In this short series, I will highlight seven foes and seven friends of system safety, both for explanation and intervention. Each is a concept, meme, or device used in thinking, language, and intervention (reinforced by more fundamental foes that act as barriers to thinking). They are not the only foes or friends, of course, but they are significant ones that either crop up regularly in discussions and writings about safety, or else – in the case of friends – should do.
In many professions, specific terms – both old and new – are often established and accepted unquestioningly, from the inside. In some cases, such terms may create and perpetuate inequity and injustice, even when introduced with good intentions. One example that has played on my mind over recent years is the term ‘second victim’.
Most organisations seem to use a classification system (or taxonomy) of some sort, for instance for safety classification, and much time is spent developing and using such taxonomies. Importantly, decisions may be made on the basis of the taxonomy and associated database outputs (or it may be that much time is spent on development and use, but little happens as a result). There is therefore a risk of time and money spent unnecessarily, with associated opportunity costs. Still, taxonomies are a requirement in all sorts of areas, and several things should be kept in mind when designing and evaluating a taxonomy. This posts introduces twelve properties of effective classification systems.
This second post in a series on Four Kinds of ‘Human Factors’ explores another kind of human factors: Factors of Humans.
It was always going to happen. The wrong Best Picture winner was read out live on…
It has variously been described as “an incredible and almost unbelievable gaffe” (Radio Times), “the greatest mistake in Academy Awards history” (Telegraph), “an extraordinary blunder…an unprecedented error” (ITV News), “the most spectacular blunder in the history of the starry ceremony” and “the most awkward, embarrassing Oscar moment of all time: an extraordinary failure” (Guardian). It was, of course, the Grand Finale of the Oscars 2017.
Written and directed by Matthew Wilkinson. A thrilling modern tragedy about a Russian architect driven…
There has been much talk in recent years about ‘never events’ and ‘zero harm’, similar to talk in the safety community about ‘zero accidents’. It sounds obvious: no one would want an accident. And we all wish that serious harm would not result from accidents. But as expressed and implemented top-down, never/zero is problematic for many reasons. In this post, I shall outline just a few, as I see them.
Again, a familiar smoke pattern has emerged from the ashes of a high-profile accident. The…
If you work in an industry such as transportation or healthcare – where human involvement is…
Humanistic Systems 