New Safety Culture Assessment at the Hanford Waste Treatment Plant

Hanford WTP

The Department of Energy (DOE) recently released the latest safety culture (SC) assessment report* for the Hanford Waste Treatment Plant (WTP or “vit plant”) project.  The 2015 report follows similar SC assessments conducted in 2011 and 2014, all of which were inspired by the Defense Nuclear Facilities Safety Board’s scathing 2011 report on SC at the WTP.  This post provides a brief overview of the report’s findings then focuses on the critical success factors for a healthy SC.

Assessment Overview

The 2011, 2014 and 2015 assessments used the same methodology, with multiple data collection methods, including interviews, Behavioral Anchored Rating Scales (BARS)** and a SC survey.  Following are selected highlights from the 2015 report.

DOE’s Office of River Protection (ORP) has management responsibility for the WTP project.  In general, ORP personnel feel more positive about the organization’s SC than they did during the 2014 assessment.  Feelings of confusion about ORP’s more collaborative relationship with Bechtel (the prime contractor) have lessened.  ORP management is perceived to be more open to constructive criticism.  Concerns remain with lack of transparency, trust issues and the effectiveness of the problem resolution process.

Bechtel personnel were more positive than in either previous SC assessment.  Bechtel has undertaken many SC-related initiatives including the promotion of a shared mental model of the project by senior Bechtel managers.  In 2014, Bechtel Corporate’s role in project decision making was perceived to skew against SC concerns.  The creation of a new Bechtel nuclear business unit has highlighted the special needs of nuclear work. (pp. 2, 39)  On the negative side, craft workers remain somewhat suspicious and wary of soft retributions, e.g., being blamed for their own industrial mishaps or having their promotion or layoff chances affected by reporting safety issues.

See this newspaper article*** for additional details on the report’s findings. 

Critical Success Factors for a Healthy SC

We always look at the following areas for evidence of SC strength or weakness: management’s decision making process, recognition and handling of goal conflicts, the corrective action program and financial incentives.

Decision Making

Both ORP and Bechtel interviewees complained of a lack of basis or rationale for different types of decisions. (pp. 9, 16)  Some ORP and Bechtel interviewees did note that efforts to clarify decision making are in process. (pp. 13, 32)  Although the need to explain the basis for decisions was recognized, there was no discussion of the decision making process itself.  This is especially disappointing because decision making is one of the possible behaviors that can be included in a BARS analysis, but was not chosen for this assessment.

Goal Conflicts

Conflicts among cost, schedule and safety goals did not rise to the level of a reportable problem.  ORP interviewees reported that cost and schedule do not conflict with safety in their individual work. (p. 6)  Most Bechtel interviewees do not perceive schedule pressures to be the determining factor while completing various tasks. (p. 23)  Overall, this is satisfactory performance.

Corrective Action Program

We believe how well an organization recognizes and permanently resolves its problems is important.  Problem Identification and Resolution was one of the traits evaluated in the assessment.  ORP interviewees said that current safety concerns are being addressed.  The historical lack of management feedback on problem resolution is still a disincentive for reporting problems. (pp. 8-9)  Some Bechtel interviewees said “issue resolution with management engagement was the single most positive improvement in problem resolution, . . .” (p. 24)  This performance is minimally acceptable but needs ongoing attention.

Financial Incentives

DOE’s contract with Bechtel now includes incentives for Bechtel if it self-identifies problems (rather than waiting for DOE or some other party to identify them).  ORP believes the incentives are a positive influence on contractor performance. (p. 8)  Bechtel interviewees also believe the new contract has had a positive impact on the project.  However, Bechtel has a goal to reduce legacy issues and some believe the contract’s emphasis on new issues distracts from addressing legacy problems. (pp. 24-25)  The assessment had no discussion of either ORP or Bechtel senior management financial incentives.  The new contract conditions are good; ignoring senior management incentives is unacceptable.

Safety Conscious Work Environment (SCWE)

We usually don’t pay much attention to SCWE at nuclear power plants because it is part of the larger cultural milieu.  But SCWE has been a long-standing issue at various DOE facilities, as well as the impetus for the series of WTP SC assessments, so we’ll look at a few highlights from the SC survey data.

For ORP, mean responses to five of the six SCWE questions were higher (better) in 2015 vs 2014, and 2014 vs 2011.  However, for one question “Concerns raised are addressed” the mean is lower (worse) in 2015 vs 2014, and significantly lower in 2015 vs 2011.  This may indicate an issue with problem resolution. (p. B-2) 

For Bechtel, mean responses to all six SCWE questions were significantly higher (better) in 2015 vs 2014.  However, the 2011 data were not included so we cannot make any inference about possible longer-term trends. (p. B-5)  What is shown is good news because it appears people feel freer to raise safety concerns.  Interestingly, Bechtel’s mean 2015 responses were 5-13% higher (better) than ORP’s for all questions.

Both ORP and Bechtel are showing acceptable performance but continued improvement efforts are warranted.

Our Perspective

The Executive Summary and Conclusions suggest ORP and especially Bechtel have turned the corner since 2014. (pp. v, 37)  This is arguably true for SCWE but we’d say the jury is still out on improvement in the broader SC, based on our look at the BARS data.

For ORP, the BARS data mean scores are higher for 4 (out of 10) behaviors in 2015 vs 2014, but only higher for 1 behavior in 2015 vs 2011. (p. B-1)  The least charitable interpretation is ORP’s view of itself has not yet re-achieved 2011 levels.  For Bechtel the BARS data shows a bit brighter picture.  Mean scores are higher for 6 (out of 10) behaviors in 2015 vs 2014, and higher for 4 behaviors for 2015 vs 2011. (p. B-4)

The format of the report is probably intended to be reader-friendly but it mixes qualitative interview data and selected quantitative data from BARS and the survey.  The use of modifiers like “many” and “some” creates a sense of relative frequency or importance but no real specificity.  It’s impossible to say how much (if any) cherry picking of the interview data occurred.****

We also wonder about the evaluation team’s level of independence and optimism.  This is the first time DOE has performed a WTP SC assessment without the extensive use of outside consultants.  Put bluntly, how independent was the team’s effort given DOE Headquarters’ desire to see improvements at WTP?  And it’s not just HQ; DOE is under the gun from Congress, the DNFSB, the Government Accountability Office, and environmental activists and regulators to clean up their act at Hanford.

