When things go wrong in the workplace, most of us are driven to find out what that one thing was that would have stopped it dead in its tracks before it even got started.

Hard-wired cognitive bias is going on for most us, but it’s also about a need to bring order to the chaos that this “wrong event” was spawned from.

Recently, I spent time reviewing 30 incident investigations that could have involved the death of a worker if they weren’t as lucky as they were. It was a bit harrowing – it nearly always is.

A couple of them were highly perceptive analytical pieces – deep, unbiased and unhurried explorations of complex socio-technical system challenges - reflective of modern-day workplaces. Lots of issues considered and uncovered in the process.

I don’t have to tell you what the other 28 were like.

It’s seductive to think a nicely branded investigation process will deliver your pathway to reliability, but how many organisations have stopped repeat failures in their tracks with this approach?

For improvement to occur, it’s not about neatly structured processes. It's about intent, it’s about curiosity, and it’s about organisations deciding they NEED to treat failure as a gift.

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