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Module 1 Theories of Risk and Crisis This module serves as an introduction to the course and to the subject area of risk, crisis and disaster management, and it is also a conceptual tool box for the rest of the course. In particular, it introduces a range of theoretical perspectives on the concepts of risk and crisis such as how risk is assessed and managed. The overarching aim of the module is to identify different perspectives and examine the extent to which they inform practice and ultimately to lay a foundation upon which future modules will build.

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Module 2 Managing Risk and Crisis

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In this module some contemporary debates about security are explored. It brings together broad developments in theories of risk in the social sciences with risk issues of relevance to security managers. It also examines the relationship between these different perspectives on risk and a general theory of security. An attempt is made to highlight the relationship between the theory and practice of risk management and security.

(updated February 2012)

Module 3 Research Methods in Risk, Crisis and Disaster Management

Theories of Risk & Crisis

This Module aims to provide students with comprehensive knowledge and understanding of methodological issues in investigation studies research. The Module introduces students to research methodology on both a theoretical and practical level. Students are encouraged to analyse critically the process of social scientific enquiry and to examine the relationship between research problems, theoretical perspectives and methodological approaches.

Module 5 Models of Risk, Crisis and Disaster This module addresses the possibility that risks, crises and disasters may be understood in different ways by different people. An air crash, for example, may be understood primarily as a potential blow to profitability by an aircraft manufacturer, as a case for investigation by the relevant police service and national accident investigation bureau, as a destabilizing influence on the stock market by brokers and investors and as a human tragedy by the tabloid press (for whom disasters provide many column-inches of material) and relatives, partners and friends of the victims. Thus the same event may be ‘constructed’ or experienced differently by different parties. This module examines how parties with different ‘investments’ (reputational, financial, emotional etc.) in crises and disasters may experience them in quite different ways.

Module 6 Emergency Planning Management This module looks at the ‘front line’ management of risks, crises and disasters. The emphasis is on practical risk, crisis and disaster management, from risk assessments produced by Britain’s Health and Safety Executive to the factors that need to be considered by emergency planners when drafting an evacuation plan. The module aims to be as eclectic as possible, including, for example, a unit on the identification and management of post-traumatic stress disorder.

The course material is and remains the property of the University (and must be immediately returned to the University upon request at any time) and is either the copyright of the University or of third parties who have licensed the University to make use of it. The course material is for the private study of the student to whom it is sent and any unauthorised use, copying or resale is not permitted. Unauthorised use may result in the course being terminated. The course material was created in the academic year 2011/2012 Civil Safety and Security Unit • University of Leicester • 14 Salisbury Road • Leicester • LE1 7QR

THEORIES OF RISK AND CRISIS

In this module a number of case studies of crises and disasters are examined. The case studies act as heuristics ‑ vehicles for exploring some of the issues and concepts introduced in modules one and two. Such issues include the impact of personality on crisis and disaster management, the influence of cultural factors and national preferences on crisis and disaster management techniques, and the impact on disaster investigations of paradigmatic interpretations of evidence. The rationale for the module is that important lessons can be learned from the detailed, objective analysis of past crises and disasters. The unit also provides an insight into the politics of the 1974 Health and Safety at Work Act, which set up the United Kingdom’s Health and Safety Executive, and into subsequent legislation on the regulation of developments close to hazardous complexes.

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Module 4 Case Studies of Crises and Disasters

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MODULE 1 THEORIES OF RISK & CRISIS Copyright The course material is and remains the property of the University (and must be immediately returned to the University upon request at any time) and is either the copyright of the University or of third parties who have licensed the University to make use of it. The course material is for the private study of the student to whom it is sent and any unauthorised use, copying or resale is not permitted. Unauthorised use may result in the student’s registration being terminated.

This course material was created in the academic year 2005/2006 and updated in the academic year 2010/2011.


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Table of Contents Unit One: An introduction to risk, crisis and disaster management.......... 1-3

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12

Introduction and study notes..................................................................................... 1-3 Contemporary issues in risk....................................................................................... 1-5 Course overview...................................................................................................... 1-8 Theories of risk and crisis........................................................................................... 1-9 Emergencies, crises and disasters............................................................................. 1-10 An introduction to health and safety......................................................................... 1-11 Systems theory and isomorphic learning.................................................................. 1-11 Safety culture.......................................................................................................... 1-12 Case studies............................................................................................................ 1-13 Guide to further reading.......................................................................................... 1-13 Study questions....................................................................................................... 1-13 Bibliography............................................................................................................ 1-14

2 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10

Unit Two: A theory of crisis.......................................................................... 2-3 Introduction.............................................................................................................. 2-3 A blizzard of terms ‌............................................................................................... 2-3 Emergencies, crises and disasters............................................................................... 2-9 Disasters................................................................................................................. 2-11 Multiple realities...................................................................................................... 2-12 Exercising................................................................................................................ 2-13 Conclusion.............................................................................................................. 2-14 Guide to further reading.......................................................................................... 2-14 Study questions....................................................................................................... 2-14 Bibliography............................................................................................................ 2-15

3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16

Unit Three: Systems ideas and risk............................................................. 3-3 Introduction.............................................................................................................. 3-3 System concepts....................................................................................................... 3-3 System categories..................................................................................................... 3-5 System environment................................................................................................. 3-8 Prediction and control............................................................................................... 3-9 Emergence and holism.............................................................................................. 3-9 System ownership................................................................................................... 3-10 World-view............................................................................................................. 3-10 Management systems.............................................................................................. 3-12 Standards for management systems......................................................................... 3-13 Integration of management systems......................................................................... 3-15 Management system risks........................................................................................ 3-16 Conclusions............................................................................................................ 3-17 Guide to reading..................................................................................................... 3-17 Study questions....................................................................................................... 3-17 Bibliography............................................................................................................ 3-18

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risk 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18

Unit 4: Health and Safety Management...................................................... 4-3 Introduction.............................................................................................................. 4-3 Definitions ............................................................................................................... 4-5 A brief history of health and safety legislation.............................................................. 4-5 The distinction between ‘health’ and ‘safety’.............................................................. 4-7 Risk and hazard......................................................................................................... 4-9 Hazard identification and risk assessment................................................................... 4-9 Hazard identification................................................................................................ 4-10 Risk assessment....................................................................................................... 4-12 Responsibility for occupational health and safety....................................................... 4-13 Some issues of application of legislation.................................................................... 4-15 Multiple jurisdictions................................................................................................ 4-18 Barriers to health and safety compliance.................................................................. 4-18 The individual within the organisation...................................................................... 4-22 The future: new technologies, health and safety....................................................... 4-23 Conclusions............................................................................................................ 4-25 Further reading....................................................................................................... 4-26 Study questions....................................................................................................... 4-26 Bibliography............................................................................................................ 4-27

5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12

Unit 5: The management of organisational risks........................................ 5-3 The development of risk management....................................................................... 5-4 Perceptions of risk..................................................................................................... 5-5 Good management is risk management..................................................................... 5-6 Problems in risk management ................................................................................... 5-7 Acts of God and other myths..................................................................................... 5-8 Organisational Learning............................................................................................. 5-9 Quantitative risk assessments..................................................................................... 5-9 Risk assessments and decision-making...................................................................... 5-10 Conclusions............................................................................................................ 5-12 Guide to further reading.......................................................................................... 5-13 Study questions....................................................................................................... 5-13 Bibliography............................................................................................................ 5-14

6 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12

Unit 6: Safety Culture.................................................................................. 6-3 Aims and objectives of this Unit................................................................................. 6-3 Introduction.............................................................................................................. 6-3 The nature of organisational culture........................................................................... 6-3 Functionalist views of organisational culture................................................................ 6-5 Interpretive views of organisational culture................................................................. 6-8 Safety Culture......................................................................................................... 6-11 Assessment of culture.............................................................................................. 6-14 The culture-risk axis................................................................................................ 6-17 Conclusion.............................................................................................................. 6-20 Guide to reading..................................................................................................... 6-21 Study questions....................................................................................................... 6-21 Bibliography............................................................................................................ 6-21


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Unit 7: Case study - the collapse of Barings Bank ...................................... 7-3 Aims and objectives of this Unit................................................................................. 7-3 Introduction.............................................................................................................. 7-3 Events leading up to the collapse of Barings Bank....................................................... 7-4 Organisational issues affecting Barings....................................................................... 7-11 Monitoring.............................................................................................................. 7-13 Losers and gainers................................................................................................... 7-14 Formal investigation of the collapse.......................................................................... 7-15 Coverage in the press............................................................................................. 7-15 Guidelines for organisations..................................................................................... 7-16 Current considerations............................................................................................ 7-17 Guide to reading..................................................................................................... 7-18 Study questions....................................................................................................... 7-18 Bibliography............................................................................................................ 7-19

8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12

Unit 8: The Summer Floods 2007................................................................ 8-3 Foreword................................................................................................................. 8-3 Objectives................................................................................................................. 8-6 A Background to Flooding......................................................................................... 8-7 Introduction to the floods of 2007............................................................................. 8-8 Social Aspects of a Flooding Disaster........................................................................ 8-10 Key Concepts......................................................................................................... 8-12 Comparative Case Studies....................................................................................... 8-16 An Ethnographic Study of a Community In Recovery after Flooding: A Researcher’s Perspective...................................................................................... 8-22 Conclusions............................................................................................................ 8-26 Study questions....................................................................................................... 8-26 Guide to further reading.......................................................................................... 8-27 Bibliography............................................................................................................ 8-28

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Welcome to the Course! Welcome to the first Unit of your MSc in Emergency Planning Management by distance learning from the University of Leicester. On behalf of all the administrative and academic staff at the Institute of Lifelong Learning please accept our best wishes for your studies, which we are sure you will find to be an interesting and stimulating experience. Producing this course is an exciting task. We now sincerely hope that you will be able to share in this experience as you progress through the units and modules – supported at every step of the way with up-to-date materials accessible through Blackboard.

You may be approaching this course with some concern and trepidation. Although natural, please do not allow yourself to be intimidated or down-heartened by the challenges that lie ahead. You can succeed – and we will do everything we can to assist. Should you begin to feel overwhelmed, isolated or otherwise unhappy – do get in touch with us as soon as possible. We’re here to help.

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Please do participate in the Discussion Forums (particularly the Module 1 forum) and have a browse of the Fresh Module Readings area where up-to-date materials are provided.

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UNIT 1 An introduction to risk, crisis and disaster management


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1 Unit One: An introduction to risk, crisis and disaster management There are three main aims to this Unit: 1. To briefly introduce you to some theoretical approaches to risk and crisis. 2. To provide you with a link between theories of ‘risk and crisis’ and the other course modules. 3. To inspire you to ask questions and develop a healthy sense of scepticism to ideas presented. Virtually everything presented to you in this course will to some degree be contentious. For those of you with limited experience in the social sciences this may seem a little confusing at first. In the social sciences, the way we define the term ‘risk’ and what is taught is to some degree subjective. to risk management in the social sciences. Each of the themes might easily be considered a worthy subject of study in its own right. The intention of this programme of study is to ‘bring together’ proactive models of risk and reactive crisis management into a coherent package. Three fundamental questions are suggested to you for consideration as you work through this Module. • If there were to be such a thing as a cohesive theory of risk, how should we define this? • What does it mean to aspire to be free from risk in contemporary society and, • How can we practically and intellectually achieve this?

1.1 Introduction and study notes It’s an exciting time to be studying risk. During the last thirty years, risk has increasingly become of interest to social analysts and practitioners. Risk, however, is not a new problem. It could be argued that humans have been attempting to manage the problem of risk for as long as they have had powers of cognition. Certainly from examining early documentary sources, the risk issue has been considered for almost as long as writing itself (Bernstein, 1996; Borodzicz, 2005). In the complex social world in which we now live, particularly since the 1980s, risk has emerged

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Throughout this course, it is our aim to systematically introduce a number of themes which relate

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as a key concept for the social sciences. Some theorists have even suggested that risk represents a fundamental principle for organisation in the social sciences (Beck, 1992; Douglas and Wildavsky, 1982; Giddens, 1991; Hood and Jones, 1996). The reasons for this profound interest in risk arise from a number of key areas. In this Unit you will first be introduced to some of the issues and debates currently surrounding risk and crisis management. You will then be given a brief introduction to the theories of risk and crisis presented in this Module and this will then be linked to the course content of the other five modules.

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The course has been designed to weld together a number of diverse themes normally considered as separate areas of study. For this reason, you are recommended to periodically reflect on the study materials as you make your progress through the course. You should find it useful to draw on risk and crisis-related coverage in the media – and further examples and readings provided in Blackboard – as well as things you come across in your personal and professional life. This Unit will also provide you with some practical instruction and advice on how to go about your studies. In this Unit you will be given a taste of what is to come in this MSc course, and it is hoped that your appetite to find out more about risk, crisis and disaster management will be sharpened. Before you attempt any of the exercises or begin work for an essay assignment, we recommend that you pay some attention to the following notes, which are designed to improve your study technique. Some of you may find these notes more helpful than others. However, it is recommended that whatever technique you finally adopt for studying, it should be systematic and rigorous.

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• Try to be systematic, the modules have been organised so that you can gain the greatest benefit by reading the material in the order that it is presented to you. • Read each unit more than once, making brief notes of your own and doing the exercises provided on the second reading. This will prove a useful habit if you do this from the outset. • You will from time to time come across new words or jargon with which you will naturally be unfamiliar. If after looking up words in a dictionary and re-reading the text the meaning of the word is still not apparent to you, then do contact us for clarification. Gradually you will become familiar with these terms. • Make a note of the way bibliographic texts are presented in the units. There is a distinction between the ways that single authored books, articles from edited books and journal papers are referenced. You will need to show your own bibliographic sources when presenting assignments in a similar manner. Much of the material presented will set up a number of conceptual problems. For example, the terms ‘risk’, ‘crisis’ and ‘disaster’ are perceived quite differently by theorists – as with many words there is little consensus on exact definitions! Units may sometimes present quite powerful arguments to support theories which conflict with those found in other units and modules. This is because many of the units were written by authors who have been highly influential in developing and applying the work they are presenting. Much of this theoretical work is contemporary and is still being developed. This may seem a little confusing at first. However, with time and experience you will get used to this and learn to relate conflicting theories. Remember, theories are merely intellectual tools to help assist the understanding of a problem. Just as one would use a variety of tools to solve some mechanical problem, so too one can use many different and even competing theories to shed light on different (or even the same) problem from alternative perspectives.

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We will provide you with a number of relevant publications to assist your studies. Each unit is accompanied by selected key readings. These readings are usually published papers from academic journals or books and are designed to complement your learning. Units also suggest a number of further reading titles should you wish to look into a particular area in more depth. We will supply you with a number of additional publications and resources to complement either specific modules or the whole course. Increasingly, these will be accessible in Blackboard. You are studying risk, crisis and disaster management at an exciting time when there has arguably never been greater interest in the subject. There are more new ideas being produced than ever before. We will endeavour to keep our study materials as up to date and comprehensive as possible. We believe that when it was developed in 1996 this course was unique in being the first ever to combine risk, crisis and disaster management. We want to maintain the unique quality of this MSc. Therefore, if there is something important that you think we might have missed, or a new development that you are aware of, please do let us know. This is your course – and we value your input to shape it.

In all societies and at all levels of organisation, choices and decisions have to be made. If all actions can be deemed to have consequences, then it is the degree of uncertainty in those consequences that can be considered to be a risk. Every time a choice is purposely made, risks will be played off against each other on the basis of a particular understanding of the world. For traditional societies, this choice can represent fundamental survival strategies, from methods of farming and a choice of crops or hunting to early systems of kinship and social ordering. These types of choices and their associated risks can be perceived as fundamental to survival against the elements. In contemporary British and other societies, risks are rarely out of the news – whether local authorities ban conker fights or hanging-baskets; emerging technologies present us with new health fears; fresh research challenges conventional beliefs; criminals exploit a loophole in Internet security; terrorists invent an improved means of achieving destruction; the global financial system faces repeated meltdown; a new variant of pandemic Influenza appears ….. risk has become an omnipresent phenomenon – usually spoken of as a negative. Risk is the hidden danger lurking beneath everything that we do, from before the unborn child is conceived through to death, we are at risk from something. Our behaviour, diet, procreation, travel, homes and work are all subject to risk. There is no risk-free aspect to our lives.

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1.2 Contemporary issues in risk

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Sometimes these risks are easily apparent, for example, driving or smoking. However, risks can also become obscured, due to conflicting or complex arguments surrounding safety. Debates about nuclear power, transport and the environment are just some examples of areas where experts disagree about risks posed.

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Contemporary interest in risk, at least among academics, can be traced to the seventeenth Century and the advent of capitalism (Todhunter, 1865). Capitalism brought new speculative risks associated with entrepreneurial activity, for example, when and what type of business to engage in and who business should be conducted with (Douglas, 1985). Alongside this increased entrepreneurial activity emerged the insurance industry, specifically interested in quantifying what are sometimes called pure risks by means of actuarial records. For over a hundred years insurance companies have been attempting to identify and record personal and third party loss using this method. Within a given population there is a statistical propensity for certain proportions of that group to suffer from adverse exposure to a risk. Insurance actuaries calculate and aggregate these pure risks as a percentage figure for the population. These figures can then be used to quantify the level of premiums charged for insurance cover. More recently, this methodology has been brought into question (Borodzicz,2005). Changes to health and safety legislation, advances in medical diagnostic techniques and changing social behaviour have all contributed to this. The heavy financial losses sustained by the “names” at

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Lloyds of London are an example. Ongoing publicity given to sufferers of asbestosis offers another illustration of how huge retrospective claims can sometimes be made against insurers, often twenty and thirty years after exposure to a risk has taken place. Social changes have also cast doubt on the efficacy of an actuarial methodology. For example, increased poverty during times of economic recession has been linked to soaring crime rates, particularly burglary and car crime. However, by the time actuarial records can be brought up to date and adjusted to reflect changed risk, many claims will already have been registered. One theorist, Ulrich Beck, has argued that we are now in a state of major social transition from a classbased society to one of risk. In his book Risk Society he argues that the fundamental arbiter of acceptable risk for the future will be the insurance industry (Beck, 1992) (Beck, 2004). For Hood and Jones, it was social concerns about ‘health, safety and security’ in society which brought risk to the forefront of contemporary debate (Hood and Jones, 1996). These concerns have resulted in major shifts in social habits and practices. The health debate is particularly interesting and topical. Contemporary (largely Western) society, it is argued, has shifted away from a position where people are concerned about having enough to eat – instead we are now becoming more concerned with the risks associated with particular foods (Beck, 1992). Consider concerns about salmonella and E.Coli in meat; fat in any form and heavy metal contamination of large sea fish such as tuna. The role of the judicial process and litigation trends have also played a major part in constructing contemporary social attitudes to acceptable risk. A massive legal industry has grown around the legal adjudication of risk issues. One criterion for the legal involvement in risk is to establish blame, guilt, liability or negligence. The ‘no win no fee’ practice in America and elsewhere may have contributed to the generation of a hugely specialised legal industry associated with adjudicating such risk claims. However legal claims are funded, this area of legal involvement in risk has aroused some social controversy. You can probably think of an example from the news this week …. Another mode of involvement for the judiciary can be observed from the large number of public inquiries following major disasters. The role of the judiciary in these contexts has also been subject

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to some controversy. Public inquiries have a function to establish both causality and blame, and this may pose a dilemma for those giving evidence. The need to tell it as it was may be seriously compromised when personal or corporate identities and liability are at stake. This area of legal interest in risk has also aroused much controversial debate. Questions such as, who is to blame; who should be compensated and how future disasters could be prevented have highlighted the complexity of modern risk management. As mentioned earlier, risk has also become a subject of interest to the business community who wish to limit potential corporate liability. However, business interest in risk is not just restricted to the production and supply of products. An area of increasing concern is that of business continuity or contingency management and the associated activity of crisis management. This area of risk is concerned with fundamental threats to the delivery of business objectives – linking everything from supply-chain dependencies through to reputational protection and product recall. Enterprise Risk Management is another way of packaging these activities across a business or group of businesses.

One could be forgiven for thinking that earthquakes, floods and high winds all represent examples of what may be termed natural disasters, while aviation accidents and other types of technological failures constitute man-made disasters. It is argued here that this distinction is problematic and reliant on assumptions about how we distinguish between the natural and non-natural world. Disasters do not respect these distinctions and one might even argue that in the aftermath of many major disasters, folk conceptions of this distinction may be liable to change. For example, if we were to consider the consequences of a major flood – are these caused by human mismanagement (e.g. allowing deforestation of an area or permitting housing development on a flood plain) or nature? What about the impact of global warming? Do we yet know beyond any doubt that this is man-made? Similarly, security is another area of increasing significance for risk theorists. Although security has emerged as an academic study only recently, debate about the constitution of a discipline and profession of security has aroused much contemporary debate. Security could be seen as risk management in practice; one theorist, Sally Lievesley, has even argued that security is the wrong term altogether and that this should be called ‘risk engineering’ (Lievesley, 1995). Again practice in this subject is beginning to respond to social changes, in the form of health and safety legislation, modern policing practices and the emergence of a huge private security industry.

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Safety has also emerged as a key issue in recent years. Concerns about the siting of nuclear establishments, health and safety at work, pollution, genetic engineering, air travel and transportation accidents are but just a handful of examples of the popular social concerns that will be discussed in some detail during this course. Of interest here is an increasing distinction drawn between so-called ‘natural’ and ‘man-made disasters’.

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Thinkers such as Frank Furedi write provocatively that we can become paralysed by fears which we may even invent to scare ourselves (Furedi 2005).

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1.3 Course overview A key question that you may be asking yourself is: why combine the study of risk, crisis and disaster management? The title of the course reflects the intention to combine three different but interrelated subject areas. The course draws on a number of complementary social science disciplines including psychology, sociology, anthropology, politics, law, economics and management. We felt that this would facilitate the understanding of the three key terms: risk, crisis and disaster through a multi-disciplinary approach. Module One introduces risk as both an established historical concept and also as the subject of a number of emerging contemporary social science debates. Risk is considered specifically in relation to a number of social science disciplines; these include psychology (decision-making, cognitive, psychometric approaches and mental modelling approaches), sociology (risk communication, socio-technical and risk society), anthropology (cultural theory and safety culture), politics and law (inquiries, compensation, negligence, risk and blame) and management (isomorphic, systems

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theory and schematic modelling). Particular attention is given to the ways in which perceptions of risk are mediated by the situational, organisational and cultural contexts in which they occur. Different cognitive approaches, mental models of risk and communications about risk, all reflect implicit assumptions and convey different impressions. Different organisational and ‘safety’ cultures can institutionalise these meanings. The key disciplines here are sociology, anthropology and psychology. The overriding intention is to demonstrate the plurality of risk as a social construct. Further multi-disciplinarity is built into Module Two drawing on the expanding field of risk management. Students are offered different conceptualisations of psychological approaches to risk together with operational risk management, from the worlds of commerce and business, including tensions between ‘minimising loss’ and ‘protecting profit’ and those between risk elimination, control and transfer. In Module Three you are introduced to some of the main methodological techniques used for social research in the human sciences. Module Three is important because it is where you will find the methodological tools required for your dissertation research. This section of the course will also help you to understand how much of the research presented in the modules has been carried out. Research methods also provide a valuable link to theory generation. Many of the theories offered in the first module will have been developed by applying one or more of the methodologies presented in Module Three. For many of you, the dissertations produced at the end of this course will also be based on your assessed assignment for Module Three. Careful attention to your Module Three assessment will put you in a good position for beginning work on your dissertation. Module Four promotes this further by highlighting a range of in-depth case studies from different areas, including events such as Underground fires, aviation accidents, natural and environmental disasters and outbreaks of public disorder. The case studies present data in a way which is typical of research in a variety of social science disciplines. For example, the case studies are based on an ethnographic (participant observation) analysis of secondary data sources (e.g. a re-examination of public inquiry findings, police reports, etc.) and interview findings. The case studies also illustrate the relationship between theoretical and methodological orientations and different academic

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disciplines. For example, a public inquiry has the dual role of establishing blame or negligence (politics and law) and recommending future good practice (management). This duality may at times cause social and political conflict (politics and sociology) and a failure for experts to agree about the perceived risks and the appropriate response behaviour (psychology). Module Five and Module Six present a number of themes relevant to how risk, crisis and disaster is both modelled and managed by practitioners. Module Five concentrates on the modelling of risk by practitioners, in terms of training, simulation exercises and contingency planning. Modelling and managing risk as a reflexive process is illustrated throughout by means of reference to the case studies, in order to create a ‘dialogue’ between the areas of application and theory, and also to promote interdisciplinary thinking. Module Six concentrates on specific issues relevant to the management of crisis and disaster situations, in particular how approaches to these physical operations are underpinned by social, psychological and cultural variables. Again, this is illustrated by reference to the case studies and theoretical debates. components of the programme to apply the lessons from different disciplines and sectors to your own special field of interest – usually one in which you have professional responsibilities or interest.

1.4 Theories of risk and crisis The theoretical approaches to risk and crisis presented in this Module are largely concerned with the types of psychological, social and cultural features which underpin choices. One clear distinction which can be made about theories of risk is that theorists appear to be in some disagreement about the extent to which risk can be both measured and defined. For some theorists, risk is a phenomenon which can be broken down into pragmatic and manageable units, and is therefore amenable to measurement. For other theorists, risk is too complex a phenomenon for this type of analysis, and they argue that risk must be understood within a wider social or cultural context. How we view risks, and perhaps more fundamentally how we manage them, have become areas of major debate among social theorists. One helpful metaphor for the landscape of risk was offered by Hood et al. in the 1992 Royal Society study group report. They argued that risk can be characterised as an ‘archipelago’, a group of islands where each represents a particular subdiscipline or associated area of expertise (see chapter one in the supplied text: Hood and Jones, 1996). The theories of risk and crisis presented in this Module will by no means visit every little rock and outcrop in this archipelago. We will, however, spend some time at the main theoretical

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Finally, you are encouraged in both the research methods (Module Three) and dissertation

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islands and it is hoped that in the last part of this course you will be able to make some explorations of your own while doing research for your dissertation. It is argued here that risk has grown so large as to now represent a major discipline in its own right. Risk, academically at least, is a well-developed theme in both the physical sciences (e.g. engineering) and, more recently and increasingly, in the social sciences (e.g. psychology, sociology, anthropology, politics, management, economics, finance, business studies and criminology). Risk analysis in the former areas is seen largely in quantitative terms, by placing an assessment figure

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on the relationship between the frequency or probability of a potential physical failure and its seriousness. This approach leads to management concerns about how best to avoid, eliminate or reduce potential threats, and to decision-making about the costs and benefits of risk control, retention or transfer. In this Module you will be introduced to a number of diverse theoretical approaches to risk and crisis. In Unit 2 you will be introduced to a growing debate about the distinctions made between the terms emergency, crisis and disaster; Analyses of risk in Units 3, 4 and 5 suggest an equally complex appraisal. Approaches to risk research have broadened considerably in the last twenty years, mainly as a complement, but also as a critique and response to the more quantitativelybased measurements in management and some psychological research. These can now be grouped together into a number of main areas of theoretical study; risk communication, systems approaches, and socio-technical or isomorphic learning approaches.

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You will be introduced to recent work developed on the theme of safety culture, sometimes also called organisational safety culture. A number of theorists are now working in this area from a variety of disciplinary backgrounds, but this should be seen as distinct from cultural theory. Case studies allow you to apply knowledge of the theories you have been introduced to throughout this Module and ask yourself questions about the the origins and management of these events.

1.5 Emergencies, crises and disasters Learning from major crises and disasters is methodologically problematic, if only because of the range of accounts of reality offered by the many informants attending public inquiries. The liturgy of disaster and crisis management is less well defined theoretically and it finds its expression as a reactive response to incidents, usually in terms of ‘best practice’. It has proved difficult to establish quantified measures of risk management for these types of incidents. In this context, understanding the complex relationship between risk, crisis and disaster, and as a single defined area of study is argued here to be of significance. The term crisis has recently aroused considerable debate among risk theorists. It is argued here that the moment of crisis could be described as a differentiating feature between emergencies and disasters. A risk could give rise to a crisis, which in turn, could become a disaster. The concept of crisis (which it is argued here is not the same thing as an emergency) is a relatively unexplored academic concept, although the analysis of human behaviour (the so-called ‘human factor’) in crisis precipitation and crisis resolution is now receiving substantial attention from academics and practitioners. In contrast, disaster management (often euphemistically called ‘emergency planning’) comprises much of what is normally taught under this label. Disaster management is largely concerned with the practical problems of emergency activity, ‘picking up the pieces’ when the unwanted and unexpected has occurred. Fundamental to more recent academic approaches to disaster management is an acknowledgement that an incident may be termed a disaster while still containing many ongoing crises and emergencies. This is because social actors involved in responding to disasters may be dealing with different response issues simultaneously.

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1.6 An introduction to health and safety The management of health and safety in the workplace is sometimes regarded as a specialist function. In many parts of the world, it is covered by specific legislation administered by dedicated regulatory bodies. Unit 4 treats the subject in a more holistic way, linking it directly with other parts of the course. It traces the evolution of concern over welfare at work and stresses its more general applicability at levels from societal to international. Health and safety is placed in the context of risk management more generally. It is considered in group and organisational contexts, looking particularly at barriers which may, or do, present difficulties in achieving good or acceptable levels of practice. Some major accidents that have been precipitated by specific failures in workplace safety management are highlighted. The particular problems of ensuring health and safety under crisis conditions are examined and, finally, the Unit looks at specific areas of topical concern such as ‘stress’ and problems associated with new and emergent technologies.

A systems approach to risk is critical of technical quantified risk assessment procedures for failing to take account of both human and technical risk systems (Perrow, 1999). More fundamentally, some systems theorists have argued that the majority of accidents and disasters occur through system failures which are socio-technical in nature. In other words, the interactions between human and technical systems also constitute systems and these systems represent vital blind spots which are often overlooked using quantified risk assessment procedures (Turner, 1978; Toft and Reynolds, 2005). Toft and Reynolds argued that disasters are typically low frequency events when viewed in the context of any one organisation or field of activity. It is therefore unlikely that any one organisation would be able to predict such events on the basis of an examination of its own operational history. However, when such incidents are viewed in the context of a whole industry employing similar practices, a number of similar incidents can be observed to be recurring in different organisational contexts. The reason for this similarity is due to the isomorphic nature of the systems which have broken down. Thus managers in organisations with socio-technical systems in their operations which are quite similar to those of other organisations, could benefit from such isomorphic foresight. Therefore, for an industry to be able to learn from the experience of managing these types of risks, individual organisations need to be able to learn from the experiences of each other. Cumulatively, Toft would argue, these same disasters keep re-occurring because what little is learnt from them is only passed on to managers in the organisation concerned.

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1.7 Systems theory and isomorphic learning

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1.8 Safety culture Safety culture as a theory represents a radical departure from the psychological risk perception paradigm for two reasons. First, it was developed by theorists interested in the use of qualitative methods in psychological research (Henwood and Pidgeon, 1994). Second, safety culture theorists argue that expert decision-makers may operate within the context of an organisation’s cultural factors. Safety culture theorists advocate that a ‘risk’ or ‘safety culture’ operates at an organisational level (Booth, 1993; Dake, 1991; Pidgeon, 1991; Turner, 1991). It is argued that safety culture provides a method for perceiving the risk management processes in hazardous operations and this can be used to analyse the pre-conditions to many major sociotechnical disasters (Pidgeon, 1991, Turner, 1991). One theorist even suggested that the concept ‘safety culture’ is one of the most important advancements in risk management to have occurred in recent times (Lee, 1993: 21-3). The origins of the term ‘organisational safety culture’ can be traced to literature relating to the

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Western nuclear industry’s response to the Chernobyl disaster. In this case, a poor ‘safety culture’ among employees in the then Soviet nuclear industry was deemed to be a human contributory factor to the accident (OECD, 1987; Pidgeon, 1991). Perhaps the real problem is not so much to define, but to recognise a safety culture and assess its qualities and parameters. In this respect the study of safety cultures may pose similar problems to that of traditional cultures in the anthropological literature. Similarly, it may be argued for the safety culture found within an organisation, that it will only reveal itself for analysis when faced with a crisis scenario. This is because it is only at this point that those shared assumptions and beliefs are tested and sometimes painfully exposed as inadequate. This also suggests that a ‘safety culture’ may be an interesting theoretical construct for the study of crises. If the safety culture of an organisation determines the extent to which foresight can be both generated and ultimately acted on, then it is by changing that safety culture that many unknown risks can be identified and avoided. Safety culture theorists also argue that by improving the safety culture of an organisation, economic efficiencies will also accrue. Hence, expenditure on promoting a positive safety culture may be more fundamental than simple insurance against disasters; it could represent sensible economic management. An organisation with a good safety culture will benefit from enhanced profit and safety in both the long and short term (ANSCI, 1993). For psychologists, safety culture represents a most innovative applied approach to the study of risk and decision-making. This represents an attempt to depart from the methodologically reductionist structures of decision-making and attitude measurement most popular in psychology. Instead, proponents of this approach concentrate upon the cultural context in which the decision-making takes place in organisational settings. A safety culture approach is also important in opening up the potential for study by means of naturalistic enquiry, thus moving away from the experimental gambling analogy scenarios and psychometric measurements which have come to characterise much psychological research in this subject.

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1.9 Two case studies The last two units of this Module are case studies of how research can probe the origins and central issues of a crisis situation. Firstly the collapse of Barings Bank in the 1990s as a result of management failures to control the activities of an individual ‘ rogue trader’ is probed in depth. A decade later we have seen the world’s banking system thrown into turmoil by highly speculative investments and rash lending that went badly wrong. Many commentators have put forward views on why this latest disaster happened; see for example Haseler (2008) and Cable (2009). Could more lessons have been learned from the Barings case or were these collective failings of the international banking system completely different? Here perhaps is something to think about when you are looking for a topic for your dissertation research.

1.10 Guide to further reading You should now read the Introduction from the course textbook provided, Accident and Design edited by Chris Hood and David Jones. It is also recommended that you browse through ‘The Good Study Guide’ that we have provided. You should also begin to make use of the popularity of this subject by monitoring the general media and use of the Internet. Both newspapers and television make a number of excellent documentary sources for you to keep up to date with activities and techniques in the area of risk, crisis and disaster management. It is also interesting to reflect on the way many disasters and risk issues are portrayed / escalated in the media.

1.11 Study questions You should now write 300 words in answer to each of the questions below. We believe that this is an important exercise that will assist your comprehension of material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University. • What is risk and why is it controversial?

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The final unit presents research into the effects of recent major floods in the UK, and concentrates on the social and community impacts. Here you will see a demonstration of some research methodologies, including how to ethically deal with first hand accounts from victims when presenting the results of field research.

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• To what extent does the way we perceive risk affect our view of the world? • Write short notes on the following:

1. Risk as a multi-disciplinary subject

2. Health, safety and security

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1.12 Bibliography ANSCI (1993) Human Factors Study Group, Third Report: Organising for Safety. London: HMSO. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage. Beck, U. (2004) A Critical introduction to the Risk Society, London: Pluto Press. Bernstein, P. L. (1996) Against the Gods: The Remarkable Story of Risk, New York: John Wiley. Booth, R. (1993) ‘Safety culture concept, measurement and training implications’, paper presented at the British Health and Safety Society Spring Conference, April 1993. Aston University. Borodzicz, E. P. (1996) ‘Security and risk: A theoretical approach to managing loss prevention’, International Journal of Risk, Security and Crime Prevention 1(2): 131-43.

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Borodzicz, E. P. (2005) Risk, Crisis & Security Management, Chichester: J Wiley & Sons. Cable, V. (2009) The Storm: The World Economic Crisis and What it Means, London: Atlantic Books. Covello, V. T. (1991) ‘Risk comparisons and risk communication: Issues and problems in comparing health and environmental risks’. In R. E. Kasperson and P. J. M. Stallen (eds) Communicating Risks to the Public, Dordrecht: Kluwer: 79-124. Covello, V. T., von Winterfeldt, D. and Slovic, P. (1986) ‘Communicating scientific information about health and environmental risks: Problems and opportunities from a social and behavioural perspective’. In V. T. Covello, A. Moghissis and V. R. R. Uppuluri (eds) Uncertainties in Risk Assessment and Risk Management, New York: Plenum Press: 39-61. Dake, K. (1991) ‘Orienting dispositions in the perception of risk: An analysis of worldviews and cultural biases’, Journal of Cross-Cultural Psychology 22(1): 61-82. Douglas, M. (1985) Risk Acceptability According to the Social Sciences, New York: Russell Sage Foundation. Douglas, M. and Wildavsky, A. (1982) Risk and Culture: An Essay on the Selection of Technological and Environmental Danger, Berkeley: California University Press. Frosdick, S. (1995) ‘Organisational structure, culture and attitudes to risk in the British stadia safety industry’, Journal of Contingencies and Crisis Management 3(1): 43-58. Furedi, F. (2005) ‘When fear leaves us paralysed’, The Observer, 4 September. Giddens, A. (1991) Modernity and Self Identity, Cambridge: Polity. Haseler, S. (2008) Meltdown: How the ‘Masters of the Universe’ Destroyed the West’s Power and Prosperity, London: Forum Press.

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Henwood, K. L. and Pidgeon, N. (1994) ‘Beyond the qualitative paradigm: A framework for introducing diversity within qualitative psychology’, Journal of Community and Applied Social Psychology, 4, 225-238. Hood, C., Jones, D. K., Pidgeon, N. F., Turner, B. A. (1992) ‘Risk Management’, in Risk: Analysis, Perception and Management, Royal Society Study Group, The Royal Society, London: 135-192. Hood, C. and Jones, D. (eds) (1996) Accident and Design: Contemporary Debates in Risk Management, London: UCL Press. Irwin, A. (1989) ‘Deciding about risk: Expert testimony and the regulation of hazard’. In J. Brown (ed.). Environmental Threats: Perception, Analysis and Management, London: Belhaven Press. Krimsky, S. and Plough, A. (1988) Environmental Hazards: Communicating Risks as a Social Process, Dover, MA: Auburn.

Lievesley, S. (1995) ‘Security into the 21st Century’, paper given at the Risk and Security Management Forum, Police Training College, Bramshill. OECD (1987) Nuclear Agency Chernobyl and the Safety of Nuclear Reactors in OECD Countries Paris: Organization for Economic Co-operation and Development. Perrow, C. (1999) Normal Accidents: Living with High-Risk Technologies, NewYork: Princeton University Press. Pidgeon, N. (1991) ‘Safety culture and risk management in organisations’, Journal of Cross-Cultural Psychology, 22(1): 129-40. Pidgeon, N. F., Hood, C., Jones, D., Turner, B. and Gibson, R. (1992) ‘Risk Perception’, in Risk: Analysis, Perception and Management, Royal Society Study Group, The Royal Society, London: 89-134. Royal Society (1992) Risk: Analysis, Perception and Management, Royal Society Study Group, The Royal Society, London. Slovic, P. and Fischhoff, B. (1982) ‘How safe is safe enough? Determinants of perceived and acceptable risk’, in Gould and Walker (eds) Too Hot to Handle, New Haven:Yale University Press.

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Lee, T. (1993) ‘Seeking a safety culture’, ATOM Journal (429): 20-3.

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Thompson, M., Ellis, R. and Wildavsky, A. (1990) Cultural Theory, Boulder, CO: Westview. Todhunter, I. (1865) A History of the Mathematical Theory of Probability from the Time of Pascal to that of LaPlace, New York: Chelsea Press. Toft, B. and Reynolds, S. (2005) Learning From Disasters: A Management Approach (Third Edition), Basingstoke: Palgrave Macmillan.

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Turner, B. (1978) Man-made Disasters, London: Wykeham. Turner, B. (1991) ‘The Development of a safety culture’, Chemistry and Industry, 241-43. Wynne, B. (1989) ‘Frameworks of rationality in risk management: Towards the testing of naive sociology’ in J. Brown (ed.) Environmental Threats: Perception, Analysis and Management, London: Belhaven Press. Wynne, B. (1992) ‘Misunderstood misunderstanding: Social identities and public uptake of science’, Public Understand Sci. 1: 281-304.


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2 Unit Two: A theory of crisis In this unit you will be encouraged to think about the term crisis. Theorists and practitioners often use a variety of terms to discuss dangerous events (accident, catastrophe, emergency, crisis, disaster, for example). It is argued here that while these terms are frequently used, there is often very little distinction made between them and this may have important implications for the way we manage risk. When looking at the literature on this subject, one finds a number of terms which are interchangeably used by authors to describe a variety of scenarios with a dangerous potential for escalation. It is argued in this Unit, that emergencies, crises and disasters may represent distinctly different types of phenomena and that this conceptualisation may have important implications for both analysis of events and training. This Unit will, therefore, consider both the context and practical implications of a distinction in terms.

In this Unit, emergencies, crises and disasters will be compared and you will be encouraged to think in some detail about what these terms could mean. It is argued here that a distinction is important for theorists, particularly if we are going to be able to make comparisons between events. How can we compare phenomena if we do not have some way of structuring the data into useful categories or units of analysis? Understanding different types of events may also be helpful for those who have to train key decisionmakers. If emergencies, crises and disasters are different phenomena, then it would appear logical that appropriate training may also need to be different. Further, identifying the appropriate people to train within organisations may also need to be re-considered for such distinctive events. This Unit will initially discuss some of the problems associated with distinguishing between emergency, crisis and disaster. A working definition of these terms will be presented. The definitions are based on the results of research work carried out for a European Union funded project on critical decision-makers. In the final sections of this Unit, debates about the multiple perceptions of reality among key decision makers and those involved in disasters will be considered, and the implications of a tighter definition of terms are discussed in the context of exercising practice.

2.2 A blizzard of terms ‌..

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2.1 Introduction

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It is argued in this Unit that most of the theoretical risk positions found in the academic literature focus on the prevention or minimisation of risk before a crisis materialises, or the analysis of events following tragic disaster. It is, however, much more difficult to find theoretical positions on the issue of crisis management itself. While prevention is a laudable aim and clearly much of this theoretical work needs to continue, the phenomenon of crisis is still in the relatively early stages of academic exploration. The field of crisis is characterised by fragmentation. In a review of crisis management literature, twenty-eight different definitions of crisis can be found (Forgues and Roux-

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Dufort, 1998). Whether crises represent events (Mitroff, Pauchant and Shrivastava, 1988; Pearson and Clair, 1988; Shrivastava, 1987) or processes (Mitroff, 1992; Pauchant; Shivastava, 1987 and Schwartz, 1987) is still a subject of intense debate. However, practical examples of crises are all too familiar: fires and explosions in complex nuclear or chemical plants, accidents in the transportation and storage of hazardous products (or ourselves) and tragic fires which sweep through ever more adventurous building structures. Many social scientists are in general agreement that there is an increase of crisis incidents with a potential for disaster. Although theorists may differ in their explanations for this increase, the focus of their interest tends to be on the reasons why disasters occur and post-incident management.

