Transforming our attitudes about occupational cancer risk reduction

Researchers argue that if leaders want meaningful change, they must convince members that “everyone else is doing it, too”


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Esteemed fire chief and attorney Curt Varone has underscored in many of his articles a critical point for all fire service leaders: You can't expect a transactional solution to solve a transformational problem.

Varone makes this point when talking about why too many fire departments are still finding themselves beset by charges of sexual harassment, sexual assault and bullying. More than two decades of policies and procedures and training classes have not had the desired impact on many fire departments.

We’re seeing a similar phenomenon in the fire service regarding our efforts to reduce the risk of exposure to the chemicals, chemical compounds and carcinogens found in the smoke and off-gassing from structure fires. We've done the education. We've developed and implemented operational policies and procedures (e.g., initial contaminant reduction/gross decontamination and removing contaminated gear on the scene). So, we should be well on our way to significantly reducing those occupational cancer risks for firefighters, right?

First-line supervisors can strengthen a firefighter’s individual will by regularly providing good training and education on safety practices and the potential risks of their work.
First-line supervisors can strengthen a firefighter’s individual will by regularly providing good training and education on safety practices and the potential risks of their work. (Photo/Spokane Fire Department)

Attitude vs. behavior

I had a conversation recently with the founder and president of a maker of disposable wipes specifically designed for use by firefighters to remove contaminants from their skin. The president told me about a recent visit to one of their client fire departments where firefighters were asked how they liked the wipes. The firefighters apparently responded along the lines of, “The wipes are on the trucks, but we don't use them.”

In “Firefighter decontamination challenges: Knowledge versus practice,” we asked the question: Is the increased awareness about the risk of cancer moving firefighters to take action? The answer: “Not all the time.”

For that article, I reviewed the study, Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk, where the researchers surveyed 482 firefighters from four Florida fire departments examining their attitudes, norms and perceived barriers to field decontamination processes. The goal of the study was to see how well firefighters were using their knowledge of the risk (awareness) and making changes in their work behaviors and practices to the desired results (reducing the cancer risk).

What they found can best be summed up with this statement from the study: “While firefighter attitudes were overwhelmingly favorable toward cleaning gear (knowledge), their actual decontamination and cleaning behaviors (doing) did not follow at the same level.”

While the firefighters who participated in the study reported positive attitudes, beliefs and perceived norms about decontamination, both on scene and back at the fire station, showering after a fire was the only decontamination process that occurred regularly. Initial contaminant reduction, use of cleansing wipes, routine gear cleaning and other behaviors all occurred less frequently.

The study results somewhat parallel the divergence between attitude and behavior in other areas of firefighter health and safety, such as seatbelt use on fire apparatus and being physically fit for duty.

The bottom line: With all that we know about what firefighters should do to reduce their risk following their exposure during structural firefighting, why have these behaviors not become the new normal? After all, an informed and educated firefighter will change their behaviors, right? Why wouldn't they?

People want to be “normal”

Looking back at past coverage of this issue, the clear focus has been on transactional solutions being employed in the hope that firefighters will respond accordingly. From their entry-level training and through their incumbent training, firefighters learn that there’s a “right way” and a “wrong way” for practically everything in their world.

So, it stands to reason that when it comes to enacting change in a fire department, most of us think that we can make progress and improvements by informing and educating firefighters, give them a new policy, procedure or process, and voila!, their behaviors will henceforth follow the new way. After all, we’re all conditioned to believe that appealing to a firefighter’s sense of right and wrong is the proper motivator. Unfortunately, that's not why people change their behaviors.

Researchers contend that if a leader wants to make meaningful and lasting cultural changes in an organization, it’s not going to be by changing what’s inside of people or appealing to their inner sense of what’s “right.” Instead, the leader must convince them that “everybody else is doing it.”

The idea that we’re often mistaken about our fellow firefighters’ beliefs and behaviors has been deployed in university anti-binge-drinking campaigns, which aim to reduce the pressure students feel to drink by showing them that their peers don’t drink nearly as much as they assume.

For example, a poster campaign at the University of North Carolina, Chapel Hill, presented students with data about their classmates: “Whether it’s Thursday, Friday or Saturday night, 2 out of 3 UNC students return home with a .00 blood alcohol concentration.” And it seems the program worked: After five years, students at the college were drinking less.

So, we can successfully change people’s behaviors, not by trying to change the individual’s behavior but rather by having a positive influence on their perceptions about the behavior of others. It’s a self-reinforcing process.

