I feel this has been developed for middle- to large-sized businesses

or organizations. My business (a shop with 6 part-time sales per-

sonnel, including 3 students) would require a severely scaled down

version for it to be practical and, more importantly, used. SHW of

my staﬀ and customers is of high importance to me, but for a

business of my size, this document is too dense. One size doesn’t ﬁt

all” (small organization).

The user friendliness for smaller organizations was also a concern of

the ISSA Steering Committee, as SMEs are an important target group for

the ISSA members (mainly national social security agencies).

Measurement

The majority of participants highlighted the need for more examples

in relation to measurement. For example, in relation to indicator 1.1, it

was suggested that the indicator would require much eﬀort to measure.

It was also suggested that pre-work SHW meeting quality is diﬃcult to

measure. While the majority of respondents found indicator 5.1 re-

levant for their organization, some respondents thought that there were

three entirely diﬀerent entities combined into one topic, which would

complicate measurement in practice. The measurement ratings were

thought to be too ambitious in some cases:

“I would suggest to give some more thought on ratings for mea-

surements, e.g. ‘Excellent’ 95%, ‘On the way to excellent’ 80% to

94%, ‘Needs improvement’ less than 80%. For most enterprises even

80% is for them a fantastic result. It would be reasonable to make

the scale lower, but in several years, with the growth of maturity,

the scale can be proposed higher. This is something to consider”

(large organization).”

Finally, it was suggested that an overview diagram for all indicators

would be useful to include that would enable organizations to trace

progress.

Prioritization

A ﬁnal key issue that emerged was around prioritization of the in-

dicators. Many participants suggested that it might be diﬃcult for or-

ganizations to ﬁnd time to measure all the indicators. The possibility of

ranking or prioritization of the indicators was highlighted in relation to

those that would achieve most impact with fewest resources:

“Is it possible to make a priority order in relation to what will

contribute with most impact and less resources? If you don't have

the possibility to mobilize resources for all seven….it would be nice

to see some speciﬁc examples of how this could work as well” (large

organization).

Some respondents suggested that organizations could choose the

indicators that were most suitable to them. Finally, it was reported that

it may be a challenge for all indicators to include all three aspects of

safety, health and wellbeing, as maturity may be diﬀerent across or-

ganizations, and as responsibility for developing them, training and

follow-up lies within diﬀerent functions of the organization, e.g. human

resources with a focus on health and wellbeing.

3.4. Stage 4: Consensus building: Proactive leading indicators for safety,

health and wellbeing

The feedback and issues raised during the pilot were discussed at

the consensus building workshop with the ISSA Steering Committee.

Several changes were implemented to the ﬁrst seven indicator drafts

and associated factsheets, as well as the seven additional indicators and

factsheets that were developed.

Clarity:

The titles of the indicators were simpliﬁed (shortened) - the

measurement scales (frequencies or percentages) were not included in

the title anymore. Indicator 4.1 ‘The number of leading SHW KPIs’, was

replaced by another indicator where relevance to SHW was more direct.

The indicator ‘Frequency of pre-work meetings’ was moved to Golden

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Safety Science 130 (2020) 104890

Rule 4, as its relationship with leadership was rather indirect.

Relevance to smaller organizations:

To increase the relevance for

smaller organizations and make the (set of) indicators more user-

friendly, the following changes were made: the factsheets were rede-

signed, whereby the ‘how to measure’ box (regarded as the greatest

bottleneck for small organizations) was transferred to the bottom of the

factsheet; and two simpler options for ‘how to measure’, in particular a

qualitative Yes’ or ‘No’ option, were introduced.

Measurement:

The ‘how to measure’ section in the pilot test ex-

plained how to measure the indicator quantitatively. Two simpler

modes of using the indicators were introduced. As a result, for each

proactive leading indicator three options for measurement are given:

qualitative, semi-quantitative, and quantitative. The qualitative mea-

surement option (‘Yes’ or ‘No’) is simple and user friendly; it can be

useful for any organization, also for small organizations. The semi-

quantitative option (a ﬁve–point scale from ‘Always’ to ‘Never’) makes

it easier for medium-sized organizations to measure and benchmark,

while the third option retained the frequency and percentage calcula-

tions. For example, in relation to indicator 7.2 Investing in people –

motivate by participation: Recognition and reward, the following op-

tions are available:

•

Option 1: Are workers given recognition for excellent SHW perfor-

mance? (Yes/No)

•

Option 2: How often are workers given recognition for excellent

SHW performance?