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For Drabek, this increase could be linked to a progressive process of industrialisation (Dynes and Drabek, 1994: 6). The social theorist Ulrich Beck argues that this represents a paradigm shift in the way human social relations are evolving from a class to a ‘risk society’ (Beck, 1992). Another theorist, Charles Perrow, suggests that the nature of technological systems themselves is becoming too complex or ‘tightly coupled’ and it is for this reason that many potentially hazardous activities may be too complex for acceptable risk management (Perrow, 1999). However, a number of theorists are now arguing that more attention needs to be given to understanding and managing situations of crisis. For the late Professor Barry Turner, it was the mismatch in the relationship between social or human and technological systems which causes the dangerous situations of ‘ill-structure which can lead to disaster’ (Turner, 1978). The sociologist, Lagadec, has also raised the issue of crisis as an increasingly dangerous phenomenon: Major crises – from Challenger, Bhopal, Tylenol or Chernobyl to Exxon Valdez and Braer – are no longer exceptional events. Indeed the risk of crisis is even becoming structural as large networks become more complex, more vulnerable and more independent ... crises continue to become more frequent and destabilising. (Lagadec 1993: 45) However, as both theorists and practitioners we are faced with a dangerous plethora of events and terminology. The words major incident, emergency, crisis, disaster, accident, catastrophe and abomination are all examples of terms used to describe events that rupture our social world and devastate our physical one. What these terms mean and how we respond to such events is problematic. However, without a model to understand the phenomena that we are describing, event response and theorising is made more difficult. Historically, disasters were popularly conceived of as ‘freak’ events, ‘acts of God’ (Toft and Reynolds, 1994:1) or ‘abominations’ (Douglas, 1970). In contrast, more recent scientific approaches to the study of disasters would appear to suggest that all disasters should have causal agents and, further, that these agents may be identifiable and therefore prevented. The notion of causal agents also suggests that blame can be identified and this issue has become a particularly important one. For public inquiries, an exhaustive amount of time and expense may be focused on establishing causality and responsibility (Toft and Reynolds, 1994:199). Some system for ordering such phenomena would enable academics to make comparisons between events in a number of ways. However, how one conceptualises the types of phenomena

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described as emergency, crisis and disaster and how this material should be categorised, poses a number of difficult problems. First, the apparent uniqueness of event aetiology (the reasons why something happens) and manifestation suggests that a general rule of categorisation may be difficult to stipulate in advance. The almost infinite ability for technological advancement in the context of ever more complex social structures continues to pose many new forms of scenario for emergency decision-makers to deal with. The evidence for this alarming trend is displayed in the form of new and difficult to deal with socio-technical incidents, which have a potential to rapidly transform into tragic disasters. What may often begin as an apparently small or routine emergency may quite dramatically turn into a major disaster, because it was impossible to envisage how the event would (or could) manifest. This apparent uniqueness, then, is caused by difficulties in predicting the timing, nature and social and geographic context.

Third, such events are difficult to categorise. There is a considerable body of literature devoted to dealing with emergency, crisis and disaster management. Rarely, however, are these concepts either defined adequately or even distinguished from each other (Borodzicz, 2005). Fourth, major incidents will place different demands on different agencies and at different times. Hence, what is defined as a disaster for one agency, may in contrast still be an ongoing crisis or emergency for another. For example, in responding to an air-crash once survivors have been removed, the police, coroner and civil aviation authorities will be involved in disaster recovery. However, for social services, this situation would constitute an ongoing crisis in the management of resources for survivors and the community. Such illustrations suggest that the nature of the liaison occurring between social workers, the health authority, emergency planning officers and those voluntary agencies which deal with the human tragedy following a major event, are dynamic and in a state of mutual construction. Fifth, crises occur in a number of different contexts which may make comparisons extremely difficult. For example, can we model a business, political or health crisis in the same way as one involving the emergency services? Clearly, establishing comparable levels of decision-making between highly structured emergency response organisations poses a problem, particularly if the hierarchies are different. However, to make this type of comparison among commercial and political organisations may suggest that an overall theoretical model of crisis is somewhat elusive.

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Second, obtaining reliable data about incidents, in other words learning through the experience of significant others, is often complicated by a number of conflicting accounts of events. Disagreements between those involved in responding to major incidents are notoriously difficult to reconcile and have become the subject of much media attention during public inquiries.

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A number of attempts have been made to model the phenomena we know as disasters, but this has proved difficult due to the amorphous nature of disasters and the varied and unpredictable contexts in which they occur.

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Modelling by type One way we might choose to model emergency, crisis and disaster is by type. For example, we could categorise such events by the type of activity affected. Therefore, incidents involving air travel might be construed as different from shipping ones. Floods and earthquakes might receive a similar distinction as would fires and explosions. Another popular distinction by type is often made between so-called ‘natural’ and ‘man-made’ disasters.

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The problem with a classification system based on type is that many contemporary incidents may easily fit into more than one category. This is because the effects of many catastrophic events can be highly complex and causality may not be easily established. For example, if we were to take all shipping accidents and attempt to compare them, we would expect an exclusive category to contain incidents which all exhibit certain similarities or patterns of events, at least in terms of causality and effect. The problem here is the plethora of different types of incident which can be found in the would-be category. Not all shipping accidents cause loss of life, some may be responsible for environmental damage through the spilling of crude oil or other chemicals, others may be caused by fire (which may itself constitute another type of incident altogether).

Modelling by severity Another way we might categorise dangerous events is by their extent or severity. We could, for example, calculate the loss of life or cost of damage caused by such events and establish frequencies. This would at least appear to suggest a pragmatic approach to establishing scales of event severity. Loss of life might appear to be one distinction which should be unproblematic. Theoretically, it should be possible to collate the number of lives lost from dangerous incidents and produce a ranking order of event severity. The problem with this approach is that while it can apply to an extent to physical accidents occurring in a short time period and where there are known numbers of fatalities, it is not so easily established for more complex ones. The BSE crisis and AIDS infection are examples of crises which may well kill large numbers of people over a longer time period. Attempts to establish the kill rates for AIDS run into millions of lives, but accurate figures are elusive. There is also the problem of establishing precise kill rates for events where both the risk and its potential outcome are subject to some scientific controversy. For example, there is still much debate about the number of fatalities following the Chernobyl nuclear accident. A simple head count after the explosion will not easily reveal the severity of the accident in human terms because of the delay before the full effects become manifest. A further point worth noting here about this type of scenario is that calculations become impossible when accounting for the risks to those who have not been born. Another problem with this approach has been the relative ranking of the worth of human life in different contexts. In terms of making financial retribution, how does the loss of life in Bhopal and a Western, hypothetically similar disaster, rate for equivalence? It might be ethically and morally questionable to place a financial value on human lives. Can people be valued on the basis of replacement cost? The legal system is frequently called on to make such decisions and this has also aroused some considerable controversy. This might also mean that in certain parts of the world

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(ironically those most in need of improved training), simulation exercises might be deemed to be too costly. In this context it might be cheaper to simply have disasters and let people die. This question may pose more of a dilemma of political and moral acceptability than one of scientific enquiry.

The Toft/Turner model of disaster A number of theorists working in the area of crisis management have also highlighted the relevance of a systems theory model for the study and prevention of disasters. They argue that major incidents can be modelled as system failures and, further, that these systems comprise both human and technical elements and that a failure in either of these systems can result in a crisis. These theorists also argue that such system failures predominantly represent human or technical failures of operation within organisational systems (Horlick-Jones, 1990).

place. In other words, the relationship between the social and technical features of a system may incubate together over a period of time producing an environment where an accident can be triggered by some small precipitating event. This, Turner argued, is not apparent from a separate review of technical and social systems of operation in isolation, because this would not reveal the intricate nature of links and mutual reliance of the two systems. Turner was highly influential in arguing for this approach. He suggested that “it is better to think of a problem of understanding disasters as a ‘socio-technical’ problem with social organization and technical processes interacting to produce the phenomena to be studied” (Turner, 1978: 3). Evidence for Turner’s view can be found in the results of many public inquiries which have argued that the way many disasters are perceived should be reconsidered (Toft and Reynolds, 2005:24). The conclusions of many contemporary theorists on the subject have suggested similar findings: “The majority of accidents are, in some measure, attributable to human as well as procedural and technological failure” (Cox and Tait, 1991: 93). Turner’s model for understanding socio-technical disasters operates in six stages and has been summarised by Toft and Reynolds (2005:33). The first stage is characterised as some starting point in time, when culturally defined beliefs about the world and codes of practice are brought together to form a system of operation, or an agreed code of practice. This system of operation may be formed at the beginning of an organisation’s life, or subsequently, as the result of some change in the organisation’s function. A fundamental feature of the first stage is potential system failure which, although difficult to perceive, is programmed in to the system’s operation. Also typical for this stage is an independent risk assessment of technical and social systems in isolation and failure to consider interaction between the two systems. Latent risks, not perceived from this stage, will be transferred to the second stage, incubation.

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Turner, in his 1978 book Man-made Disasters, proposed a model for how disasters happen in organisations. Turner’s model was based on the understanding that accidents are ultimately latent failures of socio-technical systems, and that these occur after a period of incubation has taken

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During the second stage, the system will function, with minor problems and events arising, but these will not be treated seriously as they do not fit in with the organisation’s world-view of a hazard. In other words, those members of an organisation with the responsibility for its safe running and operation do not have, in the context of the organisation’s safety culture, any historical reasons to suspect that these problems are in fact latent incubating system faults. When minor

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problems do become apparent they may be perceived as normal operational difficulties, rather than the system faults which violate the integrity of the system itself. The third stage of Turner’s model is the appearance of some precipitating event which, owing to its impact, raises the perceptual awareness of decision-makers involved in stage two. Attempts will be made to respond to the problem within the context of previously held assumptions about the system’s mode of operation. However, the system will fail to respond to these interventions and lead to stage four – a system failure or breakdown with possible catastrophic effects and a violation of the previously held world-view of the system’s decision-makers. Stage four of the model can be recognised as the onset of disaster. This will typically constitute an ‘ill-structured’ crisis scenario which does not conform to previously held assumptions of safety by members of the organisation. An ill-structured event is a situation of disorder that might arise from the errors and/or failings (e.g. poor or inefficient plans, inappropriate application of resources) that go unseen within the pre-crisis incubation period. Where problems use symbolic or verbal variables, have vague, non-quantifiable goals and lack available routines for their solution, relying instead on ad hoc procedures, a variable disjunction of information is more likely to be found – disasters may be regarded as arising from attempts to handle ill-structured problems, the full implications of which were not realised before the event (Turner, 1978: 52). Stage five of the model is the rescue and salvage operation. The need to recover and re-establish operation of the system will be compromised at this stage by the nature of the ill-structured situation. The element of ill-structure in the handling of the crisis exists when, given the nature of the event, the application of preconceived emergency plans or procedures is inappropriate, in conflict, requires cross-agency co-ordination, or even exacerbates the situation. This stage of incident response will therefore require a level of ‘flexibility and improvisation’, which is not characteristic of a normal mode of operation (Turner and Pidgeon, 1997). Stage six, the final stage of Turner’s model, is the learning phase. In this stage, those responsible for the operation of the system come to terms with what has happened. Normally this is carried out through an official ‘inquiry process’, with the aim of both establishing the cause of the problem and making recommendations for future system operations. Two features are central to Turner’s theory. First, is the understanding that social and technical systems may be an inclusive system of operation. This means any analysis of system failures should take account of both human and technical types of error, as these are mutually reliant upon each other for the operation or failure of the overall system (Turner, 1978; Toft and Reynolds, 2005). Second, is the structural failure of foresight. Theoretically, if it is possible to create systems of operation then it should also be possible to predict the failures. However, one problem with this is the complexity of modern operational systems which makes identifying the number of permutations of possibilities difficult.


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2.3 Emergencies, crises and disasters It is argued here that a clear distinction should be made between emergencies, crises and disasters and that this distinction is of critical importance for a number of reasons. This distinction is not apparent in much of the literature, and even when attempts are made by theorists to define or distinguish these terms, it is often in the form of a plurality of context-specific descriptions, which make sociological comparison difficult. If the definitions offered here provide a useful contribution to this debate, then so much the better. Terminology is problematic. The terms emergency, crisis and disaster are often used by theorists, policy-makers and practitioners to describe some quite different situations. In addition a number of other terms, for example, mass emergency, major incident or catastrophe, can also be found in the literature. This point is commented on by Quarantelli, in the introduction to a debate entitled, ‘What is a Disaster?’: “So a main reason we need clarification is because otherwise scholars who think they are communicating with one another are really talking of somewhat different It is suggested that a failure to distinguish between emergencies, crises and disasters also raises questions about the validity of any synthesis between theory and practice. For this reason a working definition of the terms will be given below. In a wider context, these terms are likely to remain problematic; therefore, it is argued that further work towards the definition of these terms is both a desirable and necessary feature of future research in this subject.

Emergencies Emergencies can be defined as situations requiring a rapid and highly structured response where the risks for critical decision-makers can, to a relative degree, be defined. You might like to note that the definition of ‘emergency’ in the Civil Contingencies Act 2004, Sec 1 is as follows: An event or situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK. Section 1 (5) of the Act comments that the definition of “emergency” is concerned with consequences, rather than with cause or source. Therefore, an emergency inside or outside the UK is covered by the definition, provided it has consequences inside the UK. A key feature of emergencies, as understood here, is that for those who manage such situations, conceptualisation (or mental modelling) both appears and is sufficient to identify an appropriate and effective strategy. A working example of an emergency might be a burning house, with the occupants desperately

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phenomena” (Quarantelli, 1995: 224).

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shouting for help from the top floor window. In this case the roles for principal emergency services are clear-cut, and it is the professionalism and speed at which procedures are put into action that will affect the outcome. Typically, the fire service would effect both a rescue and fire fighting operation, the police would mount outer cordons and facilitate access, the ambulance staff would provide medical care and transport of those injured requiring hospital treatment. The specific domains of involvement are, in this situation, structured as congruent with a command and control model (HMSO, 1991).

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Much of the existing academic literature on emergency management has been criticised for focussing too closely on the role of principal emergency response agencies (police, fire and ambulance) in the context of a highly structured response to incidents (Drabek, 1986; Dynes, 1994). It is argued here that if emergencies constitute highly structured situations, then much of this type of training may in fact be appropriate. However, for managing ill-structured scenarios, highly structured training may be more questionable.

Crises Crises could also be defined as situations requiring a rapid response (for this reason they are all too easily misconceived as emergencies), although in contrast, the risks for critical decision-makers are difficult to define owing to ill structure. It is typical for such situations that the effect of a response either is, or appears to be, unclear.

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A working example here might be the same as given above for an emergency, but this time there is some added complicating factor which makes a structured response more difficult. These factors could be numerous, for example, the fire is now on a house boat which has broken free from its moorings, or the building contains a dangerous chemical (or mixture of chemicals) which may cause an explosion, or the fire has been deliberately started by a deranged person who is threatening to kill the occupants or rescuers, as happened with a religious cult at Waco in America. A crisis, therefore, may not be apparent to those responsible for managing the situation. Crises may also cause disasters and continue to occur after the onset of a disaster. The concept ‘crisis’ has not been very well researched. However, there is now a debate emerging among some contemporary theorists about response and management of crisis situations. A growing number of academic journals, conferences, seminars and workshops on the subject of response and management of crisis appear to support this assertion. The fact that many of these have emerged only recently may be an indication of the urgent need for further research on the concept of crisis. Turner’s systems work is helpful here in providing a theoretical context within which distinctions could be made. For example, crisis could be argued to correspond to stage four of Turner’s model for understanding socio-technical disasters, although the outcome need not progress to disaster as was suggested by the model. By concentrating on the positive features of response, much can be learnt from successfully managed incidents. And this, it is argued, presents an opportunity for isomorphic learning as outlined by Toft and Reynolds. A number of theorists have acknowledged crises as distinct phenomena. For Heinzen (1996), there are four key characteristics. First, the crisis constitutes a series of events rather than the management of a single entity. Second, the crisis may be caused by a disaster (although no definition for disaster is provided). He does, however, acknowledge that the ‘disaster’ may not necessarily be a physical one. Third, the crisis has a diffuse origin making it difficult for decision-makers to gain a macro view of events. Fourth, it is unclear what action needs to be taken (Heinzen, 1996:16-17). Many of Heinzen’s points are congruent with the definitions given here and those offered by contemporary theorists. Crisis situations do pose a special problem, because despite giving the appearance to decision-makers of an emergency, there are few signals to suggest a more serious underlying threat. Lagadec makes this point in his paper: “What is missing is the characteristic

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feature of an emergency: a clear trace that would justify triggering the warning procedures and mobilising resources” (Lagadec, 1993). Lagadec has also argued that more training should be geared towards crisis management. One reason he gives to support this is the value of training to bring about a crisis among decision-makers. Lagadec comments on the reluctance of private industry, governments and Non Governmental Organisations (NGOs) to consider crisis decision-making as evidence for this (Lagadec, 1993). This view is also congruent with the theorist Uriel Rosenthal’s definition of crisis: “a serious threat to the basic structures or the fundamental values and norms of a social system” (Rosenthal, 1986). For both Lagadec and Rosenthal, the crisis can be found to operate at a social and cultural level by challenging the status quo. The crisis in this context could be perceived to be an affront to known knowledge and socially accepted notions of expertness. In contrast, some theorists have attempted to define crisis by distinguishing it from a disaster. For example, Goemans states that a “crisis is different from a disaster in a number of ways” (Goemans, 1992). Goemans then goes on to differentiate the two terms, using exactly the same four criteria as outlined for Heinzen above.

2.4 Disasters A disaster is distinct from both emergencies and crises only in that physically it represents the product of the former. Disasters, then, are the irreversible and typically overwhelming result of ill handling of emergencies and crises. Fundamental to the understanding given here is that specific socio-technical systems affected by disasters will have been indelibly challenged, possibly leading to inquiries at the highest social and cultural levels (the official public inquiry is an example of this). This can be deemed similar to the definition of disaster given by Turner as an overturning of the cultural norms for dealing with hazards (Turner, 1978). Responding to what is described as disaster may typically involve dealing with a number of smaller ongoing crises and emergencies. Disaster is perhaps the most difficult phenomenon to define due to its apparent amorphous nature. In this case using the analogy given for emergency and crisis, the disaster would have caused destruction and/or serious loss of life. Response staff, then, would be dealing with the failure to manage emergency and crisis, i.e. the house has now burned to the ground.

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The central argument offered here is that crises are ill-structured situations both in terms of technical, social and cultural contexts. The greater the degree of ill-structure, then the more difficult the incident becomes for recognition and management, more agencies become involved and hence more social agendas become juxtaposed. It is this spiral which can lead to disaster.

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A number of different context-specific ways of perceiving disaster have been proposed by contemporary theorists. The relevance of Turner’s systems theory model has already been discussed in some detail and suggests an example. This approach argues that disaster is the collapse of cultural precautions for dealing with socio-technical phenomena in some systemic way (Turner, 1978; Horlick-Jones, 1990). Another method for defining disaster in the literature is as an overwhelming situation, which could be in terms of human costs (lives lost) and financial loss or damage to social structures. This can also

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be expressed as insufficient resources to deal with the situation; for a commercial organisation this might mean bankruptcy. In this context, the disaster can be seen as ‘social vulnerability’ (Gilbert, 1995) or a ‘lack of capacity’ (Dombrowsky, 1995). Event quality also suggests a similar method for conceptualising disaster. In this context it is again event typology, or severity, which can be used to gauge the disaster (Dombrowsky, 1995; Gilbert, 1995; Kroll-Smith and Couch, 1991).

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Of concern is that many theorists still freely conflate the terms emergency, crisis and disaster in their work. For example, while Quarantelli does attempt to define disaster and stresses the importance of doing this, he then goes on to refer to the same situation as a crisis (Quarantelli, 1995). While the academic reasons for doing this may be valid, it is questionable whether theoretical confusion will facilitate a practical approach to exercise focus. Even the UK Government’s publications of Emergency Preparedness and Emergency Response and Recovery note the difficulty with terminology (Cabinet Office 2005a and 2005b). The Emergency Preparedness document (page 39, para 4.26) states that ‘Risk terminology is notoriously varied’ and does not offer a definition of disaster although the document does aim to be consistent with the main standards relating to risk management (page 39, para 4.26). A different explanation, in direct contrast with Heinzen and Goemans’, is offered by Dombrowsky’s assertion: “Disasters do not cause effects. The effects are what we call a disaster” (Dombrowsky, 1995: 242). It is perhaps easier to distinguish between emergencies and disasters in that the former at least presents a more structured and less overwhelming decision-making task. However, it is argued that the definitional problem highlighted here represents a deeper form of misunderstanding. If one were to take a neo-relativist position, a disaster is nothing more than the social construction of symptoms from emergency and crisis. In this respect, disaster becomes reified as a cultural ‘myth’ given the status of physical phenomenon (Baudrillard, 1988; Horlick-Jones, 1990). To reify disaster as anything more than this would attribute disaster with the status of agency – a Hobbesian Leviathan which must be resisted, or what Giddens refers to as the ‘dark side of modernity’ (Giddens, 1991).

2.5 Multiple realities Another reason why a distinction between dangerous phenomena is difficult is due to multiple realities. Some theorists have even suggested that experts cannot agree among themselves as to what constitutes a risk. For example, in a case study which was carried out on the Exxon Valdez oil spill, it was found that a situation of multiple realities existed among the expert decision-makers responding to the event. In particular, there was some considerable confusion among the response staff about whether the crew should have been airlifted from the stricken vessel so quickly. It was argued by some response staff that the vessel could have been moved from its collision course with the rocks if there had been a crew on board (Browning and Shetler, 1992). Another example of the confusion about expert testimonies is provided by the introduction of seat-belt regulation in the UK. This was widely hailed as a positive step towards the management of risk in a road safety context but, as has been pointed out by Adams, the net effect of this change in legislation should be considered in its meaningful context to those affected. This does not only

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include vehicle drivers. It can be argued that drivers feeling safer as a result of being strapped into their seats may well drive faster and take more chances which may adversely affect other road users such as pedestrians and cyclists (Adams, 1988, 1995). Hence to restate the earlier point about risk measurement, while it may be quite possible to measure the decrease in driver injuries, this is only possible because the variable being measured is whether a seat-belt is worn or not. The driver’s enhanced feeling of safety wearing a seat-belt may affect the driver’s speed and style of driving; the implications of this on other road users’ safety may be negative.

2.6 Exercising

The findings of the inquest into the 7th July 2005 bombings in London produced some similar conclusions (Home Office, 2011). Multi-service response exercises (or simulations) are well recognised as of value and importance for the emergency services. This has been highlighted in many of the official reports produced by both the government and the emergency services themselves (HSE, 1991; HMSO, 1991; London Emergency Service Liaison Panel, 1992). Simulations and training exercises offer a proactive means to understand and manage crises before they happen. Simulated training exercises can also be used to train organisations which need to work together in order to deal with crisis (Borodzicz, 2005: 26). Turner, commenting on the research carried out by a European consortium team, argued that a ‘clarity of goals’ is an essential feature of good simulation design (Turner, 1996: 33). Understanding the difference between emergency, crisis and disaster will facilitate the development of a more focused and meaningful training programme for key decision-makers. It is argued here that developing an awareness of these terms among those being trained may also encourage a more realistic response.

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An understanding of what is meant by emergency, crisis and disaster is argued to be of critical importance in a training context. However, specialist training for a crisis is particularly difficult and can be very expensive. The rewards of such training may only become apparent if and when a real incident occurs. On the other hand, failure to train effectively can lead to a poor emergency response resulting in lost lives, costly damage to property and industry with public and political condemnation of the responsible authorities. The King’s Fund report entitled Too Many Cooks, is an example of this type of condemnation. The King’s Fund report was highly critical of the response agencies in London attributed to a poor use of resources and lack of co-ordination at a number of incidents (King’s Fund, 1992).

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Coping with socio-technical crisis situations may require a new approach to training and management skills from both those which are normally acknowledged within the established emergency response services and those employed in the operation of hazardous industrial activities. Dealing with these types of incidents fortunately forms a small part of the overall work of the emergency response services. However, when a crisis does occur, it is often of a highly unpredictable nature and may overwhelm the emergency decision-makers by its speed of onset and ill structure.

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The problem is that our response to any crisis incident is at best dependent upon our definition of what is happening. Disagreements between experts about the cause and remedies of these tragedies can frequently be heard in public and governmental inquiries. It has been argued that training for a crisis can itself create a crisis for the response organisations themselves, as suggested by Lagadec (1993). If Lagadec’s assertion is correct, then the training crisis created is for many organisations a very necessary one.

2.7 Conclusion How we conceptualise dangerous events will remain problematic. In this Unit we have discussed a various ways that this could be done. Typology, severity and systemic modelling do provide a variety of apparently pragmatic methodologies. While these ways of managing the data can provide a pragmatic approach to classifying data, it is questionable whether these criteria will assist in understanding and managing the aetiology of such events.

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Using emergency, crisis and disaster as conceptual categories will not make the conceptual problems go away. The definitions that have been offered for these terms in this Unit are themselves problematic, although they do least provide a way in which theorists might consider the requirements to facilitate management and response. No architect who purposely sets out to design dangerous events could ever have planned for the variety of almost unique contexts in which they manifest their complexity. For this reason the work of deities is often cited. However, whether we call such dangerous events emergencies, crises or disasters, it is still difficult to accept without question their continual increase; particularly as dangerous events all have similarities and differences, yet they never appear to be exactly the same.

2.8 Guide to further reading You should now read the article provided at the end of this unit, ‘Again and Again: Is a Disaster What We Call “Disaster”?’ Some Conceptual Notes on Conceptualizing the Object of Disaster Sociology’, International Journal of Mass Emergencies and Disasters, 13(3): 241-54 by Wolf Dombrowsky.

2.9 Study questions You should now write approximately 300 words in answer to each of the questions below. We believe that this is an important exercise that will assist your comprehension of material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University. • What is the difference between emergency, crisis and disaster? • To what extent does the way we perceive events affect the way we manage them? • Why is it important to make a distinction between different types of dangerous events?

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2.10 Bibliography Adams, J. G. U. (1988) ‘Risk homeostasis and the purpose of safety regulation’, Ergonomics, 31(4): 407-28. Adams, J. G. U. (1995) Risk, London: UCL Press. Baudrillard, J. (1988) Selected Writings, Cambridge: Polity Press. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage. Borodzicz, E. P. (2005) Risk, Crisis & Security Management, Chichester: John Wiley & Sons. Browning, L. D. and Shetler, J. C. (1992) ‘Communication in crisis, communication in recovery: A postmodern commentary on the Exxon Valdez disaster’, International Journal of Mass Emergencies and Disasters, 10(3): 477-98. [a supplied reading later In the course].

http://www.ukresilience.info/ccact/index.htm. Cabinet Office, (2005b) Emergency Response and Recovery. Non-statutory Guidance to Complement Emergency Preparedness, London; available online at http://www.ukresilience.info/ccact/ index.htm. Civil Contingencies Act 2004, Chapter 36, London: HMSO. Cox, S. and Tait, R. (1991) Reliability, Safety and Risk Management: An Integrated Approach, London: Butterworth-Heinemann. Cox, S. and Tait, R. (1998) Reliability, Safety and Risk Management: An Integrated Approach, (2nd edition) London: Butterworth-Heinemann. Dombrowsky, W. R. (1995) ‘Again and again: Is a disaster what we call “Disaster”? Some conceptual notes on conceptualizing the object of Disaster Sociology’, International Journal of Mass Emergencies and Disasters, 13(3): 241-54. Douglas, M. (1970) Purity and Danger, London: Routledge. Douglas, M. and Wildavsky, A. (1982) Risk and Culture: An Essay on the Selection of Technological and Environmental Danger, Berkeley: California University Press.

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Cabinet Office, (2005a) Emergency Preparedness. Guidance on Part 1 of the Civil Contingencies Act 2004, its associated Regulations and Non-statutory Arrangements, London; available online at

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Drabek, T. E. (1986) Human Systems Responses to Disaster: An Inventory of Sociological Findings, New York: Springer-Verlag. Dynes, R. (1994) ‘Community emergency planning: False assumptions and Innapropriate analogies’, International Journal of Mass Emergencies and Disasters, 12(2):141-58.

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Dynes, R. and Drabek, T. 91994) ‘The structure of disaster research: Its policy and disciplinary implications’, International Journal of Mass Emergencies and Disasters, 12:5-23. Forgues, B. and Roux-Dufort, C. (1998) ‘Crisis: Events or processes’, paper presented at the Hazards and Sustainability Conference, University of Durham, England. Giddens, A. (1991) Modernity and Self-Identity, Cambridge: Polity Press. Gilbert, C. (1995) ‘Studying disaster: A review of the main conceptual tools’, International Journal of Mass Emergencies and Disasters, 13(3): 231-40. Goemans, B. (1996) ‘Policy exercises as a learning tool for crisis management’, paper presented at the 2nd International Conference: Local Authorities Confronting Disasters and Emergencies, Amsterdam.

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Health and Safety Executive (1991) Major Hazard Aspects of the Transport of Dangerous Substances, London: HSE. Heinzen, B. (1996) Crisis Management and Scenarios: The Search for an Approach Methodology, The Netherlands: Ministry of Home Affairs. HMSO (1991) Department of Transport Marine Accident Investigation Report, Report of the Chief Inspector of Marine Accidents into the Collision between the Passenger Launch Marchioness and MV Bowbelle with Loss of Life on the River Thames on 20th August 1989. Dept. of Transport, London: HMSO. Home Office (2011) 7/7 inquest – WMS. (available online at http://www.homeoffice.gov.uk/ publications/about-us/parliamentarybusiness/writtenHorlick-Jones, T. (1990) Acts of God? An Investigation into Disasters, London: Association of London Authorities. King’s Fund (1992) Too Many Cooks, London: King’s Fund. Kroll-Smith, J. and Couch, S. (1991) ‘What is a disaster? An ecological-symbolic approach to resolving the definitional debate’, International Journal of Mass Emergencies and Disasters 9: 355-366. Lagadec, P. (1993) ‘Ounce of prevention worth a pound in cure’, Management Consultancy (June). London Emergency Service Liaison Panel (LESLP) (1992) Major Incident Procedure, Published by Directorate of Public Affairs and International Communication, Metropolitan Police Service, New Scotland Yard, Broadway, London. Mitroff, I., Pauchant, T. and Shrivastava, P. (1988) ‘The structure of man-made organisational crises’, Technological Forecasting and Social Change, 33: 83-107.

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Pauchant, T. and Mitroff, I. (1992) Transforming the Crisis-Prone Organisation, San-Francisco: Jossey Bass. Pearson, C. M. and Clair, J. A. (1998) ‘Reframing crisis management’, Academy of Management Review, 23: 59-76. Perrow, C. (1984) Normal Accidents: Living with High-Risk Technologies, New York: Basic Books. Perrow, C. (1999) Normal Accidents: Living with High-Risk Technologies, (2nd edition) New York: Basic Books. Quarantelli, E. L. (1995) ‘What is a disaster?’, International Journal of Mass Emergencies and Disasters, 13(3): 221-29. Quarantelli, E. L. (1998) What Is A Disaster?, Routledge: London.

22: 103-29. Schwartz, H. S. (1987) ‘On the psychodynamics of organisational disasters’, Columbia Journal of World Business, 22: 59-67. Shrivastava, P. (1987) Bhopal: Anatomy of a Crisis, New-York: Ballinger. Toft, B. and Reynolds, S. (2005) Learning From Disasters: A Management Approach, (3rd edition) Basingstoke: Palgrave Macmillan. Turner, B. (1978) Man-made Disasters, London: Wykeham. Turner, B. (1996) Scenarios in emergency response simulations, Crisis Management Reader Seminar: The Use of Scenarios for Crisis Management. Ministry of Home Affairs, The Hague, Netherlands. Turner, B. and Pidgeon, N. (1997) Man-Made Disasters, (2nd edition), Oxford: ButterworthHeinemann.

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Rosenthal, U. (1986) ‘Crisis decision making in the Netherlands’, Netherlands Journal of Sociology,

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READING ‘Again and Again: Is a Disaster What We Call “Disaster”? Some Conceptual Notes on Conceptualizing the Object of Disaster Sociology’ Dombrowsky, W. R. (1995) International Journal of Mass Emergencies and Disasters, 13(3): 241-54.

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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UNIT 3 Systems ideas and risk


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3 Unit Three: Systems ideas and risk There are a variety of meanings for the term ‘management system’, all of which relate to the means by which some risks may be controlled. This Unit describes underlying systems concepts and different ideas about management systems. The Unit will also consider the potential benefit of system concepts to risk management, as well as the risks that are attached to management systems themselves. Differing sets of assumptions about systems will be outlined and you will be encouraged to adopt a cautious approach to the term ‘system’.

3.1 Introduction

It is suggested here that management systems should be based on fundamental system concepts rather than a blind acceptance of some stated dogma or orthodoxy. The remainder of this Unit seeks to address the subject of management systems and risk on the basis of fundamental system concepts developed and tested in a long theoretical and empirical tradition. The validity and value of more recent approaches to management systems (such as those advocated by national and international standards organisations) are also discussed in relation to fundamental system concepts.

3.2 System concepts Both the study and use of system ideas are hampered by a wide variety of meanings for the term ‘system’ both within and between different disciplines and professions. To varying degrees, different understandings of the term ‘system’ share a common theme, namely that of a whole consisting of components which are interconnected in an organised way. Some common examples are:

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In official reports into disasters ranging from the King’s Cross fire (Fennell, 1989), the Piper Alpha offshore fire and explosion (Cullen, 1990) and the Clapham railway accident (Hidden, 1990) to the collapse of Barings Bank (Bank of England, 1995; Singapore Minister for Finance, 1995), failures in management systems were cited as playing a significant role in the development of conditions leading to disaster. The development of updated management systems has become a common response activity in many organisations following major system failures. It is surprising therefore that, with such a focus on ‘management systems’, the approach to systems should be subject to a variety of meanings and interpretations. Equally surprising is the weak theoretical context which forms the basis for much practical ‘management systems’ thinking (Waring, 1989, 1996a, 1996c).

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• a systematic method or procedure • characteristics of an organisation as in ‘the system’ • particular arrangements of computer and information technology • a systematic framework of specific practical activities, e.g. a safety management system. By regarding systems in these terms, there is a tendency to think of a particular system of interest as an objective entity which exists in the real world. However, this approach ignores the fact

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that ‘systems’ are a perceptual construct (Waring, 1989, 1996a 1996c) and not an incontestable truth. The objective entity approach to systems (e.g. quality management systems, integrated management systems, information technology systems) explains why they often fail to deliver claimed outcomes. The history and development of systems ideas are covered in a number of references such as Burrell and Morgan, 1979; Checkland, 1981; Checkland and Scholes, 1990; Morgan, 1986 and Vickers, 1983. There is no one ‘systems theory’ as such, but rather a number of systems co-existing. Instead, systems thinking is a way of examining the ‘real’ world for the purposes of understanding and/ or improving aspects of it. The notion of a system is closely tied to an individual’s world-view or characteristic way of perceiving the world. A system, therefore, represents a metaphor for understanding a wide range of perceptions. In other words, systems thinking and practice both reflect a set of assumptions which also affect outcomes. Many theorists have argued that meaning and action are linked in some way (Denzin, 1978; Johnson, 1987; Waring, 1993, 1996c). A key point of understanding here is that a number of different meanings and interpretations can be attached to the term ‘system’, and these can result in correspondingly different sets of actions and outcomes.

System characteristics Although there is no universally agreed definition of a ‘system’, a number of theorists have suggested that systems have defining characteristics (see, for example, Carter et al., 1984; Checkland, 1981; Checkland and Scholes, 1990; Morgan, 1986; Open University, 1984; Vickers, 1983; Waring, 1989, 1996a, 1996c). As a concept, a system consists of a recognisable whole, which contains a number of components or elements interconnected in an organised way. The interaction of these components signifies what are known as processes and system outputs. System components are perceived to be interrelated in a hierarchical structure. The addition or removal of a component, therefore, may radically change the nature of the entire system and its characteristics. A component subsystem may also be equally affected by its inclusion in the system. The means for control and communication which promote system survival should be identifiable and the system should have emergent properties, some of which may be difficult to predict. Every system will also have a boundary and a ‘system environment’ which affects the system outside of the system boundary. Typically, the majority of system characteristics are not recognised by many people in their perceived systems. The connection between such a narrow view and the adverse consequences of that view also may go unrecognised. For example, a view of management systems as being only control processes or systematic procedures is questionable, because this addresses efficiency which is an unreliable indicator of effectiveness (Waring, 1989, 1996a, 1996c). There are obvious risk implications from this: a management system model may not be able to achieve what its owners claim and beneficiaries expect. Both pure and speculative risks may be adversely affected as a result (see below).


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Summary Although there is no universally agreed definition of ‘system’, there is general agreement about the defining characteristics. The 13 key characteristics of systems are: a recognisable whole

interconnected components or elements

organised interconnectedness

component interaction signifies processes

processes imply inputs and outputs

components form hierarchical structures

adding or removing a component changes the system and its characteristics

a component is affected by its inclusion in a system

means for control and communication promote system survival

emergent properties, often unpredictable

system boundary

a system environment outside the boundary which affects the system

system ‘ownership’.

3.3 System categories There are a number of perceived system categories in common use (Checkland, 1981). For example natural or ecosystems such as the oceans, pathogens and forests; or ‘abstract’ systems represented by computer languages or signing systems. Engineered or designed technical systems might typically include chemical process plants, computer systems, aircraft and information systems. Systems may also be categorised as human activity, social or cultural systems. Systems relating to work and organisations could also be perceived to include social and political systems. Social systems might also include families, institutions, towns and societies. Subsystems of these are political systems of government, international diplomacy and corporate management. Although there can be widespread agreement about the type of category a particular system belongs to, categorisation is not preordained and categories are not mutually exclusive. How one perceives a particular system will influence how one categorises it; therefore world-view and purpose can be highly relevant factors in system categorisation.

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Structures and processes Two kinds of interrelated system component are usually recognised. These are structural and process components. The structure of a system comprises relatively stable components which either carry out processes or are acted upon by processes. Structural components might include

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finance, marketing and production functions. Processes might include action, change, growth, decline and influence. System components perceived as closely related in functional terms may be organised into groups called subsystems. A subsystem is part of another system but itself has all the general characteristics of a system. The identification and analysis of subsystems is an important management function and will facilitate ease of understanding and communication.

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The link between structure and process is inextricable. Without structure, there can be no processes and conversely without a process, structure cannot be sustained. The character of system processes is heavily influenced by the character of the system structure. Where human activity systems are concerned, the system structure necessarily is both a product of functional requirements and of complex human factors such as power and culture. This essential mutuality is not admitted in what have now become conventional approaches to ‘management systems’ (see below) in which only an ill-defined ‘management process’ is recognised whose normative truth and adequacy are, apparently, obvious and incontestable. The very naiveté of such ‘management process’ models used in isolation, therefore, brings increased risks of failure.

Hierarchy and resolution Resolution and hierarchy concern the level of detail in the system structure appropriate for a particular purpose. When a system boundary is set and boundaries of subsystems identified, a process of bracketing off components, putting like with like and matching level of detail with level of detail follows. Typically, conceptual and other representational diagrams of systems are constructed and developed iteratively in order to clarify such matters, as shown in Figure 1. Hierarchy and resolution are complementary in that superordinate and subordinate relationships may be perceived between components, subsystems and functions on a range of parameters, such as authority, time and sequence. Perceived hierarchy may therefore suggest levels of resolution. For example, policy-making is usually regarded as a higher order function than strategy, which in turn is higher than operational activities in an organisation. The board is usually regarded as being at the top of the organisation with various tiers of management below it. Such top and bottom orderings are not incontestable truths but merely taken-for-granted cultural artefacts, or expressions of values and unobtrusive power structures. During the late 1980s and early 1990s, there was a trend towards smaller, leaner, flatter organisational structures, with looser hierarchical reporting relationships. Many large organisations deliberately cut out most of their middle managers and reduced the numbers of junior managers and supervisors. This was done on the premise that it should be possible to run a more cost-efficient and effective organisation that way. Reducing bureaucracy and overheads was a very attractive proposition to many organisations of the time, reflecting the competitive world markets and harsh economic climates. Although some successes have been claimed for business re-engineering (Talwar, 1995), this has not proven to be the panacea for all organisational ills (Caulkin, 1995; Davies, 1993). Indeed, in the UK at the end of its 1990-95 recession manufacturing demand for exports increased sharply. For some companies which had divested themselves of many functional managers, great difficulties were experienced in coping with the new expansion in operations and hiring replacement managers became necessary.

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Figure 1: Iterative adjustment of component resolution for the national CAA system for operating the air traffic control centre at West Drayton

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3.4 System environment In everyday speech, the term ‘environment’ signifies the surroundings of an entity of interest. Such an environment may relate to one or more of the physical, social, political, economic or cultural environments. In systems terminology, ‘system environment’ may also include such topics but it has a more particular meaning, namely components outside the system which affect it, which the system is unable to control directly and is unlikely to be able to affect to any significant extent. For example, the environment of an organisation viewed as a system might include public policy, legislation, taxation, the economy, product markets, technology, operating terrain, and so forth. An organisation may also attempt to influence its own environment, for example, by joining industry associations, public relations bodies and lobbying the Government. In conventional systems thinking, a system boundary must be set and so the concept of environment is important. However, determining where a particular system boundary exists can be both problematic and controversial. Different boundaries will have different implications for a system’s outcomes, as will different perceptions of topics to be considered in the environment. The concept of system environment also carries with it a set of biological connotations and assumptions (Korman and Vredenburgh, 1984; Morgan, 1986; Waring, 1989, 1996c). For example, adaptation and homeostasis are two features of biological systems characteristic in relation to their physical environment. Other kinds of system, such as human activity systems, may exhibit characteristics at certain times which appear similar to adaptation and homeostasis but it would be incorrect to infer that human activity systems are biological systems, or that an organisation’s behaviour is adequately explained by reference to adaptation and homeostasis in relation to its environment (Waring, 1989, 1996c). While biological metaphors may be a useful heuristic for understanding social and human organisational systems, one should be aware of the limitations of this application. A further problem of meanings arises from the widespread use of the term ‘environment’ to mean the surroundings of people, whether at a local level or at more global levels, and the wise use of resources and technical processes to avoid damage to that environment, for example, purchasing goods whose manufacture seeks to reduce adverse effects on limited natural resources, altering factory processes to limit pollution, controlling waste and managing its disposal so as to avoid contamination of land and water. It is usual for ‘environment’ in this sense to be seen as a resource affected by ‘processes’ and unusual for it to be seen in systemic terms as described here. The wide variation in meanings of ‘environment’ is becoming as problematic as are different meanings of ‘system’. In order to avoid confusion over the use of the term ‘environment’, at least so far as organisations and management systems are concerned, an alternative term ‘outer context’ is advocated to substitute for ‘system environment’ and ‘inner context’ refers to the internal environment such as culture, power relations, motivations, and so on (Pettigrew, 1985, 1987; Waring, 1993, 1996a).


