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Normal Accidents analyzes the social side of technological risk. Charles Perrow argues that the conventional engineering approach to ensuring safety--building in more warnings and safeguards--fails because systems complexity makes failures inevitable. He asserts that typical precautions, by adding to complexity, may help create new categories of accidents. (At Chernobyl, tests of a new safety system helped produce the meltdown and subsequent fire.) By recognizing two dimensions of risk--complex versus linear interactions, and tight versus loose coupling--this book provides a powerful framework for analyzing risks and the organizations that insist we run them. The first edition fulfilled one reviewer's prediction that it "may mark the beginning of accident research." In the new afterword to this edition Perrow reviews the extensive work on the major accidents of the last fifteen years, including Bhopal, Chernobyl, and the Challenger disaster. The new postscript probes what the author considers to be the "quintessential 'Normal Accident'" of our time: the Y2K computer problem.
Post Normal Accident by Jean-Christophe Le Coze Pdf
Post Normal Accident revisits Perrow’s classic Normal Accident published in 1984 and provides additional insights to our sociological view of safety-critical organisations. The operating landscape of high-risk systems has indeed profoundly changed in the past 20 to 30 years but the core sociological models of safety remain associated with classics of the 1980s and 1990s. This book examines the conceptual and empirical evolutions of the past two to three decades to explore their implications for safety management based on several strands of works in various research traditions in safety (e.g. cognitive engineering and system safety, high-reliability organisation, sociology of safety, regulatory studies) and other interdisciplinary fields (e.g. international business, globalisation studies, strategy management, ecology). It offers a new and insightful interpretation to the challenges of today. It investigates how globalisation has reconfigured the operating landscape of high-risk systems and emphasises the importance of thinking safety through a strategic angle. This book serves as an ideal resource for the safety professionals and safety researchers from any established disciplines such as sociology, engineering, psychology, political science or management. Features: Introduces an original analysis of popular safety writings, including Normal Accident, by Perrow Identifies the importance of thinking safety from a sociological angle with the help of key writers Stresses the need for greater sensitivity to strategy and "errors from the top" when it comes to the safety of high-risk systems Explains how globalisation has reconfigured the operating landscape of high-risk systems Renews our understanding of the current safety management challenges in an increasingly global risk picture
Environmental tragedies such as Chernobyl and the Exxon Valdez remind us that catastrophic accidents are always possible in a world full of hazardous technologies. Yet, the apparently excellent safety record with nuclear weapons has led scholars, policy-makers, and the public alike to believe that nuclear arsenals can serve as a secure deterrent for the foreseeable future. In this provocative book, Scott Sagan challenges such optimism. Sagan's research into formerly classified archives penetrates the veil of safety that has surrounded U.S. nuclear weapons and reveals a hidden history of frightening "close calls" to disaster.
On April 14, 1994, two U.S. Air Force F-15 fighters accidentally shot down two U.S. Army Black Hawk Helicopters over Northern Iraq, killing all twenty-six peacekeepers onboard. In response to this disaster the complete array of military and civilian investigative and judicial procedures ran their course. After almost two years of investigation with virtually unlimited resources, no culprit emerged, no bad guy showed himself, no smoking gun was found. This book attempts to make sense of this tragedy--a tragedy that on its surface makes no sense at all. With almost twenty years in uniform and a Ph.D. in organizational behavior, Lieutenant Colonel Snook writes from a unique perspective. A victim of friendly fire himself, he develops individual, group, organizational, and cross-level accounts of the accident and applies a rigorous analysis based on behavioral science theory to account for critical links in the causal chain of events. By explaining separate pieces of the puzzle, and analyzing each at a different level, the author removes much of the mystery surrounding the shootdown. Based on a grounded theory analysis, Snook offers a dynamic, cross-level mechanism he calls "practical drift"--the slow, steady uncoupling of practice from written procedure--to complete his explanation. His conclusion is disturbing. This accident happened because, or perhaps in spite of everyone behaving just the way we would expect them to behave, just the way theory would predict. The shootdown was a normal accident in a highly reliable organization.
