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Method for evaluating learning from incidents using the idea of “level of learning”
Authors:Anders Jacobsson  Åsa EkRoland Akselsson
Institution:Department of Design Sciences/Ergonomics and Aerosol Technology, Faculty of Engineering, Lund University, P.O. Box 118, SE-221 00 Lund, Sweden
Abstract:Learning from incidents is considered a very important source for learning and improving safety in the process industries. However, the effectiveness of learning from reported incidents can often be questioned. Therefore, there is a need to be able to evaluate the effectiveness of learning from incidents, and for that purpose we need methods and tools. In this paper, a method is described for evaluating the effectiveness of learning, based on the idea of “level of learning” of the lessons learned. The level of learning is expressed in terms of how broadly the lesson learned is applied geographically, how much organizational learning is involved and how long-lasting the effect of learning is. In the 6-step method, the incidents reported in a typical incident learning system are evaluated both for the actual and the potential level of learning in a semi-quantitative way with different tools. The method was applied in six process industries on a large number of incidents. The method was found to be very useful and to give insights of aspects that influence the learning from incidents.
Keywords:Incident  Learning  Lesson learned  Learning level  Underlying causes  Process industry
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