We want to see a stronger SC at Hanford but we’ll go with Ronald Reagan on this report: “Trust, but verify.”


*  DOE Office of Enterprise Assessments, “Follow-up Assessment of Safety Culture at the Hanford Site Waste Treatment and Immobilization Plant” (June, 2015).  We have followed the WTP saga for years; please click on the Vit Plant label to see our related posts.

**  Behavioral Anchored Rating Scales (BARS) quantitatively summarize interviewees’ perceptions of their organization using specific examples of good, moderate, and poor performance.   There are 17 possible organizational behaviors in a BARS analysis, but only 10 were used in this assessment:  Attention to Safety, Coordination of Work, Formalization, Interdepartmental Communication, Organizational Learning, Performance Quality, Problem Identification and Resolution, Resource Allocation, Roles and Responsibilities and Time Urgency. (p. C-2)

***  A. Cary, “DOE: Hanford vit plant safety culture shows improvement,” Tri-City Herald (June 26, 2015).

****  The report also includes multiple references to the two organizations’ behavioral norms that were inferred from the survey data.  It’s not exactly consultant mumbo-jumbo but it’s too complicated to attempt to explain in this space.

Safety Culture at Chevron’s Richmond, CA Refinery

The U.S. Chemical Safety and Hazard Investigation Board (CSB) released its final report* on the August 2012 fire at the Chevron refinery in Richmond, CA caused by a leaking pipe.  In the discussion around the CSB’s interim incident report (see our April 16, 2013 post) the agency’s chairman said Chevron’s safety culture (SC) appeared to be a factor in the incident.  This post focuses on the final report findings related to the refinery’s SC.

During their investigation, the CSB learned that some personnel were uncomfortable working around the leaking pipe because of potential exposure to the flammable fluid.  “Some individuals even recommended that the Crude Unit be shut down, but they left the final decision to the management personnel present.  No one formally invoked their Stop Work Authority.  In addition, Chevron safety culture surveys indicate that between 2008 and 2010, personnel had become less willing to use their Stop Work Authority. . . . there are a number of reasons why such a program may fail related to the ‘human factors’ issue of decision-making; these reasons include belief that the Stop Work decision should be made by someone else higher in the organizational hierarchy, reluctance to speak up and delay work progress, and fear of reprisal for stopping the job.” (pp. 12-13) 

The report also mentioned decision making that favored continued production over safety. (p. 13)  In the report’s details, the CSB described the refinery organization’s decisions to keep operating under questionable safety conditions as “normalization of deviance,” a term popularized by Diane Vaughn and familiar to Safetymatters readers. (p. 105) 

The report included a detailed comparison of the refinery’s 2008 and 2010 SC surveys.  In addition to the decrease in employees’ willingness to use their Stop Work Authority, surveyed operators and mechanics reported an increased belief that using such authority could get them into trouble (p. 108) and that equipment was not properly cared for. (p. 109) 

Our Perspective

We like the CSB.  They’re straight shooters and don’t mince words.  While we are not big fans of SC surveys, the CSB’s analysis of Chevron’s SC surveys appears to show a deteriorating SC between 2008 and 2010. 

Chevron says they agree with some CSB findings however Chevron believes “the CSB has presented an inaccurate depiction of the Richmond Refinery’s current process safety culture.”  Chevron says “In a third-party survey commissioned by Contra Costa County, when asked whether they feel free to use Stop Work Authority during any work activity, 93 percent of Chevron refinery workers responded favorably.  The overall results for the process safety survey exceeded the survey taker’s benchmark for North American refineries.”**  Who owns the truth here?  The CSB?  Chevron?  Both?    

In 2013, the city of Richmond adopted an Industrial Safety Ordinance (RISO) that requires Chevron to conduct SC assessments, preserve records and develop corrective actions.  The CSB recommendations including beefing up the RISO to evaluate the quality of Chevron’s action items and their actual impact on SC. (p. 116)

Chevron continues to receive blowback from the incident.  The refinery is the largest employer and taxpayer in Richmond.  It’s not a company town but Chevron has historically had a lot of political sway in the city.  That’s changed, at least for now.  In the recent city council election, none of the candidates backed by Chevron was elected.***

As an aside, the CSB report referenced a 2010 study**** that found a sample of oil and gas workers directly intervened in only about 2 out of 5 of the unsafe acts they observed on the job.  How diligent are you and your colleagues about calling out safety problems?

*  CSB, “Final Investigation Report Chevron Richmond Refinery Pipe Rupture and Fire,” Report No. 2012-03-I-CA (Jan. 2015).

**  M. Aldax, “Survey finds Richmond Refinery safety culture strong,” Richmond Standard (Jan. 29, 2015).  Retrieved Jan. 29, 2015.  The Richmond Standard is a website published by Chevron Richmond.

***  C. Jones, “Chevron’s $3 million backfires in Richmond election,” SFGate (Nov. 5, 2014).  Retrieved Jan. 29, 2015.

****  R.D. Ragain, P. Ragain, Mike Allen and Michael Allen, “Study: Employees intervene in only 2 of 5 observed unsafe acts,” Drilling Contractor (Jan./Feb. 2011).  Retrieved Jan. 29, 2015.