Accidents of Nature by Harriet McBryde Johnson Pdf
I'm in the middle of a full-blown spaz-attack, and I don't care. I don't care at all. At home I always try to act normal, and spaz-attacks definitely aren't normal. Here, people understand. They know a spaz-attack signals that I'm excited. They're excited too, so they squeal with me; some even spaz on purpose, if you can call that spazzing . . . An unforgettable coming-of-age novel about what it's like to live with a physical disability It's the summer of 1970. Seventeen-year-old Jean has cerebral palsy, but she's always believed she's just the same as everyone else. She's never really known another disabled person before she arrives at Camp Courage. As Jean joins a community unlike any she has ever imagined, she comes to question her old beliefs and look at the world in a new light. The camp session is only ten days long, but that may be all it takes to change a life forever. Henry Holt published Harriet McBryde Johnson's adult memoir, Too Late to Die Young, in April 2005. Ms. Johnson has been featured in The New York Times Magazine and has been an activist for disability rights for many years.
'Move over King, Chuck Wendig is the new voice of modern American horror' Adam Christopher 'A rich, rewarding tale' The Guardian ____________________________________________________________________________ A family returns to their hometown - and to the dark past that haunts them still - in this masterpiece of literary horror by the New York Times bestselling author of Wanderers When Nate's father dies, he leaves behind a final gift for his son: his childhood home. Married now, Nate decides to move in with his wife, Maddie, and their son, Oliver, seeking peace from the chaos of the city. But it doesn't take long before things get strange in the night and even stranger by day. Because Nate was a child being abused by his father, and has never told his family. Because Maddie was a little girl who saw something she shouldn't have. Because something sinister, something hungry, walks in the tunnels and the mountains and the coal mines of this town in rural Pennsylvania... And now, what happened all those years ago is happening again, and this time, it is happening to Oliver. When he meets a strange boy with secrets of his own and a taste for dark magic, he has no idea that what comes next will put his family at the heart of a battle of good versus evil. ____________________________________________________________________________ 'The dread, the scope, the pacing, the turns-I haven't felt all this so intensely since The Shining' - Stephen Graham Jones 'Universally horrifying and viscerally intimate, Wendig brilliantly uses The Book of Accidents to explore a painful truth: in the end, we all haunt ourselves' - Kiersten White
Charles Perrow is famous worldwide for his ideas about normal accidents, the notion that multiple and unexpected failures--catastrophes waiting to happen--are built into our society's complex systems. In The Next Catastrophe, he offers crucial insights into how to make us safer, proposing a bold new way of thinking about disaster preparedness. Perrow argues that rather than laying exclusive emphasis on protecting targets, we should reduce their size to minimize damage and diminish their attractiveness to terrorists. He focuses on three causes of disaster--natural, organizational, and deliberate--and shows that our best hope lies in the deconcentration of high-risk populations, corporate power, and critical infrastructures such as electric energy, computer systems, and the chemical and food industries. Perrow reveals how the threat of catastrophe is on the rise, whether from terrorism, natural disasters, or industrial accidents. Along the way, he gives us the first comprehensive history of FEMA and the Department of Homeland Security and examines why these agencies are so ill equipped to protect us. The Next Catastrophe is a penetrating reassessment of the very real dangers we face today and what we must do to confront them. Written in a highly accessible style by a renowned systems-behavior expert, this book is essential reading for the twenty-first century. The events of September 11 and Hurricane Katrina--and the devastating human toll they wrought--were only the beginning. When the next big disaster comes, will we be ready? In a new preface to the paperback edition, Perrow examines the recent (and ongoing) catastrophes of the financial crisis, the BP oil spill, and global warming.
A “delightfully astute” and “entertaining” history of the mishaps and meltdowns that have marked the path of scientific progress (Kirkus Reviews, starred review). Radiation: What could go wrong? In short, plenty. From Marie Curie carrying around a vial of radium salt because she liked the pretty blue glow to the large-scale disasters at Chernobyl and Fukushima, dating back to the late nineteenth century, nuclear science has had a rich history of innovative exploration and discovery, coupled with mistakes, accidents, and downright disasters. In this lively book, long-time advocate of continued nuclear research and nuclear energy James Mahaffey looks at each incident in turn and analyzes what happened and why, often discovering where scientists went wrong when analyzing past meltdowns. Every incident, while taking its toll, has led to new understanding of the mighty atom—and the fascinating frontier of science that still holds both incredible risk and great promise.
