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Organizational Accidents Revisited
 To Thomas Augustus Reason (1879–1958).
My grandfather to whom I owe much more than my existence.
Organizational Accidents
Revisited

James Reason
Professor Emeritus, University of Manchester, UK
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2016 by James Reason

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

Version Date: 20160223

International Standard Book Number-13: 978-1-4724-4765-4 (Hardback)

This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been
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Contents

List of Figures and Tables vii

About the Author ix

Chapter 1 Introduction  1

Part 1 Refreshers

Chapter 2 The ‘Anatomy’ of an Organizational Accident  9

Chapter 3 Error-Enforcing Conditions  13

Part 2 Additions since 1997

Chapter 4 Safety Management Systems  23

Chapter 5 Resident Pathogens  27

Chapter 6 Ten Case Studies of Organizational Accidents  41

Chapter 7 Foresight Training  87

Chapter 8 Alternative Views  99

Chapter 9 Retrospect and Prospect  111

Chapter 10 Taking Stock  123

Chapter 11 Heroic Recoveries  131

Index137
Page Intentionally Left Blank
List of Figures and Tables

Figures

1.1 The ‘Swiss cheese’ model of accident causation  2

2.1 Summarizing the stages involved in an organizational accident 10
7.1 The three-bucket model for assessing risky situations  90
7.2 How the buckets might be ‘read’ by junior staff working alone 91
7.3 Balancing the person and the system  92
9.1 The cyclical progression of stages  115
9.2 Reduction in variability on each successive cycle  120

Tables

3.1 The principal sources of latent conditions related to specific

case studies 13
3.2 Error-enforcing conditions and their relative effects  18
3.3 Error-producing situations  18
6.1 Summarizing the active failures and latent conditions that
undermined or breached the aircraft maintenance system’s
defences  58
Page Intentionally Left Blank
About the Author

James Reason is Professor Emeritus of Psychology at the

University of Manchester, England. He is consultant to numerous
organizations throughout the world, sought after as a keynote
speaker at international conferences and author of several
renowned books including Human Error (CUP, 1990), Managing
the Risks of Organizational Accidents (Ashgate, 1997), The Human
Contribution (Ashgate, 2008) and A Life in Error (Ashgate, 2013).
Page Intentionally Left Blank
Chapter 1
Introduction

The term ‘organizational accidents’ (shortened here to ‘orgax’)

was coined in the early 1990s and was developed in the Ashgate
book published in 1997 entitled Managing the Risks of Organizational
Accidents. Sales of the book indicate that many people may have
read it – it remains Ashgate’s all-time best-selling book on human
performance. So the present book is not a revision, but a revisit.
A lot has happened in the ensuing 18 years, my aim here is to
update and extend the arguments presented in the first book
to accommodate these developments. In short, this book is an
addition rather than a replacement. And enough has happened
in the interim to require a separate book.
Despite their huge diversity, each organizational accident has
at least three common features: hazards, failed defences and losses
(damage to people, assets and the environment). Of these, the
most promising for effective prevention are the failed defences.
Defences, barriers, safeguards and controls exist at many levels
of the system and take a large variety of forms. But each defence
serves one or more of the following functions:

• to create understanding and awareness of the local hazards;

• to give guidance on how to operate safely;
• to provide alarms and warnings when danger is imminent;
• to interpose barriers between the hazards and the potential
losses;
• to restore the system to a safe state after an event;
• to contain and eliminate the hazards should they escape the
barriers and controls;
• to provide the means of escape and rescue should the
defences fail catastrophically.
2 Organizational Accidents Revisited

These ‘defences-in-depth’ make complex technological systems,

such as nuclear power plants and transport systems, largely proof
against single failures, either human or technical. But no defence is
perfect. Each one contains weaknesses, flaws and gaps, or is liable
to absences. Bad events happen when these holes or weaknesses
‘line up’ to permit a trajectory of accident opportunity to bring
hazards into damaging contact with people and/or assets. This
concatenation of failures is represented diagrammatically by the
Swiss cheese model (Figure 1.1) – to be reconsidered later.

Some holes due

to active failures Hazards

Other holes due to

Losses latent conditions

Successive layers of defences, barriers, and safeguards

Figure 1.1 The ‘Swiss cheese’ model of accident causation

The gaps in the defences arise for two reasons – active failures
and latent conditions – occurring either singly or in diabolical
combinations. They are devilish because in some cases the
trajectory of accident liability need only exist for a very short
time, sometimes only a few seconds:

Active failures: these are unsafe acts – errors and/or procedural

violations – on the part of those in direct contact with the system
(‘sharp-enders’). They can create weaknesses in or among the
protective layers.
Latent conditions: in earlier versions of the Swiss cheese model
(SCM), these gaps were attributed to latent failures. But there
need be no failure involved, though there often is. A condition
Introduction 3

is not necessarily a cause, but something whose presence is

necessary for a cause to have an effect – like oxygen is a necessary
condition for fire, though an ignition source is the direct cause.