Update on INPO Safety Culture Study

On October 22, 2010 we reported on an INPO study that correlated safety culture (SC) survey data with safety performance measures.  A more complete version of the analysis was published in an academic journal* this year and this post expands on our previous comments.

Summary of the Paper

The new paper begins with a brief description of SC and related research.  Earlier research suggests that some modest relationship exists between SC and safety performance but the studies were limited in scope.  Longitudinal (time-based) studies have yielded mixed results.  Overall, this leaves plenty of room for new research efforts.

According to the authors, “The current study provides a unique contribution to the safety culture literature by examining the relationship between safety culture and a diverse set of performance measures [NRC industry trends, ROP data and allegations, and INPO plant data] that focus on the overall operational safety of a nuclear power plant.” (p. 39)  They hypothesized small to medium correlations between current SC survey data and eleven then-current (2010) and future (2011) safety performance measures.**

The 110-item survey instrument was distributed across the U.S. nuclear industry and 2876 useable responses were received from employees and contractors representing almost all U.S. plants.  Principal components analysis (PCA) was applied to the survey data and resulted in nine useful factors.***  Survey items that did not have a high factor loading (on a single factor) or presented analysis problems were eliminated, resulting in 60 useful survey items.  Additional statistical analysis showed that the survey responses from each individual site were similar and the various sites had different responses on the nine factors.

Statistically significant correlations were observed between both overall SC and individual SC factors and the safety performance measures.****  A follow-on regression analysis suggested “that the factors collectively accounted for 23–52% of the variance in concurrent safety performance.” (p. 45)

“The significant correlations between overall safety culture and measures of safety performance ranged from -.26 to -.45, suggesting a medium effect and that safety culture accounts for 7–21% of the variance in most of the measures of safety performance examined in this study.” (p. 45)

Here is an example of a specific finding: “The most consistent relationship across both the correlation and regression analyses seemed to be between the safety culture factor questioning attitude, and the outcome variable NRC allegations. . . .Questioning attitude was also a significant predictor of concurrent counts of inspection findings associated with ROP cross-cutting aspects, the cross-cutting area of human performance, and total number of SCCIs. Fostering a questioning attitude may be a particularly important component of the overall safety culture of an organization.” (p. 45)

And another: “It is particularly interesting that the only measure of safety performance that was not significantly correlated with safety culture was industrial safety accident rate.” (p. 46)

The authors caution that “The single administration of the survey, combined with the correlational analyses, does not permit conclusions to be drawn regarding a causal relationship between safety culture and safety performance.  In particular, the findings presented here are exploratory, mainly because the correlational analyses cannot be used to verify causality and the data used represent snapshots of safety culture and safety performance.” (p. 46)

The relationships between SC and current performance were stronger than between SC and future performance.  This should give pause to those who would rush to use SC data as a leading indicator. 

Our Perspective 

This is a dense paper and important details may be missing from this summary.  If you are interested in this topic then you should definitely read the original and our October 22, 2010 post.

That recognizable factors dropped out of the PCA should not be a surprise.  In fact, the opposite would have been the real surprise.  After all, the survey was constructed to include previously identified SC traits.  The nine factors mapped well against previously identified SC traits and INPO principles. 

However, there was no explanation, in either the original presentation or this paper, of why the 11 safety performance measures were chosen out of a large universe.  After all, the NRC and INPO collect innumerable types of performance data.  Was there some cherry picking here?  I have no idea but it creates an opportunity for a statistical aside, presented in a footnote below.*****

The authors attempt to explain some correlations by inventing a logic that connects the SC factor to the performance measure.  But it just speculation because, as the authors note, correlation is not causality.  You should look at the correlation tables and see if they make sense to you, or if some different processes are at work here. 

One aspect of this paper bothers me a little.  In the October 22, 2010 NRC public meeting, the INPO presenter said the analysis was INPO’s while an NRC presenter said NRC staff had reviewed and accepted the INPO analysis, which had been verified by an outside NRC contractor.  For this paper, those two presenters are joined by another NRC staffer as co-authors.  This is a difference.  It passes the smell test but does evidence a close working relationship between an independent public agency and a secretive private entity.


*  S.L. Morrow, G.K. Koves and V.E. Barnes, “Exploring the relationship between safety culture and safety performance in U.S. nuclear power operations,” Safety Science 69 (2014), pp. 37–47.  ADAMS ML14224A131.

**  The eleven performance measures included seven NRC measures (Unplanned scrams, NRC allegations,  ROP cross-cutting aspects,  Human performance cross-cutting inspection findings, Problem identification and resolution cross-cutting inspection findings, Substantive cross-cutting issues in the human performance or problem identification and resolution area and ROP action matrix oversight, i.e., which column a plant is in) and four INPO measures (Chemistry performance, Human performance error rate, Forced loss rate and Industrial safety accident rate.

***  The nine SC factors were management commitment to safety, willingness to raise safety concerns, decision making, supervisor responsibility for safety, questioning attitude, safety communication, personal responsibility for safety, prioritizing safety and training quality.

****  Specifically, 13 (out of 22) overall SC correlations with the current and future performance measures were significant as were 84 (out of 198) individual SC factor correlations.

*****  It would be nice to know if any background statistical testing was performed to pick the performance measures.  This is important because if one calculates enough correlations, or any other statistic, one will eventually get some false positives (Type I errors).  One way to counteract this problem is to establish a more restrictive threshold for significance, e.g., 0.01 vs 0.05 or 0.005 vs. 0.01. This note is simply my cautionary view.  I am not suggesting there are any methodological problem areas in the subject paper.

A Safety Culture Guide for Regulators

This paper* was referenced in a safety culture (SC) presentation we recently reviewed.  It was prepared for Canadian offshore oil industry regulators.  Although not nuclear oriented, it’s a good introduction to SC basics, the different methods for evaluating SC and possible approaches to regulating SC.  We’ll summarize the paper then provide our perspective on it.  The authors probably did not invent anything other than the analysis discussed below but they used a decent set of references and picked appropriate points to highlight.