(Always or almost always, Frequently, Occasionally, Rarely, Never

or very rarely)

•

Option 3: Determine the number of identiﬁed cases of excellent

SHW performance, and calculate what percentage were recognized

in the past 12 months.

Each measurement option can be used to diﬀerentiate ﬁve levels of

organizational performance: Starting, Learning, Progressing, Advancing

and Achieving. Results can be derived on a monthly basis, so as to be

able to use them proactively, and allow for follow-up and learning in a

timely manner. Monthly trends for an indicator can be plotted over the

last twelve months, and summary results for the indicators in each of

the seven Golden Rules can be plotted in e.g. a radar diagram.

Prioritization:

A Guide was developed that provided more explana-

tion and useful background of the set of indicators and guidance for the

users. In the Guide a description is provided of why it may not be ne-

cessary to use the full set of indicators. Examples are given of how to

tailor the set of indicators to a number of organizational contexts, and

how to prioritize the indicators.

Table 5

shows the ﬁnal set of the ISSA proactive leading indicators

for SHW at work.

4. Discussion

The multi-stage mixed-methods approach that was implemented for

the development of the proactive leading indicators, balancing the use

of evidence with usability and knowledge transfer, has previously been

highlighted as good practice in the literature. To provide practical re-

commendations for the formation of a leading indicator program

Guo

and Yiu (2015)

presented a model for developing leading indicators

based on four major steps: deﬁne the system and analysis level (con-

ceptualization), include only measurable constructs (operationaliza-

tion), develop leading indicators (indicator generation), and validate

selected leading indicators (validation and revision). In this study, these

four steps were followed to develop a set of leading indicators for SHW

which can be used by enterprises implementing Vision Zero. The de-

velopment process began with a discussion on the varying con-

ceptualizations of leading SHW indicators identiﬁed in the literature

and by practitioners in industry, which was used to operationalize and

generate a set of indicators across ISSA’s seven golden rules. In stages 2

and 3 of the study the indicators were validated, and then revised in

stage 4 to develop the ﬁnal set of 14 proactive leading indicators for

SHW. Likewise, the set of proactive indicators fulﬁl the qualities iden-

tiﬁed by

Sinelnikov et al. (2013),

being achievable, meaningful,

transparent, easy to communicate, valid, useful, timely and actionable.

Furthermore, in line with

Alruqi and Hallowell (2019)

the indicators

include a focus on resources, leadership, training, rewards, preventive

actions, evaluations and pre-task meetings.

It should also be noted that the indicators are interrelated, and al-

though they have been associated with speciﬁc ISSA golden rules, many

of the indicators will in practice have an eﬀect on more than one golden

rule. For example, indicator ‘4.1 Pre-work brieﬁngs’ can have a positive

eﬀect on ‘Rule 1 Taking leadership – demonstrating commitment’, ‘Rule

2 Identifying hazards and controlling risks’, ‘Rule 6 Improve qualiﬁ-

cations – develop competence’, and ‘Rule 7 Investing in people – mo-

tivating by participation’.

In terms of their proactivity, there seem to be at least ﬁve relevant

mechanisms that make leading indicators work. The ﬁrst is that in-

dicators should support a commitment strategy or the development of a

prevention culture. Examples include visible leadership commitment to

SHW, suggestions for improving SHW, and recognition of excellent

SHW performance (indicators 1.1, 7.1 and 7.2). Furthermore, indicators

should stimulate subsequent SHW prevention right at the start of any

process or activity. Competent leadership and integrating SHW in job

induction, organization of work, innovation, procurement and training

(indicators 1.2, 3.1, 4.2, 5.1, 5.2 and 6.1 respectively) are examples of

such indicators. It is also important that indicators stimulate early ac-

tive anticipation. Such indicator examples include learning from un-

planned events and integrating SHW in pre-work brieﬁngs (indicators

2.2 and 4.1). They should support processes for organizational learning

and continual improvement (e.g. evaluating risk management and

evaluating targeted programmes (indicators 2.1 and 3.2). Finally, they

should facilitate the translation from planning to implementation, e.g.

though refresher training (indicator 6.2).

KTE is a process of “making relevant research information available

and accessible for use in practice or policy” (Van

Eerd & Saunders,

2017, p.1).

