Causation models design factors

In the causation model presented in this chapter, there is a plea for recognition of the impact an organization s culture has on causal factor development, as well as for a balanced, systemic approach that addresses the design and engineering, the management and operational, and the task performance causal factors. 

Most causation models have minimized less than adequate design and engineering concepts and outcomes as a source of causal factors for hazards-related incidents, with one significant exception. That exception is MORT—the management oversight and risk tree. Concepts on which MORT is based have influenced my thinking greatly, and I am indebted to all who worked on the creation and betterment of MORT. 

Strong emphasis is given in this causation model to the causal factors that arise out of less than adequate design management practices. As the term is used here, design encompasses aU processes applied in devising a system to achieve results. 

Or, assume that the causation model is to relate to the concepts on which the management oversight and risk tree is based (a) the system safety idea and (b) an understanding that causal factors may derive from workplace or work methods design. 

Application of an incident causation model that properly balances causal factors deriving from less than adequate policies, standards, or procedures that impact on design management, operations management, and task performance... 

If the environment that has been constructed— which derives from the design of the physical aspects of the workplace, or the design of the work methods, or operational and management influences—results in logical and normal behavior that is considered unsafe, it would seem that a causation model should give prominent emphasis to the decision making out of which those environmental causal factors arose. 

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