Introduction to SC and its Importance
 
The paper provides some background on SC, its origins and definition, then covers the Schein three-tier model of culture and the difference between SC and safety climate.  The last topic is covered concisely and clearly: “. . . safety climate is an outward manifestation of culture. Therefore, safety culture includes safety climate, but safety culture uniquely includes shared values about risk and safety.” (p. 11)  SC attributes (from the Canadian Nuclear Safety Commission) are described.  Under attributes, the authors stress one of our basic beliefs, viz., “The importance of safety is made clear by the decisions managers make and how they allocate resources.” (p. 12)  The authors also summarize the characteristics of High Reliability Organizations, Low Accident Organizations, and James Reason’s model of SC and symptoms of poor SC.

The chapter on SC as a causal factor in accidents contains an interesting original analysis.  The authors reviewed reports on 17 offshore or petroleum related accidents (ranging from helicopter crashes to oil rig explosions) and determined for each accident which of four negative SC factors (Normalization of deviance, Tolerance of inadequate systems and resources, Complacency, Work pressure) were present.  The number of negative SC factors per accident ranged from 0 (three instances) to 4 (also three instances, including two familiar to Safetymatters readers: BP Texas City and Deepwater Horizon).  The negative factor that appeared in the most accidents was Tolerance of inadequate systems and resources (10) and the least was Work pressure (4).

Assessing SC
 
The authors describe different SC assessment methods (questionnaires, interviews, focus groups, observations and document analysis) and cover the strengths and weaknesses of each method.  The authors note that no single method provides a comprehensive SC assessment and they recommend a multi-method approach.  This is familiar ground for Safetymatters readers; for other related posts, click on the “Assessment” label in the right hand column.

A couple of highlights stand out.  Under observations the authors urge caution:  “The fact that people are being observed is likely to influence their behaviour [the well-known Hawthorne Effect] so the results need to be treated with caution. The concrete nature of observations can result in too much weight being placed on the results of the observation versus other methods.“ (p. 37)  A strength of document analysis is it can evidence how (and how well) the organization identifies and corrects its problems, another key artifact in our view.

Influencing SC

This chapter covers leadership and the regulator’s role.  The section on leadership is well-trod ground so we won’t dwell on it.  It is a major (but in our opinion not the only) internal factor that can influence the evolution of SC.  The statement that “Leaders also shape the safety culture through the allocation of resources” (p. 42) is worth repeating.

The section on regulatory influence is more informative and describes three methods: the regulator’s practices, promotion of SC, and enforcement of SC regulations.  Practices refer to the ways the regulator goes about its inspection and enforcement activities with licensees.  For example, the regulator can promote organizational learning by requiring licensees to have effective incident investigation systems and monitoring how effectively such systems are used in practice. (p. 44)  In the U.S. the NRC constantly reinforces SC’s importance and, through its SC Policy Statement, the expectation that licensees will strive for a strong SC.

Promoting SC can occur through research, education and direct provision of SC-related services.  Regulators in other countries conduct their own surveys of industry personnel to appraise safety climate or they assess an organization’s SC and report their findings to the regulated entity.**  (pp. 45-46)  The NRC both supports and cooperates with industry groups on SC research and sponsors the Regulatory Information Conference (which has a SC module).

Regulation of SC means just what it says.  The authors point out that direct regulation in the offshore industry is controversial. (p. 47)  Such controversy notwithstanding, Norway has developed  regulations requiring offshore companies to promote a positive SC.  Norway’s experience has shown that SC regulations may be misinterpreted or result in unintended consequences. (pp. 48-50)  In the nuclear space, regulation of SC is a popular topic outside the U.S.; the IAEA even has a document describing how to go about it, which we reviewed on May 15, 2013.  More formal regulatory oversight of SC is being developed in Romania and Belgium.  We reported on the former on April 21, 2014 and the latter on June 23, 2014.

Our Perspective
 
This paper is written by academics but intended for a more general audience; it is easy reading.  The authors score points with us when they say: “Importantly, safety culture moves the focus beyond what happened to offer a potential explanation of why it happened.” (p. 7)  Important factors such as management decision making and work backlogs are mentioned.  The importance of an effective CAP is hinted at.

The paper does have some holes.  Most importantly, it limits the discussion on influencing SC to leadership and regulatory behavior.  There are many other factors that can affect an organization’s SC including existing management systems; the corporate owner’s culture, goals, priorities and policies; market factors or economic regulators; and political pressure.  The organization’s reward system is referred to multiple times but the focus appears to be on lower-level personnel; the management compensation scheme is not mentioned.

Bottom line: This paper is a good introduction to SC attributes, assessments and regulation.


*  M. Fleming and N. Scott, “A Regulator’s Guide to Safety Culture and Leadership” (no date).

**  No regulations exist in these cases; the regulator assesses SC and then uses its influence and persuasion to affect regulated entity behavior.

1995 ANS Safety Culture Conference: A Portal to the Past

In April 1995 the American Nuclear Society (ANS) sponsored a nuclear safety culture (SC) conference in Vienna.  This was a large undertaking, with over 80 presentations; the proceedings are almost 900 pages in length.*  Presenters included industry participants, regulators, academics and consultants.  1995 was early in the post-Soviet era and the new openness (and concerns about Soviet reactors) led to a large number of presenters from Russia, Ukraine and Eastern Europe.  This post presents some conference highlights on topics we emphasize on Safetymatters.

Decision Making

For us, decision making should be systemic, i.e., consider all relevant inputs and the myriad ways a decision can affect consequences.  The same rigor should be applied to all kinds of decisions—finance, design, operations, resource allocation, personnel, etc.  Safety should always have the highest priority and decisions should accord safety its appropriate consideration.  Some presenters echoed this view.

