Human and Organisational Factors in Major Accident Prevention
Deepwater Horizon oil rig burns after April 2010 explosion
Photo by U.S. Coast Guard
Human and organisational factors (HOF) are a widely recognised cause of major industrial accidents. They occur in a variety of sectors, including oil and gas, nuclear, aviation, manufacturing, and mining industries. While HOF have long been recognised as an important component of major accident prevention efforts in the nuclear and aviation sectors, it is only more recently that HOF practice has been developed in the oil and gas industry.
Health, safety and the environment is a priority area for high reliability organisations (HROs), yet the past 30 years have seen Piper Alpha (1988) and Fukushima (2011), among other major accidents across high-hazard industries. While high reliability organisations initially focused on the technical factors causing major accidents, they are increasingly recognising HOF as an important issue. The relevance of near misses and critical incidents is particularly important: for these organisations, even apparently insignificant errors can combine to pose a major threat to the organisation, to individuals, and to the environment.
However, there appears to be limited academic coverage of the types of initiative implemented to prevent such accidents. In recognition of this gap, RAND Europe was commissioned by TOTAL E&P Research and Development to conduct research into academic insights and industry approaches to HOF in major accident prevention.
The project intended to deliver insights into the ways in which HOF are integrated in major accident prevention efforts in the oil and gas industry, as well as in the nuclear and civil aviation sectors. These are two sectors, which, despite their varying levels of risk acceptability, face comparable issues and challenges. RAND Europe’s study aimed to identify lessons from the nuclear and aviation sectors, which can inform HOF practice in the oil and gas industry.
By drawing on insights from industry experts and from the extensive body of existing academic literature on the topic, the work will enhance understanding of the types of initiatives that can be implemented to limit the risk of accidents in the oil and gas industry.
The project focused on three areas:
Insights from academia, including a literature review and interviews with academic experts to derive insights from academic study on the subject of HOF in major accident prevention.
Lessons from other sectors, considering initiatives pursued in the nuclear and civil aviation sectors with insights being gleaned through a combination of literature review and interviews.
Lessons from the oil and gas sector, consisting of a high-level mapping of the initiatives adopted within the oil and gas sector, largely enabled through a literature review and a series of interviews.
Academic focus on accidents has shifted from ‘human error’ to ‘human and organisational factors’, with a broader understanding of factors affecting system safety. However, studies still attribute 80 per cent of accidents to mistakes by individuals.
Accidents are no longer considered to be caused by a single ‘chain of events’ (e.g. with each accident causing the next) and are now seen as less linear and more complex.
The literature highlights several ‘good practices’ in accident prevention, such as adopting a ‘no-blame’ approach to error management, establishing a reporting culture, which involves maintaining a detailed record of errors and near misses, and providing training tailored to the specific human and organisational challenges faced by an organisation.
Economic pressures, regulatory constraints and cultural limitations can impede major accident prevention efforts within organisations.
In organisational cultures that focus on ‘human error’ leading to accidents, employees do not report errors due to a fear of being blamed, which can lead to accidents that could have been addressed at an earlier stage.
Productive partnerships have been formed between academia and industry, with instances where academic research has translated into industry practice. However, much of the academic knowledge related to human and organisational factors is too abstract to be applied practically.
Academic interviewees reported a perception that industry could do more to engage with the academic research community to capitalise on their expertise in human and organisational factors. This would be part of a wider programme of organisational learning and innovation for safety management.
A standardised classification of human and organisational factors should be developed for the oil and gas sector, drawing on both industrial and academic inputs. This would enable a common understanding of the risks of human and organisational factors, and help to stimulate new research addressing the specific challenges of the oil and gas industry.
An accessible overview of theories and trends of human and organisational factors over time should be developed for the oil and gas sector.
Oil and gas sector companies should continue to develop effective engagement models in partnership with universities and research institutes. This would help to facilitate knowledge transfer between academia and industry.
RAND Europe was commissioned by TOTAL E&P Research and Development to consider the role of human and organisational factors in major accident prevention in the oil and gas sector. The work drew on insights from industrial and academic experts.