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Effective workplace communication with employees with acquired brain injury


Talking about safety

Workplace safety is everyone's responsibility. Communicating messages about how to work safely is probably an everyday task for you. So doing it effectively is really important.

Employees need to follow health and safety rules in the workplace and know what to do if there is a health or safety problem. Many support staff in disability employment services worry over how to get employees with ABI to work within the OH&S laws and principles. Safety rules can be learned by people with ABI, and, although the ability to remember them may sometimes be a problem, support workers can do a lot to assist this process.

One of the keys to getting employees to work safely is communicating the abstract notion 'safety' in concrete terms. An effective way to do this is by linking the actual things that are done in the name of 'safety' – walking in designated walkways, wearing PPE, and so on – with the concrete experience of 'being hurt'. In other words, we do all these 'safe' things to stop ourselves getting hurt. In this way, safety 'rules' (which are themselves an abstract concept), can become personalised and linked to the individual. Therefore it is made concrete – we follow the 'rules' so we won't get hurt (or hurt other people).

It is also effective to talk about safety by linking 'getting hurt' with something you know the employee has actually experienced at some time.

Do you remember when you got a rose thorn in your thumb? What did it feel like? What did you have to do? What do you need to do to stop getting hurt like this when you are pruning roses?

Cognitive impairments that can follow a brain injury may lead to some specific safety issues for these employees. For example, the brain injury may cause them to have problems understanding conditional relationships. 'If I wear a high-visibility vest in the warehouse, I'll be a lot less likely to be run down by the forklift', is a statement of a conditional relationship. We learn this and apply this conditional statement to our own specific case as well as to general cases (all workers who wear high-visibility vests in the warehouse). We use conditional statements all the time as shortcuts to aid our thinking and reasoning, but this ability can be very limited in someone with impaired cognitive functioning.

Knowledge of the individual safety issues for each and every employee with ABI is critical. Problems will be unique to the individual and may stem from things such as:


Malcolm sustained a brain injury in a car accident 15 years ago. He is 39 years old and physically fit and strong. He drives his own car, and lives independently. He works at Frame Up where he is one of the forklift operators.

Over the years, Malcolm has had a number of minor incidents driving the forklift but has retained his licence and been given some extra training. Paul, his supervisor, has voiced some concerns recently though, because he has observed Malcolm reversing the forklift far too quickly, and failing to check in the side and rear vision mirrors. Others have commented that he also seems to drive his car erratically at times.

Paul and Bob have talked with Malcolm about his driving but he refuses to accept that there might be a problem. He says he is licensed to drive a car and the forklift and that he is the best driver they've got at Frame Up.

Malcolm does not believe that he has a disability. He sees himself as very different from any of the other supported employees, with the exception of Annika.

From Paul's notebook

I had another run-in with Malcolm and Annika today. While they were loading the order for the shelves, I was stunned to see Mal just leap onto the forklift and reverse it at great speed right up to the line. I could see that he never looked behind him once and came within less than a metre of where Robbie and Van were packing. I went up and told him to get off the forklift because he was acting dangerously.

At this point, Annika joined in and the two of them started arguing with me that Malcolm was not the problem – it was the other guys who didn't look out for themselves. I was amazed. They told me that people like Rob and Van shouldn't be working here – they were like children and couldn't understand anything. 'So', said Annika, 'it's not us that are the safety problem!'

It's really weird because some days Mal appears fine with his driving – and he's been doing it for years. At other times, though, it's a real hazard. I've noticed it with other things too. Some days when he's welding, he'll just forget to put on his PPE. Other days, he'll walk around bossing all the others about wearing their gloves and helmet and things.


  1. Gather information. Support staff need to be constantly checking the safety skills of employees with ABI, and letting other support staff know what they discover. In some cases, daily or even more frequent checks may be necessary. This can be done by:
  1. Plan for emergencies. All support staff should be aware and up-to-date regarding safety issues for employees with ABI and have a contingency plan for these employees in any emergency. Perception problems (auditory/visual perception etc) can be a particular issue.

Mary, we've noticed you sometimes can't tell if the lunch bell is going or if it's the fire siren. If the fire siren sounds I'll come and make sure you are safe.

  1. Build self-awareness about safety. ABI can prevent the person perceiving there is a problem. Try to find out how much insight the person has into their own ability to understand and follow safety rules:

Yes, you can tell me what you have to wear when you are in the welding booth, but you sometimes forget to put all the PPE on.

Today, you drove dangerously: you were too fast and did not check your mirrors.

  1. Give feedback to manage poor insight. Many people with brain injury are unaware of how their cognitive problems affect them. The best approach is an honest and up-front one that involves persistently and repeatedly giving feedback.

I know you think you drive safely, Mal, but you forget to check your mirrors. I saw this happen again today, twice.

  1. Develop external memory aids for safety. To enable the employee with ABI to focus on learning and recalling details of the safety strategies they must use:

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