“Safety was (and still is) seen as being vital to the success of the industry and hence the analysis and assessment of safety became an integral part of management decision making” (p. 41); “. . . in daily practice: overriding priority to safety is the principle, to be taken into account before making any decision” (p. 66); and “The complexity of operations implies a systemic decision process.” (p. 227)

The relationship between leadership and decisions was mentioned.  “The line management are a very important area, as they must . . . realise how their own actions and decisions affect Safety Culture.  The wrong actions, or perceived messages could undermine the work of the team leaders” (p. 186); “. . . statements alone do not constitute support; in the intermediate and long-term, true support is demonstrated by behavior and decision and not by what is said.” (p. 732)

Risk was recognized as a factor in decision making.  “Risk culture yields insights that permit balanced safety vs.cost decisions to be made” (p. 325); “Rational decision making is based on facts, experience, cognitive (mental) models and expected outcomes giving due consideration to uncertainties in the foregoing and the generally probabilistic nature of technical and human matters.  Conservative decision making is rational decision making that is risk-averse.  A conservative decision is weighted in favor of risk control at the expense of cost.” (p. 435)

In sum, nuclear thought leaders knew what good decision making should look like—but we still see cases that do not live up to that standard.

Rewards

Rewards or compensation were mentioned by people from nuclear operating organizations.  Incentive-based compensation was included as a key aspect of the TEPCO management approach (p. 551) and a nuclear lab manager recommended using monetary compensation to encourage cooperation between organizational departments. (p. 643)  A presenter from a power plant said “A recognition scheme is in place . . . to recognise and reward individuals and teams for their contribution towards quality improvement and nuclear safety enhancement.” (p. 805)

Rewards were also mentioned by several presenters who did not come from power plants.  For example, the reward system should stress safety (p. 322); rewards should be given for exhibiting a “caring attitude” about SC (p. 348) and to people who call attention to safety problems. (p. 527)  On the flip side, a regulator complained about plants that rewarded behavior that might cause safety to erode. (pp. 651, 656) 

Even in 1995 the presentations could have been stronger since INSAG-4** is so clear on the topic: “Importantly, at operating plants, systems of reward do not encourage high plant output levels if this prejudices safety.  Incentives are therefore not based on production levels alone but are also related to safety performance.” (INSAG-4, p. 11)  Today, our own research has shown that nuclear executives’ compensation often favors production.   

Systems Approach

We have always favored nuclear organizational mental models that consider feedback loops, time delays, adaptation, evolution and learning—a systems approach.  Presenters’ references to a system include “commercial, public, and military operators of complex high reliability socio-technical systems” (p. 260); “. . . assess the organisational, managerial and socio-technical influences on the Safety Culture of socio-technical systems such as nuclear power plants” (p. 308); “Within the complex system such as . . . [a] nuclear power plant there is a vast number of opportunities for failures to stay hidden in the system” (p. 541); and “It is proposed that the plant should be viewed as an integrated sociotechnical system . . .” (p. 541)

There are three system-related presentations that we suggest you read in their entirety; they have too many good points to summarize here.  One is by Electricité de France (EdF) personnel (pp. 193-201), another by Constance Perin (pp. 330-336) and a third by John Carroll (pp. 338-345). 

Here’s a sample, from Perin: “Through self-analysis, nuclear organizations can understand how they currently respond socially, culturally, and technically to such system characteristics of complexity, density, obscured signals, and delayed feedback in order to assure their capacities for anticipating, preventing, and recovering from threats to safety.” (p. 330)  It could have been written yesterday.

The Role of the Regulator

By 1995 INSAG-4 had been published and generally accepted by the nuclear community but countries were still trying to define the appropriate role for the regulator; the topic merited a half-dozen presentations.  Key points included the regulator (1) requiring that an effective SC be established, (2) establishing safety as a top-level goal and (3) performing some assessment of a licensee’ safety management system (either directly or part of ordinary inspection duties).  There was some uncertainty about how to proceed with compliance focus vs. qualitative assessment.

Today, at least two European countries are looking at detailed SC assessment, in effect, regulating SC.  In the U.S., the NRC issued a SC policy statement and performs back-door, de facto SC regulation through the “bring me another rock” approach.

So conditions have changed in regulatory space, arguably for the better when the regulator limits its focus to truly safety-significant activities.

Our Perspective

In 1995, some (but not all) people held what we’d call a contemporary view of SC.  For example, “Safety culture constitutes a state of mind with regard to safety: the value we attribute to it, the priority we give it, the interest we show in it.  This state of mind determines attitudes and behavior.” (p. 495)

But some things have changed.  For example, several presentations mentioned SC surveys—their design, administration, analysis and implications.  We now (correctly) understand that SC surveys are a snapshot of safety climate and only one input into a competent SC assessment.

And some things did not turn out well.  For example, a TEPCO presentation said “the decision making process is governed by the philosophy of valuing harmony highly so that a conclusion preferred by all the members is chosen as far as possible when there are divided opinions.” (p. 583)  Apparently harmony was so valued that no one complained that Fukushima site protection was clearly inadequate and essential emergency equipment was exposed to grave hazards. 


*  A. Carnino and G. Weimann, ed., “Proceedings of the International Topical Meeting on Safety Culture in Nuclear Installations,” April 24-28, 1995 (Vienna: ANS Austria Local Section, 1995).  Thanks to Bill Mullins for unearthing this document.

**  International Nuclear Safety Advisory Group, “Safety Culture,” Safety Series No. 75-INSAG-4, (Vienna: IAEA, 1991). INSAG-4 included a definition of SC, a description of SC components, and illustrative evidence that the components exist in a specific organization.

