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Failure to Learn


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2016 Jul 6, 8:20am   1,484 views  1 comment

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Today marks the 28th anniversary of the Piper Alpha disaster that killed 167, injured more at an insured cost of over 3 billion USD. Prior to that were the Flixborough Disaster in 1974, Bhopal in 1984 and numerous others with one of the latest being the Deepwater Horizon in 2010.

Bob Bea, an internationally recognized veteran of disaster investigations, has taken part in dissecting the 1988 Piper Alpha oil platform explosion in the North Sea, the 1989 Exxon Valdez oil tanker spill in Alaska’s Prince William Sound, the 2003 disintegration of Space Shuttle Columbia and the 2005 levee failures in New Orleans.

“There is one common thread to these disasters,” Bea said. “They are system disasters. They’re caused by human and organizational malfunctions.”

And, too often, they occur because there is a “failure to learn” from past mistakes, Bea said.

In addition to delegating responsibility for safety, BP worked under a global mantra of making sure “every dollar counts,” emphasizing reduced costs and increased productivity, Bea said. At the time of the blowout, the Deepwater Horizon rig was over budget by $60 million and more than 60 days behind schedule.

“They had gotten so lean and mean, they were falling over,” said Bea.

The same values — depending on consultants and outsourcing for the sake of efficiency — are emphasized in many business classes, an audience member said, who advocated for the development of a culture of learning from past mistakes.

Bea added that the systemic problems extend beyond corporations to government and regulatory agencies in the United States. He cited the near-failing grade of America’s infrastructure given last month by the American Society of Civil Engineers.

“The United States is the richest, most powerful country in the world,” said Bea after the talk. But such success can also lead to hubris and complacency when it comes to tasks like shoring up the country’s infrastructure.

http://news.berkeley.edu/2013/04/18/deepwater-horizon/

#Business #economics #Engineering #safety #government

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1   NDrLoR   2016 Jul 6, 8:46am  

anonymous says

Bea added that the systemic problems extend beyond corporations to government and regulatory agencies in the United States

Probably the reason we're always hearing that cliche "they fell through the cracks" of Child Protective Services.

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