Citation

Rimson IJ, Benner L. Hazard Prev. 2005; 41(4).

Copyright

(Copyright © 2005, System Safety Society)

DOI

unavailable

PMID

unavailable

Abstract

About the dreaded "Did Nots" in investigation reports, and the problems they pose.

By looking for "fault" and "blame" rather than for how to improve system performance, investigators mire themselves in myriad events that didn’t happen rather than the one set of events that did. Only the events that did happen can confirm your predictions or tell you what needs to be changed, both within the system and within your a priori analysis.

Language: en