When practitioners should keep the focus on failure
Thursday 23rd November 2017
The report's title, The Patronising Disposition of Unaccountable Power, signals the former bishop of Liverpool's belief that the families were failed by the reactions of the police and other authorities to the crowd control failures at Sheffield Wednesday's stadium.
Jones makes many recommendations that are specific to public bodies' responses to their own culpability, from an end to bottomless funding of the defence cases for public services implicated in disasters to a recommendation that a "duty of candour" be extended to the police to stop former officers refusing to testify at inquiries.
But some of the report's "points of learning" would be valuable to any organisation dealing with the media after an adverse event. Jones notes that public comments trying to pin responsibility wholly or partly on victims, such as South Yorkshire Police's attempts to blame the Liverpool fans at Hillsborough, are hard to take back later.
A "false public narrative", he says, "is an injustice in itself", and organisations and individuals should take great care in commenting before the full facts are known. He might have added that trying to shift the blame can make a bad situation reputationally far worse for the dutyholder.
A theme of the report is the tendency among the authorities to try to close the files on unfavourable episodes as fast as possible. This may reflect a desire to end the public attention, what Jones calls "an instinctive prioritisation of the reputation of an organisation", but it is not just that.
Nobody likes to dwell on failure, human nature tends towards optimism and it is understandable to want to end any chapter that causes shame or embarrassment and move on.
The report says this haste "represents a barrier to real accountability", but it can also be a barrier to a full understanding of the circumstances that allowed a catastrophe to happen.
This is a point that holds true for smaller-scale accidents short of a fatality in any organisation and even for near-misses with high potential severity. In the latter case, the urge to conclude any analysis swiftly is likely to be compounded by the fact there was no actual harm.
But OSH practitioners have a duty to make their colleagues dwell on uncomfortable events until they are sure the necessary details have been gathered, lessons learned and conditions corrected to prevent a reocurrence.
That may seem hard to square with this publication's usual message that an OSH professional is most effective when they align themselves closely with their employer's culture and objectives. But sometimes the role of critical friend is still the most valuable one a safety and health practitioner can play.