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3.5 Prediction and control Prediction and control are closely linked desirable attributes of systems. These attributes relate to a system’s ability to avoid dysfunction and to survive adverse conditions. Prediction and control therefore rely on certain assumptions, in particular that desired goals, objectives and criteria be identifiable and that monitoring and control functions be appropriate. Data based on control experience or analogy enable prediction of the particular perceived system’s behaviour. There are a number of necessary conditions and assumptions about system prediction and control. First, the process to be controlled must be understood. Second, inputs and outputs must be capable of being monitored reliably and at a suitable frequency, using appropriate means of measurement. Third, there must be an adequate communication link between monitor and controller, and agreed reference standards, goals and other performance criteria must be compatible with outputs being monitored. Fourth, time delays between monitoring, control action and control effect should be within tolerable limits.

3.6 Emergence and holism A simple ‘process control’ view of systems is based on a cause-effect model whereby the outcomes (effect) are both predictable and controllable by close attention to system inputs and process. In other words, for a given system one should expect only the system outputs which are readily predictable. However, the very interactions, which characterise a system, also produce a synergy and emergent behaviour. It is argued here that this could not readily be predicted merely from a consideration of a system’s disconnected components, inputs, processes and control characteristics. For example, despite a general improvement in the UK economy and a return to the so-called ‘feel good’ factor in public perceptions of the economy in the second half of 1995, this did not readily translate into a corresponding willingness to vote for the incumbent government. Effects on voting intentions as an emergent property of the national economic system are not predictable by sole reference to government policy and economic indicators. Vickers (1983, 1985) provides further examples of this. Using this as an analogy for risk management, examination of an individual scaffold component does not enable accurate prediction of what a particular erected scaffold will look like or how safe it will be.

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Despite these conditions and assumptions, the more complex the perceived system and the factors that influence it, the less likely that control will be reliable and that predictions will always be accurate. Recognition of this caveat is especially important when considering management systems, organisations and other aspects of human activity, which are inherently complex. The author contends that many risks are increased unnecessarily as a result of a naive simplification of complex issues relating to management. System promulgators often convince themselves and others that a systematic model and control procedures are sufficient in themselves for the control of all pertinent risks. As a result, additional vigilance beyond a particular model’s parameters may be good practice. It must be stressed that the scope of control and process characteristics in human activity systems are qualitatively different from those in other kinds of system which do not rely on variable, fallible, wilful and unpredictable human beings.

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A holistic view of systems risk is one which seeks to consider the widest set of components, systemic interactions, influences and emergent properties which may be relevant to a system. Holism, however, does not imply consideration of every possible aspect of the particular whole, but rather a consideration of the essence of all the significant aspects. It is argued here that reductionism, in contrast to holism, will deliberately attempt to mask significant features or system properties (and often in ignorance of the adverse effects on understanding and outcomes), in search of simplicity, elegance and convenience.

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The term ‘ownership’ crept into management vocabulary in the late 1980s and early 1990s. It describes the development of an organisational culture in which employees recognise both a responsibility for and a stake in the benefits of various management concepts and systems. However, in conventional systems terminology, ‘system owner’ has a different meaning to that of a stakeholding beneficiary of the system. System owners are those who have an axiomatic interest in the particular system, for example, system design, improvement, implementation or problem-solving. System ownership therefore also implies that it is worthwhile regarding a particular entity as a ‘system’. Many theorists would argue (Checkland, 1981; Checkland and Scholes, 1990; Open University 1984; Waring, 1989, 1996c) that a system owner is someone who has the power to alter the perceived system significantly or, indeed, terminate it altogether. In contrast, individuals who have an operational role in the perceived system (such as stakeholding employees in an organisation) usually have no such power. There is thus, a risk of false expectations for the success of a particular management system in cases where system ownership is perceived by senior managers as being vested in the employees, whereas the employees do not have the necessary authority.

3.8 World-view In this section, the broader perceptual phenomenon called ‘world-view’ or ‘Weltanschauung’ (Dilthey, 1931; Kluback and Weinbaum, 1957) is outlined as it forms an essential part of systems thinking (Checkland, 1981; Checkland and Scholes, 1990; Davies, 1988; Waring, 1989, 1996c) and organisational analysis (Johnson, 1987; Waring, 1993, 1996c). World-view may be regarded as a kind of ‘perceptual window’ or ‘tinted spectacles’ through which each person interprets the world and his or her relationship with it. Vickers (1983) refers to a broadly equivalent term called ‘appreciative system’ by which individuals and groups appreciate or make sense of the world and themselves. The mutual influence between the world-view of an individual and the collective world-views of groups to which the individual belongs is significant in examining the influences of culture and power in organisations, including their effects on management systems and risks. A particular world-view denotes a complex and dynamic set of beliefs, values, assumptions, opinions, attitudes and motivations. A world-view may, therefore, be regarded as a characteristic

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set of perceptual biases about how the world functions. A collective or shared world-view may also be regarded as a component of culture and equivalent to ideational culture (Johnson, 1987; Waring, 1993) which is discussed later in this Module. Shared world-views are important for integration and stability in organisations. In some circumstances, different world-views may be so irreconcilable that clashes and conflicts occur, for example, employer-trade union disputes such as in the UK coal industry in the 1980s,the ‘fuel crises’ of 2001, recent events in Greece, Thailand and elsewhere. As we go to press, events in Syria dominate the news as an autocratic regime come under pressure. It is important in many cases for risk assessment to include analysis of relevant world-views, although this requirement is rarely addressed by technical risk analysts because it falls outside the scope of their training, experience and, dare one say it? - professional world-view. As Douglas (1992: 13) notes, ‘When he brackets off culture from his work, the well-intentioned risk analyst has tied his own hands’. He wants to be free of bias, he would rather pretend that bias is not important than sully himself by trying to categorise kinds of bias.

The functionalist world-view rests firmly in the objective/regulation area and is consistent with beliefs that the structures of society, politics, business and organisations have a preordained timeless function. For functionalists, the status quo justifies itself and is a necessary mechanism for maintaining social order. Functionalism, however, is betrayed by a self-declared rationalism, claims to objectivity and a conviction that quantification is inherently better than qualitative data. Beliefs, underpinned by relatively simple cause-effect models in such concepts as market forces, survival of the fittest, efficiency in the use of resources, organisational benchmarking and, ironically, Business Process Re-engineering, are all indicative of a functionalist world-view. The functionalist perspective might be most at home in banks, financial institutions and engineering works. Other tell-tale characteristics include beliefs that organisational culture is a commodity that exists to support and serve corporate and system interests, and is firmly in the gift of senior management to manipulate, control and predetermine. Such assumptions have been challenged by various authors including Smircich (1983). Interpretative world-views combine a desire for order with assumptions that characteristics of society, politics, business, organisations, and so on, are not pre-determined but socially constructed. An interpretative world-view is pluralistic in acknowledging that multiple interests, rationalities and even realities are recognised as legitimate. For example, non-expert perceptions of risk, which might be marginalised as a nuisance or dismissed as insignificant in a functionalist world-view, would be regarded as highly relevant from an interpretative perspective.

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Burrell and Morgan (1979) identified four principal world-view types: structural/functionalist, interpretative, radical structuralist and radical humanist. Each type described a particular emphasis on two dimensions, that is subjective-objective and regulation-radical change.

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Radical world-views value change of society and its institutions by revolutionary means –– the ‘righting’ of ‘wrongs’ (Waring, 1989). The desired change is essentially a redistribution of power from those deemed to possess it to those deemed to deserve it. Radical structuralists see whole classes of persons as being dominated and exploited by social, economic and political structures set up by wealthy and powerful classes to ensure the status quo (see, for example, Allen, 1982 and

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Clegg, 1980). Such a world-view is also consistent with authoritarian ideologies of various kinds. Any risk issues that are acknowledged are frequently seen as issues of blame to be laid at the door of the exploiting classes. Radical humanists see the domination issue as essentially focused on the individual who is alienated and at the mercy of society itself. By failing to throw off the shackles imposed by social structures and norms, the individual acquiesces in his or her own domination. Individual anarchic action is advocated as the means of empowerment. Physical attacks, sabotage and intimidation against symbols of social order and power would be extreme examples of behaviour consistent with such a world-view.

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Waring (1993, 1996c) has noted that academic debate has tended to polarise the differences between functionalist and interpretative world-views to the point where they have become regarded by some as mutually exclusive (see, for example, Burrell and Morgan, 1979; Carter and Jackson, 1991). However, a synthesis of different perspectives enables a more complete understanding of organisational phenomena, which in the longer term may enable organisations to be more effective and experience fewer failures (Turner, 1992). Other labels which have been applied to functionalist and interpretative world-views are respectively ‘normative’ and ‘descriptive’ (for example, Davies, 1988; ESRC, 1993). The debate about the degree of commensurability of functionalist and interpretative world-views is also closely linked to the debate about the degree of commensurability between modernist and postmodernist perspectives (Carter and Jackson, 1991; Jeffcutt, 1991; Reed, 1991; Waring, 1993). The new ‘Realpolitik’ in both organisational analysis and systems thinking stresses continuity between world-view types and seeks to accommodate (but not necessarily merge, reconcile or subsume) different perspectives (Waring, 1993, 1996c).

3.9 Management systems Although agreement commonly exists about the need for good management, there is no commonly agreed set of constructs and language regarding management systems. In practice, the approach is highly varied, even within a single organisation. How people describe a management system reflects their world-view and the mental models they have about how the world functions. Different kinds of model have been described and compared by Freckleton and Waring (1992) and Waring (1996a) in relation to safety management systems, but the same principle applies to management systems in general. These models include: the sausage machine, clockwork/programmable robots, human activity systems and clockwork-plus-humans or socio-technical models. In summary, both the sausage machine and clockwork/robots models view of effective management systems are mechanistic and based on a simple input-process-output assumption. Prediction and control are seen as straightforward reliable outcomes of decrees, instructions and company manuals which ‘wind up’ the organisation to perform just like a clockwork or a set of identikit programmable robots. Effectiveness is measured typically in quantitative terms only. Such a model is consistent with a highly functionalist world-view.

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The clockwork-plus-humans or socio-technical approaches focus on technical efficiency of formal management systems backed up by formal attempts to control the human contribution through staff selection, training and motivational techniques. Such an approach is essentially functionalist and consistent with Total Quality Management (TQM) (Waring, 1996a) which expects that everyone In a company shares the responsibility for quality (Reason, 1997: 47). An approach based on human activity systems seeks a more holistic consideration of the inherent complexity of people as social actors and their organisations as social constructions. The baseline assumption is that any well-designed management system should possess the following systematic characteristics: • a systematic framework which connects up all the components • clear policy, strategy and objectives • clear responsibilities, accountabilities and authority of individuals • adequate means for organising, planning, resourcing and decision-making

• a coherent and adequate set of measures of performance • adequate means for monitoring, assessing, auditing and reviewing both the quality of the system itself and how it functions • adequate numbers and allocations of competent well-led people • flow of adequate information to all those who need it • adequate intelligence about the inner and outer contexts of the organisation • compatibility, if not integration, with other management systems in the organisation. In addition, in order to function effectively as a human activity system, factors in the inner context such as organisational culture, power relations, motivations and meanings of success would be critical as, indeed, would be responsiveness to the outer context. It is all these systemic contextual factors which are so often overlooked or ignored.

3.10 Standards for management systems If an organisation can show that all its various functions and processes which contribute to product quality, such as design, marketing, production, safety, human resources, sales, finance, and so forth, are working at peak efficiency and effectiveness, then in principle its chances of commercial success are improved significantly. Demonstration of product quality is therefore important strategically to most companies and represents a strategic risk.

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• adequate means for implementing plans and decisions

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One important contributor to product quality is having effective and efficient management systems. A number of national and international standards have been drawn up to cover the functionally related management areas of safety, quality and environment (SQE).

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The ISO 9000 Specification for Quality Management Systems, and ISO 14001 Specification for Environmental Management Systems are both specification standards which carry with them ‘third party’ certification schemes. The standards body (ISO or its agent) provides certificates of compliance to an organisation provided that it has successfully passed an audit by an approved or accredited auditor (the third party).

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However, confusion has arisen about such standards particularly in relation to their status. There are also frequently unrealistic expectations of a ‘clockwork’ cause-effect relationship between applying such standards and achieving rapid success. The relationship between certification and actual quality or environmental performance in a particular organisation is very debatable. The models and approaches incorporated are over-simplified and naive as paradigms for success. The ISO 9000 certificates only attest to compliance with minimal requirements for documentation and procedures, and these do not address actual product quality. It is, therefore, questionable whether such certificates represent passports to markets, rather than a guarantee of a company’s products per se (Waring, 1996b). Binney et al. (1993) and Wilkinson et al. (1993) are two relevant independent studies supporting this. Proponents of certification often point to the large number of organisations which have become certified as evidence of the value of certification. However, experience suggests that many certified organisations only demand that their suppliers be certified because the scheme requires it and not because they believe that certification necessarily brings added value. If becoming certified requires that only other certified suppliers are used, then the so-called ‘demand’ is little more than a self-fulfilling prophecy. There is a danger of certification becoming not a measure of high quality but a measure of, at best, mediocrity among weak and average organisations seeking to bolster their image and self-confidence. The message from enthusiasts is lemming-like: ‘Jumping over the ISO 9000 cliff will be good for you. Join us and the thousands of others who have jumped over before you’. Widespread concerns about the weaknesses of certification standards for safety management systems (SMS) have been raised, especially if compliance certificates would encourage false inferences about full compliance with government safety regulations and absence of hazards. Auditing in the safety field requires professionally qualified safety auditors, whereas ISO 9000 and ISO 14000 specify no comparable requirement. The requirements specified in ISO 9000 and ISO 14000 series and auditor qualifications at present fall far short of what would be absolute minimum requirements in the health and safety and major hazards fields. The British Standard for SMS (BS 8800:1996) was based loosely on Guidance Document HS(G) 65 (HSE, 1991) and thus was a guide and not a specification. In November 2008, BS 8800 was replaced by BS 18004 “Guide to Achieving Effective Occupational Health and Safety Performance”; It had been embraced by the International standard OHSAS 18001 developed to be compatible with ISO 9001 and ISO 14001, and to unify standards for OHS management systems. International cooperation also led to the launch In September 2005 of ISO 22000 Food Safety Management standards for use throughout the food supply chain.

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3.11 Integration of management systems Integration of safety, environmental and quality management systems (SQE) is now high on the agendas of many large organisations (Waring, 1996a, 1996c). In principle, SQE integration sounds an attractive proposition in terms of greater efficiency and consistency. Certainly, integration of safety and environmental management systems would be an advantage for management of emergencies. For example, a toxic release is likely to have both safety and environmental impacts. However, although the goal is seductive and the rhetoric easy, in many organisations people are struggling to cope with what for them are often unfamiliar concepts in three technical specialisms – S, Q, E – all at the same time. There is also the risk of failing to appreciate the technical breadth, depth and legal requirements essential for adequate management of safety and environment compared to that of quality.

depth of activities involved in different areas of management; hence significant differences in skill requirements may not be appreciated by those involved. Integrating management may not be facilitated by the consequences of failures. In some areas, such as safety and environmental management, the consequences of failures can be so serious that they require special diligence beyond that normally applied to other areas of management. This is a quality requirement often not appreciated. Health, safety and environment are covered by a great deal of detailed legislation requiring specific managerial and technical arrangements, whereas quality and many other areas of management are not. Adequate management systems for health, safety and environment are mandatory and must be coherent but this does not necessarily warrant their full integration. Professional rivalries also often exist between different management functions such that control of integration and of the newly integrated system becomes a power struggle which adversely affects the outcome. Some people advocate a radical step-change approach to integration and other changes claimed to be system-enhancing, on the basis that incremental approaches merely seek to make present activities more efficient and effective rather than addressing the fundamental issue of being (Talwar, 1995). However, although administrative integration and other transformations may be relatively straightforward, it is well known from management research and experience (Waring, 1993) that ‘big bang’ or radical approaches to major organisational change are more likely to fail than incremental approaches.

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It is argued here that there are a number of reasons why integration of management systems may be difficult. One reason is the confusion about the scope and practical requirements of the various management systems to be integrated. Others are the often significant differences in scope and

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Integration as a ‘big bang’ process would require either the most favourable organisational conditions to exist or a crisis of such proportions that only a radical solution makes sense. The non-extreme ‘grey area’ in which most organisations exist provides treacherous ground for radical change of any kind. It is often wrongly assumed that by creating flatter, leaner and more flexible organisations integration is a quick and automatic means to achieve improved organisational and cost efficiencies. Integration should, therefore, be a long-term goal approached gradually through better co-ordination and coherence between different management functions.

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3.12 Management system risks The success of an organisation may depend on how narrow or holistic a view is taken of its situation, goals, problems and opportunities. Seen as a human activity system, success rests on two absolute conditions: (a) an adequately designed and operated systematic framework of management functions, and (b) adequate consideration of the contexts of the particular organisation and especially complex human factors within the organisation. Management systems may be a necessary part of achieving success and avoiding failure. The risks associated with not having adequate management systems should be self-evident. However, it is less well appreciated that having naive management systems which are claimed to be adequate may be more dangerous as the social actors may be blissfully ignorant of the defects and their potential consequences. There is a need to remain aware of the ‘as if’ problem, namely that no system model reflects reality in a complete way but models are frequently used ‘as if’ they do. All system models are reductionist, but some are more reductionist than others. Highly reduced models bring the advantage of simplicity and ease of understanding, but there is also the risk of naive expectations of success. Assumptions about prediction and control may be unrealistic, especially the fact that objectives and criteria are appropriate and inclusive and that complex human factors are not significant. Because proprietary and management system standards models (such as ISO 9000, 14000, etc.) are so highly reduced and address the lowest common denominator, they cannot guarantee success or anything like it. So much fine structure is lost that compliance with the model or standard is little more than showing the barest minimum of control. Radical integrationists fail to recognise that although a common basic model for management systems may be identifiable, there are significant differences in detail which demand plurality. Marginally more sophisticated ‘system’ approaches such as Total Quality Management (TQM), Business Process Re-engineering (BPR) and organisational benchmarking offer the same seductive promise of finding the organisational ‘holy grail’, yet suffer from the same fundamental flaws. Such management fads are dangerous because they are seductive and may exaggerate promises of quick returns and success. It is perhaps pertinent to note that vast emotional, intellectual, financial and other resource commitments are made in their name with often little which is sustainable in return (Binney et al., 1992; Wilkinson et al., 1993). Caulkin (1995), in an article in Management Today entitled ‘The New Avengers’, was particularly scathing in his criticism of corporate management who persistently fall for the latest formula for organisational success, which then proves to be unsustainable or creates new problems. He refers to ‘the obstinate failure of cost-cutting and restructuring exercises to galvanise companies into promised high performance’. Ruthless re-engineering has instead produced a growing army of highly skilled people whose only loyalty is to ‘Me PLC’. Those former employees who were encouraged or forced to become contractors are now extracting what they regard as ‘overdue payment’ and selling their services to the highest bidder. Others, waiting to go freelance remain only so long as the employer is prepared to increase rewards. Organisations are quoted as having to review their executive rewards policy on a weekly basis simply to keep staff at all. Among those who remain, ‘presenteeism’ is characteristic, i.e. present in body only. The drive towards a ‘contract culture’ that promised organisational nirvana has instead created an increasingly uncontrollable many-headed monster.


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3.13 Conclusions Failure to apply a structured and systematically organised approach to management of safety and other risk topics Is often cited as a basic cause of accidents and disasters. There are necessary components for any management system to be effective. However, systems ideas about risk topics may be used in a narrow way on the assumption that complexity can be reduced to a relatively simple ‘systematic process’ without any significant adverse effect. This assumption underpins the approach to management system standards for safety, quality and environment. Used wisely, such process models may be useful. However, for many purposes a much more holistic approach is required which is based on the fundamental principles and methods of the systems tradition and able to recognise the importance of world-views.

3.14 Guide to reading

3.15 Study questions You should now write 300 words in answer to each of the questions below. We believe that this is an important exercise that will assist your comprehension of material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University. • In what ways do holistic systems approaches differ from those advocated by current management systems standards (such as ISO 9000 Specification for Quality Management Systems, 1SO 14000 Specification for Environmental Management Systems and BS 18004 Guide to Achieving Effective Occupational Health and Safety Management Systems)? • Explain why well-intentioned efforts to establish ‘safety management systems’ may not always be successful. • Why are certain types of risks not identified when using reductionist techniques?

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You should now read the article provided at the end of this unit, ‘Socio-technical Disasters: Profile and Prevalence’, by Bill Richardson.

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3.16 Bibliography Allen V. L. (1982) Social Analysis: A Marxist Critique and Alternative, Shipley: The Moor Press. Bank of England (1995) ‘Report of the Board of Banking Supervision Inquiry into the circumstances of the collapse of Barings’, House of Commons 673, London: HMSO. Binney, G. (1992) Making Quality Work: Lessons from Europe’s Leading Companies, London: Economist Intelligence Unit. BS 8800 (1996) Guide to Occupational Health and Safety Management Systems, BSI Standards, London: BSI. Burrell, G. and Morgan, G. (1979) Sociological Paradigms and Organizational Analysis, London: Heinemann.

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Carter, P. and Jackson, N. (1991) ‘In defence of paradigm incommensurability’, Organisation Studies 12(1): 109-27. Carter, R., Martin, J., Mayblin, B. (1984) Systems, Management and Change - A Graphic Guide, London: Harper and Row. Caulkin, S. (1995) ‘The new Avengers’, Management Today (November): 48-52. Checkland, P. (1981) Systems Thinking, Systems Practice, Chichester: John Wiley. Checkland, P. and Scholes, J. (1990) Soft Systems Methodology in Action, Chichester: John Wiley. Clegg, S. (1980) ‘Power, organization theory, Marx and critique’. In S. Clegg and D. Dunkerley (eds) Critical Issues in Organizations, London: Routledge: 21-40. Cullen, Lord (1990) Report of the Official Inquiry into the Piper Alpha Disaster, London: HMSO. Davies, A. (1993) ‘Business re-engineering - Just another fad?’, SPS Newsletter (2-3 December), Strategic Planning Society. Davies, L. J. (1988) ‘Understanding organizational culture: A soft systems perspective’, Systems Practice 1: 11-30. Denzin, N. K. (1978) The Research Act, McGraw-Hill. Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory, London: Routledge. ESRC (1993) Report of the Commission on Management Research, Economic and Social Science Research Council. Fennell, D. (1989) Report of the Official Inquiry into the King’s Cross Fire, chairman Desmond Fennell QC, London:HMSO.

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Freckleton, S. and Waring, A.E. (1992) ‘Safety management systems: What makes them tick? a human systems view’, paper presented at the BSI Conference on Human Factors in Offshore Safety, Aberdeen, 30 September. Hidden, A. (1990) Report of the Official Inquiry into the Clapham Railway Disaster, London: HMSO. HSE (1991) Successful Health and Safety Management, HS(G)65, Sudbury: HSE Books. Jeffcutt, P. (1991) ‘From interpretation to representation in organisational analysis: PostModernism, ethnography and organisational culture’, paper presented at the New Theory of Organisations Conference, Keele University, April. Johnson, G. (1987) Strategic Change and the Management Process, Oxford: Basil Blackwell. Kluback, W. and Weinbaum, M. (1957) ‘Dilthey’s philosophy of existence: Introduction to Weltanschauungslehre’, translation of an essay, Vision Press.

Morgan, G. (1986) Images of Organization, London: Sage. Open University (1984) Complexity, Management and Change – A Systems Approach, (Course Texts, T301, revised 1993), Buckingham: Open University Press. Pettigrew, A. (1985) The Awakening Giant: Continuity and Change in ICI, Blackwell. Pettigrew, A. (1987) ‘Context and action in the transformation of the firm’, Journal of Management Studies 24(6): 649-70. Reason, J. (1997) Managing the Risks of Organisational Accidents, Aldershot: Ashgate. Singapore Minister of Finance (1995) The Report of the Inspectors' Investigation into Barings Futures (Singapore) Pte Ltd, Government of Singapore. Smircich, L. (1983) ‘Concepts of culture and organizational analysis’, Administrative Science Quarterly 28(3): 339-58. Talwar, R. (1995) ‘Transformation’, Strategic Planning Society Newsletter (April): 4-3.

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Korman, A. K. and Vredenburgh, D. J. (1984) ‘The conceptual, methodological and ethical foundations of organisational behaviour’. In M. Gruneberg and T. Wall (eds) Social Psychology and Organizational Behaviour, Chichester: John Wiley: 227-254.

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Toft, B. (1992) ‘Changing a safety culture: A holistic approach’, paper presented at the British Academy of Management 6th Annual Conference, Bradford University, 14-16 September. Torhaug, M. (1992) ‘Where is QRA today?’, Proceedings of conference on Risk Analysis and Crisis Management, 22-23 September, BPP Technical Services, London.

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Turner, B. A. (1992) ‘Organizational learning and the management of risk’, paper presented at the British Academy of Management 6th Annual Conference, Bradford University, 14-16 September. Vickers, G. (1983) The Art of Judgement: A Study of Policy Making, London: Harper and Row (first published 1965). Vickers, G. (1985) The Vickers Papers, ed. by the OU Open Systems Group, London: Harper and Row. Waring, A. E. (1989) Systems Methods for Managers - A Practical Guide, Blackwell Scientific Publications. Waring, A. E. (1993) Management of change and information technology: Three Case Studies, PhD Thesis, November 1993, London Management Centre, University of Westminster. Waring, A. E. (1996a) Safety Management Systems, London: Chapman and Hall/ITP. Waring, A. E. (1996b) 'Safety management systems in the oil, gas and related industries', paper presented at the seminar on Safety and the Petroleum Industry, National Iranian Oil Refineries and Distribution Company, 8-10 January, Tehran, Iran. Waring, A. E. (1996c) Practical Systems Thinking, London: International Thomson Publishing. Waring, A. E. and Glendon, A. I. (1998) Managing Risk, London: International Thomson Publishing. Watson, T. J. (1982) ‘Group ideologies and organisational change’, Journal of Management Studies 19(3): 259-73. Wilkinson, A., Redman, T. and Snape, E. (1993) ‘The problems with quality management - The view of managers in findings from an institute of management survey’, Total Quality Management 15(6): 397-404.


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READING ‘Socio-technical disasters: profile and prevalence’ Richardson, B. (1994) Disaster Prevention and Management 3(4)

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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UNIT 4 Health and safety management


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4 Unit 4: Health and Safety Management This Unit gives an overview of some current thinking in occupational health and safety, together with practice in ensuring its effectiveness. Specific national legislation is not examined in detail: no one nation can be said to have definitive law or regulation. Neither does the Unit aim to provide a guide to technical and quantitative techniques; these are important in practice, but often complex and beyond the scope of the discussion. Although much of this section is generally applicable, you should also consult your own organisation’s local practice and consider the national regulations and guidance in your country. After studying the Unit and the included reading material, you should be able to place organisational health and safety management into context: • historically • within the organisation and its groupings

• in terms of the need for risk assessment and the broad principles relating to this. • within society and societal norms, and • within political and legislative imperatives.

4.1 Introduction Although occupational health and safety is often regarded as a distinct area of study and practice, it would be a mistake to separate it from the more general study of risk, crisis and disaster. An inattentive employee tripping over a badly placed cable might suffer personal harm; a similar accident might disconnect and disable a safety interlock, facilitating the triggering of a major incident. A tired truck driver might drive into a wall and sustain injury; at a different location, he or she could be involved in a collision triggering large-scale death and injury. Although in each of these cases the effect is different, the precipitating causes – inattention, tiredness – are identical. After considering the meanings of relevant terms, this Unit reviews the history of workplace health and safety regulation before considering aspects of hazard identification and risk assessment. It then considers organisational aspects of health and safety responsibility, and then describes, in a holistic way, barriers that might arise to health and safety compliance. Finally, the Unit looks at how ever increasing technological development might impact upon health and safety.

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• in terms of individual perception

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Because it concentrates on problems that are likely to be encountered in the management of organisational and operational health and safety, this Unit may seem to display a ‘negative’ viewpoint; this is intentional. To understand a subject we need to consider its possible failings. Naturally, there is an alternative: “Mr Podsnap had even acquired a peculiar flourish of his right arm in often clearing the world of its most difficult problems, by sweeping them behind him” (Charles Dickens, Our Mutual Friend, Book 1, Chapter 11).

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The nature and acceptability of risk can vary tremendously depending on the scenario, the type of organisation and the socio-cultural environment in which it has to be managed. This in turn influences what is regarded as ‘safe’. Monitoring and enforcement procedures do vary, particularly across national boundaries. This means that definitive guidance covering all combinations of circumstances is beyond the scope of this Unit. As it is not possible to summarise all these national variations, most examples given relate to the United Kingdom. National legislation can impose specific duties on both individuals and organisations, and can give directions regarding such issues as the nature and level of pre-planning. Such legislation and associated guidance documents must be consulted when considering practical applications. Before getting into the Unit proper, some statistics on work-related deaths, injuries and ill-health will help to set the scene. In the UK the Health and Safety Executive’s Statistics Branch produces annual figures; their provisional totals for UK fatal injuries in 2009/10 were, at the time of writing, (HSE, 2010) as follows: a. 151 workers were killed, a rate of 0.5 per 100,000 workers. A reduction from the 220 average of the previous five years. b. 70 members of the public were fatally injured in accidents connected to work (excluding railway related incidents).

Other key figures for 2008/09: Non-fatal injuries 131,895 other injuries to employees were reported. Ill health 1.2 million people were suffering from an illness which they believed was caused or made worse by their current or past work, 551 of these were new cases in the last 12 months. Working days lost 29.3 million working days were lost overall (1.5 days per worker), 24.6 million due to work-related ill health and 4.7 million due to workplace injury. In the UK, the term `Health and Safety’ derives its name from the 1974 Health and Safety at Work Act and from the Health and Safety Commission and Executive that the Act established. However, it cannot be emphasised too strongly that this legislation was not just about enforcement of legal duties relating to employee protection. From the outset it was much more of a generic concept, which has developed the status of an ‘ethos’ - the characteristic spirit or attitudes of a community, people, or system’ (Concise Oxford Dictionary 1995). This is demonstrated by the use of the term `Safety Culture’ for the attitude of an organisation towards risk-taking. An example would be the explosion in June 1974 at the Nypro plant, Flixborough, UK, which resulted in 28 fatalities. An illconsidered temporary modification had been made to maintain production in an industrial plant with fairly obvious H&S related defects (Parker 1975). This was seen as a failure of safety culture, rather than simply a regulatory compliance problem. This question of organisational culture is explored further in other course Units.


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4.2 Definitions Sometimes words in common usage acquire specific meanings when used in a professional context. Both H&S and risk management in general are currently bedeviled by an imprecise terminology. To quote Rockett (1999:36) To progress .... in our ability to converse and discuss meaningfully, we need to standardise what we mean… In an attempt to do this, the way in which certain words are used in this unit is given below. To some, ‘accidents’, ‘incidents’ and ‘emergencies’ represent actual events, which differ in scale and level of response. Others, particularly from an H&S background might argue that an ‘emergency’ represents a precursor stage such as a plant alarm sounding. There may be a potential for harm, but it has yet to be realised. This is similar to the way ‘crisis’ is sometimes used when an emergency arises. Some might also regard an ‘incident’ as a dangerous event but reserve ‘accident’ for one which caused physical injuries. In this Unit, unless usage is specified in the text, emergencies and incidents are regarded as synonymous terms for undesirable events, with or without actual human casualties.

Early consideration of occupational safety was on paternalistic and basic commercial grounds. Employers did not wish unduly to harm their employees, or to cause them to be off work. As Kletz (1998) said of the period to the 1960s: safety was a non-technical subject that could be left to arts graduates and elderly foremen. There was concern that people should not be hurt – great attention was paid to the lost-time accident rate – but there was no realisation that [safety] was a subject worthy of systematic study by experienced technologists. The first extension, driven largely by the introduction of increasingly hazardous industrial processes, led to the development of quantitative risk analysis or QRA as a methodology for assessing the likelihood and seriousness of identifiable hazards. However, as Kletz also noted: we soon realised that the biggest source of error was not in the QRA itself but in a failure to foresee all the hazards or all the ways in which they can occur. We were estimating the probability and consequences of the hazards we recognized with ever greater accuracy while possibly ignoring greater hazards. This observation led in turn to the development, initially within the chemical industry in the early 1960s, of hazard and operability studies – HAZOP. The aim was to replace the possibly blinkered approach of the technologist with the vision and interaction of a workplace team by means of: “systematic critical procedures for identifying hazards. It is [a technical] audit of the design intention applied at various stages in the development of a new process plant or in a major alteration to an existing one” (Blockley, 1996: 37).

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4.3 A brief history of health and safety legislation

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The emphasis remained on the identification and analysis of specific hazards, with a view to the physical safety of operation through design improvements because in some hazardous work situations long standing specific legislation applied.

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The UK background In the UK, health and safety law dates back to the early 19th Century, with legislation such as the 1802 Health and Morals of Apprentices Act and the 1833 Factory Act. There then followed a whole series of piecemeal legal provisions, usually responding to specific problems. Many loopholes and anomalies existed, and there was a need for consolidation of the law. Following a report by Lord Robens, this came in the form of the Health and Safety at Work (etc) Act 1974 (H&SAWA 1974), which is still the primary Act in the UK. This is what is termed an enabling act, as it allows the government to make further detailed regulations covering specific issues. At present there are hundreds of health and safety regulations in force, addressing both specifically national issues, and increasingly the requirements of European Community Directives. The 1974 legislation created the HSE (Health and Safety Executive) as a body independent of Government and responsible to an independently appointed Health and Safety Commission. However, in 2008 the Commission and the Executive were merged into one body that retains the HSE name and functions.

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The European background Within the European Community, each member state is obliged to enact national legislation to implement the Community’s programme of action on health and safety under Article 118A of the Treaty of Rome. Perhaps of most direct significance to this course is the 1996 ‘Seveso II’ Directive ‘on the control of major-accident hazards involving dangerous substances’ (European Communities Council 1996). Another major development that incorporated requirements of EC Directives was a package of measures entitled the Management of Health & Safety at Work Regulations (1999); these required many employers to ensure that ‘a responsible person’ conducts risk assessments and to engage ín ‘proportionate’ risk management.

The US background Legislation in the USA (US 1970) authorized the formation of the regulatory agency NIOSH (National Institute for Occupational Safety and Health) in the Department of Health and OSHA (the Occupational Safety and Health Administration) in the Department of Labor. By the 1980s, it was recognised that workplace safety was dependent not only on design, layout, practice and process but on the individual and group. In 1991 in Sweden for example, the Work Environment Act was extensively amended and: It was declared that working conditions shall be adapted to people’s individual aptitudes. Furthermore, stricter requirements were defined concerning employee participation in processes of change, and a number of stipulations were added, highlighting the psychosocial aspects of practical work environment policy. (Tanner, 1996) United States law similarly accepts this extension: Within two years of enactment of the Act, and annually thereafter the Secretary of Health, Education, and Welfare shall conduct and publish industry-wide studies of the effect of chronic

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or low-level exposure to industrial materials, processes, and stresses on the potential for illness, disease, or loss of functional capacity in ageing adults. (US 1970 as amended, sec 20(7)). There has been increasing focus on these psychosocial aspects; there is a realisation that, however safe the workplace may inherently be, accidents may be precipitated by factors including stress, group dynamics and cultural attitudes. The distinction between work and leisure has also been reduced. The Irish Health and Safety Authority notes that ‘At the end of a working day a person should be able to enjoy a full, active, social and family life’. (HSA 1999). The corollary to such thinking is, of course, that stresses from the non-working life may be brought into the workplace and may affect the actions of the worker.

4.4 The distinction between ‘health’ and ‘safety’ We all think we know the difference between health and safety. Smoking is unhealthy but running across a busy road is unsafe. Safety seems to refer to a sudden event – being knocked down by a bus, being killed in an explosion. Health refers to conditions that injure the body (cancers, communicable and industrial diseases) over a longer period of time. Definitions tend to foster this view. For example, the most widely accepted definition of ‘health’ comes from the 1958 constitution of the World Health Organisation (WHO, 2003) it states that: Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. This definition would bring welfare arrangements, such as shelter, rest, food and drink, as well as protection from injury and/or exposure to harmful substances under the general umbrella of ‘Health and Safety’. The reference to mental well-being also means that it would include injury by stress (notably in the form of Post Traumatic Stress Disorder, PTSD). With regard to safety, one dictionary (Shorter Oxford, 1973) defined it as:

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Alongside this change of emphasis from physical to social consideration has been the increase in importance of a new driving force: the threat of civil litigation. Violation penalties imposed by law have traditionally been relatively low (US legislation has for a long time prescribed a maximum fine of $7,000 for ‘a serious violation’ and $70,000 on an ‘employer who wilfully or repeatedly violates’ safety and health codes (US 1970 17(a) and (b)). British legislation imposes a not-dissimilar maximum fine of £20,000 if the offence is – as is usually the case – dealt with in a magistrates’ court (UK 1974, 33). But a successful civil compensation claim can cost an employer, or rather the insurers, a very large sum of money.

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The state of being safe; exemption from hurt or injury; freedom from danger... The quality of being unlikely to cause hurt or injury; freedom from dangerousness; safeness.... In everyday life, let alone in a crisis or emergency, although the risk of injury or exposure to a harmful substance may be extremely small, absolute safety in the sense of zero risk may not exist. When used in a technical or professional sense, a nearer meaning is ‘of acceptably low risk’

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(bearing in mind that ‘risk’ must here be quantified). The question of what is ‘acceptably low’ is considered later. Safety is, however, also a subjective feeling, and people can feel safe (or unsafe) irrespective of the actual danger they are in. The public perception of safety can often be destroyed by the presence of any identifiable threat, no matter how small, and this difference in definition often leads to conflict between the public and professionals. In the workplace, there is another distinction to be made, though it might sometimes be seen as one of effect rather than cause and the edges can be rather blurred. Insisting that a steeplejack wears a harness is a matter of safety but hospitals separate patients with highly-infectious disease from those who are chronically ill or recovering from operations to protect health. But consider the following.

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In the 1960s, laboratory technicians and chemists using carbon disulphide (a useful solvent for organic molecules) would do so in a fume cabinet but generally without skin protection. Research then showed that the substance can deleteriously affect the brain, the nervous system more generally, the liver and the heart and may have a potential to cause birth defects (ATSDR 2000). Workers now wear skin protection to protect against accidental spillage. Should the change be regarded as an improvement in safety or in occupational health? Repetitive strain injury (RSI) can be a painful, chronic upper limb condition sustained particularly by computer keyboard operators. Should it be classed as a disease or an injury? Changes in the work environment have led to a change in the balance between physical and mental activity. Technological developments have reduced the amount of heavy physical work. Mental and emotional strain have increased in new working environments that are characterised by lack of time, more uncontrollable factors, background distractions, lack of space, general uncertainty, and more administrative work. (Von Onciul, 1996) Does this represent a rise of the importance of illness/health over accident/safety? Although separating responsibility for health and for safety may be organisationally useful, accidents on the whole are not caused solely by faulty design or ‘human error’. They are a combination of the two – an example of the socio-technical disaster (Toft and Reynolds, 1997: 14) at a personal level. To analyse them, we need to look not only at design and the process of operation but also at the mental and physical state of the particular individual at the particular time. To prevent them, we need to ensure that the interaction of individual and environment cannot be dangerous. This demands the interrelationship of study of human and physical factors and the corresponding joint involvement of those responsible for the management of each: many [aircraft] accidents classed as pilot error were the result of a human error other than the pilot’s. Someone who forgot that pilots are normal. There is only so much information a pilot can receive and integrate at a given time. Anything in excess of this is not conducive to human reliability (IATA, 1972).

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4.5 Risk and hazard The HSE note that the terms risk and hazard are used interchangeably in everyday vocabulary (HSE, 2001: 5). Nevertheless, it is important to make a conceptual distinction between a ‘risk’ and a ‘hazard’. In this regard, a hazard is something that has the potential for harm arising from an intrinsic property or disposition of something to cause detriment. Risk, on the other hand, is the chance that someone or something that is valued will be adversely affected in a stipulated way by the hazard (HSE, 2001: 5-6). It is the combination of the severity of harm with the likelihood of ít happening. The Health and Safety Executive comment that:

in the first place, using less of it or a safer substance, or if there is no alternative to storing the substance, using better means of storing it. (HSE, 2001: 6) Conceptually therefore, the HSE regard anything presenting the ‘possibility of danger’ as a ‘hazard’. However, since in any given workplace there would be a large number of hazards that duty holders could address, requiring duty holders formally to address them all would be excessive. Therefore to avoid unnecessary burdens on duty-holders, the HSE will not expect them to take account of hazards other than those that are a reasonably foreseeable cause of harm, taking account of reasonably foreseeable events and behaviour. Whether a reasonably foreseeable, but unlikely event – such as an earthquake – should be considered depends on the consequences for health and safety of such an event (HSE, 2001: 6).

4.6 Hazard identification and risk assessment An important factor in successful management of any sort is knowing exactly what problems you are facing and what your obligations are. One of the major changes in H&S management in the last couple of decades has been the move away from fixed, specific regulation. Under the old regime, regulations prohibited certain actions, and made others mandatory. Anything not specifically regulated was allowed, the concept in effect was: ‘permitted unless identified as dangerous’. Provided all the rules had been complied with, liability for anything which stemmed from an unregulated cause was limited.

