Business leaders believe that we are winning the safety game, thundering towards a decisive victory of zero harm to our employees and communities, because the numbers say so. They are well intentioned, but unaware that the creative heart of the business (innovation) is slowly being suffocated by the clogging of arteries, by the safety system…

Safety performance in many companies and even industries has stalled in the last decade. Accidents rates are at a "plateau" and yet, serious accidents and fatality rates are not. In more dramatic cases, such as in the BP/Transocean Horizon Oil Rig disaster in the Gulf of Mexico, organizations that have "exemplary" safety statistics, suddenly experience a catastrophic event.

Looking into the root causes of these accidents provides an insight into the events and deficiencies that led up to the accident, but what are the common features in the organization's mindset, or its culture? What characterizes these organization's decision-making, their approach to safety and to risk and are there features that can be delineated? The research and review presented in this paper covers a period since 1994, which started in the Australian resource industry and since then covered international events.

The problem may not be what we are "doing wrong", but what are "doing right"… It may be that the very intent and processes of our current safety management paradigms are killing the heart of any business: its ability to innovate, renew and respond to adversity from within…

It may be that the organization has slowly lost its ability to be ‘safe’ within its operational processes, and increasingly became dependent on the legions of specialists, bolted-on systems and defenses.

It may be that the safety function in businesses started out like a benign tumor, grown out of proportion…and then slowly turned malignant.

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