5 ms·
https://how.complexsystems.fail/#11 https://how.complexsystems.fail/#11 > Organizations are ambiguous, often intentionally, about the relationship between pro
by awinter-py 3y ago
https://how.complexsystems.fail/#11 https://how.complexsystems.fail/#11
> Organizations are ambiguous, often intentionally, about the relationship between production targets, efficient use of resources, economy and costs of operations, and acceptable risks of low and high consequence accidents. All ambiguity is resolved by actions of practitioners at the sharp end of the system. After an accident, practitioner actions may be regarded as ‘errors’ or ‘violations’ but these evaluations are heavily biased by hindsight and ignore the other driving forces, especially production pressure.
(taps the sign)
- LambdaComplex 3y agoSidney Dekker mentions this in "The Field Guide to Understanding 'Human Error.'" Always remember: people generally show up to work with the intention of doing a good job. If someone causes an accident by doing something that is "obviously" unsafe in hindsight, step back and ask yourself why the person thought their "obviously unsafe" action was reasonable in the moment.
- Libcat99 3y agoLikewise with smaller scale "accidents". Did the ups driver fling my package over fence because he hates me, or because my long driveway interferes with his 3 minute per package metric. Measurements kill sensibility.
- yard2010 3y agoWhat about the people who make these half assed laws and regulations? Either they don't care about their job or their job definition is wrong to begin with
- Angostura 3y agoLet's apply Dekker's reasoning. Give me a example of a law/regulation that you think is half-arsed. I bet we can show why it was designed that way with good intent.
- deleted 3y ago[deleted]
- Angostura 3y agoI haven't seen this list before, I like it a lot - thanks for posting.