Implement the Risk Management plan described in PBMA Section 1.2.3, Develop Risk Management Plan.

1. NASA Continuous Risk Management (CRM) Website section on Risk Management Tools
2. US Coast Guard manual on Risk Based Decision-Making Guidelines.
3. Mission Success and Risk Management in the New Business Environment article.

In the quest to better manage risks and prevent serious program accidents, two competing schools of thought have emerged: Highly Reliable Organizations and Normal Accident Theory.

High reliability theorists contend that serious accidents with hazardous technologies can in fact be prevented. They assert that it is possible to operate highly complex and hazardous technological systems essentially without mistakes and an almost complete absence of catastrophic failure. The term 'high reliability organization' was coined by a Berkeley research group consisting of Todd La Porte, Karlene Roberts, and Gene Rochlin. According to HRO theory, high reliability organizations have four defining characteristics:

1. Political and organizational leaders must be committed to make safety a very high priority.
2. High reliability organizations require redundancy within and between organizational structures.
3. High reliability organizations utilize intelligent operations management in three areas to reduce the burden placed on redundancy.
4. High reliability organizations have a strong capability and desire to learn.

Normal Accident Theory:

In contrast to HRO theory, Normal Accident Theory was first developed by Charles Perrow in the late 1970s. Normal Accident Theory contends that "although such complex organizations may work hard to maintain safety and reliability, serious accidents are nonetheless a 'normal' result or an integral characteristic of the system. Serious accidents in organizations managing hazardous technologies may be rare, but they are inevitable over time."

 

The debate continues between these two theories, but regardless of your particular beliefs, there is much that can be learned from studying both schools of thought. Program managers in charge of highly complex and potentially hazardous systems are encouraged to investigate these theories and consider the implications for their own program.

 

There are numerous texts, articles, and Web sites devoted to Highly Reliable Organizations and Normal Accident Theory. Some references of note from which the information presented here has been extracted include:

1. Charles Perrow, Normal Accident: Living with High Risk Technologies (New Jersey: Princeton University Press, 1999).
2. Scott D. Sagan, The Limits of Safety: Organizations, Accidents, and Nuclear Weapons (Princeton, New Jersey: Princeton University Press, 1993).
3. James Reason, Managing the Risks of Organizational Accidents (Brookfield, Vermont: Ashgate Publishing Co., 1997).
4. When Failure is Not an Option, by Robert Pool.
5. Normal Accident Theory is summarized in a presentation available from the NASA Code Q, Office of Safety and Mission Assurance, Risk Management Web site.