Safety Culture at the NRC Regulatory Information Conference

NRC Public Meeting

The NRC held their annual Regulatory Information Conference (RIC) March 11-13, 2014.  It included a session on safety culture (SC), summarized below.*

NRC Presentation

The NRC presentation reviewed their education and outreach activities on the SC Policy Statement (SCPS) and their participation in IAEA meetings to develop an implementation strategy for the IAEA Nuclear Safety Action Plan. 

The only new item was Safety Culture Trait Talk, an educational brochure.  Each brochure covers one of the nine SC traits in the SCPS, describing why the trait is important and providing examples of associated behaviors and attitudes, and an illustrative scenario. 

It appears only one brochure, Leadership Safety Values and Actions, is currently available.**  A quick read suggests the brochure content is pretty good.  The “Why is this trait important?” content was derived from an extensive review of SC-related social science literature, which we liked a lot and posted about Feb. 10, 2013.  The “What does this trait look like?” section comes from the SC Common Language initiative, which we have reviewed multiple times, most recently on April 6, 2014.  The illustrative scenario is new content developed for the brochure and provides a believable story of how normalization of deviance can creep into an organization under the skirt of an employee bonus program based on plant production.

Licensee Presentations

There were three licensee presentations, all from entities that the NRC has taken to the woodshed over SC deficiencies.  Presenting at the RIC may be part of their penance but it’s interesting to see what folks who are under the gun to change their SC have to say.

Chicago Bridge & Iron, which is involved in U.S. nuclear units currently under construction, got in trouble for creating a chilled work environment at one of its facilities.  The fixes focus on their Safety Conscious Work Environment and Corrective Action Program.   Detailed activities come from the familiar menu: policy updates, a new VP role, training, oversight, monitoring, etc.  Rapping CB&I’s knuckles certainly creates an example for other companies trying to cash in on the “Nuclear Renaissance” in the U.S.  Whatever CB&I does, they are motivated to make it work because there is probably a lot of money at stake.  The associated NRC Confirmatory Order*** summarizes the history of the precipitating incident and CB&I’s required corrective actions.

Browns Ferry has had SC-related problems for a long time and has been taken to task by both NRC and INPO.  The presentation includes one list of prior plant actions that DIDN’T work while a different list displays current actions that are supposedly working.  Another slide shows improvement in SC metrics based on survey data—regular readers know how we feel about SC surveys.  The most promising initiative they are undertaking is to align with the rest of the TVA fleet on NEI 09-07 “Fostering a Strong Nuclear Safety Culture.”  Click on the Browns Ferry label to see our posts that mention the plant.

Fort Calhoun’s problems started with the 2011 Missouri River floods and just got worse, moving them further down the ROP Action Matrix and forcing them to (among many other things) complete an independent SC assessment.  They took the familiar steps, creating policies, changing out leadership, conducting training, etc.  They also instituted SC “pulse” surveys and use the data to populate their SC performance indicators.  Probably the most important action plant owner OPPD took was to hire Exelon to manage the plant.  Fort Calhoun’s SC-related NRC Confirmatory Action Letter was closed in March 2013 so they are out of the penalty box.

Bottom line: The session presentations are worth a look.


*  RIC Session T11: Safety Culture Journeys: Lessons Learned from Culture Change Efforts (Mar. 11, 2014).  Retrieved April 25, 2014.  Slides for all the presentations are available from this page.

**  “Leadership Safety Values and Actions,” NRC Safety Culture Trait Talk, no. 1 (Mar. 2014).  ADAMS ML14051A543.  Retrieved April 25, 2014.

***  NRC Confirmatory Order EA-12-189 re: Chicago Bridge and Iron (Sept. 16, 2013).  ADAMS ML13233A432.  Retrieved April 25, 2014.

Four Years of Safetymatters

Aztec Calendar

Over the four plus years we have been publishing this blog, regular readers will have noticed some recurring themes in our posts.  The purpose of this post is to summarize our perspective on these key themes.  We have attempted to build a body of work that is useful and insightful for you.

Systems View

We have consistently considered safety culture (SC) in the nuclear industry to be one component of a complicated socio-technical system.  A systems view provides a powerful mental model for analyzing and understanding organizational behavior. 

Our design and explicative efforts began with system dynamics as described by authors such as Peter Senge, focusing on characteristics such as feedback loops and time delays that can affect system behavior and lead to unexpected, non-linear changes in system performance.  Later, we expanded our discussion to incorporate the ways systems adapt and evolve over time in response to internal and external pressures.  Because they evolve, socio-technical organizations are learning organizations but continuous improvement is not guaranteed; in fact, evolution in response to pressure can lead to poorer performance.

The systems view, system dynamics and their application through computer simulation techniques are incorporated in the NuclearSafetySim management training tool.

Decision Making

A critical, defining activity of any organization is decision making.  Decision making determines what will (or will not) be done, by whom, and with what priority and resources.  Decision making is  directed and constrained by factors including laws, regulations, policies, goals, procedures and resource availability.  In addition, decision making is imbued with and reflective of the organization's values, mental models and aspirations, i.e., its culture, including safety culture.

Decision making is intimately related to an organization's financial compensation and incentive program.  We've commented on these programs in nuclear and non-nuclear organizations and identified the performance goals for which executives received the largest rewards; often, these were not safety goals.

Decision making is part of the behavior exhibited by senior managers.  We expect leaders to model desired behavior and are disappointed when they don't.  We have provided examples of good and bad decisions and leader behavior. 

Safety Culture Assessment

We have cited NRC Commissioner Apostolakis' observation that “we really care about what people do and maybe not why they do it . . .”  We sympathize with that view.  If organizations are making correct decisions and getting acceptable performance, the “why” is not immediately important.  However, in the longer run, trying to identify the why is essential, both to preserve organizational effectiveness and to provide a management (and mental) model that can be transported elsewhere in a fleet or industry.

