Behavior-Based Safety Approach

September 29, 2021


Every preventable incident is caused by unsafe behavior!  When NEMT companies need to reverse the trend of having these preventable incidents it is important to understand why employees are having them. It doesn’t matter if the incident is a vehicle accident or a worker injury, all of the preventable incidents have a cause that led them to have the incident in the first place.

Two helpers picking up disabled senior woman in wheelchair for transport

Formula to Reverse the Trends

The formula to reversing these trends is somewhat simple in its design:

  • First – identify the behaviors that led to the incident. This starts with a good incident investigation. It doesn’t matter if it is an accident or injury, you must ask the following questions:
    • Who was the person involved? Get to know the employee, DOH, DOB, Training given, Credential Facts and any previous records to review.  
    • What was factors involved? Where there any significant factors involved in the incident? These could be speeding, faulty equipment, lack of training, improper tools in use. In addition, what was environment like, daytime, nighttime, dusk, rain, snow, clear, dry, fog, roadway characteristics, your facility environment,    
    • When did the incident occur? Understand the day, date, time of day, day of the week, and what shift the employee was working.
    • Where did the incident occur? Did the employee have permission to be where the incident took place? For example, did they have permission to be with your vehicle in a fast-food restaurant parking lot?
    • Conduct an Interview. Part of this behavior identification is to interview the employee involved with the incident. Ask probing questions pertaining to actions that they took prior to the incident taking place. Did these actions match up to the training given by your company? Did the employee follow procedures?
  • Forming an Opinion.  Once you have all of the facts in front of you, form an opinion of how the incident occurred. Using the Who, What, When, Where and Interview 1st steps, you should have enough information to decide and understand what happened and determine if the employee could have prevented the incident from occurring. You must have a clear understanding of what behaviors that the employee failed to implement or carried out their actions incorrectly. 

For example, one opinion may be that if a review was conducted regarding a vehicle accident at an intersection, you might know, based on the facts of the incident and your interview, that the employee failed to scan the intersections to look for hazards, look left, right, straight, and left again to ensure no traffic was coming towards them and failed to “rock and roll”  to eliminate blind spots, before executing the intersection maneuver. In addition, based on your knowledge, this may be a bad intersection with many danger zones that you have given information to your drivers on how to avoid the intersection or dangers to be aware of.

The question that you need to decide upon is Preventability, not fault. Did the employee do everything possible to avoid the incident from happening? If the answer is no, then the incident should be labeled as Preventable and appropriate action taken.

  • Change the Behaviors!   Changing employee behaviors is not easy and can become a real challenge for most NEMT companies. Changing behaviors takes more than a good plan, or even a professional developed training program. Changing Behaviors takes not only having a plan and executing the plan,  but leadership from the top of the organization though out all levels of the organization.

Once you have identified a behavior that needs to be changed, you must outline a plan to reverse the trend and communicate the NEMT company expectations to all employees. How important is this behavior change? For NEMT companies, it is very important that when negative trends are identified, that the importance of changing employee behavior is emphasized by company leadership, and in some cases by ownership leading the way.

Your plan may include training of employees, but which employees do we train? Who is having the incidents, new employees, older employees, a class of employees? Once you know Who, then you can target them. If it is new employees, you can target them in their training. If it is older employees, you may need to conduct safety workshops, or if it is a class of employees, such as mechanics, what are the safety procedures that are implemented and review them.

Be Creative – Remember that adults will learn when they see and practice a skill. Your plan must be creative and cover all of the negative trends that have occurred. In order to change any unsafe behaviors, you need to persuade employees to change the behavior. You must develop a program that will educate them and tell them “What’s in it for me”. Adult learning can take place once your employees understand the issue and can be told why they don’t want to repeat the negative behavior, what are the consequences, and what are the rewards for good behavior.

Man driving car while female passenger sitting in back seat. Senior woman is using mobile phone in taxi. They are traveling in vehicle.


If you want to achieve better safety results and reverse the trends of bad behavior incidents, it begins with identifying the who, what, where, when, and the interview to establish a baseline of understanding. Then design your plan to reserve the trends and execute the plan. Monitor your results and make sure that your staff and ownership understand your direction so all can help. This is a team effort, and your team will help make a difference to reverse negative behaviors.

For more information, please contact me at or visit my website at

Be safe and see you next time!

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