In 1964 Jim Marshall, a defensive player for the Minnesota Vikings, committed a mistake by recovering a fumble by the San Francisco 49ers and running it into the end zone – at the wrong end of the field. In the early 1990s the US Congress made a mistake by ordering continued development of the Osprey …
Are organizations emergent?
Do organizations have properties that are in some recognizable way independent from the behaviors and intentions of the individuals who inhabit them? In A New Social Ontology of Government I emphasized the ways in which organizations fail because of actor-level features: principal-agent problems, inconsistent priorities and goals across different working groups, strategic manipulation of information by some …
Regulatory failure in freight rail traffic
On any given day some 7,000 freight trains are in motion around the United States, with perhaps 70,000 individual freight cars and intermodal units in transit daily (link). (Here is the US DOT Federal Railroad Administration (FRA) website, which provides a fair amount of information about the industry.) Freight rail is big business, with record …
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The air traffic control system and ethno-cognition
Diane Vaughan's recent Dead Reckoning: Air Traffic Control, System Effects, and Risk is an important contribution to the literature on safety in complex socio-technical systems. The book is an ethnographic study of the workspaces and the men and women who manage the flow of aircraft throughout US airspace. Her ethnographic work for this study was …
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Sources of technology failure
A recurring theme in Understanding Society is the topic of technology failure -- air disasters, chemical plant explosions, deep drilling accidents. This diagram is intended to capture several dimensions of failure causes that have been discussed. The categories identified here include organizational dysfunctions, behavioral shortcomings, system failures, and regulatory dysfunctions. Each of these broad categories has contributed …
Organizational factors and nuclear power plant safety
image: Peach Bottom Nuclear Plant The Nuclear Regulatory Commission has responsibility for ensuring the safe operations of the nuclear power reactors in the United States, of which there are approximately 100. There are significant reasons to doubt whether its regulatory regime is up to the task. Part of the challenge is the technical issue of …
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Dysfunctions of Soviet economic ministries
In my book A New Social Ontology of Government (2020) I tried to provide an analytical inventory of the sources of "dysfunctions" in large organizations and government agencies. Why do agencies like FEMA or the NRC so often do such a poor job in carrying out their missions? The book proposed that we can better understand the …
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Strange defeat
One of the consequential puzzles of the Second World War was the sudden, catastrophic collapse of the French army following German invasion in 1940. This is the subject of Marc Bloch's Strange Defeat, written in 1940, and it is an event of major historical importance and mystery. The mystery is this: France was a powerful military …
China’s food-safety governance system
Food safety is a very high-level concern for ordinary consumers. This is true because the food we eat can poison us or ruin our health, and yet consumers have little ability to evaluate the safety of the foods available in the marketplace. Therefore government regulation of food safety appears to be mandatory in any complex …
The power of case studies in system safety
Images: Andrew Hopkins titles Images: Other safety sources One of the genuinely interesting aspects of the work of Andrew Hopkins is the extensive case studies he has conducted of the causation of serious industrial accidents. A good example is his analysis of the explosion of an Esso natural gas processing plant in Longford, Australia in …
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Understanding Society 