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It is often possible to regard any hazard as having more remote causes which themselves represent the ‘true hazard’. For example, when considering the risk of explosion from the storage of a flammable substance, it can be argued that it is not the storage per se which is the hazard but the intrinsic properties of the substance stored. Nevertheless, it makes sense to consider the storage as the basis for the estimation of risk since this approach will be the most productive one in identifying the practical control measures necessary for managing the risks, such as not storing the substance

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In recent years this has been replaced by a more general ‘duty of care’ and the requirement for a risk assessment, carried out by a competent person, which has been íncorporated into UK law from EC directives. This duty places the onus on the responsible person to identify and evaluate hazards and control risks. The concept now is that potentially hazardous activities are ‘not permitted unless proved safe’. Much of the work relates to providing evidence in the form of risk

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assessments, preparedness plans and ‘safety cases’ to prove that H&S issues have been identified and covered adequately (Stranks, 2005; Ridley and Channing, 2008). If an accident occurs, if someone is injured or made ill, or if the environment is harmed, then this is regarded as evidence that the risk assessment and / or control system was inadequate. Specialist advice may sometimes be needed, but in many cases, with known or obvious hazards, the manager, or officer in charge can carry out the assessment. The HSE say that a “risk assessment is simply a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm” (HSE 2006a). They give ‘5 steps to risk assessment’ which are: 1. Identify the hazards. 2. Decide who might be harmed, and how. 3. Evaluate the risks and decide on precautions.

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4. Record your findings and implement them. 5. Review your assessment and update it if necessary. Perhaps the two most problematic aspects are the identification of hazards and the evaluation of risk.

4.7 Hazard identification A hazard is simply ‘anything that might cause harm’ (HSE, 2006b). The type of hazard being faced depends very much on the scenario. It can be physical, such as working from ladders, broken glass, an open drawer, faulty electrical equipment, or a toxic chemical. It can also be environmental, such as being swept away by floodwater, suffering from hypothermia in severe weather or being trapped by a forest fire, especially if you are an emergency services worker. Alternatively it can be organisational, such as a flawed management procedure, which might allow a delivery tanker to discharge its load without making sure that there is sufficient capacity in the receiving tank to take it. If the definition of ‘hazard’ is fairly general, when combined with the WHO definition of ‘health’, the term ‘health hazard’ can cover an extremely wide range. If applied strictly, it could make the ‘and Safety’ part of the Unit title superfluous, as most undesirable situations might be regarded as potentially damaging to health. In common usage however, health hazards are commonly regarded as being toxic, carcinogenic or biological in nature, with the potential to cause disease or illness. For the H&S manager of an international relief organisation, the possibility of workers being exposed to diseases like malaria would certainly have to be taken into account. Health hazards can have some special features which make them difficult to control. Factors identified by the UK Health and Safety Executive (Health and Safety Executive 1993:38) are: • ill health often results from complex biological processes, rather than immediate injury • these may take place over a long period, and may only become apparent after many people have been put at risk (possibly, years after actual exposure)

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• the same disease may have both occupational and non-occupational causes • exposure to disease risks is not always apparent. In an emergency there may be some extra factors: • exposure may be to initially unknown, or unidentified substances • exposure may be in an uncontrolled manner, as opposed to the controlled workplace environment • casualties may be exposed to gross contamination to levels not normally encountered • exposure to mixtures of substances might have synergistic effects • contamination may enter the body through abnormal routes, for example through physical wounds • exposure may be to substances modified by fire, or other accidental chemical reactions. circumstances is the presence of carbon fibre and similar composites in aircraft and vehicles. In normal use, such materials are perfectly safe as the fibres are bonded in resins. If exposed to fire, the resins bum away, leaving the fibres loose and capable of being inhaled and causing respiratory problems. In contact with exposed skin they can cause dermatitis. As mentioned earlier, the reference to ‘mental well-being’ in the WHO definition of ‘health’ includes `stress’, or at least the more severe form `Post Traumatic Stress’ as a health hazard. Coping with stress has become a major topic in its own right. Stress can arise from several sources. In emergency management examples are: • feeling responsible, if involved in activities giving rise to the emergency • witnessing visually distressing scenes involving physical injuries and fatalities • being exposed to physical risk • being part of a response team suffering casualties • being unable to carry out a successful rescue • working for excessively long periods • attempting tasks which are beyond personal capabilities due to lack of resources or training. In the last fifteen years or so, a large number of organisations with a disaster response role have felt it necessary to put in place counselling, debriefing and support services. The main reasons for these services are:

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An example of a health risk which may be important in disaster management, but not in other

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• the humanitarian aspect of reducing distress in the workforce • the economic savings from avoiding the premature loss of trained and experienced staff • the reduction in claims for compensation for Post Traumatic Stress Disorder.

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Recently the role and effects of debriefing and counselling have been re-evaluated, particularly the assumption that they are beneficial in reducing PTSD. The desirability of such services on health and safety grounds might not be as clear cut as was originally thought and it may be necessary to keep a lookout for the latest guidance from the British Psychological Society and other professional bodies.

4.8 Risk assessment The quantification of risk is also a topic in its own right, and a number of techniques have been developed, some originating in the nuclear and petrochemical industries. Some simply predict the potential scale and probability of an event. When considering H&S implications, consideration must also be given to the consequences in terms of injuries and potentially harmful exposures to toxic and / or carcinogenic substances. The real test of an effective risk assessment is that if it is decided that the risk is acceptable, no adverse outcome takes place.

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A fairly simplistic way of assessing risk might be to use the formula: risk = event probability x hazard severity x number exposed. The combination of severity and number exposed would give an estimate of how many people might end up as victims or casualties. This is a simplistic approach in that slight injury to a lot of people, and serious injury to a few could be regarded as equivalent, but the risk may not actually be equally acceptable. Even so, it is a starting point for an assessment of the situation. Risk estimates can be expressed numerically in various ways. One is the probability, or number of events per unit of population, in a specified period. For example, the risk of being killed by lightning in the UK has been estimated as 1 in 18,700,000 per year. (HSE, 2001) However, as Cohen (1996:92) points out, wider considerations such as the economic importance of nuclear power will affect what is deemed acceptable or tolerable. Thus he notes that in 1992 the HSE took the view that: ‘Broadly, a risk of death of 1 in 10,000 per annum is about the most that is ordinarily accepted for workers in the UK’. Also that the HSE proposed the same level for radiation risks to workers in the industry but set tighter standards for the public living near nuclear plants. Even so these official levels may still be unacceptable to the public, who base their opinion on subjective perception. Developing criteria on tolerability of risks for hazards giving rise to societal concerns is difficult. Hazards giving rise to such concerns often involve a wide range of events with a range of possible outcomes. The summing or integration of such risks, or their mutual comparison, may call for the attribution of weighting factors for which, at present, no generally agreed values exist as, for example, the death of a child as opposed to an elderly person, dying from a dreaded cause, e.g. cancer, or the fear of affecting future generations in an irreversible way. (HSE 2006a)

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Accurate numerical estimation may not always be possible, particularly when dealing with uncertain or changing situations. Thus the HSE issued guidance (HSE 1993:40) that risk can also be rated qualitatively on a simple scale of the potential to cause harm: • SLIGHT (injuries too small to require notification) • SERIOUS (injuries where people may be off work over 3 days) • MAJOR (death or other major injury) The likelihood of harm can be categorised as: • LOW (where harm will seldom occur) • MEDIUM (where harm will occur frequently) • HIGH (where it is certain or near certain that harm will occur)

4.9 Responsibility for occupational health and safety It is important to note that responsibility for health and safety is not totally focused on management. Although the employer may be considered to have prime responsibility for ensuring safe and healthy working conditions, it has been recognised since the nineteenth century that the workforce also carries responsibility: The Coal Mines Act of 1872 laid down that the deputy overseers must carry out a daily inspection of each pit in order to test the safety of the working conditions; and miners were given the statutory right to appoint from their own ranks inspectors who were to be entitled to visit any district of the pit in order to check the adequacy of the safety precautions taken by the management. (Cole and Postgate, 1961: 356) This may only have allowed the workers to check that the management was adequately fulfilling its safety role, but it is an indication of early and direct involvement of employees in determining health and safety issues. Today this is generally enshrined in law and accepted as normal. Under UK legislation, the employer is responsible for ensuring safe and healthy workplace conditions, safe methods of operation and suitable training but onus is also placed on every employee ‘to take reasonable care for the safety of himself and other persons who may be affected by his acts or omissions’ and ‘to co-operate with [the employer]’ in ensuring that safe working conditions and practices are maintained ( HSWA 1974). It cannot be supposed that senior management is omnipotent, as without operational-level compliance the best of intentions can be subverted.

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Multiplying the two scores together gives a 9-point scale. A hazard of high likelihood / major severity would score 3 x 3 = 9, and be completely unacceptable. A hazard of low likelihood / slight severity would score 1 x 1 = 1, and be acceptably low. For intermediate conditions, the higher the score, the higher the priority. Subjectively, any situation rating 4 or over (2 x 2, serious x frequent accidents) would suggest that H&S considerations had not been adequately addressed.

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This brings us to the much-discussed question of corporate liability: whether, in the event of an avoidable accident, the company as well as (or perhaps rather than) identified individuals might or

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should be held morally or legally responsible for an act or omission. In the UK the factual answer to this question has increasingly become ‘yes’. Stranks (1997: 13), elucidating section 37(1) of the Health and Safety at Work Act, pointed out that: where an offence is committed through neglect or omission by a constituted board of directors, the company itself can be prosecuted as well as the directors individually who may have been to blame where an individual functional director is guilty of an offence, he can be prosecuted as well as the company a company can be prosecuted even though the act of omission resulting in the offence was committed by a junior official or executive, or even a visitor to the company premises. But this is specific law dealing only with the relatively small penalties imposed in the HSW Act. Although in addition, individuals damaged by their employer’s action (or inaction) may be successful in a civil compensation claim, Clarkson (2000) noted that damages will be paid out by the insurers and such cases do not carry the same stigma and censure as do criminal ones. Criminal prosecution for manslaughter or negligence was more difficult, as was shown by several unsuccessful attempts following the ‘Herald of Free Enterprise’ sinking in 1987 and rail crashes during the next decade or so.

Corporate manslaughter The UK Government’s policy change came about as a result of the Law Commission’s 1996 recommendations on reform to the law of involuntary manslaughter, as it should apply to both companies and the individual. The Government tried on several occasions to establish how under the existing law it could be shown that a single individual at the very top of a company was personally responsible and a successful manslaughter prosecution brought. There was growing pressure for this difficult legal requirement to be removed (Bergman, 2000) as it did not recognise the reality of decision-making processes in large organisations. Acknowledging this problem, the Home Office commented: There has been growing public concern that current laws relating to corporate manslaughter are failing to provide an effective sanction. The Government believes that the law fails to operate in a sufficiently flexible way to reflect the reality of decision making in large organisations and therefore fails to provide proper accountability or justice for victims. It is committed to reforming this area of the law. (Home Office, 2005) In March 2005, the then Home Secretary presented to Parliament a draft Corporate Manslaughter Bill, which after extensive scrutiny was passed into law as the Corporate Manslaughter and Corporate Homicide Act 2007 (CMCHA); it came into force on 6 April 2008. This means that now companies and other organisations can be found guilty of corporate manslaughter (corporate homicide in Scotland) as a result of serious management failures resulting in a gross breach of a duty of care.


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This new offence is not part of their legislation but has been welcomed by the HSE as an important new element in corporate management of health and safety responsibilities. It should be noted that the CMCHA 2007 removed much but, not all, of the Crown immunity that applied to previous common law offences within various government and official bodies. However, some commentators have suggested that the Government should have gone further on this point. On 15 February 2010 Section 10 of the CMCHA 2007 was implemented; it enables the court to make a publicity order in respect of organisations convicted of corporate manslaughter (or corporate homicide in Scotland). Thus the court can require an organisation to publicise in a specified manner that it has been convicted, and to give details of the particulars of the offence, any fine imposed and any remedial order made.

4.10 Some issues of application of legislation H&S legislation is constantly being updated and so it would be impractical to attempt a full summary of its development and application. Having said that, there are common threads running through many of the legal provisions, which can be a general guide to roles and responsibilities. In this context ‘common’ is being used in the sense of ‘being frequently encountered’, rather than ‘shared by all’.

Enforcement Each piece of the H&S legislation identifies some organisation or body responsible for enforcement. This may be a central government department, a local authority or an enforcement agency. Local authorities, for example, have responsibilities for enforcing H&S law in many business premises including: shops, retail and wholesale distribution, catering establishments and residential care homes. The regulations frequently include compulsory notification of accidents, injuries, industrial illnesses, and ‘dangerous occurrences’ or ‘near misses’ to the appropriate enforcement authority. Enforcement officers usually have the power to serve improvement and prohibitions notices, and are involved in investigating failures of systems and the resulting accidents. Operators may be required to submit preparedness plans for approval, before permission is granted for certain commercial or industrial applications. In the UK, nuclear power stations, airports and ‘Major Hazard’ industrial sites are examples of commercial activities regulated in this way. For low risk areas, such as small and medium sized enterprises, the HSE promotes non-legislative methods to increase compliance by clarifying requirements for proportionate risk management.

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Another important development was that on 23 February 2010, Bristol High Court began hearing the first case under the CMCHA; a prosecution against Cotswold Geotechnical Holdings, a small company with one director, over the death of a young geologist who had been collecting samples in a trench at Stroud, Gloucestershire. At the time of writing (July 2010) this case stood adjourned. Whilst the outcome will be interesting as the first court test of the new legislation, a sterner test will have to await the prosecution of a larger company.

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Conflicting objectives Much H&S guidance is aimed at achieving a working environment where the base condition is safe, and the option is available to simply not start a task if the risk is too high. Occasionally this can lead to a dilemma. Take, for example, an occupational hazard such as asbestos. If found in the normal workplace, exposure can be avoided by stopping the job, and making the area secure until specially trained and equipped contractors can be found. In emergency response operations this ‘do nothing’ option may not be feasible, as people may already be at risk, or even be trapped or injured and in need of urgent help.

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The choice here is not between safety and danger, or risk and no-risk. It is between a chance of risk to rescuers, and an immediate threat to the safety of victims. At the centre of the dilemma is that in many countries, the UK and the EC included, there is no provision for the relaxation of any legal health and safety controls in an emergency. Some countries do have provision for the declaration of a ‘State of Emergency’, which might relax some controls or might cause temporary changes to national or local government structures. This difference must be taken into account when comparing ‘best practice’ measures in different countries.

The Atherstone Fire On 2 November 2007, four fire officers were killed when the roof collapsed onto them during a major fire at the Wealmoor vegetable packing plant in Atherstone on Stour, Warwickshire. Police investigations began and were reportedly nearing conclusions when this unit was being revised in November 2010; arrests had been made and files were being prepared for the Crown Prosecution service to consider charges. The HSE also investigated and concluded that the fire officers were not given enough information before they arrived on the scene. Thus in 2008 the HSE issued the Warwickshire Fire and Rescue Service with an Improvement Notice aimed at improving their information on the hazards posed by such large industrial warehouse buildings. Warwickshire FRS criticised the HSE investigation and appealed against the Improvement Notice, which was ‘stayed’ pending the outcome of the police investigations. Many questions have been asked about what went wrong with this fire-fighting operation and what could have been done to prevent this tragedy. In particular what more could have been learned from earlier fires? 1. Did the building and its use comply with regulations? At the time sprinklers were not legally required in warehouses under 20,000sq m. 2. Why did the firefighters go in when they did? The fire started at 6pm at the end of the shift so they may have suspected people were still inside. There was press speculation that migrant workers were sleeping in the warehouse. When the RCDM course was first written in 1996, Module 2 included a case study of a similar fire in Herefordshire. The Sun Valley poultry factory caught fire on Sept 6th 1993 as a result of a fault in a machine. Fire spread was rapid because of the foam panel construction of the building. Two fire-fighters became trapped in the collapsing building and died.

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After an investigation the HSE issued an Improvement Notice requiring the Herefordshire and Worcester Fire Brigade to improve the information available to fire officers on the risks posed by such buildings and the training of fire-fighters using Breathing Apparatus in smoke logged conditions. Urged on by the Fire Brigades Union and the insurers, Government introduced statutory requirements for safer types of foam panels in new buildings. (Module 5, unit 5 on ‘Hazard Construction’ refers to these perspectives). Also it was agreed that the Fire Service would change its operating procedures and adopt new tactics to “defensively” fight fires in such buildings from the outside. So what happened at Atherstone and why? By the end of 2010 six fire officers and four workers had been arrested and bailed in connection with the Atherstone fire. The various charges included suspicion of gross negligence manslaughter, misconduct in public office and offences under the HSWA. Only after any court cases are concluded will the full story be known and the lessons from this disaster made available to inform future practice.

Aberfan Meanwhile, useful historical perspective on the development of the UK’s H&S legislation can be gained by looking back to a disaster over forty years ago. On 21 October 1996 a huge tip of coal mining waste slid down into the valley village of Aberfan in South Wales. The slag engulfed about 20 houses and the village school; the resulting death toll was 144, including 116 children. Under the UK Government’s 30 years rule, many official papers on this tragedy only relatively recently became available for research. In 2000 McLean and Johnes published their analysis of those papers and the lessons to be learned from this disaster that was in many ways badly managed. There had been local concern about the stability of the tip, which was built over a natural spring and there had been earlier slides of waste tips in the area, but these concerns went unheeded. In 1996, safety in the workplace was governed by a complex series of acts and inspectorates that had grown up as industry developed…In accidents at work or on the road, intent was not an issue, no matter how negligent the perpetrator. Thus the Aberfan disaster was commonly perceived, not as a criminal act but as a tragic accident. (McLean and Johnes, 2000:184).

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The interpretation of those lessons will be shaped by the political climate of the day. Thus it should be noted that in October 2010 Lord Young produced his ‘ Common Sense, Common Safety’ report to Government on his review of the impacts of health and safety legislation and called for workplace risks to be tackled in more proportionate and less bureaucratic ways. Specifically he recommended that police and fire officers should not be at risk of prosecution under health and safety law when putting themselves at risk during emergency response duties (Cabinet Office, 2010).

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The official Tribunal of Inquiry into Aberfan found the blame rested on the National Coal Board and seven employees were identified as culpable but: “Despite the searing findings of the Tribunal, nobody was prosecuted, dismissed, or suffered a pay cut.” (McLean and Johnes, 2000: 24). There can be little doubt that Aberfan was influential in the development of the HSWA 1974 particularly as Lord Robens who was Chairman of the National Coal Board at the time then went on to chair the committee whose report bears his name and, as McLean and Johnes describe in

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detail, that committee recommended much of what became law in the legislation. Before the HSWA, opinions have varied greatly on whether an organisation or individuals who appear to control it, should be punished in the event of failures in health and safety management. Whilst the HSWA 1974 allows imprisonment as the penalty for certain offences, it was not until 1994 that such a penalty was imposed ( McLean and Johnes, 2000: 200). The same authors note that thereafter enforcement became more stringent, with more prosecutions but they were doubtful that a confrontational approach is the best means of securing compliance.

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4.11 Multiple jurisdictions An HSE discussion document, ‘Reducing Risks, Protecting People’ in a section headed ‘The Internationalisation of Regulation’ points out that:

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The regulation of risk is nowadays increasingly being undertaken at European or international level in the form of legally binding instruments on Member States such as directives adopted in the wake of the creation of new global markets and new technologies. ... Moreover, in other areas the technology is moving so fast that de facto international standards or practices are evolving all the time, e.g. in ensuring the safe use of computerised systems for controlling plant and machinery. Many countries are calling for such technologies to be regulated at international level as the only effective way to prescribe appropriate standards. (HSE 2001:13) One effect of the growth in international trade and multinational corporations, is for business activities to come under the jurisdiction of more than one legal system. For example, inquests can take place in the victims’ country of citizenship, rather than (or as well as) the place where the death took place. Another, commonly seen in aircraft accidents, is for investigations to be undertaken jointly by the authorities for the place where the accident occurred, the country where the aircraft was registered and the country where the aircraft was manufactured. It is becoming more common for lawyers seeking compensation for victims, to file claims in whichever country they feel will give the most favourable judgement for their client. This may particularly apply if any sort of link with the United States of America can be established, as American courts have a reputation both for favouring claimants and for being more generous in the size of settlements. The effect of this is that practitioners may need to be aware of the legal codes of both their country of operation, and of the parent company or organisation..

4.12 Barriers to health and safety compliance We have seen that legislation is based on societal expectations and on previous experience, but why is it that, even in apparently well-run organisations, preventable and foreseeable accidents still happen? We need to look more deeply at the organisation and the people who constitute it.

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Organisational structure Hatch (1997: 22-24) following Burns (1962) describes three phases of industrialism. The introduction of machines led to the factory system in which the subcontracting of work was replaced by a patriarchal-hierarchical system. The assignment of tasks and responsibility for hiring and firing, previously the responsibility of the subcontractor, moved upwards to the owner or general manager. The foreman (and it almost invariably was a man) was responsible only for ensuring the productivity of his section of the workforce, whilst the workforce itself – mostly women, assisted by children – typically worked at repetitive tasks under strict supervision. As industrialisation spread from the textile industry to more technically complex areas such as food manufacturing, chemicals and metal processing, there was ‘parallel growth in systems of social organization and bureaucracy’. Burgeoning of management and administrative staff and changes in complexity of organization in capitalist organisations was reflected in the growth of military and governmental organisations within the ‘managerial-bureaucratic’ organisational state.

The paternalistic-hierarchical system is perhaps the simplest in which to organise, enforce and allocate responsibility in the event of failure. There is a clear and obvious path of responsibility to the owner/ manager, who has direct oversight not only of organisational aims but also of day-to-day operations and decision-making. It is here, at least in the UK, where criminal prosecution has been successful. In the ‘Lyme Bay’ case, following the deaths on 8 December 1994 of four teenagers who were under instruction in canoeing, the managing director of an activities centre was jailed for three years and his company fined £60,000. The charge was criminal negligence (rather than corporate manslaughter). In his summing-up, the Judge reportedly remarked “But what clearly separates this case from any other of its kind is the notice you were given in chillingly clear terms of the risks you were running. Those dire forecasts became a reality with your complete failure to heed it and to act” (Stokes, 1994). Although the managerial-bureaucratic organisational structure had become increasingly common from the beginning of the twentieth century, it was not until the 1960s that an ordered approach to health and safety was instigated. Even then it was likely that the oversight of health and safety practice would be ‘hived-off’ to a specific manager or function. This seems at first sight to be straightforward – responsibility should be traceable immediately to the relevant manager and, in direct line upwards to his or her senior manager and relevant director. However, such an appointment does not remove the responsibility of other managers (and operatives) to ensure and account for safe working practice. Hence the pressures that led to the introduction of the new approach to corporate responsibility embodied in the CMCHA 2007, as discussed earlier.The regulation and prosecution of ‘post-industrial’ organisations may present further difficulties. Devolution of responsibility coupled with an increasingly flexible workforce and the internationalisation of companies increases the likelihood that the ultimately responsible directorate and senior management will be based in and be citizens of another country. Such directors may be unable to ‘keep tabs on’ the combination of local decision-making and the plethora of different national legislations and regulations.

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Hatch indicates that the third phase can be seen as a move from industrialism to ‘post-industrialism’. The move from goods-producing to service industries and the decline of manual work, was followed by increasing needs for technical and managerial skills in what has been termed ‘ the knowledge society’ (Drucker, 1993).

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Bhopal is perhaps a good illustration, with the holding company (Union Carbide) based in the United States and the relevant operation and accident occurring in India. Shrivastava (1992:105) suggested that ‘Corporations could, for example, adopt international codes of conduct with respect to health and environmental issues’ and that they ‘can adopt consistent policies – rather than the traditional ‘double-standard’ approach – on safety and environmental issues’. He also cited the example of Dow Chemical having ‘written minimum requirements on safety, loss prevention, worker health, and environmental matters for its 425 processing plants around the world’. The main problem here is one of cost. If an international company truly avoids the ‘doublestandard’ trap, then it will be applying higher standards in some countries than the relevant national legislation requires. This will increase its costs compared with locally-based concerns, making it uncompetitive in the host country (Fischbacher-Smith and Hudson, 2010: 245). Whilst law and practice are easily applicable to simply structured organisations, as organisations have become necessarily more complex in an international operating environment, further difficulties have arisen.

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The workplace group However an organisation is structured, it is a mistake to assume its employees to be a cohesive and undifferentiated whole. The formation of groups within an organisation can be prompted by structural design, where people work in a specific office or factory area physically separated from others. It may be prompted by function; secretaries and personal assistants, departmental information technology specialists, or welders for example, even though they work in disparate parts of an organisation, are likely to form more-or-less cohesive groups. Often at management levels, temporary cross-departmental or cross-divisional groups are formed for specific purposes. The formation of groups is a natural and generally beneficial human trait. From an employer’s point of view, they may improve job satisfaction and ease of access to employees. Where a group is accustomed to good working practice, it is likely that new employees will be directly influenced by that ethos. Where majority attitudes already propel the group, most newcomers will try to fit in. Because of its cohesiveness, the group also forms an ideal unit for training: its usefulness is particularly recognised in military and emergency-service organisations.. However, groups are not necessarily and always beneficial. The next three subsections consider groups and their possible effects on health and safety in more detail under the separate headings of structure and dynamics.

Group structure Groups are often categorised into two basic types; formal and informal (Buchanan and Huczynski, 1977). However, for this present discussion a third type needs to be considered. This is the semiformal workplace group, which lacks one or more (but not all) the features of formality. The semi-formal group will lack one of the requirements to have: • a common purpose; or • a formal structure; or • necessary member interaction.

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Examples of how these might impact on corporate H&S regimes are as follows: Lacking a common purpose. Although the intent may be to bring together a representational crossorganisational set of managers to discuss and make recommendations, the participants will arrive with their own sets of hidden priorities. These priorities may be at variance with the overt purpose of the group. Hidden rivalries may come to the fore in crisis conditions, to the detriment of health and safety. Lacking a rigid structure within the workplace. In the ‘post-modern’ organisational system described earlier, and responsive to external demands, loose structures are likely to become more common. Their effects on workplace welfare will be variable and unpredictable. Employers will have to be prepared to listen and both willing and able to set up channels of effective communication.

environment no interdependence. This could lead to a lack of social cohesion. Individual rather than group norms (except for those specifically and strictly imposed) are more likely to be adhered to. The result may be generally neutral to company objectives on health and safety, though possibly detrimental in a crisis where cooperation is needed.

Group dynamics and groupthink The formation and use of working groups is common in organisations. A formal and focussed group, it is widely felt that a group has the ability to see more sides of a problem and to develop greater insights than an individual. A problem can be assessed from differing individual viewpoints and recommendations or decisions made are likely to be more considered, balanced and useful than from (say) individual consultation. Often, the suggestion of synergy – that is, that the whole is more than its constituent parts – is put forward as a further argument in favour of group working. In the course of bouncing ideas off one another, the members uncover further strata of meaning. Contrary to this positive view of decision-making and action, however, are findings that groups can become polarised – to take either a more extreme conservative or more risky stance on issues (Myers and Lamm 1976; Breakwell, 2007: 99-108). The risky shift can be particularly relevant to larger, complex organisations and public political groupings. One reason for this shift may be members of the group feeling that the whole rather than a single individual will share the blame for erroneous decisions. Another group dynamic is the phenomenon of ‘groupthink’ that was first researched by Janis (1982). who described how small, cohesive and elite groups can have an inflated sense of the correctness of their views and of their own invulnerability (Breakwell, 2007: 179). Thus membership and loyalty to the group may act to override the expression of individual opinion.

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Lacking necessary member interaction. Before computer-based Information Technology, a typical example would have been the typing pool. A more current example would be the call centre. Although there is a common purpose (typing, selling) and a rigid structure (supervisor/typists, supervisor/operators) and even a tight set of rules (format standards, script), there is in the working

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In the Tokaimura nuclear incident of 30 September 1999, three workers suffered acute radiation syndrome and a number of other workers and members of the public received radiation doses. According to the International Atomic Energy Authority’s (IAEA) account: A solution of enriched uranium ... in an amount reportedly several times more than the specified mass limit had been poured directly into a precipitation tank, bypassing a dissolution tank and

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buffer column intended to avoid criticality. This action was reported to have been in contravention of the legally approved criticality control measures. (IAEA, 1999: 1.1). Without going into the technical causes of the accident, a safe procedure had been modified for reasons of convenience and had appeared to work perfectly well. The new mode of working had therefore been adopted without any of those involved – despite their presumed knowledge of criticality conditions – enquiring as to safety or voicing dissent. There was ‘the illusion of invulnerability’, the course of action was ‘not re-examined from the view of hidden risks’ and the relevant group within the organisation ‘failed to use the expert opinion that it had’. It may seem that this was an accident that should never have happened. Safe working conditions should not have been modified. The organisation and its department should not have ignored safety regulations and its own knowledge on criticality. Regrettably, this illusion of invulnerability pervades many working practices and lives.

4.13 The individual within the organisation A workforce can no more be considered to be a homogeneous whole than can ‘the public’. Even where a workforce is primarily derived from a cohesive social group – whether a London chamber of barristers or a Durban gang of gold miners – individuals will view and experience events and circumstances in differing ways. There has been extensive research into the complexity of reasons for individual differences in risk perception; they include psychological factors of personality type, cognitive style and beliefs formed through social processes and experience (Breakwell, 2007: 44). Also a worker’s attitude to safety procedures may be temporarily affected by stresses in the workplace or at home. All these considerations will recur as you progress through this course. Another dimension of this analysis that is of direct relevance now relates to awareness, training and education. Management needs to be aware that putting up health and safety notices, simply informing workers and giving basic training is unlikely to succeed in establishing a safety culture or to change unsafe working practices. To be effective, health and safety training and awareness needs to be interactive and distinct channels need to be opened up to engage employees. Thus we need to look at how the individual, however psychologically oriented, fits into the organisation and responds to health and safety imperatives. The aims of the organisation and of the individuals within it are not the same. At one end of a commercial organisation we have shareholders whose prime aim is to maximise the value of and income from their holdings. At the other, we have the shop floor worker whose immediate aims could be income, status, promotion, finishing the task in hand, moving on to another company, avoiding redundancy and so on. Between these we have the directors with strategic concerns – maximisation of marketplace status, expansion, takeover – and management with more-or-less tactical goals. This is an oversimplification but the point to stress is that health and safety objectives are not necessarily effective simply because they are a part of company policy.


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4.14 The future: new technologies, health and safety Risk assessment depends on having previous measurable experience in order to be able to predict the probability or likelihood of an accident. We can predict that if we flip a coin a large number of times, it will land either ‘heads’ or ‘tails’ an equal number of times. On the other hand, if we stand in an open field, throw a small piece of paper vertically into the air we cannot predict exactly where it will land, or when. There are too many variables: how we throw it, wind speed and direction, the weight of the paper and so on.

shock to the system. The Piper Alpha inquiry reported: “For subsea valves, Dr Gilbert ... doubted if data on the probability of successful operation ... of any large population of such valves were available” (Cullen, 1990: 307). The problem of emergent technology is not a particularly new one. Asbestos was known as a mineral capable of being woven into a fireproof material from the beginning of the seventeenth century. Its use became an emergent technology when commercial production as an insulation material began in 1879. The first case of asbestosis was described two years later; fifty deaths at a weaving mill were linked to the substance in 1906, a survey of 363 asbestos textile workers in 1930 revealed a 26% incidence of asbestosis. In the following year, the UK produced regulations applicable to factories and workshops where asbestos-containing products were manufactured or sold; in 1942 Germany made the combination of asbestosis and lung cancer a compensatable occupational disease (Early, Ludwick and Sweeney, 2000). Nevertheless asbestos continued to be used as an insulating material in buildings and railway carriages well into the postwar period in Europe and North America, and is still so used in some parts of the world. Even in Western nations, banning attempts have sometimes been late or unsuccessful. In the USA the Environmental Protection Agency (EPA) attempted a ban in the 1980s, but this was overturned by the Court of Appeals in 1991 on the grounds that it ‘actually may increase the risk of injury Americans face’ (Asbestos Institute 1996). In France, the government announced its intention in 1996 to ban asbestos products with effect from the beginning of the following year (Asbestos Institute 1996, Annex 1).

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It is the same with ‘old’ and new’ technologies. In the case of long-standing designs and processes we may have sufficient experience, if not of the exact process itself then of very similar ones, to make predictions as to safety, and to causes and frequency of failure. New – or more properly emergent or emerging, because the point at which we are most concerned is that at which they come out of the laboratory and into trial or commercial use – technologies, are different. There is too little experience and too little evidence to make precise, scientific judgements. Sometimes – because it seems that a technology has been around for some time – this lack of control comes as a

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This example demonstrates the barriers in coming to terms with emerging technologies. There are difficulties in recognising adverse effects, in investigating the cause, in compiling persuasive statistics, in the political process and in the preparation of legislation. Similar examples from the second half of the twentieth century that have had specific workplace implications include: • uncontrolled use of organophosphate sheep-dips by farmers • widespread use of high intensity x-rays for diagnostic (and even shoe-measuring) purposes

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• handling, without respiratory protection, of medium-density fibreboard (MDF) • fire and fume risk from extensive use of decorative and other interior plastics. There are also some others that have had additional rather wider public implications: • use of DDT • low-temperature incineration of dioxins and dioxin precursors • the use of leaded petrol. In each case a new technology has been introduced because it was seen to provide a positive benefit and, at the time of introduction, the risks were not recognised. It may be that in some, they should have been: scientists should have been aware that farmers’ work practices differed from those in the laboratory, they should have applied existing knowledge of radiation damage. But the sad lesson of history is that, in the rush to introduce a new technology, there is little time (and perhaps little inclination) for research into negative aspects. In the crisis period – from the time that adverse effects first become apparent to the time that regulation finally takes place – experience demonstrates a highly conservative political approach. This can be seen in the debates on BSE/CJD and on genetically modified organisms. In this politicisation, the fact that a product or process has not been conclusively proven to be unsafe is translated to statements that it is safe. Public perception to the contrary is denied as being naive or unscientific (Wynne, 1996). The locality of a factory is not a ‘workplace’ and its inhabitants are not necessarily employees. As our technologies expand their potential to affect areas beyond the immediate working environment, we must ask whether the artificial boundary created by an office wall or factory fence is not overly definitive. Under the general HSWA 1974, occupational health and safety considerations should take into account not only employees but all others who may be immediately affected, such as visitors and the general public. The creation in the late twentieth century of specific off-site ‘industrial disaster’ legislation, referred to earlier, has established the importance of public warning and risk communication. In the ‘Risk Society’ (Beck, 1992; 1996) the unknown hazards are increasing in both magnitude and, with constantly accelerating technological development, quantity. Many of the newer risks completely escape human powers of direct perception. The focus is more and more on hazards which are neither visible nor perceptible to the victims; hazards that in some cases may not even take effect within the lifespans of those affected, but instead during those of their children. (Beck, 1992: 27)


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4.15 Conclusions This Unit has considered the historical basis, some organisational perspectives and aspects of legislation as well as considering the future of health and safety management. The main discussion has been on the development of the legislative framework and some problems that are likely to be encountered in its implementation. This is intentional and should not be considered as a negative bias: managers need to understand the problems to be able to overcome them. A difficulty for the risk manager is that effective health and safety procedures cannot be seen or measured. The risk assessment process gives an opportunity to identify and eliminate hazards, so the emergency may never happen. It is one of the sad ironies that accolades are often given to people who successfully manage emergencies, but the people who routinely prevent the system from failing in the first place go unnoticed. In health and safety terms, there are many specific and general remedies, but perhaps the two most significant are:

Deconstruction of ‘groupthink’ and the ‘consensus view’ is needed; with recognition that the professed views of individuals can be modified by group membership and are not necessarily expressions of their real views. Health and safety management is a specialist function, but one which needs to be taken into broader account, both in risk management terms and in the overall management function. Good health and safety management is also outward-, not inward-looking.

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The importance of communication – Communication must not be seen as a one-way channel by which the manager or expert imparts information, but as a two-way or multi-way system which is enabling to the views of others including the apparently or allegedly inexpert. In the particular case of health and safety, this needs to include channels by which employees (and others) are able, without prejudice to their positions, to report information not only on hazards which they observe in the workplace but also on mistakes which they have made and which may, if repeated by themselves or others, have serious effects. (These issues are discussed in greater depth in the next Module)

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4.16 Further reading In order to help business and others to adapt to changes in UK health and safety law, the HSE decided in 2005 to harmonise the commencement dates of new legislation and that any changes will only be implemented on 6 April or 1 October. Thus, organisations, should be better able to plan how they will respond to new requirements by visiting the HSE website (www.hse.gov.uk/ legislation/forthcoming.) Anyone wishing to research this topic will also find this source helpful; many of the legislative changes are supported by guidance documents that can be down-loaded. There are also major texts of guidance on health and safety for professionals in the area and you may wish to make use of them, particularly if your research for an essay or for your dissertation takes you into this area of study: Stranks, J. (2005) Health & Safety Law (Fifth Edition), London : Prentice-Hall Ridley, J. and Channing, J. (2008) Safety at Work (Seventh Edition), Butterworth-Heinemann Before attempting to answer the following questions, you should read the study material provided at the end of this Unit: • Chapter 5, ‘Accident causation’, from Jeremy Stranks’ book Human Factors and Safety, published in 1994 by Pitman. • Part of the final chapter of Scott D Sagan’s ‘The Limits of Safety: Organizations, Accidents and Nuclear Weapons’, published in 1993 by Princeton University Press.

4.17 Study questions To assist your own comprehension, you should now write approximately 300 – 500 words on each of the following: • You have been called in to help an industrial company to reduce its accident rate. You find that it complies with all relevant legislation, it has full written plans and instructions, and its workforce is well briefed. Nevertheless, it has suffered a higher than normal casualty rate from workplace accidents over the last year. How might you proceed? • You are chairing a tribunal which is considering the compensation case of a ‘shop floor’ employee of a small company who, while in the office, has tripped over a cable and broken her arm. What factors do you need to investigate? • How does your answer to the question above change if the person seeking compensation is a paid director of a multinational company visiting an unfamiliar outpost?


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4.18 Bibliography Asbestos Institute (1996) Press Release, Background Information on the Ban of Asbestos Products in France, Asbestos Institute, Canada, 22 July 1996. ATSDR (2000) Carbon Disulfide: United States Agency for Toxic Substances and Disease Registry, http://www.atsdr.cdc.gov/tfacts82.html: accessed 28 January 2000. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage. Beck, U. (1996) ‘Risk Society and the Provident State’, In Lash, S., Szerszynski, B. and Wynne, B. (eds) Risk. Environment and Modernity, London: Sage: 27-43. Bergman, D. (2000) The Case for Corporate Responsibility, London: Disaster Action.

Breakwell, G. M. (2007) The Psychology of Risk, Cambridge: Cambridge University Press. Buchanan, D. and Huczynski, A. (1997) Organisational Behaviour: An Introductory Text (3rd edition), London: Prentice Hall. Burns, T. (1962) ‘The sociology of industry’. In Walford, A. T., Argyle, M., Glass, D. V. and Morris, J. N. (eds) Society: Problems and Methods of study, London: Routledge Kegan and Paul: 157-169. Cabinet Office (2010) Press release on Lord Young's Report. www.cabinet office.gov.uk; accessed 2 December, 2010. Clarkson, C. M. V. (2000) ‘Corporate risk-taking and killing’, Risk Management: An International Journal 2.1, 7-16. Cohen, A. V. (1996) 'Quantitative Risk Assessment and Decisions About Risk', In Hood, C. and Jones, D.K.C. (1996) Accident And Design: contemporary debates in risk management, London: UCL Press. Cole, G. D. H. and Postgate, R. (1961) The Common People, 1746-1946, London: Methuen. Cullen, Lord (1990) Public Inquiry into the Piper Alpha Disaster, London: HMSO.

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Blockley, D. I. (1996) ‘Hazard engineering’. In D. Hood, and D. K. C. Jones (eds) Accident and Design: Contemporary Debates in Risk Management, London: UCL Press: 31-39.

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Drucker, P. (1993) Post-Capitalist Society, New York: Harper Collins. Early, Ludwick and Sweeney, LLC (2000) Asbestos: Medical History, http://www.mesothelioma. com/medhistory.htm, undated, accessed 31 January 2000. European Communities (1996) Council Directive 'On the Control of Major-accident Hazards Involving Dangerous Substances, Official Journal of the European Communities. No L10, 96/82/EC, 14 January 1997.

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Fischbacher-Smith, D. and Hudson,R. (2010) 'Exporting Pandora's box - exploitation, risk communication and public health problems associated with the export of hazard', In Bennett et al.(Eds) Risk Communication and Public Health, Oxford: Oxford University Press. Hatch, M. J. (1997) Organization Theory: Modern, Symbolic and Postmodern Perspectives, New York: Oxford University Press. HSWA (1974) Health and Safety at Work Act, 1974, London: HMSO; available online at: http:// www.healthandsafety.co.uk/haswa.htm, accessed 26 January, 2006. Home Office (2005) Press Release on Corporate Manslaughter; available online at: www.corporate accountability.org; accessed 20 Jan, 2006. HSA (1999) Health and Safety Authority, Republic of Ireland, homepage, http://www.hsa.ie/osh/ info.htm 18 March 1999.

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HSE (1992) The Tolerability of Risk from Nuclear Power Stations (2nd edition), Norwich: HMSO HSE (1993) Successful Health and Safety Management, Norwich: HMSO HSE (2001) Reducing Risks, Protecting People, HSE Books; available online at: www.hse.gov.uk, accessed 8 October 2010. HSE (2006a) Five Steps to Risk Assessment, HSE, INDG163 (Rev2); available online at: http://www. hse.gov.uk/pubns; accessed 8 October, 2010. HSE (2006b) Essentials of health and safety at work (Fourth Edition), Norwich: HMSO. HSE (2010) Health and Safety Executive, Statistics Homepage; available online at: http://www.hse. gov.uk/statistics/index.htm; accessed 8 October, 2010. IAEA (1999) Report on the Preliminary Fact Finding Mission Following the Accident at the Nuclear Fuel Processing Facility in Tokaimura, Japan, Vienna: International Atomic Energy Authority. IATA (1972) ‘Safety in the accident-prone flight phases of take-off and landing’, International Air Traffic Association, in: Faith, N (1977) Black Box: Why Air Safety is No Accident, London: Boxtree: 144. Janis, I. (1982) Groupthink: Psychological Studies of Policy Decisions and Fiascos, Boston MA: Houghton Kletz, T. A. (1998) ‘Making Safety Second Nature’, Paper presented at the First Annual Symposium of the Mary Kay O’Connor Process Safety Center, Texas, 30-31 March 1998. McLean, I. and Johnes, M (2000) Aberfan: Government and Disasters, Cardiff: Welsh Academic Press. Myers, D. G. and Lamm H. (1976) ‘The group polarization phenomenon’. Psychological Bulletin 93, 602-627.

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Parker, R. J. QC (1975) The Flixborough Disaster- Report of the Court of Inquiry, London: HMSO. Ridley, J. and Channing, J. (Eds) (2008) Safety at Work (7th Edition), Butterworth- Heinemann. Rockett, J. P. (1999) ‘Definitions are not what they seem’, Risk Management, vol1, No. 3: 37-47. Shorter Oxford Dictionary (1973) 3rd edition, volumes I and II, Oxford: OUP. Shrivastava, P. (1992) Bhopal: Anatomy of a Crisis (2nd ed), London: Chapman.

