Understanding safety holistically –
without oversimplification.
Weekly articles from research and consulting practice: safety culture, human factors, high-reliability organisations, learning from incidents, and risk management. Every Monday.
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The Assumption Behind the Incident: Single-Loop, Double-Loop, and the Gap in Inquiry
Read article: The Assumption Behind the Incident: Single-Loop, Double-Loop, and the Gap in InquiryAfter an incident, the typical review changes the procedure, not the assumption behind it. Single-Loop corrects the action; Double-Loop asks about the assumption that helped…
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Restorative Just Culture: The Other Question After an Incident
Retributive Just Culture asks who broke the rule. Restorative Just Culture asks who is hurt and what those affected need in order to keep working.…
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Resilience Is Not What Most People Mean by It
What organisations call “resilience” is usually robustness, and in complex systems often its opposite. An essay on a consequential confusion.
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Conklin: Pre-Accident Investigations, When Incidents Are the Second-Best Option
Todd Conklin inverts safety work: the most valuable investigation is the one you run while nothing has happened yet. A book note on the mindset…