Diana F. Lopes, Mónica D. Oliveira and Carlos A. Bana e Costa

Diana F. Lopes, Mónica D. Oliveira and Carlos A. Bana e Costa
Designing and building a value risk-matrix for the evaluation and mitigation of health and safety risks with MACBETH Diana F. Lopes, Mónica D. Oliveira and Carlos A. Bana e Costa Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Portugal

Agenda Context and objectives Methodological framework Structuring
Context & objectives Methodological framework Structuring Value measurement Future research Context and objectives Methodological framework Structuring EI: Nomenclature EII: How to identify and measure risk sources and their consequences? EIII: Identification of impact dimensions EIV: Impact scale construction EV: How to estimate the consequences’ impact in each dimension? Value measurement MI: Independence test between impact dimensions MII: Impact value measurement (MACBETH-Choquet model) Future research

Risk matrix in use by the Health Service Executive
Probability Impact levels Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Almost Certain (5) 5 10 15 20 25 Likely (4) 4 8 12 16 Possible (3) 3 6 9 Unlikely (2) 2 Rare/remote (1) 1 Prob. × Impact Similar systems are used by multiple public and private organizations…

U.S. Department of Defense
…prioritise risks that threat the health system, organisations, business units and team and/or patients (OSQHC, 2005) …prioritise risks encountered in the development, test, production, use, and disposal of defense systems (US DoD, 2012) Department of Education, Training and Employment (DETE) …prioritise risks that threat the health system, organisations, business units and team and/or patients (OSQHC, 2005) …managing health and safety risks in DETE workplaces (Figueiredo and Oliveira, 2009)

Why are risk matrices widely used?
Context & objectives Methodological framework Structuring Value measurement Future research Allow for intuitive use, demanding for limited expertise (Cox, 2009) Imposed by International Standards (ISO, IEC/FDIS 31010) and recommended by guidelines in many contexts (e.g. health and safety) Are included in several packages: SAP (SAP AG, 2012) Active Risk Manager (Microsoft Pinpoint, 2012) MITRE’s risk matrix tool (The MITRE corporation, 1999) Provide a clear framework for systematic review of risks, enabling organizations to prepare convenient documentation Allow for stakeholders participating in the process of building risk matrices (Cox, 2008)

Key problems with risk matrices
Context & objectives Methodological framework Structuring Value measurement Future research Cox Jr., L. A. (2008). "What’s wrong with risk matrices?" Risk Analysis 28(2): Pickering, A. and S. P. Cowley (2010). "Risk Matrices: implied accuracy and false assumptions." Journal of Health & Safety Research & Practice 2(1): 9-16. Linkov, I., F. K. Satterstrom, et al. (2006). "From comparative risk assessment to multi-criteria decision analysis and adaptive management: Recent developments and applications." Environment International 32: 1072–1093. Levine, E. S. (2011). “Improving risk matrices: the advantages of logarithmically scaled axes.” Journal of Risk Research 15(2): 209–222. Levine, E. S. and J. F. Waters (2013). "Managing risk at the Tucson sector of the U.S. border patrol." Risk Analysis 33(7): Wall, K. D. (2011). The trouble with risk matrices. Working Paper, Naval Postgraduate School, Defense Resources Management Institute,. 2/2011. Smith, E. D., W. T. Siefert, et al. (2009). " Risk matrix input data biases." Systems Engineerings 12(4):

Key problems with risk matrices (examples)
Context & objectives Methodological framework Structuring Value measurement Future research Use of interval scales such that the difference in attractiveness between two consecutive impact (probability) levels is the same. Use of the same qualitative impact scale for all the risk dimensions and characterize each source of risk only by the worst impact level across all the dimensions, ignoring the cumulative effects of multiple impacts Probability Impact levels Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Almost Certain (5) 5 10 15 20 25 Likely (4) 4 8 12 16 Possible (3) 3 6 9 Unlikely (2) 2 Rare/remote (1) 1 Use of interval scales such that the difference in attractiveness between two consecutive impact levels is the same… Financial losses of €3M & 20 Deaths Financial losses of €3M =