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Stokes, P. (1994) ‘Director jailed for canoe trip manslaughter’. The Daily Telegraph, 9 December. Stranks, J. (1997) A Manager’s Guide to Health and Safety at Work, London: Kogan Page. Stranks, J. (2005) Health and Safety Law (5th Edition), London: Prentice Hall. Tanner, R. (Translator) (1996) Swedish Work Environment Legislation with brief comments, Swedish

Toft, B. and Reynolds, S. (1997) Learning from Disasters: A Management Approach: (2nd edition) Leicester: Perpetuity Press. US (1970) Occupational Safety and Health Administration Compliance Assistance Authorization Act. Public Law 91-596. Amended 1990, 1998. Von Onciul, J. (1996) ‘ABC of work related disorders: stress at work’, in: British Medical Journal 313:745-748, 21 September 1996. WHO (2003) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948; http:// www.who.int/about/definition/en/; accessed 20 January, 2006. Wynne, B. (1996) ‘May the sheep safely graze?’. In Lash, S., Szerszynski, B. and Wynne, B. (eds) Risk. Environment and Modernity, London: Sage.

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National Board of Occupational Safety and Health, September 1996.

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READING ‘Accident causation’ Stranks, J. (1994) Human Factors and Safety, London: Pitman. Chapter 5.

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READING ‘The Limits of Safety’ Sagan, S. (1993) NJ: Princeton University Press, pp 250-259.

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UNIT 5 The management of organisational risks


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5 Unit 5: The management of organisational risks There are two distinct streams of activity in risk management which this Unit will introduce and bring together. Firstly, there are specific professional activities in business areas such as banking, insurance and technological project management that are based on systematic, quantitative techniques of risk estimation, prediction and to some extent control. Secondly, academic research and theoretical thinking has probed the merits and limitations of such techniques, particularly in relation to broader questions of public policy or social issues. Unfortunately the work in each of these areas has tended to be conducted within narrow silos of discourse and it can be argued that more needs to be done to bridge the gaps; especially to avoid the academic versus practitioner split that can so often be so limiting in any area of professional activity.

The activity of risk management is the embodiment of the old adage ‘Prevention is better than cure’, the idea being that management should be proactive and attempt to attend to the hazards and the risk of them happening before they take place. Unfortunately, there are many managers who appear to hold the belief that risk management is some kind of secret esoteric art whose credibility is just slightly better than that of black magic, and that it is an activity outside ‘normal’ management practices. It will be argued in this paper that such a view is more myth than fact and that once an organisation has recognised this then it is, at least theoretically, in a position to improve its performance by either preventing or reducing the potential for losses to which it is exposed. (Toft and Reynolds, 2005: 12) One measure of how this area of professional practice has developed is the ‘Risk Management Standard’ developed and launched in September, 2002, by the three major risk management organisations in the UK: the Association of Insurance and Risk Managers – AIRMIC, the National Forum for Risk management in the Public Sector – ALARM (now the Public Risk Management Association) and the Institute of Risk Management – IRM. The standard is a best practice guide recognised throughout Europe and internationally. The intention of the standard was to ensure that there was an agreed: • terminology related to the words used • process by which risk management could be carried out

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In 1997, Toft and Reynolds published the second edition of their book on how organisations could do more to learn from disastrous events; in recognition of developments in the business world they added a chapter, “The management of risk”, which is now chapter two in the third edition. It begins:

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• organisation structure for risk management • objective for risk management (IRM, 2002: 1). The standard is still available online at the IRM website, but following publication in 2009 of the ISO 31000 ‘Risk Management Principles and Guidelines’, a new document ‘A Structured Approach to Enterprise Risk Management (ERM) and the Requirements of ISO 31000’, was produced by the same three organisations. However, the IRM has maintained its support for the original risk

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management standard because of its international appeal as a multi-lingual practical approach for business managers (IRM, 2010). A parallel development has been the growth of a professional practice area of Business Continuity Management, and a body of related research and academic study (Elliott et al., 2002). Also a membership body for practitioners, the Business Continuity Institute, was set up in 1994 and by 2010 it had 5000+ members in over 90 countries (BCI, 2010). However, as one of the papers in the 1992 Royal Society report noted: “It has to be recognised that it is impossible to completely eliminate risk.” (Crossland et al., 1992:29). Thus there are issues about how far the mathematical and engineering tools of risk prediction and control can be developed and how broadly they can be applicable. What else is needed for effective risk management in modern society?

5.1 The development of risk management Toft and Reynolds (2005: 12) state that: “the concept of risk taking can be traced back to the early Greek and Arab civilisations”’, before moving straight on to developments in organisational risk management In the 1950s and 1960s. However, Bernstein(1996) provides a lively review of the steps whereby advances in mathematics from ancient Greek times onwards through the centuries have helped to shape human understanding of risk. He asserts that man’s helplessness in the face of fate was replaced by choice: The revolutionary idea that defines the boundary between modern times and the past is the mastery of risk: the notion that the future is more than a whim of the gods and that men and women are not passive before nature. (Bernstein, 1996:1) The mathematical theory of probability emerged during the seventeenth century. We should note that Bernstein describes how Sir Francis Galton, a nineteenth century scientist, discovered the powerful ‘tendency of the average to dominate’ which has become a basis for rational choice in decision making in medicine and many other fields, when linked to historic data on causes and effects. Incidentally, Galton also studied the patterns of fingerprints and estimated the very unlikely chances that two sets of prints would match randomly as 1 in 64 million. Thus he began the use of fingerprinting in police work, and although some imperfections have been found subsequently (Gigerenzer, 2002: 12) the value of this discovery still stands. Mathematical methods of quantifying risks in engineering came forward, ‘to express design criteria in terms of events having a prescribed probability of occurrence in the lifetime of a structure.’ (Crossland et al., 1992: 13). Such methods have been developed into a body of sophisticated Quantitative Risk Assessment (QRA) techniques with broader application beyond engineering. For example Cohen (1996) describes use of QRA to estimate the incidence of illnesses following varying levels of exposure to toxic materials in industrial workplaces. He also usefully distinguishes between QRA as a means of estimating a risk and ‘risk evaluation’, which is a wider based decisionmaking process.


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Closely allied with QRA are cost-benefit analysis (CBA) techniques that can similarly contribute to risk management planning and decisions. The example of railway safety is discussed by HorlickJones (1996) who records how expensive measures to effect some degree of increased operational safety have sometimes been considered unjustified when set against the few lives that would be saved. Such a cold calculation could provoke a reaction against CBA but Sunstein (2002) argues that a merit of CBA is that it helps to get an objective view of the issue ‘ on-screen’ when considering how people’s ordinary thinking about risks can be addressed in law and political judgements made. Turning to risk management in the form of Business Continuity Management (BCI), the development of professional practices in BCI has been described by Elliott et al. (2002) as taking place in three distinct phases: 1. Technology, in the 1970s and 1980s: for protecting IT systems from breakdowns. This became increasingly important as more and more business functions were computerised and particularly as the threat of the so called ‘millenium bug’ loomed larger and larger.

3. Value-based, 2000 onwards: taking a broad view of how the organisation works, and including social risks to performance. The overall resilience of the organisation has become the key target.

5.2 Perceptions of risk Those involved in these areas of professional practice will perceive risk in terms of the outputs of the methods they use to assess and predict effects in order to institute preventative or controlling measures. However, alongside the development of these activities have been the sociological and psychological studies of individual and group perceptions of risk, and which pose considerable challenges for the rational, quantitative methods of business risk management. The first concern is that those using such tools within their professional work will believe in their efficacy to such an extent that they might be inclined to overstatement when challenged, and not recognise or be reluctant to admit the role of their own beliefs in their subjective thought processes.

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2. Audit and Compliance, 1980s and 1990s: checking the organisation against regulatory controls and external standards; including security and Health & Safety requirements together with standards for corporate governance set by Government regulations that apply particularly to financial matters.

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Secondly research has shown how people will often base their risk perceptions on experiences and beliefs that have nothing to do with any mathematical model or scientifically reasoned understanding of the situation. Thus Douglas and Wildavsky (1982) argued that different societies, and the individuals of which they are composed, create their own sets of criteria against which the risks associated with a particular hazardous circumstance will be interpreted and ‘measured’. The use of such social and individual reference schemas suggests that the risks perceived by a given society or individual are not objective but subjective.

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Other authors have argued similarly and asserted that: “it is unrealistic to presume that the fundamental processes of risk assessment are objective” (Reid, 1992: 151). Also that: “[a]ll judgements about hazards or risks are value-laden” (Shrader-Frechette, 1996: 220). A very radical position was taken by Paul Slovic (1992: 119) who stated that: “[t]here is no such thing as ‘real risk’ or ‘objective risk’”. Drawing upon these assertions, it can be postulated that to some extent, all risks can be envisaged as being subjective in nature. During this course there will be many examples of individual and group subjective perceptions of risk that can be regarded as determined by psychological and sociological processes; see for instance Breakwell ( 2007) for one useful overview but many other published works cover this area.

5.3 Good management is risk management

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Just because there are some difficulties with the processes of risk management and the interpretation of their outputs does not mean that it should be treated with extreme caution or indeed can be set aside. Toft and Reynolds (2005:13) sought to dispel such suspicion by regarding risk management as not: any more mysterious an activity than any other form of management. The management of any organisation, in its simplest form, can be envisaged as being three separate, but interrelated, activities: business development, logistical support and operational management.’ Business development is concerned, for example, with ascertaining customers’ requirements, procuring orders for the product or services to be provided or ensuring invoices to clients are despatched. Logistical support management tries to ensure that those elements that are required to support both business and operational activities are present, for example, people, computers, faxes, telephones and so on, while operational management is about making sure the product or service is produced and carried out to the appropriate specification for a client. Toft and Reynolds point out that all of these management activities are aimed at achieving targets and so have activities to try to remove, control or reduce the risk that an unwanted incident will prevent such success. Therefore they place risk management as a ‘mainstream’ management activity. Similarly it should be influential at the top of every business because: ‘Risk management is a central part of any organisation’s strategic management’ (IRM, 2002: 2). Such thinking was taken forward in early 2002 by a grouping of academic researchers and business managers, who met at the Massachusetts Institute of Technology (MIT) to begin a threeyear project that was partly funded by the UK Government. Their initial aim was to research corporate security and resilience, with the aim of countering the increasing threats of terrorism to business continuity. However, as their research progressed it embraced other threats, including technological accidents and natural disaster such as earthquakes. By examining case studies of companies that had successfully countered such threats, and others that had not, this research was able to develop a positive body of information on, ‘…the ways in which companies can recover from high-impact disruptions.’ (Sheffi, 2005: ix). The research found many examples of flexible, robust supply chains that enabled companies to deal with disruptions because of the analytic and positive approach to risk management that had informed their design.

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Thus a key finding was that: “[m]any of the characteristics that make for successful firms in today’s uncertain marketplace are the same characteristics that make them resilient” (Sheffi, 2005: 283). The fact that in risk management, the principles of cost benefit analysis and quality management can be modelled and related to each other supports the argument that the fundamental principles of risk management are inherent within all good management systems. Also proactive risk management can yield significant financial savings. If an organisation has in place a system which actively searches for and analyses risk issues corporation-wide, then any problems should be identified before there are reasons for a mass of complaints from customers. Early problem identification means that remedial action can be taken much sooner. The Institute of Risk Management (IRM, 2002: 4) stated that: Risk management protects and adds value to the organisation and its stakeholders through supporting the organisation’s objectives by:

• improving decision making, planning and prioritisation by comprehensive and structured understanding of business activity, volatility and project opportunity/threat • contributing to more efficient use/allocation of capital and resources • reducing volatility in the non essential areas of the business • protecting and enhancing assets and company image • developing and supporting people and the organisation’s knowledge base • optimising operational efficiency. These points fit very well with the third stage identified by Elliott et al. (2002) with risk management a good way further on from its roots in technical, numerical assessments of specific risks. However, those tools are now part of the comprehensive effort to build organisational resilience.

5.4 Problems in risk management As noted earlier, there are problems of subjectivity of risk perception processes associated with attempting to engage in risk management. Toft and Reynolds (2005: 15) set out some further difficulties, as follows: • Many of the hazards that plague organisations are frequently geographically dispersed, typically each individual organisation afflicted by a particular hazard believing that they are the only ones to suffer from it. Therefore, it often takes time before the ‘real’ extent of a particular hazard comes to light.

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• providing a framework for an organisation that enables future activity to take place in a consistent and controlled manner

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• The threat of litigation often prevents organisations from revealing or sharing information on actual and potential hazards. • an organisation’s staff are often embarrassed or afraid of having their employment terminated if they reveal that they were responsible (or they feel responsible) for a potential

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or realised hazard. Consequently staff tend not to inform management of any errors which they might have made. This reluctance to advertise any human factor errors unfortunately also includes errors that led to ‘near miss’ incidents. • Much of the hazard and risk information that is currently available is not in a form immediately ready for risk pattern or trend analysis. • There are difficulties in disseminating the lessons learned from unwanted organisational events. • There is a tendency for the managements of some organisations not to take advantage of the lessons others have learned through experience. • It is impossible for anyone to specify what they do not know. • While the past is ‘fixed’ in time there are multiple future realities, and thus organisations cannot rely upon past achievements to unerringly predict future performance.

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As you progress through this course you will meet research findings and theoretical concepts from other writers to assist you in testing and challenging these points, which you should treat as opinions rather than facts to be accepted without question. Certainly research into the procedures for minimising errors on the flight decks of aircraft carriers and in other ‘High Reliability Organisations’ (HROs) offers strong evidence to counter some of the negativity of the Toft and Reynolds list. For an introduction to HRO research and concepts, see Reason (1997:213- 218). The position you are offered in this Unit is that while risk management techniques have various limitations and problems, these are not intractable and the benefits of utilising them are potentially significant. Indeed Toft and Reynolds (2005) go on to demonstrate, with diagrams adapted from Allen (1992), how proactive risk management can gain from early warning measures by plotting the number of unwanted incidents against time and conducting cost-benefit analyses. In the supplied article at the end of this Unit you will get an argument that, ‘risk management needs to be contextualized from a practical organizational perspective in which responsibility, expertise, accountability, trust, coordination and communication are essential.’ (Boholm, 2010:235).

5.5 Acts of God and other myths One reason why people might believe they cannot engage in proactive risk management is because disasters are frequently described in the media with words like freak, unforeseen, human error, act of god, technical failure, and so forth. These terms are often used as if to explain the reasons for the incident occurring. Unfortunately, such language promotes the belief that such tragic events can be explained away as being the work of uncontrollable forces such as random chance events, divine wrath, or solely as the result of some unfathomable technical defect or simply fate. It can be argued that one of the consequences of people holding such views has been the emergence of a belief that the retrospective analysis of any large accident would be extremely limited in its usefulness. They might liken such analysis to locking a stable door after the horse has bolted. Or they would be minded to trust to luck that it won’t happen again. As Sheffi (2005: 284) observed:

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“[t]hinking about what can go wrong is unpleasant for most people. The normal human tendency to see the world as we want it to be, rather than as it is, stands in the way of preparedness”. However, there is evidence to support a different opinion of retrospective analysis of disastrous events in order to learn how to prevent or minimise the effects of repetitions. Thus the tools and techniques of risk management can play a part in such endeavours.

5.6 Organisational learning

Therefore organisational learning opportunities should always be looked for and the concept of isomorphism is a useful tool. However, careful use is needed to ensure that the situation that is to be learned from is genuinely isomorphic with that in which the lessons learned are to be applied.

5.7 Quantitative risk assessments In his chapter in Hood and Jones (1996), Brian Toft makes a strong case for recognition of the limits of mathematical modelling and the engineering approach to risk management. He refers to major disasters that were not prevented by the extensive scientific and engineering effort that went into planning, building and operating complex systems such as space vehicles (Challenger 28 January 1986) and nuclear plants (Three Mile Island 28 March 1979, and Chernobyl 26 April 1986). After such tragic events, society turns to the engineers for help in understanding why they occurred and how they might be prevented in the future. The intense public and political pressure generated by media coverage of this type of event has often been driven by unrealistic expectations as to what can be done to make systems totally safe. There are also particular and strong demands to blame someone.

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The main thrust of the course text by Toft and Reynolds (2005) is that organisations can learn from the experiences of others, particularly similar organisations or when their operations or circumstances are analogous and therefore some form of isomorphism exists. Although when looking for isomorphic resemblances either within or between organisations, the perceived similarities can be deceptive. A similar looking event may seem to be taking place when in fact that is not so. Also when looking for isomorphic properties in situations care must be taken to avoid the ‘decoy phenomenon’ identified by Turner (1978), whereby organisational personnel, because they recognise and take action on some well defined hazard, miss other potentially more serious problems.

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Toft discusses how engineers using mathematical methods to ‘objectively’ assess the safety of a particular technology, installation or process, can fail to look beyond the limits of their own assumptions and models. The weight to be given to a particular risk ought not to be isolated from judgments about the social cost and how people will perceive it, but there must be a tendency for the numerate technologist to focus on what can be quantified and included in the equations. Thus the engineers’ approach to risk measurement may not take account of qualitative human factors that can lead to errors and accidents; especially as such considerations are not measurable in the same terms as physical concepts like the strength of a critical component. Toft develops his

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analysis of this issue and casts considerable doubt on the efficacy of quantitative techniques in risk assessment and prevention as a consequence of this limitation and the facts that disasters have happened in highly engineered systems. However, we should for instance note that detailed studies of the Challenger disaster have revealed that the decision to launch was taken despite technical advice that the temperature was too low. The engineering considerations were overridden by the organisational power of political considerations (Perrow, 1999: 379-380). It would seem that this disaster was caused by faulty decision-making at the top and not by errors in the quantitative risk analysis. Thus awareness of the context in which quantitative tools are being used is important. Those using such tools to make risk assessments need to be alert to the biases that their own judgments will feed into the calculations. Then quite separately those who will interpret the results and feed them into decision-making processes need to be constantly reminded of the subjectivity of what they are doing. The latter applies particularly to matters of public safety such as transport and health concerns.

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Public perceptions of risk can lead to pressure on politicians but in relation to environmental issues Sunstein (2002) argued that before governments act to regulate a risk, there should be a quantitative cost-benefit analysis (CBA) of the proposal and its alternatives, so that the consequences are explored fully. He presents CBA as a useful tool: ‘... a corrective to cognitive limitations and a response to democratic needs.’ (Sunstein, 2002: ix). He discusses various social influences and psychological factors such as wrong perceptions arising from the availability heuristic (Kahneman, et al. 1982) as some of the sources of these limitations. Then he argues that CBA is a good ‘tool to get ‘on-screen’ important social facts that might otherwise escape private and public attention.’ (Sunstein, 2002: 29); also to inform people on the likely consequences of different courses of action. Thus quantitative risk assessment techniques can inform the debate even though the numerical outputs of such techniques may not be unambiguous and uncontroversial probabilistic values on which lay and expert risk assessors can agree. For example, the pressure group Greenpeace and those who work in the nuclear power industry hold diametrically opposed views as to the safety of nuclear technology. However, both claim that it is their particular selection and interpretation of the available data to which society should give credence.

5.8 Risk assessments and decision-making Ultimately it falls to elected governments to be the decision-makers to determine which public safety hazards are acceptable and which are not. Those with that responsibility need to bear in mind that “Numerical information is capable of seriously misleading those who use it” (Funtowicz and Ravetz, 1990: 10). Whilst experts may be on hand to help, the argument will have to be expressed in terms that can be presented convincingly in parliament, and to the general public by means of the media. Here we meet a problem that can be very difficult to resolve because many people have difficulties with some mathematical concepts, particularly expressions of probability such as a numerical evaluation of a hazard. As Gherardi and Turner (1987: 10) suggested: On the one hand we are mesmerised by numbers, even when they are pseudo-numbers, those who deal with them frequently no less than those who are thrown into a panic by them. On the

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other hand, the general standard of teaching about mathematical issues is so poor that few people understand fully the nature of the properties of the numbers and number systems which they are advocating or excoriating. Furthermore professionals who the public trust can also make mistakes when dealing with probability estimates. Gigerenzer (2002) reports research showing that senior doctors made such mistakes when interpreting the results of diagnostic tests to advise patients on their chances of having an illness and of being treated successfully. He argues that confusions arise where data is presented as percentages and probabilities, and that calculating what he terms ‘natural frequencies’ gives a more accurate and thus better picture of the situation. Gigerenzer (2002: 5) demonstrates this with the example of mammogram screening for breast cancer, on which medical textbooks state: The probability that a woman of age 40 has breast cancer is about 1 percent. If she has breast cancer, the probability that she tests positive on a screening mammogram is 90 percent. If she does not have breast cancer, the probability that she nevertheless tests positive is 9 percent. What are the chances that a woman who tests positive actually has breast cancer?

Think of 100 women. One has breast cancer and she will probably test positive. Of the 99 who do not have breast cancer, 9 will also test positive. Thus, a total of 10 women will test positive. How many of those who test positive actually have breast cancer? Now it is easy to see that only 1 woman out of ten who test positive actually has breast cancer. This is a chance of 10 percent, not 90 percent. (Gigerenzer, 2002:6) As well as raising the need for decision-makers to master techniques for handling probability data better, Gigerenzer uses several examples to show that decision-makers need to be aware of the ‘illusion of certainty’ that can come from accepting numerical data uncritically and failing to recognise that a low probability event is still a possibility. This relates to the problem set out by Toft (1996:103) that reliable historical data on the frequency of unwanted events may be incomplete or weak because such events are rare. Thus probability estimates based on limited data ought to be treated with caution. Toft develops the issue using the concept of the ‘open system’ to refer to an organisation which is greater than the sum of its parts. A quantitative risk analysis will use a finite number of data points to model various identified risks and then these are summed to give an overall risk probability but that sum does not fully represent the open system. If such a closed calculation has been used to estimate total risk for an open system then this is a paradoxical or self-contradictory situation (Toft, 996: 105).

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This presentation leads one to think that the probability of the woman who has tested positive actually having cancer is about 90 percent, because the test error rate is only 9 percent. However, the same facts presented as natural frequencies lead to a different conclusion:

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An example of this ‘open system’ problem for risk calculations is given by Gigerenzer (2002: 2829); he describes visiting the manufacturers of the Ariane rocket used for putting satellites into orbit and hearing that the system’s security was computed from the design features of the rocket’s components. Accidents due to human errors were not included.

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In response to these criticisms a more recent text (Vose, 2008) shows how quantitative data and assigned qualitative values can be combined to make a probability by impact assessment of system sensitivity and an uncertainty analysis. such work is done within a defined context or framework of questions to be asked and of identified assumptions. He also describes use of Monte Carlo simulation to model the uncertainty or variability in a situation where some quantification of risk is needed to aid decision-making. Thus it can be argued that QRA has advanced considerably from the techniques criticised by Toft (1996) but that his concerns still sound some appropriate warnings.

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Finally in this section, we should note that Brian Toft (1996:107-110) called for the creation of a national organisation to collect, analyse and disseminate information on socio-technological failures. He envisaged that analyses of incidents could be conducted using his failure reduction model. However, since that chapter was written there has been the massive development of the professional risk management bodies and it may be that those working within the standards set by those bodies and thereby producing a substantial body of knowledge and best practice principles are filling Toft’s prescription. As this unit has argued, quantitative risk management techniques need to deployed within a system where organisational and regulatory decision-makers are open to the widest possible contemplation of hazards, are willing to investigate system and technological failures, and hence will be proactively committed to creating a climate or culture in which safety related matters are discussed openly. The importance of safety culture within organisations will be developed in a later Unit.

5.9 Conclusions Knowledge about losses from accidents, crises and disastrous events, can be costly information both in terms of lives lost and capital squandered. Hence, we should attempt to use the data generated from such events as effectively as possible so that further casualties and costs are kept to a minimum, and in business terms that the company can continue to trade successfully. The creation of an effective organisational learning system is necessary and the concept of isomorphism could be of help in pursuing this goal. Even though the complexity of some incidents may make it impossible to achieve a total understanding of all that has taken place, useful analyses can nonetheless be carried out. Such analyses show quite clearly that while the technical aspects of any disaster are important, those elements that relate to management, information and personnel are equally significant as potential causes. During the two decades up to 2011, there has been a huge growth in risk management as a field of professional practice; the millennium bug did not wreak the havoc with computer systems that some feared, so the preventative measures taken may have been successful or perhaps the risks were overstated? Certainly the work done to strengthen IT systems before the first day of 2000 has been developed further and systematic risk management and business continuity work has broadened out to embrace all aspects of commercial and other enterprises.

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It is recognised that the methodologies currently in use to identify and assess organisational risks have practical and conceptual limitations. Some analysts take the view that these weaknesses are so serious as to negate the whole approach; whilst their concerns can be regarded as based on some good points about the subjectivity of the hazard identification and risk evaluation stages, their stance can be considered a minority position. A risk-free industrial and commercial world is undoubtedly a utopian impossibility but there is no reason why any organisation should not utilise risk management techniques to create its own future; there is the view that risk can be opportunity.

5.10 Guide to further reading You should now make use of the two supplied texts. Review Chapter 4 in the supplied textbook Accident and Design, edited by Chris Hood and David Jones and Chapter 2 in Learning from disasters, by Toft and Reynolds.

5.11 Study questions You should now write 300 words in answer to each of the questions below. We believe that this is an important exercise that will assist your comprehension of material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University. • Why is it difficult to measure risk? • To what extent does systems theory enable us to manage risk proactively? • How does academic thinking about risk management inform business continuity planning?

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For those wishing to take this topic further, a useful collection of articles about corporations and risk is Kasperson, J. X. and Kasperson, R. E. (2005) The Social Contours of Risk, Vol. II: Risk Analysis, Corporations and the Globalisation of Risk, London: Earthscan.

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5.12 Bibliography Allen, D. E. (1992) ‘The role of regulation and codes’. In Blockley, D (ed.) Engineering Safety, New York: McGraw-Hill. BCI (2010) Business Continuity Institute website, accessed 8 Dec 2010. Bernstein, P. L. (1996) Against the Gods: The Remarkable Story of Risk, New York: John Wiley. Boholm, A. (2010) ‘On the organizational practice of expert-based risk management: A case of railway planning,’ Risk management, 12, 235-255. Breakwell, G. (2007) The Psychology of Risk. Cambridge: Cambridge University Press.

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Cohen, A. V. (1996) ‘Quantitative Risk Assessment and Decisions about Risk: an Essential Input into the decision process’, in Hood, C. and Jones, D. K. C. Accident and Design: Contemporary Debates in Risk Management, London: UCL Press. Crossland, B., Bennett, P. A., Ellis, A. F., Farmer, F. R., Gittus, J., Godfrey, P. S., Hambly, E. C., Kletz, T. A. and Lees, F. P. (1992) ‘Estimating Engineering Risk’, Chapter 2 in Risk: Analysis, Perception and Management. Report of a Royal Society Study Group. London: The Royal Society. Douglas, M. and A. Wildavsky (1982) Risk and Culture, University of California Press. Elliott, D., Swartz, E. and Herbane, B. (2002) Business Continuity Management: A Crisis Management Approach. London: Routledge. Funtowicz, S. O. and Ravetz, J. R. (1990) Uncertainty and Quality in Science for Policy, Kluwer. Gigerenzer, G. (2002) Reckoning with Risk: Learning to Live with Uncertainty, London: Penguin Books Gherardi, S. and Turner, B. A. (1987) Real Men Don’t Collect Soft Data, Quaderno 13, D. di Politica Sociale, Universita di Trento. Horlick-Jones, T. (1996) ‘Counting the Cost: Risk Reduction but at what Price?’, in Hood, C. and Jones, D. K. C. Accident and Design: Contemporary Debates in Risk Management, London: UCL Press. IRM (2002) A Risk Management Standard, (2002), London: Institute of Risk Management; available online at: www.theirm.org/publications/documents. IRM (2010) Institute of Risk Management: publications website, accessed 3 Dec 2010. Kahneman, D., Slovic, P. and Tversky, A. (Eds) (1982) Judgment under Uncertainty: Heuristics and Biases, New York: Cambridge University Press Perrow, C. (1999) Normal Accidents: Living with High Risk Technologies. Princeton: Princeton University Press.

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Pidgeon, N., Hood, C., Jones, D., Turner, B. A. and Gibson, R. (1992) ‘Risk perception’. In Risk: Analysis, Management and Perceptions, London: The Royal Society: 89-134. Reason, J. (1997) Managing the Risks of Organisational Accidents, Aldershot: Ashgate. Reid, S.G. (1992) ‘Acceptable risk’. In D. Blockley (ed.) Engineering Safety, New York: McGraw-Hill: 138-166. Shrader-Frechette, K. (1991) ‘Reductionist approaches to risk’, in D.G. Mayo and R.D. Hollander (eds) Acceptable Evidence: Science and Values in Risk Management, Oxford: Oxford University Press: 218-248. Sheffi, Y. (2005) The Resilient Enterprise, London: MIT Press. Sunstein, C. R. (2002) Risk and Reason: Safety, Law and the Environment, New York: Cambridge University Press.

Toft, B. and Reynolds, S. (2005) Learning from Disasters - A Management Approach, Basingstoke: Palgrave macmillan. Turner, B. A. (1978) Man-made Disasters, Wykeham Publications. Vose, D. (2008) Risk Analysis: a Quantitative Guide (Third Edition), New York: John Wiley & Sons.

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Toft, B. (1996) 'Limits to the Mathematical Modelling of Disasters.' in Hood, C. and Jones, D. K. C. Accident and Design: Contemporary Debates in Risk Management, London: UCL Press.

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READING ‘On the organizational practice of expert-based risk management: a case study of railway planning’ Boholm, A. (2010, Risk Management, 12, 235-255 (October) )

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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UNIT 6 Safety Culture


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6 Unit 6: Safety Culture 6.1 Aims and objectives of this Unit In this Unit, you will learn about various aspects of culture at different levels (national, inter- and intra-organisational, and professional) which are likely to have a bearing on risk. Different worldviews about culture, risk and ‘safety culture’ are outlined and the implications discussed.

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6.2 Introduction Culture, especially of an organisation, is increasingly identified as a key factor in the success or failure of enterprises. Official inquiries into disasters such as Chernobyl, King’s Cross and Piper Alpha specifically pinpointed cultural characteristics as important both to understanding why the disasters occurred and to other similar organisations ensuring that they avoid such events. However,

Along with concepts such as power, love and, indeed, risk, culture is yet another recursive (recurring), sensitising concept which alerts us to a litany of other related concepts in an endless, circular pursuit of ‘the truth’ about the human condition. To a great extent, ‘culture’ has become in the West a managerial label for a rag-bag of ill-defined and poorly understood ideas about ‘how we do things around here’. The ‘we’, of course, generally is expressed by senior managers in the particular organisation on an assumption that ‘we’ means everyone in the organisation. Such a normative stance tends to ignore the fact that most organisations are assemblages of multiple cultures (Turner, 1988) of which the managerial culture is only one. It is likely that a particular world-view will include closely allied perceptions of and attitudes towards culture, risk and many other issues. For example, those who regard risk as an objective phenomenon which is best approached through a limited set of quantifiable parameters concerning prediction and control are likely to regard culture in a similar vein. It is therefore important to consider different perspectives on these topics and the implications of the differences for managerial practice and outcomes. This Unit seeks to describe and discuss different perspectives on culture, risk and safety including some of the more controversial aspects such as cultural assessment and culture change.

6.3 The nature of organisational culture

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stating that culture is a vitally important factor in determining risk is easy. It is much more difficult to establish a well-informed and realistic practical approach to what is a very complex subject.

For the purposes of comparison and contrast, the literature on organisational culture may be assigned to one or other of two categories, functionalist and interpretive (Burrell and Morgan, 1979; Smircich, 1983). These two categories are equivalent respectively to modernist and postmodernist sociological perspectives of organisation and organisational analysis (Carter and Jackson, 1991; Jeffcutt, 1991; Reed, 1991). The two categories are also equivalent to the normative and descriptive categories discussed by Davies (1988) and ESRC (1993).

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Although, as described below, the modernist and postmodernist approaches and discourses are different, there is much common ground among authors about the components of organisational culture. For example, both functionalist authors such as Deal and Kennedy (1986) and Dyer and Dyer (1986) and interpretive authors such as Watson (1982) and Davies (1988) recognise the inclusion of characteristic sets of values, beliefs, assumptions, symbols and so on in the essential concept of organisational culture. To an extent, such similarities emphasise the ‘new theory’ tendency of commensurability (Reed, 1991) which holds that world-view types are not mutually exclusive. Lundberg (1990) states that organisational culture is ‘a phenomenon of reality construction - allowing members to see and comprehend particular events, actions, objects, utterances and whole situations, including their own behaviours, in an acceptable way that is sensible and meaningful.’ Quoting Deal and Kennedy (1986), Lundberg notes that organisational culture has three layers of meaning: manifest level – including symbolic artefacts, for example; language, stories, rituals and normative conduct; the strategic level – including strategic beliefs; the core level, including, ideologies, values and assumptions.

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Table 1 (Waring, 1996a) provides examples from the health and safety area of risk for each of the above levels and components. Table 1: Levels of organizational culture Level Component Examples Manifest

Symbolic artefacts

Safety award schemes

Prominent display of lost time accident (LTA) figures

Safety policy statement

‘Zero LTAs’

Language

‘Safety management systems’

‘Loss prevention’

‘We have a new safety culture’

Stories

‘The day the managing director went on a safety tour …’

Rituals

Continued use of canaries as mine gas detectors

Safety award presentations

User of hard hats on construction sites

Normative conduct

Consensus or conflict in safety committees

Strategic

The quality plan and the safety plan must be closely linked

Strategic beliefs

Safety is a matter for operational managers and the safety department

Core Ideologies

Safety dominated by particular group values and assumptions, e.g. those of engineers

Safety is a managerial responsibility

Values

Profit before safety

Accidents are caused by stupidity

Assumptions

Attitudes towards safety can be changed quickly by directives and training

Source: Waring, 1992, 1996a

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These layers of meaning refer to the content of organisational culture. Gorman (1989) adds three further dimensions: Strength:

extent to which organisational members embrace core level meanings.

Pervasiveness:

extent to which beliefs and values are shared across the organisation.

Direction:

extent to which organisational culture embodies behaviour consistent with espoused strategy.

Localisation could be added as a further dimension, i.e. the extent to which particular locations in the organisational structure have their own (sub)cultural identity within the overall organisational culture. Localisation would also apply to different countries, regions, religions, professions etc. Waring (1996a) points out that because individuals usually belong at one and the same time to a number of different groups, they may as individuals exhibit characteristics of several different cultures, e.g. Texan (i) engineers (ii) working in an offshore drilling (iii) company (iv) which has been based for many years in the Gulf of Mexico (v).

• general agreement about components of organisational culture • components include characteristic shared sets of values, beliefs, assumptions, symbols, modes of behaviour etc • functionalist and interpretive perspectives disagree about how these components operate and their relative emphasis • as a meaning system, three layers are identifiable: manifest, strategic and core • important dimensions are: content, strength, pervasiveness, direction and localisation.

6.4 Functionalist views of organisational culture Functionalist views of organisational culture are characterised by the following assumptions (Waring, 1992, 1993, 1996a): • organisational culture has a pre-determined function.

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Smircich (1983) introduces the notion that organisational culture is yet another metaphor for organisation along with (interpretive) metaphors such as theatres and political arenas, and (functionalist) metaphors such as organisms and machines. She suggests that organisational study and cultural study are analogous as they are both concerned with patterns and order. Organisation and culture provide two intersecting sets of images:

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• organisational structures epitomise the particular organisational culture. • the function of organisational culture is to support formal, rationally designed management systems and strategies • organisational culture can be reduced to relatively simple cause–effect models i.e. a large degree of determinism, predictability and control;

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• organisational culture can be and should be manipulated to serve corporate (i.e. managerial) interests • there exists an ideal type of organisational culture to which organisations should aspire • there exist ideal or appropriate ways in which to manipulate organisational culture for the purposes of (managerial) prediction and control. For example, Kono (1990) in discussing the relationship between corporate culture, strategy and long-range planning offers a very rationalistic cause-effect model for producing a revitalised culture based on corporate philosophy, product market strategy, organisational structure and the personnel management system, and the attitudes of top management.

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Dobson (1988) cites a number of cases of culture change. ‘Why did organisations change their culture? The answer is quite simple. They changed their culture in order to implement a corporate strategy.’ In support of this assertion, Dobson argues that a strategic change has implications for work methods and behaviour, and that new methods and behaviour require a change in beliefs and attitudes. The modernist stance of Dobson is echoed by a number of other authors. For example, Green (1988), in noting a relationship between strategy and culture, states that strategic management ‘is a cultural process aimed at altering managers’ interpretations about the fundamental nature and purpose of their organisation and their roles within it.’ He further argues that culture can be used as a manipulative instrument to influence strategy and change. Gorman (1989) follows a similar line in terms of cultural fit with strategy, i.e. company goals. In his view, there is an appropriate culture for an organisation. Lundberg (1990) states that strategic beliefs ‘refer not to the long-range plans or strategic pronouncements of organisational spokespersons, but rather to the fundamental “oughts” in the minds of the influential organisational leaders.’ Leadership is seen by functionalists as a key determinant in cultural change and in organisational change which such culture change is thought to enable. Dyer and Dyer (1986), for example, in their comparison between a cultural approach and a systems approach to organisational change, argue that a leadership change is crucial to a cultural change. Westley (1990) reports a case study of cultural change involving an attempted socio-technical redesign of a large automobile assembly plant. He notes that culture is a crucial factor in determining the receptivity of an organisation to change. However, he also notes that although some individuals underwent ‘conversions’, ‘efforts to change core assumptions through structural and stylistic interventions met with resistance...’. Consensus decision-making became a new means for blocking initiatives and passing the buck’. All in all, Westley observed that the ‘transition was experienced as a kind of human relations nightmare.’ Beer et al. (1990) studied six large organisations undergoing change and noted that senior managers believed that ‘promulgating company-wide programs – mission statements, corporate culture programs, training courses, quality circles, and new pay-for-performance systems – will transform organisations’. However, Beer et al. concluded that such beliefs about such programs themselves constitute the greatest obstacle to revitalisation – ‘the fallacy of programmatic change’.

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The case studies of Westley and Beer et al. underline the difficulties and risks of functionalist approaches to organisational change (through culture change) in that there is likely to be a difference between, on the one hand, managerially espoused values and change strategies and, on the other hand, enacted values and strategies in the organisation as a whole. Gorman (1989), for example, assumes that company goals are the only set which operate within the organisation and that they have been articulated clearly and are understood and agreed upon by the organisation’s members. His reference to the appropriate culture for an organisation is discussed only in terms of the corporate leaders’ view. Dyer and Dyer (1986) demonstrate an assumption that problems (as defined by management) relating to an organisation exist and these can be solved by formal engineering of a cultural change by management. In extreme cases, culture change programmes may lead to managerial use of ‘culture’ as a weapon of internal coercion and control.

purpose of control and legitimation of activity.’ She suggests, however, that the very notion of corporate culture may be as disappointing a managerial tool as ‘other previous managerial fads.’ For those aspects of risk which can be shown to follow a reliable cause–effect relationship or model, functionalist assumptions are well suited. For example, readily quantifiable relationships include: • the mortality rate 5 years after becoming antibody positive to HIV • the probability of a company going into liquidation within its first three years of trading • the probability of being killed in an aircraft accident expressed per million passenger miles • the probability of winning a major prize on the national lottery. However, culture needs to be regarded more as a mediating factor than as a causal one, and certainly not one that can be reduced satisfactorily to a quantitative relationship. For example, it is not simply a matter of classifying a culture on a scale of, say, risk aversion and then trusting that the particular measurement will enable reliable prediction about what will happen in that organisation in all matters to do with risk. An organisation judged to have a highly risk aversive culture may avoid spectacular failures in the areas of speculative risk but is also less likely to enjoy spectacular successes. Risk aversiveness in speculative risk often goes hand-in-glove with risk-taking in areas of pure risk, e.g. reducing risk controls in the name of cost control. • Functionalist views of organisation culture centre on cause-and-effect beliefs about human behaviour, the purpose of culture, and managerial imperatives.

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The modernist or functionalist approach to organisational culture places the topic of culture very much in a supporting role to managerial ideology, goals, strategies and so on. However, Smircich (1983) notes: ‘Those of a more sceptical nature may also question the extent to which the term corporate culture refers to anything more than an ideology cultivated by management for the

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• A functionalist perspective places organisational culture as a ‘commodity’ which is in the gift of management to manipulate and control in a predictive way to serve managerial interests. • A purely functionalist approach to organisational culture is likely to encounter difficulties in practice.

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6.5 Interpretive views of organisational culture Interpretive views of organisational culture are characterised by the following (Waring 1992, 1993, 1996a): • Culture is regarded as an emergent phenomenon of social groupings. • Organisational culture is regarded as complex and incapable of reduction to a (relatively) simple cause–effect model. • Organisational culture is a means for the organisation’s members to interpret their own existence, identity and actions and to institute, guide and moderate those actions. • Organisations may be regarded as multi-cultural assemblages having characteristic discourses within and between them. • Organisational structures, systems, strategies, processes and culture(s) reflect each other.

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• Formal structures, systems, strategies and processes support the prevailing organisational culture. • ’Ownership’ of organisational culture is not the sole prerogative of senior management. • Pursuit of an ideal type of organisational culture begs the question ‘whose ideal?’; each organisation’s culture is a unique creation of all of its members. • Managerial attempts to manipulate organisational culture to achieve rapid organisational change are likely to fail. Turner (1988) describes organisations as ‘cultural assemblages’ and contrasts the interpretive and functionalist approaches. Whereas the modernist or functionalist view is characterised by those who want to have things cleared up, sorted out and neatly stacked, interpretive analysts see the importance of seeking out, acquiring and interpreting data through a unique personal perspective in which the subjective and objective are in constant interplay. This ‘abduction process’ (Denzin, 1978) recognises the action-meaning dialectical process of ideational culture (Johnson, 1987). The cultural web model for understanding stability and change in organisations (Johnson, 1987) is very much an interpretive approach. Exemplifying the post-modernist view of organisations, Watson (1982) links group ideology, political processes, power and language (rhetoric) as having a combined influence on the actionmeaning dialectical process. ‘There is a trend away from viewing organisations as unambiguously rationally devised and pre-given structures into which people are slotted. Instead, they are being seen as the outcomes of joint involvement in certain tasks of a multiplicity of individuals and groups with a variety of goals and values and in relationships of inequality....’ He argues that coalitions are inevitable in the face of potential disadvantages stemming from power differentials. ‘Group ideologies are sets of ideas associated with groups which both give meaning to the activities of group members and also justify the activities of the group to insiders and to outsiders.’ There are thus shared understandings and rationalisations which lead to ‘ideological scripts’ which mediate political processes tending to reinforce real, material and symbolic differences between groups.

