In this post we highlight the doctoral thesis paper of Antti Piirto, “Safe Operation of Nuclear Power Plants – Is Safety Culture an Adequate Management Method?”* One reason for our interest is the author’s significant background in nuclear operations.** Thus his paper has academic weight but is informed by direct management experience.
It would be impossible to credibly summarize all of the material and insights from this paper as it covers a wide swath of safety management and culture and associated research. The pdf is 164 pages. In this post we will provide an overview of the material with pointers to some aspects that seem most interesting to us.
The paper is developed from Piirto’s view that “Today there is universal acceptance of the significant impact that management and organisational factors have over the safety significance of complex industrial installations such as nuclear power plants. Many events with significant economic and public impact had causes that have been traced to management deficiencies.” (p. i) It provides a comprehensive and useful overview of the development of safety management and safety culture thinking and methods, noting that all too often efforts to enhance safety are reactive.
“For many years it has been considered that managing a nuclear power plant was mostly a matter of high technical competence and basic managerial skills.” (p. 3) And we would add, in many quarters there is a belief that safety management and culture simply flow from management “leadership”. While leadership is an important ingredient in any management system, its inherent fuzziness leaves a significant gap in efforts to systematize methods and tools to enhance performance outcomes. Again citing Piirto, safety culture is “especially vague to those carrying out practical safety work. Those involved...require explanations concerning how safety culture will alter their work” (p. 4)
Piirto also cites the prevalence in the nuclear industry of “unilateral thinking” and the lack of exposure to external criticism of current nuclear management approaches, accompanied by “homogeneous managerial rhetoric”. (p. 4)
“Safety management at nuclear power plants needs to become more transparent in order to enable us to ensure that issues are managed correctly.” (p. 6) “Documented safety thinking provides the organisation with a common starting point for future development.” (p. 8) Transparency and the documentation (preservation) of safety thinking resonates with us. When forensic efforts have been made to dissect safety thinking (e.g., see Perin’s book Shouldering Risks) it is apparent how illuminating and educational such information can be.
Culture as Control Mechanism
Piirto describes organizational culture as…”a socially constructed, unseen, and unobservable force behind organisational activities.” (p. 13) “It functions as an organisational control mechanism, informally approving or prohibiting behaviours.” (p. 14)
We would say that in terms of a control mechanism, culture’s effect should be clarified as being one of perhaps many mechanisms that ultimately combine to determine actual behavior. In our conceptual model safety culture specifically can be thought of as a resistance to other non-safety pressures affecting people and their actions. (See our post dated June 29, 2012.) Piirto calls culture a “powerful lever” for guiding behavior. (p. 15) The stronger the resident safety culture is the more leverage it has to keep in check other pressures. However it is also almost inevitable that there can be some amount of non-safety pressure that compromises the control leverage of safety culture and perhaps leads to undesired outcomes.
Some of Piirto’s most useful insights can be found on p. 14 where he explains that culture at its essence is “a concept rather than a thing” - and a concept created in people’s minds. We like the term “mental model” as well. He goes on to caution that we must remember that culture is not just a set of structural elements or constructs - “It also is a dynamic process – a social construction that is undergoing continual reconstruction.” Perhaps another way of saying this is to realize that culture cannot be understood apart from its application within an organization. We think this is a significant weakness of culture surveys that tend to ask questions in the abstract, e.g., “Is safety a high priority?”, versus exploring precisely how safety priorities are exercised in specific decisions and actions of the organization.
Piirto reviews various anthropologic and sociologic theories of culture including debate about whether culture is a dependent or independent variable (p.18), the origins of safety culture, and culture surveys. (pp. 23-24)
Some other interesting content can be found starting at Section 2.2.7 (p. 29) where Piirto reviews approaches to the assessment of safety culture, which really amounts to - what is the practical reality associated with a culture. He notes “the correlation between general preferences and specific behaviour is rather modest.” and “The Situational Approach suggests that the emphasis should be put on collecting data on actual practices, real dilemmas and decisions (what is also called “theories in use”) rather than on social norms.” (p. 29)
Knowledge Management and Training
Starting on p. 39 is a very useful discussion of Knowledge Management including its inherently dynamic nature. Knowledge Management is seen as being at the heart of decision making and in assessing options for action.
In terms of theories of how people behave, there are two types, “...the espoused theory, or how people say they act, and the theory-in-use, or how people actually act. The espoused theory is easier to understand. It describes what people think and believe and how they say they act. It is often on a conscious level and can be easily changed by new ideas and information. However, it is difficult to be aware of the theory-in-use, and it is difficult to change...” (p. 46)
At this juncture we would like to have seen a closer connection between the discussions of Knowledge Management and safety management. True, ensuring that individuals have the benefit of preserving, sustaining and increasing knowledge is important, but how exactly does that get reflected in safety management performance? Piirto does draw an analogy between systematic approaches to training and proposes that a similar approach would benefit safety management, by documenting how safety is related to practical work. “This would turn safety culture into a concrete tool. Documented safety thinking provides the organisation with a common starting point for future development.” (p. 61)
One way to document safety thinking is through event investigation. Piirto observes, “Event investigation is generally an efficient starting point for revealing the complex nature of safety management. The context of events reveals the complex interaction between people and technology in an organisational and cultural context. Event investigations should not only focus on events with high consequences; in most complex events a through investigation will reveal basic causes of great interest, particularly at the safety management level. Scientific studies of event investigation techniques and general descriptions of experience feedback processes have had a tendency to regard event investigations as too separated from a broader safety management context.” (p. 113)
In the last sections of the paper Piirto summarizes the results of several research projects involving training and assessment of training effectiveness, knowledge management and organizational learning. Generally these involve the development and training of shift personnel.
Ultimately I’m not sure that the paper provides a simple answer to the question posed in its title: Is safety culture an adequate management method? Purists would probably observe that safety culture is not a management method; on the other hand I think it is hard to ignore the reliance being placed by regulatory bodies on safety culture to help assure safety performance. And much of this reliance is grounded in an “espoused theory” of behavior rather than a systematic, structured and documented understanding of actual behaviors and associated safety thinking. Such “theory in use” findings would appear to be critical in connecting expectations for values and beliefs to actual outcomes. Perhaps the best lesson offered in the paper is that there needs to be a much better overall theory of safety management that links cultural, knowledge management and training elements.
* A. Piirto, “Safe Operation of Nuclear Power Plants – Is Safety Culture an Adequate Management Method?” thesis for the degree of Doctor of Science in Technology (Tampere, Finland: Tampere Univ. of Technology, 2012).
** Piirto has a total of 36 years in different management and supervision tasks in a nuclear power plant organization, including twelve years as the Manager of Operation for the Olkiluoto nuclear power plant.