Probability of the event
Context: case study Context & objectives Methodological framework Structuring Value measurement Future research Occupational Health and Safety Unit (OHSU) of the ARSLVT composed by an engineer, nurses, doctors and technicians, makes use of traditional risk matrices: Severity of the injury 1. Very low 2. Low 3. High 4. Very high Probability of the event 1. Unlikely 2. Very low Low 4. Moderate 2. Likely 6. Moderate 8. High 3.Quite likely 3. Low 9. High 12. Very high 4. Very likely 16. Very high Source: (ARSLVT, 2010)

Context: case study Problems with Risk Matrices
Context & objectives Methodological framework Structuring Value measurement Future research Occupational Health and Safety Unit (OHSU) of the ARSLVT composed by a engineer, nurses, doctors and technicians, makes use of traditional risk matrices: Problems with Risk Matrices Severity of the injury 1. Very low 2. Low 3. High 4. Very high Probability of the event 1. Unlikely 2. Very low Low 4. Moderate 2. Likely 6. Moderate 8. High 3.Quite likely 3. Low 9. High 12. Very high 4. Very likely 16. Very high Interviews, reports and manual’s analysis Source: (ARSLVT, 2010)

Context: Interviews, reports and manual’s analysis
Context & objectives Methodological framework Structuring Value measurement Future research Ambiguous nomenclature Problems in resource allocation Difficulty in identifying the risk sources Problems identified Decision makers’ opinions incompatible with the manual Arbitrariness when estimating impacts and probabilities

Objectives Context & objectives Methodological framework Structuring Value measurement Future research This study aims to answer the call for help from the OHSU of the ARSLVT Risk Assessment in health and safety at work Challenge: Improve risk matrices’ design to avoid inconsistencies Selection of corrective measures with the greatest potential to mitigate risks

Multicriteria resource allocation model
Methodological framework Context & objectives Methodological framework Structuring Value measurement Future research Risk Assessment’s context for Health and Safety at work Risk management Value risk matrix, using MACBETH Multicriteria resource allocation model OUTPUTS Multicriteria risk impact value and probability for each risk & Classification of risks into risk categories Selection of mitigation actions that maximize value given available budget Structuring SI: Identification of issues and challenges SII: Nomenclature SIII: Tables match SIV: Identification of impacts dimensions SV: Impact scales SVI: impacts Estimation Structuring and alocation Mitigation actions Value measurement MI: Dependency test between dimensions MII: Impact MIII: Subjective Probability Selection of mitigation actions Risk classification Acceptability System to support risk assessment ACTIVITIES PROPOSED Model requisiteness

STRUCTURING

Capability to return to work
Structuring Context & objectives Methodological framework Structuring Value measurement Future research S I Nomenclature Appraisal Risk Sources S II Health consequences CORRESPONDENCE S III Identification of relevant dimensions to assess the impact Impact scales construction Employee’s health Capability to return to work Absenteeism S IV Best 0 yhll Best ND Best 0 days year of healthy life lost Null Disability (ND Irrecoverable Total Disability (ITD) Worst 34 yhll Worst ID Worst 18 years Nota - yhll: years of healthy life lost; ND: null disability; ID: irrecoverable total disability Impact estimation on each dimension S V

Grooves on the stairs to access the building
Proposed Nomenclature Following (ISO, IEC/FDIS 31010), (ARSLVT, 2010), (Vose, 2008) Grooves on the stairs to access the building Fall Expression levels Grooves: 0 cm 2 cm 10 cm RISK SOURCE RISK (…) Expression’s levels Foot fracture 3,5 dhll RD 1 month of absenteeism IMPACT CONSEQUENCE Nota - dhll: day of healthy life lost; RD: Recoverable Disability

Appraisal S I Nomenclature Appraisal S II Context & objectives
Methodological framework Structuring Value measurement Future research S I Nomenclature Appraisal Risk Sources S II Health consequences CORRESPONDENCE