The applied integrated KTE process (Van

Eerd, 2019; Van

Eerd & Saunders, 2017)

in this study proved fruitful whereby ISSA,

organizations, companies and researchers were all actively engaged in

the conceptual phase and all four research stages of the project. The

request from organizations involved in ISSA’s VZ strategy triggered the

initiation of the research project. In all stages of the project, the ISSA

sections for prevention were actively involved by providing critical

feedback and stimulating associated organizations to also provide input

(in terms of sharing indicators and practical evidence, and participating

in the online survey and qualitative evaluation). The KTE process is still

underway, with ISSA and its various industrial sectors taking respon-

sibility for the initial global dissemination of the indicators and the

accompanying guide, thus contributing to making the research in-

formation available and accessible for use in policy and practice.

The development of the proactive leading indicators for SHW that

can be a common set of leading indicators at a ’high level’ across in-

dustries and organizational contexts internationally (Shea

et al., 2016)

was ambitious in various ways. The development process addressed

issues relating to conceptual clarity, measurement, interpretation of

results, and applicability of indicators to speciﬁc workplace contexts

(Amick

& Saunders, 2013).

Applicability for all areas of safety, health

and wellbeing was one of the key criteria that were used in their de-

velopment. This created the dilemma of integration versus separate

measurement. Conceptual integration in terms of the same indicator

being used for all areas was maintained in the developed indicators, to

ensure they become an integrated part of business processes. However,

it is advised that measurement addresses the three aspects separately to

ensure that health and wellbeing are prioritized in the same way that

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Table 5

International Social Security Association’s (ISSA) proactive leading indicators for safety, health and wellbeing (SHW) at work.

Rule No. 1: Take leadership – demonstrate commitment

Indicator No. 1.1

Visible leadership commitment

Indicator No. 1.2

Competent leadership

Through visible leadership commitment and being exemplary role models, leaders demonstrate their commitment to SHW, and actively

promote and support SHW improvement processes and the development of a prevention culture.

Committed and competent SHW leadership is essential to drive the development processes of VISION ZERO. Such leaders are intrinsically

motivated to improve SHW and promote SHW as personal and organizational core values. Leaders then regard SHW as integrated parts of

business processes, and support processes of continual improvement of SHW, while creating a strong prevention culture.

Rule No. 2: Identify hazards – control risks

Indicator No. 2.1

Evaluating risk management

Indicator No. 2.2

Learning from unplanned events

Evaluation of the eﬀectiveness of SHW risk management shows leadership focus and commitment to improving SHW, and stimulates

active participation and inﬂuence of workers. It allows leaders and workers to improve the eﬀectiveness and sustainability of SHW

promotion measures as an integrated part of business. In addition, it allows for organizational learning and continuous development.

Learning from unplanned events (incidents, events, cases) is necessary to prevent similar undesirable events from reoccurring, and to

create a culture of SHW prevention and learning. Adequate follow-up of reported unplanned events will increase reporting and learning.

Rule No. 3: Deﬁne targets – develop programmes

Indicator No. 3.1

Workplace and job inductions

Indicator No. 3.2

Evaluating targeted programmes

Integrating SHW in induction (on-boarding) processes demonstrates that SHW are an integrated part of each job and each business

process. SHW are an essential part of leaders’ and workers’ new job in a workplace. It can be both a formal and informal way of

welcoming new personnel to an organization, group and/or job function, and highlights SHW purpose, values and goals.

Evaluating targeted programmes (e.g. temporary campaigns) that integrate SHW in work processes helps to verify that they are

implemented as intended, and that the improvement goals for SHW are met.

Rule No. 4: Ensure a safe and healthy system – be well organized

Indicator No. 4.1

Pre-work brieﬁngs

Indicator No. 4.2

Planning and organization of work

Integrating SHW in pre-work brieﬁngs allows leaders and workers to identify context speciﬁc hazards, risks and prevention measures.

This shows leadership focus and commitment to SHW, and a commitment to stimulating the active participation and inﬂuence of workers.

Planning and organization of work are essential for the success of every organization and for ensuring SHW. This is because planning can

make an organization competitive and eﬃcient. Several issues need to be considered in eﬀective planning and work organization in order

to promote SHW. Good planning and work organization promote good morale and a healthy organizational culture.