Institute of Medicine,Committee on Quality of Health Care in America
Author : Institute of Medicine,Committee on Quality of Health Care in America Publisher : National Academies Press Page : 312 pages File Size : 45,8 Mb Release : 2000-03-01 Category : Medical ISBN : 9780309068376
To Err Is Human by Institute of Medicine,Committee on Quality of Health Care in America Pdf
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine
A fascinating and highly accessible look at the surprising role serendipity has played in some of the most important medical discoveries in the twentieth century.
The Normal Accident Theory of Education by Andrew K. Milton Pdf
Much of the current debate about education too often resembles the blind men describing an elephant--apprehending only a particular part of the situation or the process, many analysts tell an evocative but incomplete story. The so-called ‘reform’ discussion proceeds with a lack of depth about the nuances and realistic limitations in the institutional order of school. This book argues that as regulation of schools moves further up the bureaucratic hierarchy (first to state departments of education then to the national department of education) the legal and institutional requirements get more intensive but less concretely useful in class rooms. This bureaucratization serves to ‘tighten’ the organizational environment, thereby increasing the risk of normal accidents. The increasing governmental management, in other words, makes it more likely that schools will ‘fail’ to meet their goals. Analyses of education are too often developed for public consumption in a fast-moving political world. This book examines some of the deeper organizational reasons why things don’t work so well in school, as well as a look at some of things that do work. Most importantly, the book will explain how the social and cultural expectations of what schools can do may create unrealistic hopes. We, as a society, and schools, as institutions, embrace these unreasonably high hopes at our collective peril.
Pre-Accident Investigations by Dr Todd Conklin Pdf
This book is a set of new skills written for the managers that drive safety in their workplace. This is Human Performance theory made simple. If you are starting a new program, revamping an old program, or simply interested in understanding more about safety performance, this guide will be extremely helpful.
Many organisations live with hazards that have the potential to cause disaster. This was the case at Moura underground coal mine in Central Queensland, where 11 men died in an explosion in 1994. Andrew Hopkins shows that the explosion was the result of organisational failure, and uses it to draw lessons about managing major hazards. He argues that there are always tell-tale signs of impending disaster, and that organisations need to find ways of gathering this information and reacting to it appropriately. The Moura story also demonstrates the need to move responsibility for risk management up the corporate hierarchy to ensure that it is not overshadowed by production pressures. Otherwise disasters will repeat themselves in horrifyingly similar ways. Managing Major Hazards is a gripping story and essential reading for occupational health and safety professionals, executives working in hazardous industries, policy makers, and readers interested in risk management and disaster studies.
Winner of the 2019 National Business Book Award A groundbreaking take on how complexity causes failure in all kinds of modern systems—from social media to air travel—this practical and entertaining book reveals how we can prevent meltdowns in business and life. A crash on the Washington, D.C. metro system. An accidental overdose in a state-of-the-art hospital. An overcooked holiday meal. At first glance, these disasters seem to have little in common. But surprising new research shows that all these events—and the myriad failures that dominate headlines every day—share similar causes. By understanding what lies behind these failures, we can design better systems, make our teams more productive, and transform how we make decisions at work and at home. Weaving together cutting-edge social science with riveting stories that take us from the frontlines of the Volkswagen scandal to backstage at the Oscars, and from deep beneath the Gulf of Mexico to the top of Mount Everest, Chris Clearfield and András Tilcsik explain how the increasing complexity of our systems creates conditions ripe for failure and why our brains and teams can't keep up. They highlight the paradox of progress: Though modern systems have given us new capabilities, they've become vulnerable to surprising meltdowns—and even to corruption and misconduct. But Meltdown isn't just about failure; it's about solutions—whether you're managing a team or the chaos of your family's morning routine. It reveals why ugly designs make us safer, how a five-minute exercise can prevent billion-dollar catastrophes, why teams with fewer experts are better at managing risk, and why diversity is one of our best safeguards against failure. The result is an eye-opening, empowering, and entirely original book—one that will change the way you see our complex world and your own place in it.
Crash Course by Diane Poole Heller,Laurence S. Heller Pdf
Trauma following automobile accidents can persist for weeks, months, or longer. Symptoms include nervousness, sleep disorders, loss of appetite, and sexual dysfunction. In Crash Course, Diane Poole Heller and Laurence Heller take readers through a series of case histories and exercises to explain and treat the health problems and trauma brought on by car accidents.