Designers, builders, maintainers and managers unwittingly

seed latent conditions into the system. These arise because it
is impossible to foresee all possible event scenarios. Latent
conditions act like resident pathogens that combine with local
triggers to open up an event trajectory through the defences
so that hazards come into harmful contact with people, assets
or the environment. In order for this to happen, there needs to
be a lining-up of the gaps and weaknesses creating a clear path
through the defences. Such line-ups are a defining feature of
orgax in which the contributing factors arise at many levels of
the system – the workplace, the organization and the regulatory
environment – and subsequently combine in often unforeseen
and unforeseeable ways to allow the occurrence of an adverse
event. In well-defended systems, such as commercial aircraft and
nuclear power plants, such concatenations are very rare. This is
not always the case in healthcare, where those in direct contact
with patients are the last people to be able to thwart an accident
sequence.
Latent conditions possess two important properties: first, their
effects are usually longer lasting than those created by active
failures; and, second, they are present within the system prior
to an adverse event and can – in theory at least – be detected
and repaired before they cause harm. As such, they represent a
suitable target for safety management. But prior detection is no
easy thing because it is very difficult to foresee all the subtle ways
in which latent conditions can combine to produce an accident.
It is very rare for unsafe acts alone to cause such an accident
– where this appears to be the case, there is almost always a
systemic causal history. An obvious domain where unsafe acts
might be the sole factor is healthcare – where the carer appears
to be the last line of defence. Three healthcare case studies are
among the 10 discussed below. In each, the unsafe actions of the
immediate carers are shaped, even provoked, by systemic factors.
Promising candidates for close study are the generic
organizational processes that exist in all systems regardless of
4 Organizational Accidents Revisited

domain – designing, building, operating, managing, maintaining,

scheduling, budgeting, communicating and the like.
This book extends and develops these ideas using case studies
that have occurred in a variety of domains in the period that has
passed since the 1997 book was written and published. These
analyses provide the ‘raw data’ for the process of drilling down
into the underlying causal pathways. Many contributing latent
conditions recur in a variety of domains. A number of these –
organizational issues, design, procedures and communications
in particular – are examined in detail in order to reveal likely
problems before they combine to penetrate the defences-in-depth.
Beyond this point, the book is divided into two parts. The first,
comprising Chapters 2 and 3, summarizes the basic arguments
underlying orgax and the unsafe acts (or active failures) that can
contribute to them. These are intended as starters for those who
haven’t read the 1997 book or have forgotten it.
The second and main part of this book contains seven chapters
that go beyond the mid-1990s. Chapter 4 digs down into the
factors underlying latent conditions. Promising candidates are
the generic organizational processes that exist in all systems
regardless of domain – designing, building, operating, managing,
maintaining, scheduling, budgeting, communicating and the like.
Chapter 5 extends and develops these ideas using a series of
10 orgax case studies that have occurred in a variety of domains
in the nearly 20 years that have passed since the first book was
written and published. Three are taken from healthcare, two
involving the unwanted release of radiation, one railway accident,
two explosions of hydrocarbons and two aviation accidents. They
show the almost unimaginable ways in which the contributing
factors can arise and combine. These analyses provide the ‘raw
data’ for the process of drilling down into the underlying causal
pathways. Many contributing latent conditions recur in a variety
of domains.
Chapter 6 discusses a well-publicised regulatory disaster
relating to an NHS Foundation Trust. The various layers of
regulation failed to identify a very distressing number of
shortcomings in this hospital. It is highly likely that these failures
are not unique to this hospital. Even as I write, news is breaking
Introduction 5

of a comparable set of regulatory deficiencies in a maternity

hospital in the north-west of the UK.
Chapter 7 describes foresight training: a set of measures that
are designed to make people at the sharp end more ‘error-wise’
and aware of the situational risks. These often form the last and
all-too-neglected line of defence. It addresses the issue of what
mental skills can we give sharp-enders to make them more alert
to the dangers.
Chapter 8 looks at alternative theoretical views. These are
important because it is often assumed that the Swiss cheese model
is the principal explanatory metaphor. But, as you will see, it has
its critics – and rightly so.
Chapter 9 is mainly concerned with patient safety. It traces
a cyclical patient journey that looks both to the past and to the
foreseeable future.
Chapter 10 asks the following question: is any kind of optimism
justified in the matter of organizational accidents? The answer
offered is a very tentative maybe.
Chapter 11 relates two stories of heroic recovery: the 2009
‘miracle on the Hudson’ and the saving of the Japanese Fukushima
Daini nuclear reactor in 2011.
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