Rule No. 5: Ensure SHW in machines, equipment and workplaces

Indicator No. 5.1

Innovation and change

Indicator No. 5.2

Procurement

Technological, organizational and personnel changes occur frequently in organizations. Instead of assessing SHW risk after the changes,

these changes should be considered proactively, and to utilize innovation to improve SHW right from the start in the design phase.

The indicator aims to trigger the systematic use of procurement for SHW improvement. Procurement, particularly of hardware, can

determine SHW risks for a long period, while procurement of services such as maintenance, is often associated with increased SHW risks.

Rule No. 6: Improve qualiﬁcations - develop competence

Indicator No. 6.1

Initial training

Indicator No. 6.2

Refresher training

Competence is key to ensuring good SHW. Being proactive requires training/qualifying leaders and workers in advance, before they start

their job. It also shows that no job or task should be carried out without the relevant SHW competences, and that SHW are an integrated

part of any job or profession.

Developing SHW competence should be an aspect of continuous professional development. Refresher training ensures that leaders and

workers’ knowledge and skills on SHW remain up to date and include new SHW insights.

Rule No. 7: Invest in people – motivate by participation

Indicator No. 7.1

Suggestions for improvement

Indicator No. 7.2

Recognition and reward

In the development of a prevention culture and the active involvement of workers, it is important that suggestions of workers for SHW

improvements are welcomed and are taken seriously. This will stimulate workers’ active commitment to SHW and demonstrates their

leaders’ commitment to improving SHW.

Providing timely, proactive and relevant recognition and reward for excellent SHW performance to both leaders and workers is essential

for fostering a SHW culture that is based on trust, respect, participation and cooperation.

safety issues are. In many industries there is the tradition of managing

safety, but much less a similar tradition in managing health and well-

being. The indicators developed are explicitly meant to support all

three SHW aspects, both individually and jointly. The indicators may

inspire safety professionals to address health and wellbeing in similar

ways to safety. It may also help health and wellbeing professionals to

put these issues higher on the agendas of the senior leaders of their

organizations. The indicators may then support a shift to a more com-

prehensive perspective and fruitful cooperation between the various

SHW professionals. As the management of psychosocial risks and

wellbeing is generally least developed, the indicators imply a great

potential for improvement in these areas. Whether this potential will be

used or not, will, of course, mainly depend on organizations in various

sectors.

Another one of the key criteria for the development of the indicators

was their applicability across diﬀerent types of organizations, including

SMEs. This was a challenging aim in the development process, as was

highlighted through the feedback received during the pilot. It is widely

acknowledged that SMEs often lack structure, a strategic outlook and

resources (Champoux

& Brun, 2003).

Several changes were made to the

indicators to make them more applicable to SMEs, including additions

of new indicators and introduction of new measurement options. The

measurement options allow for a qualitative evaluation that may be

more applicable to smaller organizations. However, it is acknowledged

that some of the indicators may still be ambitious for smaller organi-

zations to use. Furthermore, it is acknowledged that not all organiza-

tions will use all indicators. They may choose to begin with those that

make sense in their context, level of knowledge, processes and im-

mediate priority issues. However, they can be useful in providing gui-

dance in terms of good practices across organizational contexts and

help organizations develop a more long-term strategic perspective on

the basis of prevention in all areas of SHW.

Benchmarking was another one of the key criteria in the develop-

ment process. That fact that the indicators were to be useful for

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G. Zwetsloot, et al.

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benchmarking implied that in the process of selection of proactive

leading indicators, it was important to choose indicators that could be

measured quantitatively. Sometimes quantity can be realized at the

expense of quality. To compensate for the fact that qualitative factors

are neglected in the indicators, each factsheet contains ﬁve good

practices. However, it is important to note that all three measurement

options would need to be tested in practice in order to establish how

feasible and useful they are, and the level of resources they require, as

e.g. option three will require more resources and would be more sui-

table for larger organizations. This would allow further development to

enable benchmarking. Organizational performance could then be

compared with high performers and targets could be set in the short and

longer term.

The development of this set of proactive leading indicators was

triggered by a request from industries that had associated themselves

with the ISSA Vision Zero campaign. The need for a harmonized set of

leading indicators is illustrated by both the high numbers of indicators

identiﬁed in this study, and a study by

Searcy et al. (2016),

who

identiﬁed 892 distinct work environment indicators in 100 Canadian

CSR reports. Indeed, there is a need for a set of (proactive) leading

indicators that is broadly accepted, in order to allow benchmarking

within and between industries, countries and continents. Now that this

set of 14 indicators is available, industries can start using it, and ISSA

and its aﬃliated organizations will promote the use in the more than 80

countries involved in the global Vision Zero strategy.