In a study on workplace behavior, researchers said, “It is widely accepted that in a comprehensive occupational safety program that addresses psychological, social, engineering, and organizational concerns, the inclusion of effective behavior-change processes can further promote worker safety and health.”

The implication of that statement for fire department leaders is that improving cancer risk reduction attitudes among firefighters requires a multi-dimensional approach. While many fire departments have addressed the engineering component (e.g., PPE, decontamination equipment and supplies, washer/extractors) and the organizational concerns component (e.g., policies and procedures), many still haven’t adequately addressed the psychological and social aspects of cancer risk reduction.

With that in mind, consider the following as the “primer pump” that facilitates your organization’s ability to obtain a “draft” that’s necessary to deliver sufficient water to your organization’s psychological and social “pumps.”

PPE compliance: The role of culture and peers

In “How to increase firefighter PPE and SCBA compliance,” we learned how fire department leaders can effect positive change on firefighter compliance regarding wearing their structural firefighting PPE and SCBA. Using those same lessons learned can prove to be extremely useful in both defining the “new normal” and motivating firefighters to embrace that new normal.

Lesson Learned #1 – Focus on firefighter identity: Firefighter identity is one of the most influential components of fire department culture. For example, look at the efforts being made within fire departments to reverse the perceptions of being a “real” firefighter as having the most smoke-stained PPE and helmet. Or getting firefighters to wear anything other than a heavy traditional leather helmet that’s frequently in conflict with their SCBA, when lighter and more functional helmets (e.g., European-style fire helmets) are available.

This is part of what makes firefighter identity, and the acceptance of group cultural norms (e.g., what it means to be a “real” firefighter) far more powerful influences on firefighter behavior than being informed and educated about the risks from exposure to potentially cancer-causing chemicals, chemical compounds and carcinogens.

Lesson Learned #2 – Reframe “goals”: Goal seduction affects firefighter behavior when firefighters are led to prioritize “getting done” over their own health and safety and “skipping” key behaviors (e.g., wearing the proper PPE when handling contaminated gear on scene (or back at the station), not showering ASAP, not changing their uniform or clothing) following a structure fire.

Think of the goal as being things like getting back to a meal that’s been interrupted by a call, getting back in the rack after being awakened to respond to a call, getting back to watching an important sporting event on the station TV, or getting off duty on time to get to an off-duty job.

Lesson Learned #3 – Understand situation aversion: Belonging to the group is another powerful cultural element that leads firefighters to engage in situation aversion. In situation aversion, firefighters can be led away from making safe choices because those choices are inconvenient or uncomfortable, such as in situations where choosing to be safe and doing the required tasks following a structure fire may invite ridicule from their peers.

Lesson Learned #4 – Support individual will and organizational solidarity: In their individual interviews and focus groups with firefighters, researchers discovered two factors that contributed heavily in overcoming firefighter identity, goal seduction and situation aversion: individual will and organizational solidarity.

Key in any fire department's efforts to create a new normal and encourage and support those firefighters who embraced the new normal begins and ends with the first-line supervisor (e.g., lieutenant or captain). As such, here's how first-line supervisors can support firefighters’ individual will with organizational solidarity:

  1. When an individual firefighter’s knowledge of the occupational cancer risks associated with interior structural firefighting (awareness) compels them to comply with departmental risk reduction policy, procedures and processes (action) despite these other pressures, it’s because of their individual will. First-line supervisors can strengthen a firefighter’s individual will by regularly providing good training and education on safety practices and the potential risks of their work. Firefighters who understand the what, why and how regarding occupational cancer risk reduction are better prepared to resist negative pressure from others who choose not to comply.
  2. Do as I say because I do as I say. First-line supervisors must know and understand the policies and procedures that have been put in place by departmental leaders to reduce the risk created by exposures during structural firefighting. They must then model the mandated behavior 100% of the time. Organizational solidarity is a powerful tool for showing that those leaders promote and embrace the organization’s occupational cancer risk reduction policies.

What are you doing to create the new normal?

The first of the 16 Firefighter Life Safety Initiatives from the Everyone Goes Home program urges firefighters and fire officers to “define and advocate the need for a cultural change within the fire service relating to safety; incorporating leadership, management, supervision, accountability and personal responsibility.”

So, what are you doing to change the culture in your fire department to create a new normal regarding occupational cancer risk reduction?

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