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As Turner (1988) notes, whereas functionalism seeks to eradicate or deny ambiguity in an organisation (whether in study and analysis or in managerial action), interpretive approaches recognise the multiplicity of subcultures and discourses which nonetheless are mutually translatable within the organisational culture as a whole (Davies, 1988). Parker and Dent (1991) explore this theme in relation to the National Health Service and specifically the 1990 White Paper and Resource Management. Parker and Dent argue that the government had been trying to radically change the prevailing NHS culture from the language of paternalism and medical responsibility to a language based on market rationality and business metaphor. In doing so, however, the government failed to recognise that the NHS is a multicultural assemblage whose various discourses are distinct and sometimes in disagreement. Reed and Anthony (1991) come to similar conclusions.

Alvesson (1991) notes that organisational symbolism and organisational ideology might be seen as different orientations within the broad topic of organisational culture. Although Alvesson’s view is perhaps radical humanist rather than interpretive (he sees symbolism as having a potential emancipatory role), he does suggest that culture is part of a family of related concepts such as symbols and ideology i.e. it is a recursive, sensitising concept. Davies (1988) criticises normative (functionalist) notions of successful organisational culture management: ‘...stating that an organisation that is successful and manages its culture is not evidence that such management causes success. Such causal links are very difficult to show within the complex scenarios found in organisational behaviour.’ This assertion has been supported by grounded theory research undertaken by Waring (1993). Davies further suggests that within individuals, ‘success’ is both socially and culturally defined and functionally defined. For example, the ‘organisational value which espouses that participation is the most morally acceptable form of decision making, may be in direct conflict with the departmental ones (sic) which recognise that in fact decision making is autocratic.’ In other words, autocracy (as an example) may be a functional but culturally biased stance linked to survival in a particular organisation. This argument is to some extent supported by Waring’s empirical evidence (1993), i.e. political processes (largely opaque) having a functional overlay (manifest), both of which are mediated by context (e.g. cultural).

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Parker and Dent studied a group of managers and doctors in the NHS but did not include nurses and paramedics. They concluded that managers’ rhetorics about their task and the use of Information technology (IT) were focused on efficiency whereas medical staff were more concerned that IT should benefit patient care. Coombs (1992) drew similar conclusions, as did Waring (1993) in relation to nurses and paramedics, efficiency and its benefits for patients being a high priority. Parker and Dent also noted the changing vocabulary towards a business discourse brought about by the White Paper and Resource Management, a feature also noted by Waring (1993). (See also Hughes, 1991) for a study of NHS managers’ rhetorics in persuading other relevant social actors to adopt particular kinds of short-term business plan).

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An interpretive view of culture change in organisations involves ‘organisational learning’ (Lyles and Schwenk, 1992; Toft, 1992; Turner, 1992). This concept has been expressed (Toft 1992) as the results of a shared immersion in organisational life and exposure to change-related activities over a considerable period of time. This view is somewhat different to the cognitive psychological view of learning in organisations.

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An interpretive perspective of culture has an explicit inclusion of multiple rationalities, interests, etc and, unlike a functionalist perspective, is not deliberately reductionist. Unlike the extremes of a functionalist perspective, culture is not seen as a euphemism for corporate or managerial policy and strategy to be hijacked and used as a cynical weapon of control against potential dissent or even constructive criticism within the organisation. Culture is not seen as a commodity or resource which is there at the beck and call of particular groups to support their interests, decisions and actions. Rather, culture is seen as a dynamic collective property emerging from all the human members of the particular organisation or entity (Waring, 1989; 1993; 1996b) which reinforces behaviour and is therefore linked to psychological survival. An interpretive perspective enables better understanding of culture as a qualitative concept and its relationship with the highly subjective concept of risk. • An interpretive view of organisational culture focuses on multiple rationalities and interests within an organisation and emphasises its dynamic nature. • Complexity and ambiguity are seen as essential characteristics (in contrast to the functionalist view).

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• Culture is seen as a mediating and reinforcing factor in human behaviour rather than as a causal factor. • ’Organisational learning’ is seen as a more realistic approach to culture change than simple prescriptions. Table 2 (Waring 1992, 1996a) suggests some contrasts between two major world-view types in relation to safety matters. Table 2: Comparison of different world views of some current safety topics Safety topic

Functionality/‘engineering’ world view

Interpretive world-view

Safety A set of documented procedures management of people using such a set of system procedures

A human activity system including control, monitoring, communication, operational and other elements as well as complex human factors

Safety case

Holistic coverage of how technology and people are applied to ensure safety

Dominated by quantified risk assessment and technology topics

Human factors Human reliability and ergonomic design

Human reliability, ergonomic design, personnel qualities, group behaviour and safety culture

Safety culture Determined by the chief Complex outcome of all the people executive/board Exists to support safety strategy

Strategy is culture in action, i.e. strategy supports culture

Can be trained/sloganised into people

Cannot be trained or sloganised into people

Culture change is slow by ‘learning’

Culture change can be engineered quickly

Source: Waring, 1992; 1996a

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6.6 Safety Culture 6.6.1 Definitions The term ‘safety culture’ has arisen relatively recently (in relation to the 1986 Chernobyl disaster) and subsequently has become a byword for a range of safety characteristics concerning organisations (Taylor, 2010). You should note that safety culture is not separate and distinct from the culture of the particular organisation. It is part of that culture. An individual’s perception of safety culture will itself be influenced by his or her own world-view. For example, if you believe that the human world is largely socially constructed and not simply ‘there’ as a predetermined state of affairs, then you are likely to regard safety culture in a holistic way as being all those aspects of culture which affect safety. Not everyone thinks like this and many will have a narrower view which focuses on how organisations ideally ought to behave towards safety. The following are three definitions of safety culture (IOSH, 1994; Waring, 1996a) derived from a variety of sources: • those aspects of culture which affect safety

• the product of individual and group values, attitudes, competences and patterns of behaviour that determine the commitment to, and style and proficiency of, an organisation’s health and safety programmes. Organisations with a positive safety culture are characterised by communications founded on mutual trust, by shared perceptions of the importance of safety and by confidence in the efficacy of preventive measures. There is no objective way of deciding which view of safety culture is ‘best’. As indicated in Table 1, so many aspects of culture are not manifest. There is also no consensus yet about what the key defining variables are, and this creates a problem for those who feel that safety culture ought to be measured.

6.6.2 Different world-views about safety culture Different categories of world-view differ in their assumptions and beliefs about culture in general and safety culture in particular, as discussed in 6.3 and 6.4 above. Localisation as a dimension is especially important in analysis of safety culture in organisations. Just as there are characteristics which are common to the majority of individuals in an organisation (e.g. in oil companies, beliefs about the importance of energy production), there are also characteristics which apply to particular groups within it. For example, in the offshore oil and gas industry the characteristics of offshore production staff are likely to differ from those of onshore and headquarters staff because their daily work demands and experiences are different. Differing group definitions of organisational reality and perceptions of priorities provide one example of different subcultures which may lead to safety problems not only in communication but also in decisions affecting safety, resource allocation and so on. Habituation to the cultural backdrop in an organisation often results in different groups being unaware of the gulfs between them and the consequences. For example, many professional groups tend towards a functionalist world-view whereby people are expected to behave like clockwork or programmable robots and it is assumed that behaviour can be readily ‘engineered’.

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• the characteristic shared attitudes, values, beliefs and practices concerning the importance of health and safety and the necessity for effective controls;

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The functionalist urge of ‘engineering’ is to reduce uncertainty, to introduce control, to enable prediction and to impose order – in short to iron out or even deny the very ambiguity which characterises human behaviour. Turner (1988) has noted the functionalist intolerance of ambiguity in wanting to ‘have things cleared up, sorted out and neatly stacked’. Management approaches which assume that safety culture can be dictated and determined by decree or prescription alone may therefore prove unrewarding.

6.6.3 Development of a safety culture In the three cases studied by Waring (1993), perceptions of culture and of desired culture changes were a reflection of organisation structure, political processes and power. Whereas the authority power of senior managers could impose some changes relevant to culture, it could not enforce a lasting change on an inner context of conflicting subcultures, especially where local group values differed markedly from those of senior management. Countervailing effects of influence and power from and among individuals and groups within the organisation must also be taken into account. Culture change is unlikely to be a simple and relatively rapid shift from one major valuation to another. It is much more likely to be a complex realignment of a pattern of different valuations, some of which may change more quickly and more lastingly than others. If one accepts these conclusions, it is not possible to ‘train’ or ‘sloganise’ safety culture into people. An instruction, a decree or an exhortation from senior management to adopt a new safety culture is unlikely to succeed. A rationalistic prescription for changing safety culture based solely on awareness courses on safety policy, safety procedures and motivational training for employees is also unlikely to work. An expectation that all these necessary items are sufficient in themselves to ensure development of a positive safety culture is optimistic as it ignores other mutually reinforcing factors such as identity, organisational structures, power figures, business priorities and organisational history. In contrast, changes in safety engineering, technology and the formal aspects of management are relatively easy to arrange. A realistic approach to changing safety culture would need to accept the inherent complexity of the phenomenon and its resistance to rapid change. The role of ‘organisational learning’ (Toft, 1992; Turner, 1992; Waring, 1992; 1996a) is significant as it recognises that people in organisations learn new ways of thinking and acting (coping strategies) over a period of time in response to a variety of experiences. A framework for developing appropriate learning towards desired cultural characteristics is therefore required. The following Table 3 (IOSH, 1994) offers some practical suggestions for developing a safety culture, but overall there needs to be clear ownership of safety management at a senior level (Taylor, 2010). Given such leadership, businesses with a positive safety culture will be: “…characterised by communication founded on mutual trust, by shared perceptions of the importance of safety and by confidence in the efficacy of preventative measures.” (Hughes and Ferrett, 2005: 43).


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Table 3: Practical recommendations for developing a safety culture Employers should: 1. Take steps to establish what their managers and employees actually believe about health and safety, in particular: • ‘ownership’ of health and safety responsibilities and benefits • match between statements and actions • attitudes towards risk-taking and risk acceptance • motivations to act appropriately • conflicts of interest between different groups. 2. Codify what is expected of all their personnel in terms of values, beliefs, attitudes and practices concerning health and safety.

concerning health and safety. In particular, account should be taken of: • the right balance between decree, prescription and ‘organisational learning’ • the likely time scale to achieve a permanent change in cultural characteristics. Health and safety practitioners should: 4. Always consider health and safety cultural factors when: • Planning, and assisting in the completion of, risk assessments • Drawing up plans for health and safety training • Preparing safe systems of work and permit-to-work procedures • Monitoring specific health and safety programmes • Auditing the overall SMS and reviewing its effectiveness.

• Safety culture has no single agreed definition. Different definitions reflect either functionalist or interpretive biases about organisational culture. • Localisation is an important dimension of safety culture in an organisation as it relates to different functions and groups whose views, interests and actions may have a major effect on safety.

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3. Consider the most appropriate way in which to address any differences between corporate expectations and the characteristics of the organisation’s personnel

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• Rationalistic prescriptions for changing safety culture relatively quickly based solely on policy, procedures and motivational training are likely to fail because they do not take account of other complex influences. • ’Organisational learning’ is a more realistic approach to changing safety culture than relying on decrees from directors or simple prescriptions based on training (although leadership, commitment and practical activities including training will be necessary).

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6.7 Assessment of culture One of the more controversial aspects of organisational culture concerns its assessment. In businesses and other employing organisations, particularly the larger ones, it has become increasingly fashionable to seek to assess a range of parameters thought to indicate how far the organisation meets criteria such as ‘total quality’ or ‘world-class benchmarks’. Culture is typically a key parameter. The pressure to make such assessments is attributed by organisations to the need to know their performance characteristics in a fiercely competitive world market so that these can be portrayed to customers, employees, financiers and anyone else who makes critical judgements about the organisation. On this basis, the principle appears reasonable and difficult to criticise. However, as soon as attempts are made to operationalise the principle, substantive theoretical, ethical and practical problems arise concerning the assessment of culture. Unfortunately, many organisations are unaware of such problems. In order for any topic to be assessed, there has to exist in the minds of those involved (a) a notion of cause-and-effect which relates to important and relevant aspects of the topic, i.e. what can cause those aspects to change (otherwise if they cannot be changed what is the point of assessing them?), and (b) some means to scale and attribute degree, whether qualitatively or quantitatively, to those aspects. Where culture is the topic of interest, unfortunately the underlying cause–effect models used in assessments are usually woefully inadequate, for example assumptions that a significant and rapid change in organisational culture is caused by: • beliefs espoused in boardroom edicts, mission statements and policy documents; • briefings and training courses about a desired culture change; • quality circles and TQM programmes. Beer at el. (1990) and Waring (1993; 1996a), while not decrying the possible value of such functionalist prescriptions to the good of the organisation, point out that as cause–effect models of culture they are extremely naive and almost certain to disappoint those who rely on them, in the long if not the short term. The problem of selecting appropriate cultural dimensions is also difficult as there is no widespread agreement about what those should be. The recursive nature of the subject and terminology does not help. Waring (1996a) suggests that rather than seeking to measure organisational culture in a comprehensive way, it is more defensible in the light of present limitations on definitive knowledge about the phenomenon to measure only selected dimensions which are better understood. If this suggestion is taken up, two caveats are necessary. First, the limited nature of the measurements must be emphasised; it is not culture which is being measured but only specific aspects of it. Second, the collection, analysis and interpretation of data about culture require expert knowledge. In addition to dimensions proposed by Gross and Rayner (1985), dimensions of culture which would be suitable for measurement are those identified in section 6.3 and 6.4 above, namely: Content or layers of meaning (Deal and Kennedy, 1986; Lundberg, 1990) Strength, pervasiveness and direction (Gorman, 1989) Localisation (Waring, 1993).


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The measurement of ‘safety climate’ proposed by Zohar (1980) is problematic in that the definition of ‘safety climate’ attached to his proposition is limited to a set of perceptions or beliefs held by an individual and/or group about a particular entity. It does not seek to measure other key dimensions such as those identified above. Brown and Holmes (1986) failed to validate Zohar’s model and proposed a modified model whose validity and reliability they claim is supported by factor analysis. However, the fact remains that what is measured by such methods is only a very limited aspect of culture compared to the dimensions identified above.

with human relations in organisations in which the system analyst acted as ‘therapist’, to a more advanced methodology (Checkland and Scholes, 1990) which does not preclude the analyst, problem owners and other social actors collaborating closely. Although cultural analysis in a limited way was an implicit task in the original SSM, in the developed form it has been expanded into a ‘stream of cultural enquiry’ which incorporates analyses of roles, relevant ‘social systems’ of roles, norms and values, and relevant ‘political systems’ of power characteristics and power relations. One criticism of SSM is that the methodology tends to attract system specialists who are rarely knowledgeable about the breadth and depth of organisational behaviour and there is always the suspicion that the elaborate sounding ‘stream of cultural enquiry’ masks a superficial and possibly distorted analysis. For a safety-related SSM case study see Waring (1996b). The grid-group approach of Gross and Rayner (1985) based on the work of Douglas seeks to measure the consistency of patterns of ideas and behaviour in a social organisation with its social structures. The grid component measures the overall strength of the system of categorical distinctions such as boss/worker, adult/adolescent/child. Multiple hierarchies of grid components may be applied such as role specialisation, role entitlement, accountability and so on. The group component measures the extent to which the behaviour of individual members depends on their membership of the social unit. Group components might include proximity (degree of involvement in the network of activities), transitivity (probability of interaction), frequency (proportion of available time allocated to interaction), etc. In the grid-group approach, four sets of cultural biases are identified. These are: •

hierarchists (high grid-high group)

fatalists (high grid-low group)

sectarians/egalitarians (low grid-high group)

individualists (low grid-low group)

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Two particular methodologies for cultural assessment are worthy of note. These are the ‘stream of cultural enquiry’ used as part of Soft Systems Methodology (SSM) (Checkland and Scholes, 1990; Waring, 1996b), and grid-group analysis (Douglas 1992; Gross and Rayner, 1985; Pidgeon et al., 1992). SSM is a systems methodology which seeks to enable social actors in the setting of interest to reach a level of understanding about themselves in terms of ‘purposeful human activity systems’ which then enables them to decide what, if anything, could and should be done about these notional systems (Waring, 1989; 1996b). SSM has developed from an original seven-stage methodology (Checkland, 1981) which focussed on ‘wicked’, ‘messy’ and other intractable problems associated

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Hierarchists view risks as being relative in a hierarchical way. They take for granted what they are told by risk experts and tend to believe official views on risk acceptability. Fatalists seek to avoid risks as far as they are able within the extent of their knowledge but accept that their actual degree of control is limited. Sectarians and egalitarians regard industrialisation, technology development, business interests and economic growth as posing linked threats to their particular lifestyle. They tend to exaggerate the risks in order to advance their case for protecting their world-view at the expense of others. Individualists are seen as opportunists whose attitude towards risks is likely to vary in proportion to perceived opportunity. Individualists would have an overriding focus on the speculative aspects of any particular risk setting. The four major cultural biases emanating from grid-group are world-views by any other name, although not coincident with those paradigms posited by Burrell and Morgan (1979). A problem for this ‘cultural theory’ of risk is similar to that faced by Burrell and Morgan and supporters of the argument that world-view types are necessarily mutually exclusive (Carter and Jackson, 1991). Indeed, the Royal Society report (1992: 113) notes that:

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‘there remains a basic problem in unambiguously classifying existing social units in terms of the grid and group dimensions, that the basic ...cultural types may oversimplify more complex shades of social difference’. As Waring (1993; 1996a) has noted, individuals frequently possess combinations of apparently contradictory beliefs, attitudes and motivations concerning different risks, i.e. a complex and dynamic interplay between different world-views rather than having a single world-view which can be forcefitted into only one of the ‘pigeonholes’ created by incomplete analytical devices such as grid-group. Gross and Rayner pose a number of hypotheses. Different organisations with the same grid-group scores will reflect the same cultural patterns of behaviour and attitudes, regardless of whether the organisations are as different as, say, the London Stock Exchange and a village in the Amazon rainforest. A further hypothesis is that risk perceptions in modern societies are subject to the same cultural biases as those in traditional societies. Such biases influence, for example, what evidence is selected on which to base assessment of risk. The idea that cultural types are independent of organisational context is intriguing, if not debatable, but nonetheless may lead to an unrewarding focus on comparison of types instead of actual characteristics of the particular organisation in the particular context. Senior managers are more likely to be interested in the strategic implications of their organisation or particular parts of it having a particular location in the grid-group matrix and, moreover, may seek to compare their organisations with others. Gross and Rayner (1985) point up the ethical problems of cultural analysis and particularly the danger of making comparisons between organisations. They note that ‘it is easier to substantiate a judgement that a particular organisation has evolved to become, say, less competitive and more ritualistic, than to prove that one organisation is more competitive or less ritualistic than another’. Waring (1996a) goes further: seeking to measure an organization’s culture is rather like seeking to measure the culture of a nation or the quality of a religion – it can be described but against what standard can it be measured? Who would be so arrogant as to suggest a benchmark? Could one ever really establish that the culture of organisation A is better than the culture of organisation B, a logical and tempting extension of ‘measurement‘?

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Thus, although it may be worthwhile to make qualitative judgements of particular cultural dimensions which could be used for internal comparisons over time, such measurements should not be used for competitive inter-organisational comparisons or ‘benchmarking’. Descriptive comparisons may be enlightening and may lead to better understanding of the present state of the organisation and indeed to possible change strategies but that is quite different to competitive benchmarking. • Assessment and measurement of culture are controversial topics and approaches to them tend to reflect different world-views • Cultural assessment and measurement raise major theoretical, ethical and practical problems • Although a number of dimensions to safety culture have been proposed, there is as yet no agreement about a complete set of dimensions

• The use of cultural assessment for competitive comparison among different organisations (e.g. ‘benchmarking’) is a flawed strategy which is likely to mislead and disappoint organisations which use it

6.8 The culture-risk axis One of the basic assumptions of this Unit is that risk is a largely socially constructed phenomenon whose cognition is culturally mediated if not defined. In this respect, the author belongs to the ‘sociological camp’ of risk analysts acknowledged to exist by the Royal Society report (1992). The sociological argument for a broader and less technically biased basis for risk analysis and assessment proposed by Douglas (1992), Turner (1988; 1992), Toft (1992; 1993) and others has now gained and continues to gain greater acceptance, if slowly. This shift is inevitable given the failure of purely technical risk approaches to answer increasingly important questions which the sociological camp is able to answer. Culture, a sociological concept, is one such aspect of risk for which technical risk analysis is the wrong set of tools for the task (Douglas, 1992; Toft, 1992; 1993, Carter and Jackson, 1994).

6.8.1 A cultural dimension to risk Carter and Jackson (1994) refer to the ‘riscomancy culture’ particularly prevalent in western society which attributes special knowledge and authority to risk experts who nonetheless may not always know everything of significance. Such risk experts are rarely exposed personally to the risk scenarios which they assess and frequently are not involved in decisions about those risks. Because of their assumed knowledge, they enjoy a privileged, almost priest-like, status which absolves them from getting too involved with the messy realities of organisations and the consequences of their risk assessments for individuals who may be exposed. As Douglas (1992) notes, risk analysts detest anything ‘sticky or messy’ which might, just might, confound their clean, scientific formulae. Riscomancy is also embedded in the cultures of particular industries and organisations and one

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• Grid-group analysis and soft systems methodology (SSM) are two methodologies which seek to assess organisational culture and which could be used similarly to assess safety culture but neither is free from substantive criticism

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may cite the major hazards industries as prominent examples as far as pure risks are concerned. However, other industries and other organisations with different cultures may have no time for risk experts, preferring instead to practise their own unstructured risk assessment and risk management focusing on areas of risk which they ‘know’ to be more important. Such differences are associated with cultures which may be risk orientated in some areas and risk aversive in others and with inconsistent and even contradictory rationales for the different areas (as noted in the discussion above about grid-group). For example, some major management consultancies, law practices and financial institutions intimately engaged in speculative risks (on their own and their clients’ account) may nonetheless send their top fee earners into high risk territories and settings (e.g. civil strife, epidemics, lawlessness, unsafe aircraft, industrial hazards, etc.) with minimal efforts to protect them. In the cultures of such firms, such pure risks are to be played down and ignored as part of the macho image they wish to project in relation to their primary tasks. Unfortunately (or perhaps fortunately), a growing number of such professionals are women who are less willing to honour such taboos. The grid-group theory of risk and culture (Douglas, 1992; Gross and Rayner, 1985) offers a rationale for different risk orientations although, as noted above, it does not offer a complete explanation.

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Another aspect of the riscomancy culture concerns the risk experts themselves – the subject of the discourse. They exert a powerful self-protective influence or unobtrusive power (Hardy, 1985) over what may be discussed and considered and the risk methodologies which may be adopted. In view of the fact that for mainly historical reasons pure risk areas have been dominated numerically by physical scientists and engineers for so long, it is unsurprising that social scientists and their knowledge are still largely excluded. The Royal Society report on risk (1992), which acknowledges that social science requirements are not met by conventional views on risk, has not been widely read, let alone accepted, by the technical risk fraternity.

6.8.2 Failures of hindsight Brian Toft’s PhD thesis (Toft, 1990), entitled ‘The Failure of Hindsight’ and later abridged as a management text (Toft and Reynolds, 1994), has become a landmark in the development of understanding of risk behaviour in organisations. It had been assumed that organisations not only seek to learn from their own and other organisations’ accidents but also actively seek to implement changes which would help avoid those kinds of accidents. Toft showed that such an assumption is generally unwarranted. The prevailing culture of industrial organisations as a whole tends towards denial of failure and even disasters in which multiple organisational and human failings have been demonstrated as causes are explained as ‘freak accidents’. For example, when the author was engaged in examining aspects of the Kings Cross disaster he discovered a general reluctance among employees of the underground to acknowledge and accept that there had been serious shortcomings which required change. If an organisation experiences difficulty in learning from its own mistakes and accidents, is it surprising that organisations may also find it difficult to learn from the mistakes of others? The failure of hindsight is a generalised phenomenon. The concept of hindsight failure has led to a search for better understanding of how organisations ‘learn’ and for improved learning methodologies (see, for example, Toft, 1992; Turner, 1992; Waring, 1992). The concept of ‘organisational learning’ is itself problematic in that its meaning varies according to how functionalist or how interpretive a world-view is being expressed. For example, Toft (1992) states that since culture is both a product and a moulder of people,

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organisational learning has to recognise a much longer term, holistic approach than simply policy, framework, procedures and rules i.e. ‘a cumulative, reflective, saturating process through which all the personnel learn to understand and continually reinterpret the world in which they work by means of all the formal and informal organisational experiences to which they are exposed’. Turner (1992) elaborates by emphasising that organisations as multicultural assemblages have a corresponding number of different reference frames for thinking and learning. ‘New’ organisational learning focuses not only on ‘learning within frame’ or enhancing what a particular group already know but also on ‘out of frame learning’ which means taking on board other world-views and changes in world-views. Turner also stresses that ‘new’ organisational learning may also involve ‘liminal learning’ or learning on the threshold of more than one framework of understanding. ‘Old’ organisational learning is associated with cognitive psychological and cybernetic models at the level of the individual i.e. logic driven information processing. The doubleloop learning concept (Argyris and Schon, 1977) is a well-known example. Such instrumental approaches are ‘within frame’ and encourage a ‘training’ or ‘encounter group’ view of facilitating the process, whereas Turner’s suggestion is to regard organisational learning as a cultural activity, i.e., it is ongoing.

6.8.3 Some risk cultures It is sometimes said that certain cultures are risk orientated and others risk aversive. To what extent is this true and what are the implications? One can identify kinds of industry, organisation and even nations whose characteristics may appear at first glance to be either more risk orientated or aversive than others. For example, public sector organisations tend to be cautious in all areas of decision making and to be aversive to political risks. Public accountability in theory also makes them risk aversive in matters of finance yet they are not immune to financial failures and scandals such as those which have befallen the London Borough of Lambeth and Liverpool City Council. The threat of individual surcharging of councillors by the District Auditor was apparently considered an acceptable risk by some councillors in the ‘homes for votes’ scandal at Westminster City Council. What these rather different cases reveal is a common feature of public sector organisations, namely a risk-aversive sub-culture of professional staff informing elected councillors of what could and should be done and what may be done legally, countered by a risk-orientated subculture of elected councillors who do not always wish to be so constrained. The overall culture of such organisations is therefore neither risk-orientated nor risk aversive. A dynamic tension exists between two major sub-cultures with different attitudes towards risks. Their meanings of success may share some common components but are nevertheless significantly different.

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One reason for apparent failures of hindsight could be the culture of blame and secrecy in reaction to the threat of individuals and organisations being exposed to litigation if mistakes are admitted (Rozakis, 2007). Such thinking and fear could create a barrier to active learning if organisations are reluctant to openly acknowledge faults or near misses. Thus as Bennett (2001:vii) argues, a culture of “blamism” could be “…dysfunctional in the matter of accident prevention”.

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Such relativism may be identified in many kinds of culture, which is not surprising since total homogeneity is rare. Cultures are often said to be risk-orientated on the basis of prominent examples of behaviour of particular individuals or groups but, of course, this may mask quite different characteristics of other people. The new Russia, the Middle East and Far East are thought of as being especially risk orientated in matters of business and many examples of entrepreneurial risk-taking are evident.

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However, it is important to consider the particular context in which such a risk-taking sub-culture flourishes. If the country’s economy is dire, individuals may feel that there is little to lose and a lot to gain from a high risk strategy. Pride, assertiveness and avoiding loss of face are also influential on risk behaviour in some cultures. For example, in many Middle Eastern countries driver behaviour is very risk-orientated by western standards. Individual drivers feel compelled to assert their control over the territory of the highway in competition with other drivers. Giving way to another driver is taboo until the last possible moment to avoid an accident. This appears not to be ‘road rage’ or aggressiveness in the western sense but more a game of skill, and accidents are surprisingly rare.

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Context is all-important. In the West, large sections of the population seek to at least hang on to and hopefully improve the material possessions they gain relatively early in life. Home, mortgage, car(s), video(s), computer(s), satellite TV, foreign holidays are all part of a growing me-centred consumerist culture, catalysed by UK government policy since the early 1980s. Fear of losing such possessions, particularly through unemployment, has made many people risk aversive in their attitudes towards work and consumer expenditure – the very antithesis of the entrepreneurial model of risk-taking the government sought to encourage. In many other countries where consumer affluence is not widespread and people are used to a less materially sophisticated existence, fear of losing possessions is less of a demotivator and hence individuals may feel they have a lot to gain by entrepreneurial risk-taking. From the above, it may be seen that labelling organisations, industries, or nations as either risk orientated or risk aversive is likely to be misleading as it masks the multicultural assemblages and the complex contexts involved. • A sociological perspective on risk assumes that risk is a largely socially constructed phenomenon which is culturally mediated if not defined. • A technical risk perspective has failed to answer important questions which a social perspective is able to answer. • Social scientists will be needed to provide a more balanced approach to risk than is available from technical risk experts alone. • Organisations frequently fail to learn from their own or other organisations’ safety failures because their cultures discourage ‘organisational learning’. • The context of an organisation is all-important in seeking to understand its cultural and other characteristics relating to risk. Simple labels such as ‘risk orientated’ or ‘risk aversive’ are likely to be misleading since they mask the complex reality.

6.9 Conclusion Organisational culture can be regarded as two kinds of paradigm. One paradigm is a means for an organisation’s own members to interpret their own existence, identity and actions and to institute, guide and moderate those actions. It is their world-view. The other kind is culture applied as an analytical paradigm by external observers. The latter is as problematic as the former since, as Jeffcutt (1991) notes, the ‘understanding of organisation is inseparable from the organising of understanding.’

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Since culture both influences and is influenced by the values and meaning systems of the social actors in an organisation, the latters’ understanding and actions in relation to particular processes are assumed to be culturally linked. Cultural aspects of organisations are therefore highly significant factors to be addressed in relation to risk. A further pertinent feature of safety culture is that it need not be considered in isolation from other socially inspired theories of risk. Safety culture in an interpretive context may complement other approaches to risk and its management, such as systems thinking and risk cognition. An eclectic approach to theoretical considerations underpins much contemporary research in the risk area and increasingly informs risk management practice.

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6.10 Guide to reading You should now read the supplied articles, ‘To Risk or Not to Risk’, by Paul Bellaby. This article discusses the practical limitations of cultural theory work as outlined by the anthropologist Mary Douglas.

There is a useful article about corporate culture (see Chapter 7) in Kasperson, J. X. and Kasperson, R. E. (2005) The Social Contours of Risk, Vol. II: Risk Analysis, Corporations and the Globalisation of Risk, London: Earthscan.

6.11 Study questions You should now write approximately 500 words on each of the following: • Discuss why the concept of safety culture may be difficult to put into practice. • Discuss the pros and cons of the following approaches to developing a safety culture: managerial decree/instruction, prescription, organisational learning.

6.12 Bibliography Alvesson, M. (1991) ‘Organizational symbolism and ideology’, Journal of Management Studies, 28 (3). Argyris, C. and Schon, D. (1977) Theory in Practice: Increasing Professional Effectiveness, San Francisco: Jossey-Bass Publishers.

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‘The Case for Deep Systems Investigation’ by Dr. Simon Bennett.

Beer, M., Eisenstat, R. A. and Spector, B. (1990) ‘Why change programs don’t produce change’, Harvard Business Review, 68, (6):158-166. Bennett, S. A. (2001) Human Error – by Design? Leicester: Perpetuity Press. Brown, R. L. and Holmes, H. (1986) ‘The use of a factor-analytic procedure for assessing the validity of an employee safety climate model’, Accident Analysis and Prevention, 18 (6): 455-470.

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Burrell, G. and Morgan, G. (1979) Sociological Paradigms and Organizational Analysis, London: Heinemann. Carter, P. and Jackson, N. (1991) ‘In defence of paradigm incommensurability’, Organization Studies, 12 (1): 109-127. Carter, P. and Jackson, N. (1994) ‘Risk analysis as discourse’, paper presented at the Changing Perceptions of Risk Conference, Bolton Business School, 27 February-1 March 1994. Checkland, P. (1981) Systems Thinking, Systems Practice, Chichester: John Wiley and Sons. Checkland, P. and Scholes, J. (1990) Soft Systems Methodology in Action, Chichester: John Wiley and Sons.

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Coombs, R. (1992) Organisational Politics and the Strategic Use of Information Technology, PICT Policy Research Paper No. 20, presented at the Fourth Charles Read Memorial Lecture, Economic and Social Research Council. Davies, L. J. (1988) ‘Understanding organizational culture: a soft systems perspective’, Systems Practice, (1): 11-30. Deal, T. E. and Kennedy, A. A. (1986) Corporate Cultures: Rites and Rituals of Corporate Life, AddisonWesley. Denzin, N. K. (1978) The Research Act, New York: McGraw Hill. Dobson, P. (1988) ‘Changing cultures’, Employment Gazette, 96 (12): 647-650. Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory, London: Routledge. Dyer, W. G. and Dyer, W. G. (1986) ‘Organization development: System change or culture change?’ Personnel, 63 (2): 14-22. ESRC (1993), Report of the Commission on Management Research, Economic and Social Research Council. Gorman, L. (1989) ‘Corporate culture’, Management Decision, 27 (1): 14-19. Green, S. (1988) ‘Strategy, organizational culture and symbolism’, Long Range Planning, 24 (1): 121-129. Gross, J. L. and Rayner, S. (1985) Measuring Culture: A Paradigm for the Analysis of Social Organisation, New York: University of Columbia Press. Hardy, C. (1985) ‘The nature of unobtrusive power’, Journal of Management Studies, 22 (4): 384-399. Hughes, D. (1991) ‘NHS managers as rhetoricians: A case of culture management?’, paper presented at the BSA Annual Conference, Manchester, 25-28 March 1991. Hughes, P. and Ferrett, E. (2005) Introduction to Health and Safety at Work, Oxford: ButterworthHeinemann.

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IOSH (1994) Policy Statement on Health and Safety Culture, Institution of Occupational Safety and Health, Leicester. Jeffcutt, P. (1991) ‘From interpretation to representation in organisational analysis: Post-Modernism, ethnography and organisational culture’, paper presented at The New Theory of Organisations Conference, Keele, April 1991. Johnson, G. (1987), Strategic Change and the Management Process, Oxford: Basil Blackwell. Kono, T. (1990) ‘Corporate culture and long-range planning’, Long Range Planning, 23 (4): 9-19. Lundberg, C. C. (1990) ‘Surfacing organizational culture’, Journal of Managerial Psychology, 5 (4): 19-26. Lyles, M. A. and Schwenk, C. R. (1992) ‘Top management strategy and organizational knowledge structures’, Journal of Management Studies, 29 (2): 155-174.

Parker, M. and Dent, M. (1991) ‘The changing culture and language of the NHS’, paper presented at BSA Annual Conference, Manchester, 25-28 March 1991. Pidgeon, N. F., Hood, C., Jones, D., Turner, B. and Gibson, R., (1992) ‘Risk Perception’, In Risk: Analysis, Perception, Management, London: The Royal Society: 89-134. Reed, M. (1991) ‘Organisations and modernity: Continuity and discontinuity in organisation theory’, paper presented at The New Theory of Organisations Conference, Keele University, April 1991. Reed, M. and Anthony, P. (1991) ‘Between an ideological rock and an organizational hard place: NHS management in the 1980s and 1990s’, paper presented at the Conference on International Privatisation: Strategies and Practices, St Andrews, 12-14 September 1991. Royal Society (1992) Risk: Analysis, Perception, Management, London: The Royal Society. Rozakis, M. (2007) The cultural context of emergencies, seeking an holistic approach on disaster management, Disaster Prevention and Management, 16(2): 201-209. Schein, E. H. (1985) Organizational Culture and Leadership, San Francisco: Jossey-Bass Inc. Schwenk, C. R. (1989) ‘Linking cognitive, organizational and political factors in explaining strategic change’, Journal of Management Studies, 26 (2): 177-187.

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Morgan, G. (1986) Images of Organization, London: Sage Publications.

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Smircich, L. (1983) ‘Concepts of culture and organizational analysis’, Administrative Science Quarterly, 28(3): 339-358. Taylor, J. B. (2010) Safety Culture: Assessing and Changing the Behaviour of Organisations. Aldershot: Gower. Toft, B. (1990), The Failure of Hindsight, PhD Thesis, Department of Sociology, University of Exeter.

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Toft, B. (1992) ‘Changing a safety culture: A holistic approach’, paper presented at the British Academy of Management 6th Annual Conference, Bradford University, 14-16 September 1992. Toft, B. (1993) ‘Behavioural aspects of risk management’, paper presented at the Association of Insurance and Risk Managers in Industry and Commerce Annual Conference, University of Warwick, 1-4 April 1993, AIRMIC Proceedings, London. Toft, B. and Reynolds, S. (1994), Learning from Disasters: a Management Approach, London: Butterworth Heinemann. Turner, B. A. (1988) ‘Connoisseurship in the study of organizational cultures’. In Bryman, A., Doing Research in Organizations, London: Routledge: 108-122. Turner, B. A. (1992) ‘Organizational learning and the management of risk’, paper presented at the British Academy of Management 6th Annual Conference, Bradford University, 14-16 September 1992.

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Waring, A. E. (1989) Systems Methods for Managers – a Practical Guide, Oxford: Blackwell Scientific Publishing. Waring, A. E. (1992) ‘Organisational culture, management, and safety’, paper presented at British Academy of Management 6th Annual Conference, Bradford University, 14-16 September 1992. Waring, A. E. (1993) Management of Change and Information Technology: Three Case Studies, PhD Thesis, November 1993, London Management Centre, University of Westminster. Waring, A. E. (1995) ‘Management systems, behaviour and emergencies’, paper presented at the International Conference on Emergency Planning and Management, Institution of Mechanical Engineers, 21-22 November 1995, IMechE Transactions, London. Waring, A. E. (1996a) Safety Management Systems, London: Chapman and Hall/ITP. Waring, A. E. (1996b) Practical Systems Thinking, London: International Thomson Publishing. Waring, A. E. and Glendon, A. I. (1998) Managing Risk, International Thomson Publishing, London. Watson, T. J. (1982) ‘Group ideologies and organisational change’, Journal of Management Studies, 19 (3): 259-275. Westley, F. R. (1990) ‘The eye of the needle: cultural and personal transformation in a traditional organization’, Human Relations, 43 (3): 273-293. Wilkins, A. L. and Dyer, W. G. (1988) ‘Towards culturally sensitive theories of culture change’, Academy of Management Review, 13 (4): 522-533. Zohar, D. (1980), ‘Safety climate in industrial organizations: Theoretical and applied implications’, Journal of Applied Psychology, 65(1): 96-101.

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READING ‘To risk or not to risk’ Bellaby, P. (1989)

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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READING ‘The Case for Deep Systems Investigation’ Bennett, S. (2004) Alert: Journal of the Institute of Civil Defence and Disaster Studies, Winter Edition. Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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UNIT 7 Case study - the collapse of Barings Bank


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7 Unit 7: Case study - the collapse of Barings Bank 7.1 Aims and objectives of this Unit The aim of this Unit is to explore one of the most dramatic collapses in the financial services industry in the 1990s, and to consider some of the risks associated with the industry, and of the firm of Barings, which contributed to this collapse. The objectives are to identify lessons which might be taken from the case study to improve both internal control and external regulation of firms within the industry and to consider broader issues of public policy. On completion of the Unit and the associated reading you should have: • an overview of issues affecting internal regulation and control in financial services firms • an overview of the significance of derivatives in the collapse of Barings

You should be able to: • identify the main events leading up to the collapse of Barings • outline managerial failings which contributed to the collapse • assess the responsibility of external agencies for the failure to prevent the problems which arose • describe mechanisms which could have been put in place to reduce the risk of loss from trading activities. Key questions to consider in reading this case study are: • what measures senior managers within Barings should have taken to reduce or eliminate the risks which led to the collapse, in particular in dealing with human resource management and with policies on risk management? • what intervention by outside agencies, including regulatory bodies, should have prevented Barings from getting into such difficulties? • what part was played in the collapse by external events outside the control of Barings?

7.2 Introduction

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• an overview of some of the weaknesses in external control over financial services firms.

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Once upon a time there was a young man who had a dream. In his dream he was allowed to gamble large amounts of other people’s money, taking a share of any winnings but passing on any losses to the others. This dream came a reality. Ultimately, of course, it seemed to be more of a nightmare than a dream. Barings bank collapsed as a result of the gambles that were taken by Nick Leeson, and these gambles were made possible by the managers of Barings, even though it seems clear that there was no positive decision at a senior

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level to allow Leeson to realise his dream. It is, of course, possible to envisage circumstances in which such a positive decision might have been made, where senior managers actively sought to take on high levels of risk in order to benefit from potential high returns, but such a policy would probably have entailed more careful selection of the young man in question together with much more detailed monitoring of his activities. Instead events developed in an uncontrolled way and the outcome was inevitably one which had not been planned for. There should be valuable lessons from the case, since the problems of control over risks were not unique to Barings. Many other financial institutions took on similar risks in similar circumstances. Some of the later financial crises referred to in the case study suggest that lessons remain to be learnt. In reading this Unit, it will be useful to relate the material to some of the conceptual issues, discussed previously in the Course, in particular organisational culture, organisational learning. More broadly, questions of quantitative and qualitative approaches to risk assessment are also highly pertinent.

7.3 Events leading up to the collapse of Barings Bank On 24 February 1995 Nick Leeson offered his resignation to Barings Bank – sending his managers a fax from a hotel in Kuala Lumpur, having fled from Singapore once he realised the true enormity of the problem that he faced. By that stage, the trading losses incurred by the derivatives operation in Singapore far exceeded the capital of the banking group and the business had collapsed (although it took a couple more days before it was clear that the bank could not be saved). Leeson was then arrested at Frankfurt airport, as he attempted to return to England, and was subsequently extradited to Singapore to face charges relating to his trading activities. Photographs of his arrest made the front pages of national newspapers in the UK and across the world.