What is not useful, and possibly even a disservice, is a feckless organizational SC “analysis” that focuses on a laundry list of attributes or limits remedial actions to retraining, closer oversight and selective punishment.  Such approaches ignore systemic factors and cannot provide long-term successful solutions.

We have always been skeptical of the value of SC surveys.  Over time, we saw that others shared our view.  Currently, broad-scope, in-depth interviews and focus groups are recognized as preferred ways to attempt to gauge an organization's SC and we generally support such approaches.

On a related topic, we were skeptical of the NRC's SC initiatives, which culminated in the SC Policy Statement.  As we have seen, this “policy” has led to back door de facto regulation of SC.

References and Examples

We've identified a library of references related to SC.  We review the work of leading organizational thinkers, social scientists and management writers, attempt to accurately summarize their work and add value by relating it to our views on SC.  We've reported on the contributions of Dekker, Dörner, Hollnagel, Kahneman, Perin, Perrow, Reason, Schein, Taleb, Vaughan, Weick and others.

We've also posted on the travails of organizations that dug themselves into holes that brought their SC into question.  Some of these were relatively small potatoes, e.g., Vermont Yankee and EdF, but others were actual disasters, e.g., Massey Energy and BP.  We've also covered DOE, especially the Hanford Waste Treatment and Immobilization Plant (aka the Vit plant).

Conclusion

We believe the nuclear industry is generally well-managed by well-intentioned personnel but can be affected by the natural organizational ailments of complacency, normalization of deviation, drift, hubris, incompetence and occasional criminality.  Our perspective has evolved as we have learned more about organizations in general and SC in particular.  Channeling John Maynard Keynes, we adapt our models when we become aware of new facts or better ways of looking at the data.  We hope you continue to follow Safetymatters.  

Timely Safety Culture Research

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.

Overview

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.

Take Away

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.

2012 NRC Safety Culture Survey Results

ADAMS ML13087A326

Originally published 4-4-13.  This version updated with data from the associated staff briefing slide presentation.

The 2012 NRC Safety Culture and Climate Survey results are available in an Inspector General report* and a consultants' slide briefing.**  The top-level findings are (1) the 2012 results are not as favorable as the previous 2009 survey results and (2) the NRC compares favorably with national norms but lags when compared to a group of high performing companies (with strong financial results and high employee survey scores).  Let's look at some of the details.  All page references are to the report except where noted otherwise. 

The survey's 132 items were aimed at evaluating employee perceptions in 20 categories.  Many of these categories primarily addressed personnel practices—communication, supervision, diversity, training, development and the like.  However, it should come as no surprise to our regular readers that the categories of interest to us address, at least in part, the key business processes of decision making, priority setting and conflict resolution, i.e., areas where the goal of safety often competes with other goals.

Four categories appear to satisfy our criteria:

DPO/Non-Concurrence (DPO): “. . . employee awareness and perceived effectiveness of the Differing Professional Opinions program and the Non-concurrence process.”  This is one type of conflict resolution.  This category had the lowest number of favorable responses (although still over 50%) in the survey. (p. 13)  Three specific DPO items were among those that showed the most slippage, i.e., had fewer favorable responses, in 2012 compared to 2009. (Slides, p. 16)  Region IV had significantly*** fewer favorable 2012 scores on DPO compared to 2009. (p. 26) 

The consultants' cover letter identified this as an area for NRC management attention, saying the agency was “Losing significant ground on negative reactions when raising views different from senior management, supervisor, and peers.” 

NRC Mission and Strategic Plan: “. . . whether employees believe management decisions are consistent with the mission and strategic plan. . . .”    Compared with the high performing companies, the NRC scored 1 point lower on NRC Mission and Strategic Plan. (p. 17)  The Office of New Reactors and Region IV had significantly fewer favorable 2012 scores on NRC Mission and Strategic Plan compared to 2009. (pp. 25-26) 

The NRC Mission and Strategic Plan was identified as one of three key drivers of employee Engagement, also a survey category**** but treated as a dependent variable in a supporting multiple regression analysis.  In responding to specific questions, employees said they believed they were “sufficiently informed about NRC's performance of its mission” and that “management decisions are consistent with the mission” but both items scored significantly lower than in 2009 and compared to the high performing companies. (Slides, p. 33)

Quality focus: “. . . employee views on . . . the sacrifice of quality work due to the need to meet a deadline or the need to satisfy a personal or political agenda.”  This category had the third lowest number of favorable responses in the survey. (p. 13)  This category was also mentioned in the consultants' cover letter: “Reinforcing a key point raised in the focus groups [but one that did not stand out in the survey results], there is a clear opportunity to impact the perception that people sacrifice quality in order to meet metrics.”

Senior Management: “. . . confidence in management’s decisions.”  Compared with the high performing companies, the NRC scored 7 points lower on Senior Management, in a 3-way tie for second lowest. (p. 17)  This result may have been affected by this item: Only 41 percent of the respondents “. . . feel significant actions have been taken as a result of the previous Safety Culture and Climate survey.” (Slides, p. 23)  This issue was included in the list of conclusions to the consultants' report.  On the other hand, at least 75% favorable responses were recorded for senior management providing a clear sense of direction and employee confidence in senior management decisions. (Slides, p. 23)  That may look good but both items scored significantly lower than in 2009 and compared to the high performing companies.

The Office of New Reactors and Region IV had significantly less favorable 2012 scores on Senior Management compared to 2009. (pp. 25-26)  Region IV also had a significantly less favorable 2012 score on Senior Management than the overall NRC score. (p. 23)

Our Perspective

The report consists of mostly charts and graphs, with a lot of superficial data slicing and dicing and some authoritative-sounding conclusions.  The slide presentation shows additional data to illustrate some problem areas.  Both documents reinforce our belief in the limited usefulness of surveys and the problems associated with over-reliance on outside experts.  My “analysis” above is obviously limited but it's difficult to dig deeply because only a few of the 132 specific items are detailed in the report and slides. 