Furthermore, the proactive leading indicators are not only useful to

organizations that have committed themselves to VZ. Leading in-

dicators, including the 14 indicators developed in this project, overlap

with those covered by instruments which measure safety climate and

OSH management systems, which in turn overlap with process safety

indicators and management system performance (ANSI/API,

2010).

The

indicators support a continual improvement process and can be used by

any organization that genuinely aims to continually improve SHW.

While VZ has been criticized for focusing too much on outcomes rather

than processes, and that counter-productive and costly eﬀects are likely

to stem from the inaccurate ways of interpreting and implementing VZ

(e.g.

Dekker, 2014),

these proactive set of leading indicators may

clearly help to overcome the scepticism and poor practices, as the

nature of the indicators will support organizations to be innovative, and

by making leaders or organizational units accountable for objectives

related to the indicators.

This study implemented good practice through the use of a multi-

stage mixed methods approach based on KTE principles. However, it is

important to recognize some shortcomings. First, the study would have

beneﬁted from a large sample size in the pilot study, with more re-

presentation from SMEs and companies in a more diverse range of in-

dustrial sectors. Furthermore, a drop-out was observed in the pilot

survey, as more feedback was provided for the initial four indicators

than the last three, which is a common issue with online surveys. The

pilot focused on the evaluation of seven indicators (one for each golden

rule) where measuring quantitatively was the only measurement op-

tion. This implies a limitation, as in every situation qualitative factors

are also important. Finally, the ISSA VZ golden rules for prevention

were used as a guiding framework for the indicator development. This

implies a possible conceptual limitation, however, the extensive review

and KTE processes ensured that the indicators were evidence-based and

had practical value.

5. Conclusion

A set of proactive leading indicators for safety, health and wellbeing

at work was developed to support ISSA’s Vision Zero strategy.

Principles of knowledge transfer and exchange were integrated in a

mixed method approach in four stages. The result is a set of 14

proactive leading indicators, two for each of ISSA’s Golden Rules for VZ,

with associated factsheets and a Guide which will be available on ISSA’s

VZ website (http://visionzero.global/indicators). The proactive leading

indicators are not only intended to better direct and control SHW re-

levant processes, but also to support the development of a prevention

culture. Indeed, even the qualitative use of the indicators can support

agenda-setting for proactive activities. The ‘communicative power’ of

the indicators is important for VZ and a prevention culture (Zwetsloot,

2014; Zwetsloot et al., 2017a).

Due to the fact that we included only

indicators that do not require additional tools, they are relatively easy

to communicate and understand. Several of the proactive leading in-

dicators also could have a symbolic message which may have a positive

impact on the development and credibility of a prevention culture (e.g.

when leaders and workers are trained before they start their job).

It is important to stress that this is only the beginning of the process

and a ﬁrst step towards a harmonized/standardized set of SHW in-

dicators. It is vital that the indicators are used in practice and are tested

in organizations across sectors, sizes and countries. This will allow the

development of evaluation case studies to ascertain the impact of the

use of indicators in practice, their usability and potential further de-

velopmental needs both within and outside the VZ framework. If the

indicators are implemented suﬃciently and benchmark options are

developed, this may lead to an informal standard on proactive leading

indicators, which can be reﬁned and improved after future research.

Declaration of Competing Interest

The authors declare that they have no known competing ﬁnancial

interests or personal relationships that could have appeared to inﬂu-

ence the work reported in this paper.

Acknowledgements

We are grateful for the funding of this research by the seven inter-

national sections for prevention of the International Social Security

Association (Switzerland). We would like to thank the members of the

ISSA Steering Committee, and in particular its chair Helmut Ehnes, for

their active support in all stages of the project. We would also like to

thank the organizations that shared their leading indicators and avail-

able evidence from industrial practice, as well as the organizations and

individuals who provided us with feedback via the online survey or

otherwise. Finally, we would like to thank research assistant Lene

Rasmussen and librarian Elizabeth Bengtson from the National

Research Centre for the Working Environment in Denmark for their

contribution to the literature search, and research assistant Lorraine

Dillon at University College Cork for her contribution to the online

survey design and analysis.

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