7.3.1 First steps on the path The course of events leading up to the collapse begins much earlier, though selecting a starting point for an analysis of the process is somewhat arbitrary. In some respects the seeds of the decline were sown during Barings’ history as a leading and respected investment bank. Arguably, this had bred a culture of superiority within the bank and, perhaps, an exaggerated belief among senior managers that the bank had the strength and skills to survive in all circumstances. An alternative starting point for analysis might be the background and personality of Nick Leeson himself, but this seems a less helpful approach since it suggests, quite wrongly, that the failure of the organisation could be largely or wholly attributed to the actions of one person. Leeson’s own account of the events adopted the ironic title of ‘Rogue Trader’ to imply that he was misrepresented as being solely responsible. Although it was convenient for senior managers at Barings to emphasise Leeson’s responsibility, and to place blame on him for the events which occurred in Singapore, it is clear from the independent reports of both the Bank of England, and the Ministry of Finance in Singapore, that a wide range of poor decisions across the organisation contributed to the bank’s failure.


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7.3.2 Barings and the derivatives market A more direct chain of events can be traced from early 1992 when Baring Futures (Singapore) applied for clearing membership of SIMEX, the financial market in Singapore in which financial futures and options were traded, to enable Barings to handle transactions in a range of financial instruments. Barings had a history of entering new trading markets, and had developed a strong reputation in Japan through a team led by the charismatic Christopher Heath. Some senior managers of Barings in London had been suspicious of Heath and his aggressively entrepreneurial, sales-focused style, which contrasted strongly with the more traditional, reserved and cautious culture of the parent bank. However, Heath had produced good results and had developed a profitable empire within the Barings group. The move into Singapore was seen as strengthening the trading arm of Barings.

back office operations were carried out efficiently. His previous experience had certainly been in the accounting function, dealing with the recording of transactions. He had had no experience, or training, in working as a dealer prior to his arrival in Singapore. However, in June 1992, he sat and passed the formal test to enable him to act as a trader. At the beginning of July he was registered as one of the employees of Barings authorised to trade on SIMEX. Checks on his background to complete the formal process of accepting him as a suitable person to engage in trading business were not completed until August. This delay does not seem to have had a direct influence on events, but the checks did fail to reveal previous incidents which might well have led to Leeson’s rejection. Once Leeson was accepted as a trader on SIMEX he was able to buy and sell financial instruments traded on the exchange. These instruments are known as derivatives because their price is derived from some other underlying asset price or indicator, and include interest rate futures such as the ten year Japanese government bond contract and stock index futures such as the Nikkei 225 contract. The ten year government bond contract would vary in price according to shifts in longterm interest rates for the yen. The Nikkei 225 contract would vary in price according to changes in the value of the leading shares on the Tokyo stock market. Similar contracts were also traded on options and futures exchanges in Osaka and in Tokyo, and one of the ways in which a trading operation could make money was by taking advantage of the very small differences between the prices on these different markets. Leeson was expected to do this, and he had contact with Barings staff in Japan specifically to enable him to operate in that way. This kind of trading, known as arbitrage, could be carried out with relatively little risk by ensuring that contracts sold on one market were always matched by corresponding contracts bought on another market. This was provided there was no mismatch at the end of a trading day. The only risk incurred was that of the failure of a counterparty to one of the contracts, and even if such an event occurred (as, of course, it did for the securities firms which had entered into contracts with Barings just before it collapsed) the exchange itself provided protection as it held cash from the participants

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It was in this context that, in April 1992, Nick Leeson began work in Singapore. From the outset his exact role was a little unclear, an issue which had been identified the previous month by James Bax, the managing director of Barings Securities (Singapore). Bax raised his concerns over the potential problems this uncertainty might create. In principle, it seems that it was expected that Leeson, as derivatives operations manager, would exercise a supervisory role, particularly in ensuring that

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in the market to meet just such an eventuality. In theory, cash would only be lost if a counterparty, and the exchange itself, both failed at the same time. The low risk meant that returns would never be very high. Pricing differences never become very great because as soon as a differential is spotted by traders on the markets they carry out arbitrage trades which move the prices closer together. In addition to this arbitrage trading, Leeson was authorised to buy, or sell, contracts for clients of the bank. A major company which had taken out large loans in yen might wish, for example, to enter into contracts for Japanese government bonds so that if interest rates rose, leading to higher interest payments on the loan, a gain would be made on the futures contracts to counteract that extra interest. This type of hedging had become a standard technique for corporate treasurers as part of their overall financial risk management alongside other hedging techniques for dealing with foreign exchange risk. The major financial risks for businesses can be broadly categorised as exchange risk, interest rate risk and credit risk. By the beginning of the 1990s, derivatives had become widely used in dealing with both the first two types of risk. Credit derivatives for hedging credit risk are a more recent development, by 1999 it was available only in limited circumstances.

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Any profits from such interest rate or exchange rate hedging deals for client companies would go to the client, with Barings simply collecting a fee for its part in handling the transaction. Clients could also choose to enter into contracts as a form of speculation, particularly if they had strong financial backing, and speculative trades would naturally tend to be treated confidentially. So, as Leeson took on more and more contracts it was rumoured that he was acting for a secret client gambling heavily on market conditions. Leeson, himself, added weight to these rumours in his comments to colleagues based in Japan as it helped to divert attention away from the real situation. The rumours seemed plausible given the marked growth in Barings market share of the turnover on the Singapore exchange. This was less than 3 per cent in 1992, with Barings 26th in ranking of turnover of clearing members of the exchange, rising to nearly 8 per cent of turnover by the end of 1993, with Barings ranked 9th for the year, then to over 12 per cent by September 1994 with Barings 2nd in turnover for the year. Finally in the first two months of 1995 Barings was taking more of the turnover on the exchange than any other market participant (San and Kuang, 1995). What Leeson was not authorised to do was to buy and sell unmatched contracts on behalf of the bank. This type of activity, referred to as proprietary trading, involved taking on greater risk. For example, by buying contracts which would lead to a profit if the Tokyo stock market rose a trader who guessed correctly about favourable market conditions could make speculative gains. This risktaking had the potential to lead to much more profit, but required the bank to put up money in the form of margin payments to the trading exchange, in this case SIMEX.

7.3.3 Leeson’s trading losses Various accounts of the events leading to the collapse of Barings record that, shortly after beginning to operate as a trader, Leeson opened a secret account to conceal trading losses (Fay, 1996; Gapper and Denton, 1997). This account, No. 88888, was later found to have been the means by which Leeson was able to show consistent profits even though he was actually making losses. In general, it would have been expected that any attempt by a trader to conceal losses would have been identified by the back office staff responsible for recording transactions. In this case Leeson, as the trader, also had the responsibility for monitoring and recording, so he was able to conceal the true position.

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Although he was required to report regularly to the head office in London he was able to make sure that details of the secret account were not included in his figures. The complexity of the transactions, as well as the timing differences related to different trades on different exchanges, meant that it was not immediately apparent that Leeson was providing an incomplete picture. However, it does seem surprising that reconciliations carried out at head office did not identify the increasingly serious inconsistency in the data provided. One of the key roles of SIMEX was to protect participants from the financial collapse of other parties to deals, and this was done, as on other financial exchanges, through margin payments which became bigger as the number and value of outstanding contracts grew. Although Leeson concealed the true extent of his outstanding positions, even from SIMEX itself by techniques such as reversing transactions after trading had closed, SIMEX did query the level of margin payments made by Barings, for example on 11 January 1995. The Singapore report (San and Kuang, 1995) details the differences between the reported level of outstanding contracts and the actual level. This was a crucial part of the evidence that Leeson had acted fraudulently in his dealings with SIMEX.

As the Bank of England report illustrates, the outflows, from three different parts of the Barings group, simply grew bigger and bigger. See Table 1. Table 1: Cumulative funding of Baring futures (Singapore) [£ million] Company

7 Jan 94

31 Dec 94

24 Feb 95

Baring Securities London

7

13

105

Baring Securities

33

142

337

Baring Securities Japan

(1)

66

300

TOTAL

39 221 742

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In principle, the margin payments for client transactions should have been made by the clients themselves and merely passed on to SIMEX by Barings. Only if Barings was entering into contracts on its own behalf, should there have been any need to use the bank’s own funds to make margin payments. Since Leeson was not authorised to gamble the bank’s own money, there should have been no need for funds to be transferred to Singapore from Barings group companies in London and in Japan. In fact, massive transfers were made, and queries raised by some of the staff at the treasury department of Barings in London did not prevent the flow of funds. Certainly if margins were needed, for example to cover arbitrage trading, it would have been expected that there would also have been reductions in margins at other times, implying that funds would have flowed into the Barings treasury rather than always flowing out (Hogan, 1997: 31).

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Source: Bank of England (1995) These figures are an indication that the trading operations in Singapore were losing money, but at the same time profits were being reported. The evidence of this mismatch between the real situation and the reported situation was hidden in the secret 88888 account (which the Singapore Ministry of Finance report suggests was known about by Barings staff in London, but which other accounts indicate had been concealed by Leeson. See, for example, Gapper and Denton, 1997).

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The balances on the 88888 account are reported in San and Kuang (1995) (See Table 2) and confirm the impression that Leeson himself puts forward (Leeson/Whitley, 1996), that in mid-1993 he had, in effect, traded his way out of the losses incurred during 1992. He could, at that stage, have stopped taking the risks inherent in his unauthorised trading. During the period in which these losses were being incurred, the accounts of Barings showed profits rising, notably in the Asia/Pacific region, and the increased profits seem to have been considered a justification for investing more of the group’s funds there (Hogan, 1997). Table 2: Cumulative monthly losses on account 88888 from July 1992 – February 1995 Year

Month

US$ million losses

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1992 Jul 0.1 Aug 0.8 Sep 8.8 Oct 10.7 Nov 4.1 Dec 4.9 1993 Jan 4.7 Feb 4.9 Mar 1.7 Apr 2.8 May 2.5 Jun 1.2 Jul 0.1 Aug 4.2 Sep 7.7 Oct 12.9 Nov 65.7 Dec 57.7 1994 Jan 131.5 Feb 166.7 Mar 107.1 Apr 113.6 May 217.3 Jun 231.9 Jul 249.5 Aug 226.6 Sep 375.6 Oct 347.2 Nov 468.4 Dec 373.9 1995 Jan 590.3 Feb 2210.0 Source: San and Kuang, 1995: Appendix 3K

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The figures in Table 3 show how the position developed from 1992 to 1993. With little more than a tenth of the group’s assets in 1992 the Asia/Pacific region generated over 90 per cent of the group’s profits, most of this coming from the supposed profits from trading in Singapore; Leeson was seen as a hero within the organisation and was rewarded with substantial bonuses. Table 3: Profits and net assets [£ million]

1992

1992 1993 1993

Profits

Asia/Pacific

26,150

36,506 45,987 79,046

The Barings Group

27,914

353,822

Net assets

Profits

105,184

Net assets

410,097

Source: Hogan (1997)

7.3.4 Specific evidence of fraud The losses which occurred could conceivably have arisen from acceptable trading practices. This is because it is in the nature of financial markets that trades take place which result in gains for one party at the expense of losses incurred by another party. It is important to recognise that financial institutions which participate in markets across the world take major risks and pay their risk-takers highly for their skill in making rapid judgements which will benefit the organisation at the expense of other parties to the trades they make. As Fox -Andrews and Meaden comment (1995:183) ‘Barings was a big loser, but there were also some big winners’. The fact that an account was established early on by Leeson to record losses could also be considered uncontentious given that trading institutions do have short-term difficulties in reconciling transactions, but the nature of the account and the way it was used were certainly part of the evidence that Leeson had been disregarding the bank’s rules in a deliberately fraudulent way. In addition, the consistent misreporting to SIMEX of the level of outstanding contracts was clearly a fraudulent breach of the rules of the exchange. This deception was designed to reduce the level of margin payments made to SIMEX, and therefore it increased the risk to all participants in the market.

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Overall for Barings, during 1992 and the first half of 1993, the failure to recognise the real risks which Leeson was taking was more of an issue than the actual losses. By the beginning of 1994 the position had become so serious that the bank’s chances of recovering were already small, but opportunities for spotting the problems continued to arise, notably with the internal audit in mid 1994. By November 1994 Leeson’s trading had reached a peak with sales of 22,000 options on the Nikkei 225 index. Although these instruments were not the only transactions which Leeson entered into, the nature of these particular contracts meant that he would incur heavy losses from any large movement of the Japanese stock markets whether this movement was up or down.

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More significantly, there was clear evidence of fraud at a later stage in the story, when it became apparent to the external auditors that there was a serious discrepancy in the accounts. This was discovered in mid January 1995, and Coopers and Lybrand then tried to get an explanation from Leeson. To cover up the losses, which were the real explanation for the discrepancy, Leeson forged a document purporting to come from a client firm of brokers, Spear, Leeds and Kellogg in New York. Later commentators, such as Fay (1996) argued that the forgery was so poor that it

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should have been apparent to the auditors that it was not a valid explanation, but by the time any serious doubts over it could have been explored further the bank had collapsed.

7.3.5 The Kobe earthquake Just as the evidence of missing funds began to create problems for Leeson, a major shock to the external environment added to his problems. He had entered into a large number of contracts, referred to as straddles, which meant that he would lose money if the market was volatile, with movements sharply up or down. Some commentators suggested that the extent of his trading was so great that he may have even helped to make the market less volatile by betting heavily against price movements. A significant difference between betting in the financial markets and betting on external events like horse races or lottery draws is that betting in the markets affects the markets and can lead to self-fulfilling prophecies; heavy selling of any traded financial instrument, for example, lowers prices and justifies the heavy selling. However, even the most determined betting could not overcome the impact of a major external shock to the system. When the news broke of the Kobe earthquake on 17 January 1995 it was clear that the Tokyo stock market would be affected, and this meant that derivatives contracts based on the stock market index would also be affected. The exact impact was unclear at first, as there were different possible interpretations of the economic impact of the event, with losses likely to arise in insurance companies, but potential gains in construction businesses which would win large new contracts to carry out repairs and reconstruction work. For Leeson, the outcome was that he needed to enter into even more contracts to raise money in the short term to pay increased demands for margin payments. These new contracts simply increased the risk to the bank. It is notable that, within a week of the Kobe earthquake, Barings’ Asset and Liability Committee responsible for monitoring overall risk decided that Leeson should reduce the group’s positions; their statement to this effect suggests that they had some knowledge of the circumstances leading to the build-up of positions, and rather goes against the claim that all Leeson’s trading was carried out in direct contravention of the instructions given to him. However, it is clear that Leeson failed to comply with this specific instruction.

7.3.6 The final days On 16 February 1995, Peter Norris, Chief Executive of Barings Securities, arrived in Singapore to try to find out why the apparently profitable operation now seemed to be having some problems. He met managers responsible for the business including Leeson. At that stage, the Asset and Liability Committee in London again confirmed that positions should be reduced. Internal audit suggested that there was a serious discrepancy in the accounts of the trading operation, but Leeson avoided meeting the staff who wanted to question him about this. Further instructions to reduce positions were given to Leeson, but he failed to comply with the orders and the bank’s treasury received further requests for margin payments. Leeson’s failure to obey an order at that time, and again later on, may justify the claim that he was a rogue trader, but this does not give a valid explanation of how he was put in a position to cause such damage to the institution in the first place. When, on 23 February, Leeson finally met with two of the managers investigating the discrepancy in the accounts, he made an excuse to leave quickly, and then flew out of Singapore that day. A day later, managers at Barings head office in London realised that Leeson had disappeared.


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7.3.7 The attempted rescue Once the evidence was clear that the capital of the Barings group was inadequate to meet the group’s liabilities, the Bank of England intervened to see whether it would be possible to organise other UK banks to mount a rescue operation. The government had clearly been reluctant to provide funding via the Bank of England to cover the full losses as they were known at that time. Leading bankers were invited to an emergency meeting to brief them about the situation and to invite them to put up funds to cover the losses and save Barings from the formal process of appointing administrators to deal with the insolvency of the business. Some banks were willing to support this proposal, apparently on the grounds that it would help to maintain confidence in the UK financial system in general, and in British banks in particular. Others felt that allowing the bank to fail would be better than pouring in more money to an organisation which had failed to handle its own resources adequately. One of the factors which discouraged both the government and the industry from committing to a rescue package was the uncertainty, at that stage, about the exact extent of the losses. On 25 February 1995, these were estimated to amount to £625 million. Contracts traded on out the contracts, by buying equal and opposite contracts, was clearly going to be difficult when the whole market was aware of the situation and would recognise that any such contracts could be priced at a very high level because the buyers would be desperate. From the initial meeting, it became clear that there was not enough support for a rescue by other banks, and the Bank of England considered other options. Amongst the options considered by them was a purchase of the bank by the Sultan of Brunei. In the end, this too fell through and the bank was declared insolvent. The administrators then entered into negotiations with possible buyers and, on 6 March 1995, it was agreed that the Dutch banking and insurance group ING would buy Barings for a token price of £1, taking on at the same time the extensive liabilities estimated, by then, to amount to £930 million. In the long term, this seems to have been a successful purchase for ING which now has a good reputation for investment banking services in emerging markets, a strength which it would have been difficult for the group to develop by internal growth.

7.4 Organisational issues affecting Barings As the preceding evidence suggests, many of the factors which contributed to the collapse of Barings were related to the way in which the bank was organised. The structure of the group changed quite substantially during the period in which Leeson was based in Singapore. More details of these changes are provided in the Bank of England report (1995), which incorporates organisation charts at different points in time.

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SIMEX were still outstanding and they were a growing liability as the discussions went on. To close

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In broad terms the group was involved in three types of activity: • Fund management, the main part of which was in a separate business called Baring Investment Management and held client accounts in trust, safe from the claims of the administrators when the group failed.

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• Investment banking, including advice to corporate clients on mergers and restructuring, as well as standard banking operations like deposit-taking and lending. • Securities trading, buying and selling shares, bonds and equities, though this area of activity overlapped both with some fund management business, buying and selling for clients, and with the banking operations arising out of bank services to customers. Some centralised functions for the group were based within the banking arm of the business.

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The internal politics of the group had become complicated as the old, established centre of power in investment banking had lost out, to some extent, to the more aggressive and entrepreneurial securities trading business which had developed new markets. A downturn in the securities business then opened up opportunities for new players to put forward their claims. In September 1992, there was some significant reorganisation of the Barings group of companies, partly as a result of losses unrelated to Leeson’s activities in Singapore. This led to the resignation of Christopher Heath, one of the directors of Baring Futures (Singapore) who had played a major role in the development of trading activities as part of the product range of the bank. Among the promotions which followed in May 1993, Peter Norris was appointed a director of Baring Futures (Singapore) and he was later to have a significant role in some of the unsuccessful attempts to identify the problems and losses which were occurring in Singapore. A Financial Products Group was established, as part of Baring Investment Bank, to cover a range of activities including offering risk management to clients through the provision of futures and options. This group was headed up by Ron Baker who, although keen to establish his leadership of a team of traders, seems to have run counter to the previously established approach of managing trading operations through Baring Securities rather than through the banking arm of Barings. When Baker took charge, it seems that Leeson was not formally part of the Financial Products Group team. His status from his original appointment in Singapore had been unclear. The finance director of Baring Securities decided that he should report to the risk manager of Baring Securities based in London and to one of the directors of Baring Futures (Singapore) based in Singapore. This split in the reporting lines for Leeson was the source of potential problems identified by James Bax. In 1992, Leeson had reporting lines to Mary Walz in London, responsible for treasury operations as part of Baker’s Financial Products Group, and to Simon Jones in Singapore, responsible for derivatives operations. In addition, there is evidence that Leeson saw himself as having a third reporting line, arising from his involvement in trading, and this was to Mike Killian, head of futures and options sales based in Tokyo. By the end of 1993, the restructuring meant that Killian came under Peter Norris, the new Chief Executive of Baring Securities, while Walz continued to report to Baker as head of the Financial Products Group, part of Barings Bank rather than Barings Securities. Judging from the Bank of England’s account (1995), further reorganisation meant that Leeson also had a reporting line to Fernando Gueler in Tokyo. Overall the relationships were complex and open to misunderstandings and breakdown in communication. Once Leeson had got into difficulties with his trading it was relatively easy for him to hide behind the lack of clear reporting lines. It had become impossible for any one person in the organisation to have a full picture of the group’s trading risks.

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7.5 Monitoring

unallocated capital from a different area of the group could be used to support the loss-making activity. In effect the capital of the bank was committed from the outset to cover any losses should they occur. The Bank of England also authorised some exceptional levels of exposure beyond the limits which would normally have been acceptable, apparently on the grounds that the senior managers at Barings were fully aware of the risks involved in what they were doing. It may be surprising that those at the head office of Barings and the regulatory body responsible for the bank failed to recognise that excessive risks were being taken by Barings staff in Singapore. Remoteness from the activity may be some explanation for the failings in this respect. Barings did, of course, have mechanisms in place to exercise closer monitoring of activities. Potentially one of the most important of these mechanisms was the internal audit of Baring Futures (Singapore). In the summer of 1994 an internal audit did take place and the audit report recognised that Leeson should not be responsible for both trading and back office recording of transactions. By this time Leeson had already made substantial losses but these were not discovered by the audit team, a surprising failing in the eyes of many commentators (Fay, 1996; Rawnsley, 1996). The recommendation to change the control structure was simply not implemented, even though the audit report was circulated to senior managers at Barings. The external monitoring of the derivatives trading operation in Singapore as part of the overall audit of the Barings group was a little more successful in identifying that there was a problem, with the specific issue of the fictional transaction with Spear, Leeds and Kellogg spotted by Coopers and Lybrand. Given the figures on profits from the Asia/Pacific region for 1992 and 1993, it seems surprising that more attention was not paid to Leeson’s activities in the earlier external audits. Questions raised at that time about the implausibility of a supposedly low-risk trading operation generating such apparently high profits might have prevented the eventual collapse.

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Following the collapse of Barings it was natural that questions should be asked about the failure to identify problems earlier. Banks can normally be expected to take full responsibility for their own management of the risks incurred in their business operations. However, in addition to this level of internal monitoring and control, the banking sector also has an external regulatory framework intended to protect the financial system as a whole and safeguard the interests of ordinary investors. Primary responsibility for external monitoring of Barings lay with the Bank of England and therefore, it was to the Bank of England that Barings reported on levels of exposure to different types of financial risks. It was normally a requirement of the Bank of England that securities trading operations should be backed by capital identified as separate and different from capital of a banking operation. In general, securities trading businesses reported to the separate regulatory body, the Securities and Futures Authority. At the time there was debate about the best ways to ensure that businesses combining banking and securities trading did not fall between regulators. In the case of Barings, the Bank of England agreed to the unusual principle of solo consolidation, treating all of the capital of the Barings group as a single amount. This was recognised at the time as increasing the risk that Barings might play one supervisor off against another. It also meant that when major losses were incurred there was no possibility that

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The case of the fictional profits at Kidder Peabody in 1993/94 might have been taken as a warning to auditors of other financial institutions. As in the Barings case, managers at the company involved, a subsidiary of the major US conglomerate General Electric, blamed a rogue trader, Joseph Jett, who had reported high profits on transactions involving low-risk government bonds. Jett argued that his managers had been well aware that the techniques he had developed reported profits on deals which might later turn into losses; in fact Kidder Peabody had lost around $350 million. Like Leeson, prior to the discovery of the true extent of the losses, Jett had been a hero, declared man of the year at Kidders in 1994. As a result of the losses, and the impact on the reputation of the business, General Electric sold Kidders in 1995 -this came rather late to provide a lesson for the auditors or management of Barings. Jett was dismissed and his salary and bonuses were frozen, but an arbitration panel in 1996 exonerated him and allowed him to reclaim over $5 million owing to him.

7.6 Losers and gainers

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The losses incurred on the collapse of Barings took a variety of forms, and the simple measure of £930 million is an inadequate summary of the impact of the bank’s liquidation. Although ING took over the business of Barings, many staff lost their jobs, apart from the managers who were sacked by ING because they were seen as being responsible for the lack of management control. The Securities and Futures Authority (SFA), responsible for regulating securities trading businesses in the UK, followed up the collapse of Barings by carrying out its own investigation of breaches of its regulations by Barings staff. Fay (1996) reports that the SFA ‘judged that its rules had been breached by nine former Barings employees’, among them Peter Norris. More senior managers; Andrew Tuckey, deputy chairman of Barings plc and Peter Baring, chairman, were not among those held responsible. As Barings had been primarily owned by family shareholders the loss incurred by external shareholders was relatively limited. However, part of the financing of the group had been in the form of $150m of Barings perpetual bonds, long-term funds provided by outside investors, and the holders of these bonds received no payment when the business was taken over. Over three years later, holders of the bonds were still seeking compensation for their losses. In November 1998, a press report indicated that an offer worth £85m had been rejected by the bondholders (some of whom had bought the bonds since the collapse specifically in order to claim compensation). The proposed package, put forward by the City Disputes Panel, included funds from ING, from former Barings directors and from the accountants who had been acting as auditors of Barings at the time of the collapse. Further legal action to resolve the dispute is now likely to go on for many years (Inman, 1998). However, a financial disaster is often rather different from disasters like fires or floods arising from natural causes. Where money is lost on financial transactions there are normally counterparties to those transactions who gain. The contracts which Leeson entered into made losses for Barings but made real profits for those he dealt with, the other members of SIMEX. It is worth noting that, broadly speaking, SIMEX gained from Leeson’s activities too. The exchange is a business, trying to make money like any other business, and it makes more money if turnover is high. As Fox-Andrews and Meaden (1995) comment, the exchange would have been glad to see Barings putting through a lot of trades, and even though they did not get the full benefit of this because of Leeson’s deception, they gained more than if Leeson had not been trading actively on his own initiative.

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7.7 Formal investigation of the collapse After Barings had collapsed, inquiries were set up to find out what had caused the bank’s failure. In Singapore, the Ministry of Finance appointed investigating accountants to look into what had happened there, whilst in England, the Bank of England commissioned a formal inquiry by the Board of Banking Supervision. The UK report appeared in July 1995, and the Singapore report in September, but both had focused on the narrow areas of interest of the two commissioning bodies. As Hogan (1997) argues, the failure of the two regulators to co-operate meant that neither was well placed to achieve a full picture of the causes of the collapse of the bank. The governor of the Bank of England took the view that the findings of the Singapore report were consistent with those in the Bank of England’s report (Hunt and Heinrich, 1996) but there were clear differences. Notably, this lay in the extent to which the Singapore report placed direct blame on specific managers at Barings including Peter Norris, implying that there might well have been some form of organisational cover-up rather than just a failure to exercise adequate control. charges. Partly, this was on the grounds that his actions had been on behalf of Barings which was a UK regulated organisation, though, no doubt, also because there was an expectation that any punishment would be more lenient in the UK than in Singapore. Investigating bodies in the UK, in particular the Serious Fraud Office, chose not to seek his extradition and were apparently happy to see the case tried in Singapore. One of the implications of this, as Hunt and Heinrich (1996) point out, is that the transfers of funds from Barings in London to the trading operation in Singapore, in breach of Bank of England guidelines, were never raised as an issue in a court of law and no formal legal sanctions were taken against those who had authorised the payments.

7.8 Coverage in the press The events led to extensive analysis in the press, and to a number of books by journalists who had investigated the case. Leeson also published his account of the events, though this does not seem to have added to the evidence produced by other research. The first response in the press followed news agency reports on 26 February. As Stonham (1996) reports, the Sunday Times headlined the news as ‘Queen’s bank near collapse in £400m loss. Bank desperate to find buyer after losing £600m in derivatives trading’. Similar reports followed in national and international newspapers on the Monday, as the estimated losses grew bigger. The claims about Barings, as a highly reputable bank with royal patronage, were rather misleading as market participants had recognised well before the collapse that the securities trading arm of the group was culturally very different from the investment bank. As more evidence came to light, it was clear that Barings had not been as sound as some of the early press comment had suggested. The business was relatively small compared to leading investment banks, particularly those in the US, and this made it vulnerable to losses which would not have wiped out a group with a larger capital base.

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After Leeson’s arrest in Germany, he argued that he should be extradited to the UK to answer

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One of the arguments put forward in the press, at the time of the collapse of Barings, was that derivatives trading was inherently risky and that the development of derivatives was a threat to the

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stability of the financial system. In fact, as other incidents show, losses arise from the culture of risktaking in the industry rather than from derivatives. Derivatives, if well managed, can reduce risk by enabling businesses to transfer risks which interfere with their activities to others who are better equipped to take the risks. More recent analysis suggests that there is more of a threat to the financial system from the large-scale use of index tracking investments by risk-averse investors than from derivatives, because tracker funds automatically switch funds between investments as circumstances alter, and they all do so in similar ways at the same time.

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7.9 Guidelines for organisations The lessons to be learnt from the Barings case include specific issues of relevance to organisations in the industry. However, it is clear that these have importance and relevance way beyond the financial services sector. Some of these issues were outlined by Fox-Andrews and Meaden (1995) shortly after the collapse:

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1. Market participants must have an independent and powerful middle office/back office function over which sales traders have no influence. 2. Market participants must have effective information and risk management systems. 3. Regulators of exchanges must have constructive open channels of communication. 4. Whilst the dealing room culture of individualism, competition and security can be highly rewarding and creative, a management structure of co-operation must reduce the room for rogue traders to operate. There needs to be a reality check.’ Fox-Andrews and Meaden also commented on the reduced effectiveness of domestic regulators as a result of the globalisation of markets. The first point here is widely accepted, and commentators with experience in the industry have seen this particular failing in the case of Barings as both shocking and untypical. The emphasis on risk management systems is interesting given that Barings did have in place the formal mechanism of a group: Asset and Liability Committee. This group was designed to take an overview of risks facing the organisation as a whole but it was clearly ineffective in that role. A major aspect of the committee’s failure seems to have been in communication about risk; there is little evidence of a properly established two-way process with checks that decisions made by the Asset and Liability Committee were being implemented. More thorough-going systems are probably needed in many firms within the industry, because the risks of the industry are changing and increasing and because traditional models of financial risks have proved inadequate. Concerns over the relationships between regulators continue to trouble the industry as constant changes in products, and in industry structure, make old patterns of regulation outdated even as they are developed. Organisations, operating in the financial markets, therefore need to focus on assessments of risk which go beyond the traditional analysis of credit risk in which banks have particular strength. Other risks which seem less obviously relevant to the industry have grown in importance as the financial markets have come to be dominated by technology which diminishes the impact of time and distance. Globalisation of financial services is one of the key factors which has transformed the pattern of risk which financial services firms need to handle.

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The concern over management control and the culture of the industry is possibly the most difficult of the areas to address. Traders are rewarded for the business they generate, and this inevitably encourages them to generate business at all costs, particularly when it is recognised that shortterm success is often so well rewarded that star traders do not need to sustain long-term careers. The drive to make (or, more precisely, to show) high levels of profit in the short term, overrides most other considerations, and, as Smith and Walter (1997) argue, this can be to the detriment of shareholders in securities firms in the longer term. It could, therefore, be argued that rewards for ethical behaviour need to be strengthened and rewards for short term profit need to be reduced. Such measures to achieve this go strongly against the prevailing culture in the industry.

7.10 Current considerations

These examples confirm that the Barings case was not unique, and that businesses involved in securities trading have to deal with difficult conflicts of interest whether those securities are shares, bonds or derivatives. Punch (1996) provides a wider view of ethical problems in business, including some further examples relating to the financial services industry. Table 4: Examples of major losses subsequent to the collapse of Barings Date Institution suffering loss

Amount of loss ($)

Source of Loss

Oct 1995

Daiwa Bank

1.1bn

Bond trading

Jun 1996

Sumitomo Corporation

1.8bn

Copper futures trading

Sept 1996

Morgan Grenfell Asset 0.7bn Management

Unauthorised investment in shares

Mar 1997

NatWest Markets

Derivatives trading

0.1bn

Source: various press reports The clash of cultures evident in the Barings case, one culture based on risk-taking trading and one based on a much more measured, controlled assessment of risks, is a primary source of problems in the industry. This is particularly so, as consolidation takes place in the financial services sector, in order to benefit from economies of scale. In Barings, the misperception, at the highest level, of the risks inherent in trading operations is characterised by the infamous comment by Peter Baring, quoted in the Bank of England report, that

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Now that it is possible to look back on the events in a considered way it is clear from other incidents in the industry, including the Joseph Jett case, that the culture of securities trading businesses does push individuals towards behaviour which leads to high levels of risk-taking, to an extent which can threaten the organisations which employ them. A representation of some later examples is given in Table 4.

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‌ the recovery in profitability had been amazing, leaving Barings to conclude that it was not actually very difficult to make money in the securities business.

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Few senior managers in the financial services industry would make such a claim now, however, some have seen diversification into securities dealing as a potential source of increased profit, and have lived to regret this view, having ignored, in their own way, the principle that risk and return are related.

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Whether the risks incurred by Barings could have been hedged is a secondary issue, because the real risks which arose were not the financial risks associated with interest rate movements or changes in stock market indices which had an impact on the value of the contracts which Leeson had entered into on behalf of the bank. More fundamental were the risks arising from a lack of proper internal controls and associated poor risk management. Ideally risk-taking decisions should have been separated from profit-making decisions (as they often are in commercial banking, where major loans offered to customers need the separate approval of a credit committee), but the way in which securities trading is carried out tends to make such a separation difficult. The next best option is to separate the trading (which bears risk and makes profit) from the recording of transactions, as should certainly have happened at Barings. In addition, policies on limits to exposure to particular risks needed to be established and fully monitored. The pressure on traders to make profit means that they need to be closely supervised to see not just whether they are making money, but how they are making money. External controls over risk also need to be addressed if supervision of the financial services industry is to be meaningful. There is a good case for allowing financial firms to fail if they do perform badly, but supervision should imply some degree of intervention to make poor performance less likely, and the events at Barings do not offer much evidence that external monitoring was effective. Dale (1996) argues that the failure to separate risky securities business from low-risk deposit-taking was an issue in the Barings case. Cheap funds obtained from depositors were misapplied in operations where those funds were put at risk, in a way which would not be possible under a more severe regulatory regime, such as that in the United States, where separation of commercial banking and investment banking has traditionally been more rigorously enforced. This is a matter of broader public policy and the debate in the United States has moved towards a less restrictive approach which could imply an increased risk of further incidents like those which brought down Barings.

7.11 Guide to reading The supporting reading for this Unit is a chapter from Waring and Glendon’s text on risk management, Waring, A. and Glendon, I. (1998) ‘The Collapse of Barings Bank’, in Managing Risk, London: Thomson. Waring and Glendon adopt a strongly risk management oriented approach. Although their analysis of financial risk is rather unusual they do provide excellent coverage of the risk arising from poor human resource management practices.

7.12 Study questions You should now write approximately 300 words in answer to each of the questions below. We believe that this is an important exercise that will assist your comprehension of material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University.

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• To what extent can a single rogue trader be considered responsible for major losses at a financial institution? • What forms of internal control are needed in financial institutions to prevent unauthorised risk-taking? • What forms of external regulation are most likely to prevent future problems similar to those experienced at Barings Bank ? • How can staff incentive systems be adapted so that they do not encourage unacceptable risk-taking?

7.13 Bibliography Bank of England (1995) Report of the Board of Banking Supervision Inquiry into the Circumstances of the Collapse of Barings, London: HMSO.

Dale, R. (1996) Risk and Regulation in Global Securities Markets, Chichester: John Wiley. Fay, S. (1996) The Collapse of Barings, London: Arrow. Fox-Andrews, M. and Meaden, N. (1995) Derivatives Markets and Investment Management, Hemel Hempstead: Prentice-Hall/Woodhead Faulkner. Gapper, J. and Denton, N. (1997) All that Glitters: The Fall of Barings, Harmondsworth: Penguin. Hogan, W. P. (1997) ‘Corporate governance: lessons from Barings’, Abacus, 11(1): 26–45. Hunt, L. and Heinrich, K. (1996) Barings Lost, Singapore: Butterworth-Heinemann. Instefjord, N., Jackson, P. and Perraudin, W. (1998) ‘Securities fraud’, Economic Policy, 27: 587–623. Inman, P. (1998) ‘Barings’ victims say no to £85m pay-out’, The Guardian, 12 November: 26. Leeson, N. with Whitley, E. (1996) Rogue Trader, London: Little and Brown. Punch, M. (1996) Dirty Business – Exploring Corporate Misconduct, London: Sage.

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Brown, M. (1996) ‘Derivative instruments’. In E. Gardener and P. Molyneux (eds) Investment Banking In Theory And Practice, London: Euromoney: 221-242.

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Rawnsley, J. (1996) Going for Broke, London: Harper Collins. San, M. L. C. and Kuang, N. T. N. (1995) Baring Futures (Singapore) Ptd Ltd: Investigation ... Report of the Inspectors appointed by the Minister of Finance, Singapore: Ministry of Finance. Smith, R. C. and Walter, I. (1997) Street Smarts: Linking Professional Conduct with Shareholder Value in the Securities Industry, Boston MA: Harvard Business School.

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Stonham, P. (1996) ‘Whatever happened at Barings? Part 1’, European Management Journal, 14(2): 167–175. Stonham, P. (1996) ‘Whatever happened at Barings? Part 2’, European Management Journal, 14(3): 269–278. Waring, A. and Glendon, I. (1998) ‘The collapse of Barings Bank’, in Managing Risk, London: Thomson. Winstone, D. (1995) Financial Derivatives, London: Chapman and Hall.

Internet Useful material on Barings is accessible on: http://www.numa.com/ref/barings/index.htm

TV/Video BBC2: 12 June 1996, ‘Inside Story Special – Nick Leeson and the Fall of the House of Barings’. BBC2: 3 February 1999, ‘Blood on the Carpet – Nightmare on Wall Street; Joseph Jett’.


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READING ‘The collapse of Barings Bank’ Waring, A. and Glendon, I. (1998) In Managing Risk, London: Thomson.

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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7-29


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7-30

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7-44

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7-46

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7-48

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7-49


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7-50

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7-51


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7-52

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7-53


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7-54

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7-56

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7-58

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7-60

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UNIT 8 The Summer Floods 2007


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8 Unit 8: The Summer Floods 2007 8.1 Foreword In 2008 the United Kingdom Government published a National Risk Register (NRR). The NRR assessed the likelihood and probable impacts of a range of risks, from electronic attacks to animal disease. In 2009 the Government identified the risks that most worried business leaders: The risks of most concern were electronic attacks (58 per cent) and human disease, such as pandemic influenza (57 per cent). Severe weather (52 per cent) was also seen as a major risk, with flooding separately identified as a particular concern by 39 per cent [of business leaders]. (Woodman and Kumar, 2009)

Of all the myriad risks facing the individual at the end of the twentieth century, environmental risks are amongst the most pervasive, the most serious and the most feared... environmental concerns have moved up the psychological agenda. (Tindale, 1998) The Copenhagen conference, held under the auspices of the United Nations Framework Convention on Climate Change (UNFCC), faced numerous challenges, like persuading the United States, Canada and Australia to significantly reduce emissions of greenhouse gases (in 1997 U.S. President George Bush rejected the Kyoto Protocol on climate change. The U.S. Senate voted down the Protocol by 95 to zero (Monbiot, 2007: xv)). Bush’s successor, Barack Obama, is more willing to discuss emissions. In April 2009, Secretary of State Hillary Clinton remarked that the United States of America was ‘determined to make up for lost time both at home and abroad’ (Clinton cited in Edge and Adam, 2009). Unfortunately Obama was unable to engineer a U.S. climate change bill in time for Copenhagen (The Observer, 2009). Industrialising countries like India and China are looking to the developed nations to set an example (countries like China say they are morally entitled to develop and grow). According to the European Union (EU) a temperature rise of 2 degrees Centigrade is ‘dangerous’. On 1 November, 2009, The Observer described the problem thus: This figure... is the maximum warming that our planet can tolerate. If we go beyond it, we will face global calamity in the form of spreading deserts, increasingly violent storms, destruction of swaths of farmland, flooding and widespread loss of life.

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At the end of 2009 world leaders gathered in Copenhagen in Denmark to discuss the issue of climate change. While scientists dispute the precise causes and consequences of global warming (Giddens, 1998), there is no doubt that the issue has impacted public consciousness:

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To avoid the EU’s ‘dangerous’ level the world must achieve an 80% cut in emissions by 2050 (from 1990 levels). Nearly nine out of ten climate scientists do not believe this will happen (Edge and Adam, 2009). On the eve of the conference The Observer (2009) editorialised: ‘Agreeing long-term global deals is simply beyond human nature, suggest the sceptics, obsessed as we are with our own local, short-term concerns’. Increased flooding seems inevitable. The nations of the world need

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to invest in flood defences and develop effective contingency plans. In Britain’s case, according to Handmer (1997: 5), the former has been given greater priority than the latter: In the post-war period British flood hazard management has been characterised by substantial government investment in structural works to protect both urban development and agricultural areas…. The emphasis has been on flood prevention through flood water control – known as ‘flood defence’. Dealing with the risk (the residual risk) remaining after flood control works are in place through warnings, planning and compensation, has received much less attention. The increased attention being given to flood risk would appear to support Beck’s (1992: 20) thesis that – at least in the most highly developed economies – there is a strong public and governmental focus on risk. Woollacott (1998: 120) observes: [T]he containment of future dangers has, without our quite noticing it, gradually become the main business of government. We are the risk society... composed of people constantly calibrating risks in our personal lives and with a deeply established expectation that the job of the political class is the avoidance or minimisation of future risk... and the provision of compensation when this fails. Perhaps mindful of its obligation to ‘minimise future risk’ the Blair government commissioned economist Sir Nicholas Stern to investigate the costs of climate change. As Monbiot (2007: x) explains, Stern concluded that (successfully) tackling climate change would cost less than living with the consequences: [Stern] found that the global cost of a high level of warming during the twenty-first century would equate to between 5 and 20 per cent of the world’s spending power, while the cost of preventing it would amount to only 1 per cent of global gross domestic product. It makes economic sense to act [on global warming]. Mindful again of its obligation, in March 2007 the U.K. government launched the climate change bill which committed the government to achieving a 60% reduction in carbon emissions by 2050. ‘Too little, too late’ judges Monbiot (2007: xiii), who reminds us about the government’s commitment to expanding airport and road capacity. As of November 2009 the Brown government remained committed to building a third runway at Heathrow Airport, London. In an effort to cut CO2 emissions from power generation the U.K. government has recommitted itself to nuclear power (after several years of opposition). In his 1985 book Science and Technology in World Development Robin Clarke (1985: 124) wrote something that, in hindsight, was rather prophetic: ‘[R]eal fears now exist of altering the Earth’s climate.... Paradoxically, this danger has been increased partly as a result of the environmentalists’ insistence on the dangers of nuclear power’. U.K. government policy presents something of a mixed picture (Monbiot, 2007) the result, perhaps, of several changes of direction. Government ‘flip-flopping’ might help explain the British public’s resistance to lifestyle change: ‘A recent survey [2007] by the Energy Saving Trust shows that only 4 per cent of people have made substantial changes to the way they live’ (Monbiot, 2007: ix). The British people remain wedded to their cars, cheap weekend breaks on mainland Europe courtesy of no-frills carriers like bmi-baby, easyJet and Ryanair and trans-global food imports.