Risk sources identification Measurement of expression levels
Appraisal Context & objectives Methodological framework Structuring Value measurement Future research Problem Difficulty in identifying and measuring the expression levels of risk sources and their consequences Proposal Based on an intensive literature review RSA RSB … Risk sources identification Pictorial Qualitative Quantitative Measurement of expression levels CA CB Health consequences CORRESPONDENCE Falta de instrumentos técnicos conduz a arbitrariedade na medição Por ex.: a falta de um decibelímetro para medir os Levels de ruído presentes numa sala de estar.

Example: Noise Context & objectives Methodological framework
Structuring Value measurement Future research Description of noise dB Exposure limit Health consequences Normal breathing 10 Without limit Without efect Air conditioning 50 Home 55 8h Annoyance Normal conversation (public lounges, offices, cafes, bars) 60 Annoyance pronounced yhllirator 70 Alarm Clock (airport wainting room) 75 An increase in hearing threshold level (TL) can occur Hairdryer 80 Annoyance and possible increase in TL Backhoe 85 Possible increase int the TL’s level Exposure Limit 87 6h Hearing loss of dB in a working period from 1 to 2 years Hearing loss of 50 dB in the working period of 50/52 years Mowing machine 89 4h30min Sheet Metal Shop 100 1h Ambulance siren 120 3,75 min Pain and hearing loss treatable or not treatable Very loud rock concert 130 56,25 s Jet plane 140 14 s Pain and acoustic trauma. Hearing loss may be accompanied by a buzzing Work from: (HCN, 1994);(Passchier et al., 2000);(Decreto-Lei 182/2006)

Dimensions identification
Context & objectives Methodological framework Structuring Value measurement Future research S I Nomenclature Appraisal Risk Sources S II Health consequences CORRESPONDENCE S III Identification of relevant dimensions to assess the impact

Dimensions identification
Context & objectives Methodological framework Structuring Value measurement Future research The identification of relevant dimensions to assess the risk impact was performed in workshops with OHSU Final Value Tree

Impact scales Context & objectives Methodological framework Structuring Value measurement Future research S I Nomenclature Appraisal Risk Sources S II Health consequences CORRESPONDENCE S III Identification of relevant dimensions to assess the impact Impact scale construction Employee’s health Capability to return to work Absenteeism S IV Best 0 yhll Best ND Best 0 days Worst 34 yhll Worst ID Worst 18 years Nota - yhll: years of healthy life lost; ND: null disability; ID: irrecoverable disability

Impact scales Context & objectives Methodological framework Structuring Value measurement Future research Best: Null disability The employee is fit for the full exercise of his usual functions Recoverable diss. The employee’s usual functions are committed but in a retrievable form Irrecoverable partial dis. with return to work Some of the normal duties of the employee are irreversibly committed and the return to the usual work is possible with restrictions Irrec. Partial dis. with No return to work Part of the normal duties of the employee are irreversibly committed and the return to work is not possible Worst: Irrec. disability All the usual functions of the employee are irretrievably committed Better 0 years of healthy life lost 34 years of healthy life lost Worst Employee’s Health Better 0 (zero duration) Capability to return to work 18 years = [Retirement age] – [Average age of ARS’ employees] Worst Absenteeism

Impact estimation Context & objectives Methodological framework Structuring Value measurement Future research S I Nomenclature Appraisal Risk Sources S II Health consequences CORRESPONDENCE S III Identification of relevant dimensions to assess the impact Impact scale construction Employee’s health Capability to return to work Absenteeism S IV Best 0 yhll Best ND Best 0 days Worst 34 yhll Worst ID Worst 18 years Nota - yhll: years of healthy life lost; ND: null disability; ITD: irrecoverable total disability Impact estimation on each dimension S V

