I’ve recently seen and done a few incident investigations which really fell short of any mark except for ticking the box on the form that says ‘investigation completed’. There are ongoing debates about whether ICAM is better than TapRoot or if that is better than Root Cause Analysis or BowTie or … [Read more...] about A Much Better Way To Think About Incident Investigations
icam
Culture Silences in Safety – Stress, Personality and Behaviours
In all the mythology projected by BBS (the darling of safety) you never read about the subjectivities of perception, aberrations of behaviour or how personality/temperament determination enactment. The crazy assertion of BBS is that behaviours in themselves are somehow objective, when they are not. … [Read more...] about Culture Silences in Safety – Stress, Personality and Behaviours
Investigations and The Simplicity Attraction
Investigations and The Simplicity Attraction In the face of so much noise, competing values, diversity and confusion stands the myth of Occam’s Razor, a wish that when faced with multiple factors, humans will always opt for the shortest simplest route. The 14th Century philosopher/theologian … [Read more...] about Investigations and The Simplicity Attraction
Ritual as Embodied Learning in Safety
Ritual as Embodied Learning in Safety I have written about the nature of ritual previously, particularly the properties of ritual: https://safetyrisk.net/safety-as-ritual-performance/ All rituals (and associated semiotics) ‘embody’ learning. It is important when understanding learning that we … [Read more...] about Ritual as Embodied Learning in Safety
The Seduction of Templates, Set and Forget
The Seduction of Templates, Set and Forget Image Source One of the favourite activities of Safety is downloading and sharing templates. This is promoted by the idea that paperwork is an end in itself. Once the paperwork is completed in comes ‘set and forget’, nothing to worry about except the next … [Read more...] about The Seduction of Templates, Set and Forget
The Bias of Method Design in Risk
The Bias of Method Design in Risk Anything that is designed hides the assumptions and philosophy of the designer. The methodology (philosophy) of the designer is not visible but is rather hidden in the method, what is enacted. So, if one looks at the iCam method one tends not to see its bias … [Read more...] about The Bias of Method Design in Risk
Deconstructing iCam, Useful or Useless
Deconstructing iCam, Useful or Useless? It’s always an education to see what Safety flocks to and makes ‘orthodox’. Safety always seeks out mechanistic-behaviourist methods to suit its assumptions about what constitutes personhood. It actually never discusses personhood, it just leaves that silent … [Read more...] about Deconstructing iCam, Useful or Useless
Serendipity and Risk
Serendipity and Risk One of the great challenges for traditional safety is the problem of uncertainty, unpredictability and luck. I have written before about luck: https://safetyrisk.net/good-luck-to-the-luck-deniers/ https://safetyrisk.net/do-you-believe-in-good-and-bad-luck/ … [Read more...] about Serendipity and Risk
All Risk is Subjective
The latest research confirms what SPoR has known for sometime, that all vision is subjective, objective vision is impossible (https://medicalxpress.com/news/2020-06-philosophy-lab-vision-impossible.html ), just as zero is impossible. Researchers at John Hopkins University found that it's impossible … [Read more...] about All Risk is Subjective
Detailed Root Cause Analysis Leads to Industrial Manslaughter Charge
Following a recent fatality at a residential construction site, the WorkOver Authority commissioned me to undertake an independent, unbiased root cause investigation to help them confirm what they already knew and to justify further action against those even remotely involved. As a result of my … [Read more...] about Detailed Root Cause Analysis Leads to Industrial Manslaughter Charge
