Volume 17 Number 1 March 2009
Enhancing Organizational Resilience Through Emergency Planning: Learnings from Cross-Sectoral Lessons
Margaret T. Crichton*, Cameron G. Ramsay** and Terence Kelly***
*People Factor Consultants Ltd, 41 Regent Quay, Aberdeen AB11 5BE, UK. E-mail: margaret@peoplefactor.co.uk **Cogna Limited, Aberdeen, UK ***UKAEA, The Manor Court, Chilton, Oxfordshire, OX11 ORN
After every emergency exercise or actual incident, reports are circulated that usually identify lessons that have been learned from the event. This paper identifies recurring themes from the lessons learned that can be widely applied across sectors. Typically, lessons are expressed in a form that is specific to the actual event that has transpired, the sector in which it has occurred, and the aims of the reporting organization. Reports relating to seven incidents that have occurred in the United Kingdom and internationally, from a range of sectors and with varying parameters, have been reviewed. It is concluded that organizations can become wiser by looking at incidents outside their own sector and by using these recurring themes to explore the resilience of their emergency plans. Recommendations are also made for best practices to improve the learning of lessons within organizations.
1. Introduction
F
ollowing every accident or incident, and usually every emergency exercise, reports are prepared that typically culminate in a series of ‘lessons learned’. Reports are prepared by the organizations involved in the event, and are often circulated internally and to other related organizations. The aim is to learn from the event that has occurred and to avoid this event occurring again. Occasionally, the lessons identified are adopted across sectors. For example, lessons learned from such high-profile accidents such as Bhopal (1984: chemical), Chernobyl (1986: nuclear) and Challenger (1986: space) have had widespread influence
References: Baker Report (2007), The Report of the BP US Refineries Independent Safety Review Panel.http://news.bbc.co.uk/2/ shared/bsp/hi/pdfs/16_01_07_bp_baker_report.pdf (accessed 17 January 2007). Boin, A. and McConnell, A. (2007), ‘Editorial: Unravelling the Puzzles of Critical Infrastructures’, Journal of contingencies and crisis management, Volume 15, Number 1, pp. 1–3. Buncefield Major Incident Investigation Board (2007), Recommendations on the design and operation of fuel storage sites.http://www.buncefieldinvestigation.gov.uk/reports/recommendations.pdf (accessed 1 April 2007). Cabinet Office (2005), Preparing for emergencies.http:// www.ukresilience.info/upload/assets/www.ukresilience. info/guidance1.pdf (accessed 4 October 2007). Crichton, M. and Flin, R. (2002), ‘Command Decision Making’, in Flin, R. and Arbuthnot, K. (eds.), Incident Command. Tales from the Hot Seat, Ashgate, Aldershot, UK, pp. 201–238. Crichton, M., Flin, R. and Rattray, W.A. (2000), ‘Training Decision Makers - Tactical Decision Games’, Journal of Contingencies and Crisis Management, Volume 8, Number 4, pp. 208–217. Crichton, M., Lauche, K. and Flin, R. (2008), ‘Learning from Experience: Incident Management Team Leader Training’, in Schraagen, J.M., Militello, L., Ormerod, T. and Lipshitz, R. (eds.), Naturalistic Decision Making and Macrocognition, Ashgate, Aldershot, pp. 103–120. Crichton, M. and Ramsay, C.G. (2007a), ‘‘Lessons Learned’’: Review of NEPLG Consolidated Guidance. Confidential Report prepared for Nuclear Emergency Planning Liaison Group (NEPLG) Lessons Learned Working Group by People Factor Consultants Ltd., Aberdeen. Crichton, M. and Ramsay, C.G. (2007b), Guidance to emergency response personnel on command and control. Confidential report prepared for UK Atomic Energy Authority by People Factor Consultants Ltd. and Cogna Limited, Aberdeen. Cullen, The Hon Lord (1990), The Public Inquiry into the Piper Alpha Disaster, Volumes I and III (Cm 1310). HMSO, London. Cullen, The Hon Lord (2001), The Ladbroke Grove Rail Inquiry, Part 2 Report, Health and Safety Commission, London. Fennell, D. (1988), Investigation into the King’s Cross Underground Fire, HMSO, London. Journal of Contingencies and Crisis Management Volume 17 Number 1 March 2009 & 2009 Blackwell Publishing Ltd. Enhancing Organizational Resilience Through Emergency Planning Tranfield, D., Denyer, D. and Marcos, J. (2003), ‘Management and Development of High Reliability Organisations’, Management Focus, pp. 16–18. UK Resilience (2007). Available atwww.ukresilience.info US Chemical Safety and Hazard Investigation Board (2007), Final Investigation Report, BP Texas City Refinery Explosion and Fire, Report No. 2005–04-I-TX.http://www.chemsafety.gov/comple ted_investigations/docs/BP%20Final%20Report%203.23.07.pdf (accessed 28 March 2007). 37 Voogd, H. (2004), ‘Disaster Prevention in Urban Environments’, European Journal of Spatial Development Number 12. Weick, K.E. and Sutcliffe, K.M. (2001), Managing the Unexpected. Assuring high Performance in an Age of Complexity, Jossey Bass Wiley, San Francisco, CA. Woods, D. (2005), ‘Creating Foresight: Lessons for Enhancing Resilience from Columbia’, in Starbuck, W. and Farioun, M. (eds.), Organization at the Limit: Lessons from the Columbia Disaster, Blackwell, Malden, MA, pp. 289–308. & 2009 Blackwell Publishing Ltd. Journal of Contingencies and Crisis Management Volume 17 Number 1 March 2009