A case study using Human Factors to understand culture, its link to incidents and their prevention.
When analyzing your process safety incidents, it is vitally important to investigate deeply. Look beyond the immediate errors, asking why they made sense at the time. Organizations that look for deep cultural and causal factors can expect to be rewarded with solutions spanning challenges much broader than the specific incident at hand. Seemingly unrelated incidents often emerge from the very same cultural factors.
Investigations that only scratch the surface leave future disasters lurking quietly, only to erupt later. The Human Factors Analysis and Classification System (HFACS) is a tool and methodology for deep investigations that lead to broad, proactive solutions. Deeper insights lead to broader solutions, which can head off lurking disasters before they happen.
A Client’s Story
Picture this: A complex chemical manufacturing plant with several commodity products and some extremely dangerous ingredients in high volumes. This plant is one of a dozen similar plants, globally dispersed, comprising one division of an even larger organization.
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