Impact estimation Problem Proposal
Context & objectives Methodological framework Structuring Value measurement Future research Problem Difficulty in estimating impacts due to the decision makers’ lack of knowledge Proposal Sources: (Bowie et al. ,1997); (Mathers et al., 1999);(Murray et al., 1996); (Stouthard et al., 1997); (U.S. Department of Labor, 2013); … Consequences Employee’s Health Capability to return to work Absenteeism Amputation of a finger (except the thumbs) 3,5 years of healthy life lost Irrecoverable Partial Disability with return to work 26 days Sprain 1 day of healthy life lost Recoverable Disability 10 days Tuberculosis 1,6 months of healthy life lost 6 months …

Value Measurement

Value measurement M I Dependency test between impact dimensions
Context & objectives Methodological framework Structuring Value measurement Future research M I Dependency test between impact dimensions Impact value measurement using the MACBETH-Choquet model: Construction of a global descriptor that combines the various dimensions Issues Protocol using the interactive version of Microsoft PowerPoint Populate the MACBETH global matrix with the judgements elicited by the decision makers Determination of IC’s parameters (Shapley and interaction) M II

Dependency test Context & objectives Methodological framework Structuring Value measurement Future research RD RD 1,6 mhll Strong Weak 15 yhll IPDR 1 year IPDR 1 year Employee’s health Capability to return to work Absenteeism Capability to return to work Employee’s health Absenteeism The capability to return to work is cardinally dependent on the employee’s health dhll: day of healthy life lost; RTD: Recoverable Total Disability Nota - yhll: years of healthy life lost; mhll: months of healthy life lost; IPDR: Irrecoverable Partial Disability with return to work; RD: Recoverable Disability

Impact value measurement
Context & objectives Methodological framework Structuring Value measurement Future research M I Dependency test between impact dimensions Impact value measurement using the MACBETH-Choquet model: Construction of a global descriptor that combines the various dimensions Issues Protocol using the interactive version of Microsoft PowerPoint Populate the MACBETH global matrix with the judgements elicited by the decision makers Determination of IC’s parameters (Shapley and interaction) M II

MACBETH … uses qualitative judgments of differences of attractiveness…
Context & objectives Methodological framework Structuring Value measurement Future research MACBETH is an interactive decision support approach … uses qualitative judgments of differences of attractiveness… … based on seven qualitative categories of difference in attractiveness Wide applicability in MCDA: Health care: (Bana e Costa et al., 2011)(de Castro et al., 2011)(Lopes, 2013) (Oliveira et al., 2011) Energy: (Bana e Costa et al., 2008)(Barin et al., 2012) Environment: (Bana e Costa et al., 2013); (Cox et al., 2013) Risk management: (Bana e Costa et al., 2008b);(Dall'Osso et al., 2009); (Joerin et al., 2010); (Oliveira et al., 2004) … [4] Prioritize interventions and allocate resources (Oliveira et al., 2011) [5] e [6] (Bana e Costa et al., 2011) (Lopes, 2013) [7] Medical decision making (de Castro et al., 2011) [8] Bana e Costa et al., 2008 [9] Barin et al., 2012 Typically, MACBETH applications use an additive value model (preference independence conditions are verified)… …but many studies are using MACBETH with CI to model interdependencies

MACBETH-Choquet model
Context & objectives Methodological framework Structuring Value measurement Future research Proposal Use of the MACBETH-Choquet methodology to model interdependencies Friendly and intuitive questioning protocol Judgments based on seven qualitative categories of MACBETH Intuitive meaning of the results MACBETH Choquet integral [4] Prioritize interventions and allocate resources (Oliveira et al., 2011) [5] e [6] (Bana e Costa et al., 2011) (Lopes, 2013) [7] Medical decision making (de Castro et al., 2011) [8] Bana e Costa et al., 2008 [9] Barin et al., 2012 Mathematical formulation of the 2-additive CI operator: (Lopes et al., 2014)