But the available data suggest that raising views inconsistent with the party line can lead to negative reactions.  NRC employees have some confidence the agency makes decisions consistent with its mission but less confidence in their senior management to take action on survey results.   

NRC senior management has a much more favorable view of the agency's situation than the overall organization.  Senior managers' survey responses were significantly more favorable than the overall NRC response in ALL 20 categories and an average of 18 percent more favorable in the 4 categories included in this post. (Slides, p. 37)  This suggests a possible disconnect between the bosses and everyone else.

And speaking of disconnections, it appears neither the group responsible for the Nuclear Renaissance nor Region IV is fully on the same page as the rest of the agency.

Finally, the documents' omission of safety as a goal or priority is notable.  “Nuclear safety” as a goal is only mentioned in the definition of SC.  Safety is mentioned as “safety concepts” in the Training category and the “NRC’s commitment to public safety” in the Continuous Improvement Commitment category.  One might expect safety to be more front and center in the SC survey. 


*  NRC Office of the Inspector General, “2012 NRC Safety Culture and Climate Survey,” OIG-13-A-15 (March 28, 2013)  ADAMS ML13087A326.  Although this was mostly a survey, the consultants (Towers Watson) did conduct some individual interviews and focus groups to help shape the survey content. Interestingly, the definition of safety culture used in the 2012 survey was not the same as the definition in the current NRC policy statement.  Instead, an earlier definition was used to permit comparisons between current survey results and prior years.

**  Towers Watson, “Nuclear Regulatory Commission 2012 Safety Culture and Climate Survey Briefing for NRC Staff” (Nov. 8, 2012).

***  “Significant” means statistically significant.

****  Engagement “Probes employees’ willingness to recommend the NRC as a good place to work, whether they feel they are a part of the agency, their pride in working for the NRC and their belief in NRC goals, objectives, and values.” (p. 10)

The Corporate Culture Survival Guide by Edgar Shein

Our September 21, 2012 post introduced a few key elements of Prof. Edgar Schein’s “mental model” of organizational culture.  Our focus in that post was to decry how Schein’s basic construct of culture had been adopted by the nuclear industry but then twisted to fit company and regulatory desires for simple-minded mechanisms for assessing culture and cultural interventions.

In this post, we want to expand on Schein’s model of what culture is, how it can be assessed, and how its evolution can be influenced by management initiatives.  Where appropriate, we will provide our perspective based on our beliefs and experience.  All the quotes below come from Schein’s The Corporate Culture Survival Guide.*

What is Culture?

Schein’s familiar model shows three levels of culture: artifacts, espoused values and underlying assumptions.  In his view, the real culture is the bottom level: “Culture is the shared tacit assumptions of a group that have been learned through coping with external tasks and dealing with internal relationships.” (p. 217)  The strength of an organization’s culture is a function of the intensity of shared experiences and the relative success the organization has achieved.  “Culture . . . influences how you think and feel as well as how you act.” (p. 75)  Culture is thus a product of social learning. 

Our view does not conflict with Schein’s.  In our systems approach, culture is a variable that provides context for, but does not solely determine, organizational and individual decisions. 

How can Culture be Assessed?

Surveys

“You cannot use a survey to assess culture.” (p. 219)  The specific weaknesses of surveys are discussed elsewhere (pp. 78-80) but his bottom line is good enough for us.  We agree completely.

Interviews

Individual interviews can be used when interviewees would be inhibited in a group setting but Schein tries to avoid them in favor of group interviews because the latter are more likely to correctly identify the true underlying assumptions. 

In contrast, the NEI and IAEA safety culture evaluation protocols use interviews extensively, and we’ve commented on them here and here. 

Group discussion 

Schein’s recommended method for deciphering a company’s culture is a facilitated group exercise that attempts to identify the deeper (real) assumptions that drive the creation of artifacts by looking at conflicts between the artifacts and the espoused values. (pp. 82-87)   

How can Culture be Influenced?

In Schein’s view, culture cannot be directly controlled but managers can influence and evolve a culture.  In fact, “Managing cultural evolution is one of the primary tasks of leadership.” (p. 219)

His basic model for cultural change is creating the motivation to change, followed by learning and then internalizing new concepts, meanings and standards. (p. 106).  This can be a challenging effort; resistance to change is widespread, especially if the organization has been successful in the past.  Implementing change involves motivating people to change by increasing their survival anxiety or guilt; then promoting new ways of thinking, which can lead to learning anxiety (fear of loss or failure).  Learning anxiety can be ameliorated by increasing the learner’s psychological safety by using multiple steps, including training, role models and consistent systems and structures.  Our promotion of simulation is based on our belief that simulation can provide a platform for learners to practice new behaviors in a controlled and forgiving setting.

If time is of the essence or major transformational change is necessary, then the situation requires the removal and replacement of the key cultural carriers.  Replacement of management team members has often occurred at nuclear plants to address perceived performance/culture issues.
 
Schein says employees can be coerced into behaving differently but they will only internalize the new ways of doing business if the new behavior leads to better outcomes.  That may be true but we tend toward a more pragmatic approach and agree with Commissioner Apostolakis when he said: “. . . we really care about what people do and maybe not why they do it . . . .”

Bottom Line
Prof. Schein has provided a powerful model for visualizing organizational culture and we applaud his work.  Our own modeling efforts incorporate many of his factors, although not always in the same words.  In addition, we consider other factors that influence organizational behavior and feed back into culture, e.g., the priorities and resources provided by a corporate parent.


*  E.H. Schein, The Corporate Culture Survival Guide, new and revised ed. (San Francisco: Jossey-Bass, 2009).