Shapley and interaction’s parameters
MACBETH-Choquet model Context & objectives Methodological framework Structuring Value measurement Future research Levels Description SQ: Status quo IN RS RTD RI IPDR P : Pior ITD Levels Description SQ: Status quo 0 anos saudáveis perdidos RS 1,6 meses saudáveis perdidos P: Pior 34 anos saudáveis perdidos Levels Description SQ: Status quo 0 anos RS 1 mês P: Pior 18 anos Levels Description P1P2P3 34 anos saudáveis perdidos, inc. absoluta irrecuperável, 18 anos de ausência laboral (34yhll, ITD, 18a) 15 anos saudáveis perdidos, inc. absoluta irrecuperável, 18 anos de ausência laboral (15yhll, ITD, 18a) 15 anos saudáveis perdidos, inc. parcial irrecuperável sem regresso ao trabalho, 18 anos de ausência laboral (15yhll, IPDN, 18a) 4 anos saudáveis perdidos, inc. absoluta irrecuperável, 18 anos de ausência laboral (4yhll, ITD, 18a) (…) Interactive questioning protocol Global Descriptor Choquet integral’s parameters MACBETH Global Matrix Shapley and interaction’s parameters M-MACBETH

1,6 months of healthy life lost 15 years of healthy life lost
Global descriptor Context & objectives Methodological framework Structuring Value measurement Future research (2) Incapability to return to work Levels Description SQ: Status quo ND UR RD LR IPDR I IPDN W: Worst ID (1) Employee’s Health Levels Description SQ: Status quo 0 days of healthy life lost UR 1,6 months of healthy life lost X 0,5 year of healthy life lost Y 1 year of healthy life lost Z 4 years of healthy life lost LR 15 years of healthy life lost W: Worst 34 years of healthy life lost (3) Absenteeism Levels Description SQ: Status quo 0 years UR 1 month T 6 months LR 1 year W: Worst 18 years Construção de descritores de impacto em cada dimensão identificada pelos decisores e definir dois Levels de referência com significado substancial Construção de um descritor global tendo apenas em conta as combinações viáveis (conjunto de consequências que fazem sentido no contexto da ARS)

Global descriptor Context & objectives Methodological framework Structuring Value measurement Future research Levels 34 yhll, ID, 18 y 15 yhll, ID, 18 y 15 yhll, IPDN, 18 y 4 yhll, ID, 18 y 4 yhll, IPDN, 18 y 15 yhll, IPDR, 1 y 15 yhll, IPDR, 6 m 15 yhll, IPDR, 1 m 15 yhll, RD, 1 y 15 yhll, RD, 6 m 15 yhll, RD, 1 m 4 yhll, IPDR, 1 y 4 yhll, IPDR, 6 m 4 yhll, IPDR, 1 m 4 yhll, RD, 1 y Levels 4 yhll, RD, 6 m 4 yhll, RD, 1 m 1 yhll, IPDR, 1 y 1 yhll, IPDR, 6 m 1 yhll, IPDR, 1 m 1 yhll, RD, 1 y 1 yhll, RD, 6 m 1 yhll, RD, 1 m 1,6 mhll, IPDR, 1 y 1,6 mhll, IPDR, 6 m 1,6 mhll, IPDR, 1 m 1,6 mhll, RD, 1 y 1,6 mhll, RD, 6 m 1,6 mhll, RD, 1 m No impact (0 yhll, ND, 0 y) Para a aplicação do modelo MACBETH-IC, é necessário construir descritores de impacto em cada dimensão e definir dois Levels de referência com significado substancial: Referência superior Referência inferior Os dois Levels de referência devem ser escolhidos de tal forma que possam ser combinados viavelmente nas três dimensões, ou seja, devem ser selecionados os maiores intervalos de impacto em cada dimensão compatíveis entre si. Nota: os Levels Status quo e Pior não foram selecionados como Levels de referência por darem origem a conjuntos de impactos não viáveis quando combinadas as várias dimensões Nota - yhll: years of healthy life lost; mhll: months of healthy life lost; ID: Irrecoverable disability; IPDR: Irrecoverable Partial Disability with return to work; RD: Recoverable Disability; ND: Null Disability; y:years; m: months

Interactive questioning protocol
Context & objectives Methodological framework Structuring Value measurement Future research Questioning protocol based on questions-type: “What is the attractiveness of reversing certain combination of impacts?” Support system: Microsoft Office PowerPoint 2007 Sequential Interactive Para medir a atratividade relativa ou valor de reverter cada combinação de impactos, um conjunto de questões foi colocado aos decisores. Exemplo de questões: Qual a atratividade de reverter determinada combinação de impactos? Sistema de apoio: Microsoft PowerPoint 2007, de forma interativa. No modo de “apresentações de diapositivos” do MS PowerPoint 2007, as questões foram colocadas de forma interativa e sequencial aos decisores e as respostas registadas em tempo real pelas opções de ponteiro dispoLevels

Interactive questioning protocol
Final Judgments No impact No impact No impact No impact No impact No impact No impact No impact No impact No impact No impact 34yhll, ID, 18y 15yhll, ID, 18y 15yhll, IPDN, 18y 4yhll, ID, 18y 4yhll, IPDN, 18y 15yhll, IPDR, 1y 15yhll, IPDR, 6m 15yhll, IPDR, 1m 15yhll, RD, 1y 15yhll, RD, 6m 15yhll, RD, 1m No impact No impact No impact No impact No impact No impact No impact No impact No impact No impact No impact No impact 4yhll, IPDR, 1y 4yhll, IPDR, 6m 4yhll, IPDR, 1m 4yhll, RD, 1y 4yhll, RD, 6m 4yhll, RD, 1m 1yhll, IPDR, 1y 1yhll, IPDR, 6m 1yhll, IPDR, 1m 1yhll, RD, 1y 1yhll, RD, 6m 1yhll, RD, 1m No impact No impact No mpact No impact No impact No mpact No impact No impact No impact No impact No impact No impact 0,5yhll, IPDR, 1y 0,5yhll, IPDR, 6m 0,5yhll, IPDR, 1m 0,5yhll, RD, 1y 0,5yhll, RD, 6m 0,5yhll, RD, 1m 1,6mhll, IPDR, 1y 1,6mhll, IPDR, 6m 1,6mhll, IPDR, 1m 1,6mhll, RD, 1y 1,6mhll, RD, 6m 1,6mhll, RD, 1m

MACBETH global matrix Judgments elicited by the decisions makers

Scale validated by the decision makers
MACBETH global matrix Validated scales obtained in decision conferences based on the elicited judgments Scale validated by the decision makers

Choquet integral parameters
Context & objectives Methodological framework Structuring Value measurement Future research Combinations of impacts required to determine the CI parameters UR1,UR2,UR3 UR1,UR2,LR3 UR1,LR2,UR3 UR1,LR2,LR3 LR1,UR2,LR3 LR1,UR2,LR3 LR1,LR2,UR3 LR1,LR2,LR3 A escala gerada pela matriz MACBETH global constitui a informação de base para a determinação dos parâmetros do integral de Choquet São necessárias todas as combinações de impacto com as referências superior e inferior definidas em cada dimensão Shapley’s parameters Interaction’s parameters

Future research Context & objectives Methodological framework Structuring Value measurement Future research Conclusion of the probability scale construction considering a group test of risks Value risk-matrix 100

Future research Context & objectives Methodological framework Structuring Value measurement Future research Conclusion of the probability scale construction considering a group test of risks Construction of a DSS in order to facilitate the use of the risk assessment system by the OHSU Selection of mitigation measures (allocation resources)

Questions? Suggestions?

ACKNOWLEDGEMENTS FUNDING FROM THE PORTUGUESE PUBLIC BUDGET THROUGH FCT – FUNDAÇÃO PARA A CIÊNCIA E A TECNOLOGIA, WITHIN THE PROJECT PTDC/EGE-GES/119230/2010

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