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In the United States the Natural Resources Defence Council (NRDC) has cautiously linked global warming to ‘increased droughts and wildfires, heavier rainfall and a greater number of Category 4 and 5 hurricanes’ (Natural Resources Defence Council, 2009). Addressing the question of sea-level rise, the NRDC (2009) says: Current rates of sea-level rise are expected to increase as a result both of thermal expansion of the oceans and melting of most mountain glaciers, and partial melting of the West Antarctic and Greenland ice caps [Greenland holds 10% of the total global ice mass]. Consequences include loss of coastal wetlands and barrier islands, and a greater risk of flooding in coastal communities. Lowlying areas... are especially vulnerable. Global sea level has already risen by 4 to 8 inches in the past century, and the pace of sea level rise appears to be accelerating. The Intergovernmental Panel on Climate Change predicts that sea levels could rise 10 to 23 inches by 2100, but in recent years sea levels have been rising faster than the upper end of the range predicted.

8.1.1 Copenhagen fallout Before the Copenhagen conference, journalist Fraser Nelson (2009: I) wrote: ‘[G]iven that a legally-binding solution in Copenhagen has already been ruled out, should they bother to meet at all?’. In the event the conference made progress, but not as much as the organisers and many participants would have liked. During a January 7, 2010 exchange in the House of Commons, Joan Ruddock, the United Kingdom’s Energy and Climate Change Minister observed: ‘This was a kind of success [but] not as much as we wanted’. Despite the best efforts of numerous heads of government (including Obama and Brown) it was felt that a further conference was required to make real progress on reducing emissions. The question of whether a further conference will secure real progress is open to debate, however, given that many countries are preoccupied with economic issues. Lomborg (2009: VI) notes:

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Regarding rainstorm activity the NRDC (2009) notes of the United States: ‘National annual precipitation has increased between 5 and 10 per cent since the early 20th Century, largely the result of heavy downpours. The Intergovernmental Panel on Climate Change reports that intense rain events have increased in frequency during the last 50 years, and human-induced global warming most likely contributed to the trend’. Such trends and issues have been highlighted by the environmental movement, whose members have become adept at cultivating media attention (witness, for example, the way in which Greenpeace used the media to foreground the Brent Spar decommissioning debate). In response, governments and corporations have themselves tried to manipulate the media. According to Rowell (1996), they have also tried to undermine the environmental movement, whose arguments have not been helped by the fact that, as Rowell (1996: 87) puts it, ‘… there are inherent uncertainties about predicting something as complex as the world’s climate and how it will change … ’.

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Just two in five Brits [sic] think that global warming is taking place, and is man-made. Only onethird of Americans think that humans are responsible for climate change. The number of Australians who deem global warming a ‘serious and pressing problem’ has dropped sharply. The urgency which grips politicians around the world seems not to be shared by the general public .... Yet against the backdrop of a global economic crisis, it is understandable that people everywhere have become more sceptical about policies that stand to cost them a fortune ...

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If, as Beck insists, we live in a Risk Society, then it is a society composed of multiple risks, from nuclear proliferation and global warming, to health threats and economic risks. At the beginning of the Nineties Beck (1992: 12-20) wrote: ‘[W]hile in classical industrial society, the “logic” of wealth production dominates the “logic” of risk production, in the risk society this relationship is reversed .... In the welfare states of the West ... the struggle for one’s “daily bread” has lost its urgency .... Parallel to that the knowledge is spreading that the sources of wealth are “polluted” by growing “hazardous side-effects”’. We may well be more conscious of environmental risks, but we are still acutely aware of economic risks like unemployment, underemployment, property market slumps, house repossessions, credit card black-lists, inflation, stagflation, falling interest rates (a threat to savers), rising interest rates (a threat to borrowers), etc. For many the struggle for one’s daily bread has not lost its urgency. If you lived on a sink estate in Birmingham (a city especially hard hit in the recession of 2009/2010) what would worry you most: global CO2 emissions, or the very real risk of losing your job or having your car repossessed or being refused credit? What would be uppermost in your mind: species diversity or the easy availability of hard drugs to teenagers, including your own children who had just left school with few qualifications and little hope of getting a first job?

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Looking forward to the Copenhagen conference The Economist (2009: 12) ventured: Public awareness of global warming picked up significantly about three years ago .... But consumers’ commitment to greenery is rather doubtful. There is a big market for organic products ... but shoppers are more concerned about their families’ health than about the planet, and few are prepared to pay premium prices for green products .... Global carbon-dioxide emissions have risen by 20% since the [Kyoto] protocol was signed in 1997, so the plan has evidently not worked all that well. Given that almost everyone has an agenda (The Spectator, for example, is noted for its right-ofcentre editorialising), such comments should be treated with a degree of scepticism. Logically such scepticism should also extent to totalising narratives like Beck’s Risk Society thesis. The remainder of this Unit has been authored by Lucy Easthope, a member of the external team of the Civil Safety and Security Unit (CSSU). It was written over the summer/autumn of 2009.

8.2 Objectives This Unit has two main objectives. First it explores the floods that devastated parts of the UK in 2007. Secondly, and more specifically, it explores the social aspects of disasters like these by drawing on UK case studies and also the aftermath of Hurricane Katrina in the United States of America in 2005. Pre-existing vulnerabilities and social and political conditions cannot be extricated from the disaster response and recovery, and this conjunction is also discussed here. To describe and critically analyse the events a number of enquiries and reviews into both the UK and USA incidents have been referenced: most prominently the review conducted by Sir Michael Pitt into the UK floods of 2007.

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This Unit also highlights the importance of applied research conducted in universities in collaboration with communities affected by disaster and draws on a number of recent studies. Data and images from various studies are drawn upon throughout, and the methodology of one study, an ethnography of a community affected by floods, is explored in more detail, with an opportunity for the student to review examples of research material collected. This Unit poses a number of questions for students to consider: • What are the health and social impacts of events such as flooding? • How do key emergency management discussions such as those around concepts of Recovery and Resilience apply here? • How can governments (at local, regional and national levels) plan to respond to these impacts? • Would Impact Assessments help to mitigate some of these issues?

Flooding occurs from a number of sources: • River (Fluvial) flooding occurs as a result of water overflowing from river channels • Surface water (Pluvial) flooding occurs when natural and man-made drainage systems have insufficient capacity to deal with the volume of rainfall • Groundwater flooding occurs when the level of water underground rises above its natural surface • Coastal flooding occurs when the sea level rises above the level of coastal land The events that occurred in the summer of 2007 were characterised by fluvial and pluvial flooding, and there was direct flooding of areas with insufficient drainage capacity. (Adapted from Pitt, 2008) In the United Kingdom, The Environment Agency leads on working with the public to prepare for flooding in their area1. Enshrined within the Civil Contingencies Act 2004 is the principle of Integrated Emergency Management and as a result of this local authorities work together with the emergency services and the Environment Agency to develop flood plans, evacuation plans and also carry out mitigation work such as drain clearance and barrier repairs.

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8.3 A Background to Flooding

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When major flooding occurs often one of the first actions is to evacuate displaced residents to rest centres. Once the waters have been cleared, a clean-up operation can then begin.

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Their website is at http://www.environment-agency.gov.uk as at 1st October 2009.

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8.4 Introduction to the floods of 2007 Internationally in 2007 there were over 200 major floods which affected 180 million people. During the August 2007 monsoon season in South East Asia over 16 million people were displaced (Oxfam International, 2007). The human cost of the floods internationally was more than 8,000 deaths and £40 billion worth of damage. However, in terms of economic losses, the flooding that devastated England ranked as the most expensive in the world in that year (Pitt, 2008).

8.4.1 Flooding in the United Kingdom The weather that swept England in June and July 2007 was unusual, especially at a time of year that is normally more clement:

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The thing that really freaked everyone out with this last flood was that it happened in the summer … and it just came so quickly, before anyone could really act (a West Oxfordshire householder cited in Pitt, 2008) In England, 55,000 properties were flooded, 7,000 people were rescued from the flood waters and 13 people died. Some areas were particularly badly affected. In June, the focus was on South Yorkshire and Hull. In July, it was Gloucestershire, Worcestershire and the Thames Valley. Many more areas were affected to a lesser but still significant degree (Pitt, 2008). A specific summary for each of the UK areas affected can be found on the Environment Agency website at http://www.environment-agency.gov.uk. The effects on the United Kingdom of the floods in 2007 should not be underestimated. As Pitt stated in his foreword: The floods of last year caused the country’s largest peacetime emergency since World War II. The impact of climate change means that the probability of events on a similar scale happening in future is increasing. So the Review calls for urgent and fundamental changes in the way the country is adapting to the likelihood of more frequent and intense periods of heavy rainfall. We have searched for practical solutions to highly complex problems and thought carefully about the public interest. Our recommendations are challenging and strong national leadership will be needed to make them a reality. (Pitt, 2008: vii)

8.4.2 The UK: A history of flooding Flooding is not unusual in many parts of the UK but historically events have tended to be as a result of either river or coastal flood hazards. Increasingly, however, concerns are raised about drainage and surface water flooding, in areas that were not previously impacted. In Doncaster, just one of the many areas severely flooded in 2007, records relating to the flooding of communities span over 500 years (as evidenced by collections held at the local museum) and the echoes of the past bear striking resemblance to the kinds of narratives captured in 2007:

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You can still see the tidemarks on some of the houses, on the old houses... So you’ve got tidemarks from the, the ‘30s, the ‘50s and 2007. We’ve got tidemarks, if you look on, if you look closely on the old houses. I mean you’ve got to stand and sort of look, really look, and people might think you’re odd.... And if you look you can see the tidemark... and some people when they’ve been decorating the houses before the, these floods, they found tidemarks in the houses, of where the water’s been. (Easthope, 2009)

The following year floods again caused devastation, this time in Cumbria, when a major incident was declared by Police on the 8th January 2005 and thousands of people were moved from their homes. In one area, Carlisle, 6,000 residents in 3,500 homes were directly affected by water inundation and 60,000 homes were cut off from electrical supplies (Convery, 2008). This, then, is the historical setting against which the events of 2007 should be assessed.

8.4.3 The Civil Contingencies Act 2004 and the floods It is also important to note that the floods in 2007 occurred a number of years after the enactment of the Civil Contingencies Act 2004 in the UK. The duties this Act imposes on emergency responders had, therefore, been in force for over two years. Accordingly, prior to the events of 2007, many areas did have flooding rated as a high risk on their Community Risk Register and plans were in place to deal with flood risks, including warning and informing the public about the risks. However the scale of events and the long-lasting effects still took many by surprise and despite planning and preparedness, The Pitt Review describes how the scale and speed of the floods in summer 2007 came as a shock to people generally:

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Historical records, such as those in Doncaster, provide evidence that human settlements in the UK have been exposed to flood hazards for perhaps as long as they have existed. The twentieth century, however, provided numerous memorable events which have each tested the institutional capacity to cope. These include the Thames floods of 1947, the Lynmouth flood disaster of 1952 (this event is strikingly similar to the recent Boscastle flood disaster (see Eric Delderfield’s book The Lynmouth Flood Disaster)), the East Coast storm surge of 1953 and more recently the widespread inundations of 1998 and 2000 (Johnson et al., 2005). These events have continued throughout the past decade, with the UK suffering a number of iconic floods, such as that which occurred on August 16th 2004, when a severe rain storm triggered flash flooding, which devastated parts of the village of Boscastle in North Cornwall.

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Even if people were aware that heavy rain was forecast, they did not expect it to affect them, and certainly not so seriously. Most people had never experienced flooding like this before and did not know how to react – what preventative steps to take or who to call for help. (Pitt, 2008: 7)

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8.4.4 Sir Michael Pitt’s Review Sir Michael Pitt and his review team were asked by the UK Government to undertake an independent examination of the lessons that could be learned from the summer floods. This resulted in an interim report in December 2007, and then a final report published in June 2008. The Pitt Review makes 92 recommendations which can be viewed in full by downloading the report (see bibliography). The UK government has pledged to address key areas and there was a formal response published by the UK Department for Environment, Food and Rural Affairs (DEFRA) which stated that: Sir Michael has rightly put the needs of ordinary people at the heart of his Review. It identified six themes covering what people need: • Knowing when and where it will flood: • Improved planning and reducing the risk of flooding and its impact: • Being rescued and cared for in an emergency:

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• Maintaining power and water supplies and protecting essential services: • Better advice and helping people to protect their families and homes: and • Staying healthy and speeding up recovery. The Government supports changes in response to all of the recommendations in the Review. The Government is taking steps in response to these and has already taken action on a number of the recommendations. Investment required for longer term implementation will be considered as part of the next comprehensive spending review and any net new burdens for local authorities will be fully funded. (DEFRA, 2008) The Pitt Review paid specific attention throughout to the affects of flooding on people and their communities. One of the chapters that examines these specifically has been reproduced here in the further reading.

8.5 Social Aspects of a Flooding Disaster In the United Kingdom it could be argued that there is now a particular paradigm of psycho-social perspectives on disaster. A specific government department, the Department of Culture, Media and Sport, has lead responsibility for guidance relating to what has been termed humanitarian assistance after disaster and working groups on this subject operate out of all Local Resilience Forums. The strategies for responding to and managing people affected by disaster are evidenced in many government publications e.g. see Cabinet Office, 2009a. A primary objective of this unit is to explore the ways in which flooding will affect the individual and also the fabric of the community, and ways in which emergency response can be problematic in relation to this aspect.

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First it is salient to highlight the physical impacts of a flooding event: You had to keep looking at the picture postcards to remind yourself what it used to be like. There were no buildings now where centuries-old homes had once stood. No trees where there used to be shade from the summer sun, nor any sound from the shops that once bustled with activity .. And no happy holidaymakers now, not a single one, only an army of rescue workers picking methodically through teetering wreckage. (Harris, 2004) This newspaper quote describes a journalist’s interpretation of the picture that met him as he arrived in the village just a few days after the floods in Boscastle in 2004. It conveys some sense of the damage and loss felt by a community after it has experienced floods.

Work by Disaster Sociologists such as Dr Anne Eyre and Kai Erikson illustrate just how traumatic any sort of sudden event that affects people on both individual levels and as a community (or as a member of ‘several communities’) can be (see Eyre, 2006, and Erikson, 1994). This discussion also reacquaints us with different definitions of disaster and different definitions of trauma: concepts and legal arguments around aspects of disaster management such as post-traumatic stress disorder place great emphasis on events that involve confrontation with serious injury or death (e.g. see the discussions within Adamou and Hale, 2003) whereas events such as floods may be perceived as ‘less traumatic’. The statistics from areas such as Hull indicate the human story within. According to Coulthard et al. (2007) 2,681 households were displaced from their homes and over 1,400 people ended up living in caravans. In some cases this was for over a year. This means families, elderly, pets, all living in temporary homes, in some cases taken away from their existing support networks, while their own places of safety are dried out and rebuilt. Convery defines the health and social impacts of a flooding event in more detail: The potential health and social impacts of flooding range from immediate death, injury and harm from contaminated water, through to detrimental longer term health and social impacts caused by damaged homes, loss of possessions, financial worries, forced moves into temporary accommodation and fear of vacant homes being burgled.

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Arguably, during the aftermath of environmental hazards such as flooding, the impacts on people have not always been fully considered. Responders may tend to think in terms of a hierarchy of traumatic events and subconsciously will rate events like air crashes or bombings as being ‘different’ and ‘more serious’ in terms of their potential to cause trauma. This discussion reacquaints us with key themes from modules one and two: particularly concepts of quantitative risk assessment focussing on physical impacts rather than harder-to-define psycho-social consequences. There is also the historical perspective on emergency management where the focus was on saving life and limb: survivors are ‘lucky to be alive’ and therefore the loss of homes or personal effects may appear insignificant in the bigger picture.

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(Convery, 2008: 4) Understanding these potential impacts is the responsibility of emergency responders and coupled with them are a number of concepts that come into play in disaster. These are discussed in the next section.

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8.6 Key Concepts There are a number of key concepts that are embedded within the discussions of the social aspects of a disaster and are highlighted repeatedly within the material supplied with this unit. It is therefore necessary to explore them in more depth. Resilience The Pitt Review defines resilience as: [T]he ability to recover readily. (Pitt, 2008: 349) In the context of the floods he applies this to the ability of both individuals and communities to withstand the consequences of the event, and states that the review has received many illustrations of this:

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[T]he extent to which communities came together to respond to the flooding events was both heart-warming and commendable. (Pitt, 2008: 348) A resilient system will need to expend fewer resources on recovering than one which lacks resilience and that leads on to a discussion of recovery. It is crucial to remember that many people demonstrate resilience and fortitude in the face of extreme events, and again this concept has been a regular area of discussion in disaster sociology (e.g. see Eyre, 2006, and Erikson, 1994). The entrance of the term resilience into disaster discourse could be seen as the birth of a new culture of disaster response. The outcomes of the 2005 World Conference on Disaster Reduction (WCDR) confirmed that the concept has gradually found more space in both theoretical and practical terms in a wide range of disaster risk reduction discourse areas and in some interventions. Phrases like ‘sustainable and resilient communities’, ‘resilient livelihoods’ and ‘building community resilience’ have become common in journal articles and programme documents. (Manyena, 2006: 433) This is also illustrated by the usage of the term resilience in the UK emergency response lexicon e.g. the UK government chose to name their emergency response website ‘UK Resilience’ (now absorbed into the Cabinet Office website), and the forums used to oversee emergency initiatives at local and regional level under the Civil Contingencies Act 2004 are termed Local and Regional Resilience Forums. Recovery In the Autumn of 2009 the UK Government released an updated version of guidance designed to accompany the Civil Contingencies Act that is specifically concerned with responding to, and recovering from emergencies. This states that:

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Recovery is defined as the process of rebuilding, restoring and rehabilitating the community following an emergency, but it is more than simply the replacement of what has been destroyed and the rehabilitation of those affected. Local communities may also look upon an emergency as an opportunity to regenerate an area. Regeneration is about transformation and revitalisation. (Cabinet Office, 2009a: 104) Recovery from floods can be a long-term process, sometimes taking many months and even years. The case studies highlight the many complications that can affect the pace of the recovery. ‘Recovery’ from a disaster has been a source of debate in text books and journal articles for many years, with much of the discussion focussed on whether it is a useful heuristic to create a clear phase of disaster, or whether it is in fact a dangerous myth (e.g. see Wisner et al., 2004) that creates an inaccurate model of phased development resulting, finally, in a ‘recovered’ community. In addition to questioning the ‘orderliness of recovery’, researchers have also highlighted the evidence that suggests:

(Fothergill et al., cited in Wisner et al., 2004: 358) This leads on to a discussion of vulnerability. Vulnerability Concepts of vulnerability have proved equally controversial: Disasters visit those who don’t expect them but they do not strike entirely at random. Discharged along the lightning conductors, they preferentially affect the underprivileged: third world inhabitants: ethnic minorities: physical and manual workers: women, or isolated old people. ‘The issue’ writes Charles Perrow in the 1999 ‘Afterword’ to his Normal Accidents ‘is not risk but power’. The greater the distance, social, political, economic, cultural and geographical, from the powerful, the greater the vulnerability if something goes wrong. (Law and Singleton, 2004: 2) Like many disasters before, the recent studies into the social consequences of the 2007 floods, have highlighted the issue of people who are vulnerable before, during and after the emergency. The UK Government has attempted to address this issue with guidance to local authorities on how to support and manage vulnerable people within their local populations (Cabinet Office, 2009b). Certain vulnerabilities do require specific practical measures such as treatment for medical conditions like diabetes and hypertension that require regular medication. However, vulnerability can also be dynamic over time and space: it can be acute or chronic in nature, dependent upon individuals’ circumstances.

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...people who were marginal, excluded and who enjoyed poor access to power and resources before a disaster may lag behind the recovery model’s tidy curves and face greater difficulties in accessing assistance.

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However it can be detrimental to consider those caught up in a disaster as being inherently vulnerable, as the discussions about resilience above, and social capital below illustrate. Furthermore it is important to acknowledge that the emergency responses put in place can actually exacerbate

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the situation e.g. a person in a wheelchair may be very used to living independently prior to the emergency, but if, as part of an evacuation, we put in place busses that do not have ramps, we could be seen to be creating a vulnerability that was not previously there. Social Capital Social Capital has become a key theme within discussions of resilience during, and recovery from disasters, and has been simply defined as: [T]he capacity of a community to help itself or its resilience. (Coulthard et al., 2007: 8) It is based around the premise that people in disasters often demonstrate strength, fortitude and innovation after events like these (Barton, 1969; Dynes, 2005). Testimonies captured after the 2007 floods reinforce this:

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The people of Hull proved remarkably resilient when it came to coping with the severe disruption caused to their homes, lives and livelihoods by the flooding, reflecting the underlying strength of communities and the social cohesion within neighbourhoods in the city. This underlying strength needs to be more fully appreciated and better capitalised upon. (Coulthard et al., 2007: 10) Testimonies from many of the areas flooded, such as parts of Hull and Doncaster, capture the vibrancy of the community as they worked to recover their own areas. Woolcock and Narayan (2000: 226) defined social capital as: [T]he norms and networks that enable people to act collectively. They expand on this further with this analysis: Intuitively, then, the basic idea of social capital is that a person’s family, friends, and associates constitute an important asset, one that can be called on in a crisis, enjoyed for its own sake, and leveraged for material gain. What is true for individuals, moreover, also holds for groups. Those communities endowed with a diverse stock of social networks and civic associations are in a stronger position to confront poverty and vulnerability (Moser, 1996; Narayan, 1995), resolve disputes (Schafft, 1998: Varshney, 2000), and take advantage of new opportunities (Isham, 1999). (Woolcock and Narayan, 2000: 226) The practical application of these concepts in an emergency planning setting may lead responders to explore ways of mapping who is vulnerable in their community. It may also lead responders to try to identify where the social capital can be found before any emergency. These inquiries may find expression in an Impact Assessment (IA). (See, for example, Boin and McConnell (2007)). Impact Assessments The idea of capturing the damage caused by the disaster after the devastation is not a new one and is used frequently by organisations such as aid agencies working in developing nations. These are often termed Disaster Impact Assessments (DIAs). Arguably these are also linked to an ethos that disaster management works best when grounded and integrated within the community.

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There are numerous examples available on the internet, including examples from the United Nations and countries such as Australia, New Zealand, America and Canada, where their use is more prevalent (Manitoba Emergency Measures Organisation (EMO), 2009). There is also a move towards capturing some information pre-emptively to gather an indicative picture of the needs of a particular demographic area. Various iterations of this idea are emerging with titles such as ‘social impact assessments’ and ‘community needs templates.’ These preemptive approaches to assessment could be argued as representing effective attempts to interpret the community strength and social capital that exists within an area. A number of UK local authorities have begun to develop pre-emptive community impact assessments as part of their flood plans, often using software systems and Geographic Information Systems (GIS). We have yet to see true evaluations of their effectiveness in a major UK emergency, and there are concerns that information could be subjective and biased. However, international examples have suggested that they could be an extremely useful tool (Easthope and Coles, 2009).

Insurance is a way of transferring some elements of the risk of flooding, and arranging financial cover for aspects such as damage to homes and lost personal items. A number of Western nations underwrite flood risk on behalf of their citizens, but the United Kingdom does not, and issues around insurance prove increasingly problematic after flooding (Pitt, 2008; Sims et al., 2008). People who were not insured at all, or were underinsured, may face considerable hardship. Policy makers struggle with the best way to help here, because if they provide too much support it can be argued that they are incentivising a decision to not insure. This can cause resentment from people who have prioritised this cost within their household budgets. Since the floods of 2005 and 2007, it has also proved much harder or much more expensive to get insurance in certain areas (Rodgers, 2007).

8.6.1 Key Concepts: An Exercise When reviewing the articles supplied with the unit it is a good idea to draw up a table like this one. Within the articles try to find examples of the following concepts ‘in action’: Examples of: Resilience

The references from the articles (in the course style, and please remember to include page numbers)

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A Word on Insurance

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8.7 Comparative Case Studies Using a case study from 2007 and the further example of the aftermath of Hurricane Katrina in 2005, these case studies will highlight practical examples of the concepts discussed above. For the

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Hull case study much of the material is drawn from two academic studies initiated soon after the floods (which demonstrate the importance of acting quickly to capture research data).

8.7.1 Capturing a case study It can be deceptively easy to impose a chronology of events and experiences after the emergency that fail to capture the ‘realtime’ process of recovery. A number of research studies in recent years have attempted to chronicle the experiences of individuals and the communities to which they belong. One such study is: Flood, vulnerability and urban resilience: a realtime study of local recovery following the floods of June 2007 in Hull Since 2007 Lancaster University has been conducting research with people affected by the floods in Hull. Local people agreed to keep diaries which could then be analysed as qualitative data. Co-funded by the Environment Agency, this project is a real-time longitudinal study of flood recovery following the events in Hull. The project’s aim was to document and understand the everyday experiences of individuals following the floods of June 2007. Full details of the project are available at http://www.lec.lancs.ac.uk/cswm/Hull%20Floods%20 Project/HFP_%20outputs.php The specific objectives of this research were to: • Identify and document key dimensions of the longer term experience of flood impact and flood recovery, including health, economic and social aspects. • Examine how resilience and vulnerability are manifest in the interaction between everyday strategies of adaptation during the flood recovery process, modes of institutional support and the management of infrastructure and built environment. • Explore to what extent the recovery process entails the development of new forms of resilience and identify the implications for developing local-level resilience for flood recovery in the future.

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• Develop an archive that will be accessible for future research. By developing an archive that will provide an ongoing public resource, researchers will be able to bring different perspectives to the analysis of peoples’ experiences of the flood recovery process. There is also an important capacity-building role to the archive because, by empowering participants to articulate their experiences, the project is helping to build a group of ‘community experts’ that the authorities can draw on in future. The findings of this study, and those from an additional study looking at the technical aspects of the events are used here.

8.7.2 The floods in Hull

exacerbated the problem. The review highlighted serious issues with the design, maintenance and operation of Yorkshire Water’s (the water company responsible for this area in the UK)pumped-drainage system, and concerns were raised that the company had failed to address recommendations that had been made to them as early as 1996 (Coulthard et al., 2007: 62).

8.7.3 The response in Hull The floods of 2007 were potentially a real test of the effectiveness of the Civil Contingencies Act 2004, as by now the duties imposed on local emergency responders had been in force for over two years. A number of areas for attention were raised in official debrief reports such as: • Examine the declaration of a Major Incident, and involvement of Category 2 Responders • Assess how best to manage volumes of emergency calls during exceptional conditions and develop resilient communications • Determine multi-agency preparedness for Severe Weather Warnings • Determine appropriate arrangements for alerting of support services and raising awareness of available resources • Ensure the competence of volunteer responders • Determine how to provide a visible focal point for Communities during an Emergency

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In June 2007, the city of Kingston upon Hull, like many other cities across the United Kingdom (UK), experienced unusually high rain fall. According to an independent review, conducted by a team chaired by Professor Tom Coulthard, 8,657 residential properties and 1,300 businesses were damaged by the resulting floods. This review found that the main reason this city was so badly flooded was because the drainage system was overwhelmed. Its low-lying position

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• Consider evacuation issues • Ensure that organisations address flooding from Drains / Sewers and other watercourses and address contingency issues associated with them • Determine the most appropriate mechanisms for managing Government information requests during an incident • Examine how best to predict further flooding events

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• Ensure that the protection of critical infrastructure is addressed • Determine how best to address road closures and traffic management issues in flooding emergencies • Examine the approach to ‘standing down’ from emergency situations • Discuss how we can better understand the scale of emergencies • Undertake a review of the Command and Control Structure operated during an emergency • Discuss the predicting of flash / storm flooding • Address the Military Aid to the Civil community dimension • Address the potential for improved Local Authority Mutual aid Support • Determine how best to use the Flood Warnings Direct Service. (Humber Local Resilience Forum (LRF), 2007: 5)

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These action points illustrate that while many aspects of the response did work well, there were still fundamental areas that required attention.

8.7.4 Pre-Existing Social Vulnerability in Hull According to Coulthard et al. (2007) the statistical profile of Hull identifies it as one of the most deprived cities in the country. In 2008, over half of the population lived in neighbourhoods amongst the 20% most deprived in England, and it was the ninth most disadvantaged of the 354 English local authorities.

8.7.5 Schools Schools were particularly badly affected by the flooding in Hull: 91 schools were damaged and 114,000 pupil-days were lost (Coulthard et al., 2007). Schools are not just a place of education but a social hub too, and their closure can be particularly disruptive to the local community.

8.7.6 Tackling Vulnerability Local responders attempted to identify those who were vulnerable and graded them according to need: To maximise care for the vulnerable a graded response was adopted where households were classed as gold, silver and bronze and received different levels of care accordingly. (Coulthard et al., 2007: 61) A Community Wardens scheme ‘proved to be an effective and flexible human resource’ (Coulthard et al., 2007: 18) during the floods. This was initiated by the local authority (rather than a spontaneous response from within the community) and they were involved in many tasks including evacuations, giving out information, providing information about the situation on the ground and the distribution of cleaning equipment.

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8.7.7 Recovery Early findings from the Hull studies have shown that the stresses involved in flood recovery can have a profound effect upon people’s mental and physical health and wellbeing, while interview and diary transcripts also illustrated the difficulties involved in making insurance claims and managing builders. Tenure was also found to have an impact, with home owners, private renters and council tenants often having different experiences of flood recovery (Medd et al., 2008). Findings to date have informed the Pitt Review. Various other national recovery initiatives and recommendations have been made about how flood recovery could be handled. An article by the authors has been included in the additional reading here.

8.7.8 The Aftermath of Hurricane Katrina, August–September 2005 This second case study provides an international comparison. Research material here is drawn from both official reports and academic critique of the response. The aftermath of Hurricane Katrina was particularly severe: When Hurricane Katrina made landfall near the Louisiana-Mississippi border on the morning of August 29, 2005, it set in motion a series of events that exposed vast numbers of Americans to extraordinary suffering. Not only would Katrina become the most expensive natural disaster in U.S. history, it would also prove to be one of the deadliest. (U.S. House of Representatives, 2006: 7) In August 2005, Hurricane Katrina caused devastation across large parts of America, and not just New Orleans which received much of the media attention. Mississippi, for example, was left without power and severely damaged by wind and water: the U.S. House of Representatives estimated that 66,000 Mississippians were displaced from their homes. Geographical factors combined to unleash terrible consequences: While winds upon landfall were not as powerful as those of Hurricane Camille in 1969, Katrina was in many ways the ‘perfect storm’ for coastal Mississippi. The combination of high winds, extraordinarily low barometric pressure, and arrival during a high tide resulted in a storm surge nearly twice that of Camille’s.

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As the article by Medd et al. (2008) (please see the reading) illustrates, those flooded often went on to endure months and even years of hardship: this included living in small spaces such as caravans, watching as homes are torn apart as part of the drying and rebuilding process, coming to terms with the loss of precious personal items and trying to return to a normality where normal infrastructure, support networks and transport providers have also been affected. This was also mirrored in many other parts of the country (Easthope and Coles, 2009).

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(U.S. House of Representatives, 2006: 8) New Orleans is a city built primarily below sea level so levees (bunds or low dams) had been designed to protect it. Some overtopping of the levees had been expected but when Hurricane Katrina hit, the levees broke in 13 locations allowing both sea and river water to inundate the city (Cabinet Office, 2006).

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Residents who had not evacuated either stayed put, or fled to points of higher ground, and 30,000 people congregated in the New Orleans Superdome, 25,000 people at the Convention Centre and 14,000 people on the bridges on the I-10 highway intersection (Cabinet Office, 2006).

8.7.9 The Response to Katrina The response to Katrina was hampered by many serious factors including a lack of access to affected areas and a complete loss of communications. The Louisiana State National Guard was mobilised as was the Coast Guard, Environment Protection Agency and Department of Wildlife and Fisheries. Over 100,000 people were saved by these agencies, which was nearly a quarter of the population (Brunsma et al., 2007: 239). Responders such as police were stranded themselves, or in some cases evacuated with their own families (Cabinet Office, 2006): this ‘role abandonment’ aspect of Katrina was, however, unusual in the context of the disasters literature, which shows it to be extremely rare (Friedman, 1986). The governmental response was strongly criticised:

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Hurricane Katrina represented a major test of the policies and practice developed to protect the nation following the 9/11 attacks in 2001. The collapse of the emergency response system at all four levels of jurisdiction – city, parish, state, and federal – revealed serious flaws in governmental capacity to act in response to threat. (Comfort, 2005: ii) A key feature of much of the commentary since 2005 has centred on pre-existing tensions between local and national-level responses, and the way in which this affected the response: Louisiana is a relatively small and poor state, and it lacked the resources to handle a catastrophe on its own. Louisiana officials’ belief that they lacked resources—a key advisor to the governor admitted as much one month before Katrina struck—might have encouraged state and local officials to rely on the federal government in their disaster plans more than they should have. During the actual disaster, however, federal officials criticized state and local leaders for not requesting federal aid sooner. Inadequate state and local resources, combined with federal help that was too slow to arrive left New Orleans without sufficient capability to respond. One reason the federal government exists, however, is to support states and localities that are overwhelmed by a rare event. The federal government, and especially FEMA, was caught unprepared for a major urban catastrophe. The danger hurricanes posed to New Orleans was well known, and the Department of Homeland Security had encouraged states and cities to file emergency preparedness plans. New Orleans had such a plan, but it was never subject to strict scrutiny by federal officials. As a result, the plan failed to anticipate the damage that could be caused by a large and intense hurricane at landfall. It also lacked guidelines for dealing with additional failures, such as the levy break, radio and cell phone breakdowns, and lawlessness. A plan cannot ensure a perfect response but it can prompt serious thought about how to cope with the unexpected contingencies that accompany a major catastrophe. (Roberts, 2005: 5)

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8.7.10 The Social Consequences of Katrina The scale of the devastation that occurred in 2006 is hard to imagine: The Infrastructure, and with it any semblance of normality, had been utterly destroyed. There are no shops, no schools, and most forms of employment (except those trades engaged in the recovery process) have been lost. (Cabinet Office, 2006: 24) It is often the case that the social and political aspects of a disaster are linked (Wisner et al., 2004). Also, as with the floods in the UK, pre-existing vulnerabilities and pre-existing tensions are highlighted and further exacerbated in the aftermath. New Orleans was classified as the ninth poorest city in the USA, and 70/% of the population were African American. Louisiana had the fourth highest poverty rate in the Country. Around 120,000 people in New Orleans do not own their own cars (Cabinet Office, 2006)

The loss of life reflects this inequality: in Louisiana approximately 71% of the victims were older than 60 and 47% of those were over 75. At least 68 dead were found in nursing homes, some allegedly abandoned by their carers (Cabinet Office, 2006). Tragically the final death toll may remain unconfirmed as some people are missing and it is feared that not all of those lost in the disaster were able to be recovered.

8.7.11 Housing after Katrina In the longer term, thousands of people did attempt to carry on living in their own homes but many others were displaced, so use was made of trailer parks and temporary housing units. Financial assistance with rent, housing repairs, other emergency costs, crisis counselling, unemployment support etc. was provided, with a cost of over $3 billion by December 2005 (Cabinet Office, 2006). As a lesson identified from Katrina, post-disaster housing has become a major theme of reconstruction and recovery conferences in recent years (Easthope and Coles, 2009) and there is now a particular focus on temporary structures that can be made available quickly (FEMA, 2009).

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When people are ordered to evacuate, as was the case before the hurricane hit, there is a crucial assumption made that people have somewhere to go and some way of getting there. In August 2005 many people were still in their homes and had not evacuated: typically these were older people, less mobile people, people without cars (please see the statistics above), and those unable to move ‘through poverty or disadvantage, disability or special circumstances’ (Cabinet Office, 2006: 6).

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8.7.12 A Postscript to Katrina In the final chapter of Brunsma et al’s (2007) work on this disaster, the author Lee Clarke states that there can be no postscript to Katrina because the disaster is still ongoing but that his final chapter can be used to ruminate on the event (Clarke cited in Brunsma et al. 2007: 235). This is arguably true of all the case studies used in this unit. Clarke also goes on to initiate a discussion that is recurrent within Disaster Sociology:

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If Katrina revealed anything it was that institutional failures put people in harm’s way. The flood controls were inadequate. Subsidence of the ground beneath New Orleans was caused by human activities. Poverty is entirely the result of institutional arrangements. …The label ‘natural disaster’ carries risks of its own, especially that it deflects attention and responsibility from the institutions that actually put people at risk’. (Clarke cited in Brunsma et al. 2007: 237)

8.8 An Ethnographic Study of a Community In Recovery after Flooding: A Researcher’s Perspective This section provides a first person account of a member of the Leicester University Civil Safety and Security Unit (CSSU) external team’s recent research.

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This research was conducted in a South Yorkshire village near to where she was living, and was initiated immediately after the flood waters had receded in 2007. Note: The term In Recovery has been placed in italics to highlight the ambiguity of this concept, and the tensions that surrounded it: a very practical example of this would be the way in which local people would query the use of the term ‘in recovery’ in relation to their own experience during my field work. My field notes show people deriding it as an overly-formal, process-focussed term, a preferred term of responders but not of those who were flooded (Easthope, 2009). This also illustrates how there can be multiple worldviews and perspectives on an incident.

8.8.1 What is Ethnography? Through my explorations in the last few years I have come to realise that the exact definition of ethnography may be far from coherent, with many different types of research taking inspiration from an ethnographic approach. These would include observations, case studies and the study of individual life histories. There are also political difficulties with definitions as it is often described as originating from Western anthropology but this has a complex history involving concerns about colonialism, cultural bias and exploitation. It is therefore much easier to describe it in terms of what an ethnographer actually does in the field: [E]thnography usually involves the researcher participating, overtly or covertly, in people’s daily lives for an extended period of time, watching what happens, listening to what is said, and/or asking questions through informal and formal interviews, collecting documents and artefacts – in fact gathering whatever data are available to throw light on the issues that are the emerging focus of inquiry. Generally speaking ethnographers draw on a range of sources of data, though they may sometimes rely primarily on one. (Hammersley and Atkinson, 2007: 3)

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For my own study this involved: • Observation: in people’s homes and temporary homes, their caravans, out on the streets, at community clubs, flood warden meetings (This was my main type of field work) • Interviews and testimonies or ‘oral histories’ of the events • Setting up discussion groups with local residents and local responders • Collection of artefacts e.g. council leaflets distributed to residents, newsletters and flyers, health and safety advice • Putting on an exhibition in conjunction with the local council and local people that displayed art work, crafts, poetry and photographs that had been produced between 2007-2009 • Taking over 1200 digital images

Please take a few minutes to examine them. Try to list the key themes that you would identify if you were analysing the images.

© Lucy Easthope, 2008

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Below are examples of these images and also extracts from the raw data which are being analysed thematically. They were also displayed at both the Doncaster Museum and Art Gallery and the Cabinet Office Emergency Planning College in 2009.

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In the village of Toll Bar, Doncaster, UK the local council took the decision to create a park of mobile homes for people displaced by the floods. The floods had caused damage across Doncaster, and in this particular area a large number of families were in council housing. They asked the council to keep them all together rather than displace them to other types of temporary accommodation such as hotels and guest houses. The council utilised lessons from Hurricane Katrina as there can be pitfalls with an approach such as this.

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© Lucy Easthope, 2008 Rebuilding and regenerating a community after a disaster takes many months and years. There are periods of transitions where an area may be dominated by building work and the clearing of waste material, as illustrated by this photograph.

© Lucy Easthope, 2008 This picture of the contents of a skip has become particularly memorable. It is often used in presentations and was displayed at the 2009 exhibition. The contents includes children’s toys, Christmas decorations, power tools, household waste and building rubble.

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The Neighbourhood Support Centre, from where recovery issues were managed, was also housed in a temporary cabin and was sited on the estate within easy reach of the caravans where local people were living.

8.8.2 The Voices of Recovery These quotes were taken from interviews with local residents: ‘We’ve got some really, really good neighbours. I mean we came into that house with nothing.... Somebody gave us a three piece suite, somebody turned up with a bed, furniture, somebody turned up with wardrobe... . ’ ‘So you see the worst of extremes, don’t you, and then you see, you see better, better sides?’ ‘These tears we cried, we sat there and we just cried and cried and cried. It wasn’t just me, it was all of us.’ ‘Something like this makes you sort of wake up and think, well, there’s a big wide world out there, you know.... There’s a big wide world out there. We just decided to embrace whatever’s coming.’

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© Lucy Easthope, 2008

‘She lives right down on the farm, down the bottom, near the rugby field, and she got flooded first. She lost everything, it’s all wiped out, all the farm stock, all gone.’ ‘Because, it’s like I said before, you’ve got to, you’ve got to experience something to understand what it’s like. Like you know like you see something on the telly, like oh, those poor souls, they got flooded, but now we can understand where they’re coming from. We can understand where they’re coming from, we know now what it’s like, and that’s why we probably will be the first to volunteer if it happens again.’

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‘We’re just taking each day as it comes. Don’t make any long term plans, cause you don’t know, cause something could happen that could take them away. Something that, erm, something like that could happen again, anywhere.’ ‘It was awful, ‘cause we went in and I automatically went to the kitchen and put my bag on the side, and thought there’s nothing there. ... They’d taken it all, because of the water, they’d taken all, the units had to go, all the walls had to be stripped back bare to the brick, and I, went in’t living room and it were just...ah, it was just like, you walked in, it’s like you’d just left everything but when I went in the settee was turned upside down, and coffee table, that was ruined, that had gone, erm, my grandma’s pictures, the mirror had gone, they’d all got wet through you see, we couldn’t touch them. The insurance, my brother’s insurance for the buildings told him he’s got to clear the lot. I mean insisted that he came in and cleared it. But, you know. Now we try and build on things. It’s just like, like coming to this time of year, erm, thinking it’s so wet and everything. You just hope it doesn’t happen again.’ [Going back to the house for the first time]

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8.9 Conclusions In the United Kingdom there is continued pressure to build new homes, and developments continue to be built in flood risk areas. Most of Hull already lies within a flood risk area. This also has parallels with the situation in the Southern States of America where building work continues in areas at frequent flood risk. Floods are an omnipresent feature in many countries’ risk profiles and with them come an array of health, social and economic issues. This Unit has endeavoured to demonstrate that the impact of flooding is not confined to the initial devastation and the consequences are often long-lasting. Like many of the other case studies used within the unit, lessons may take many years to become clearly apparent, and as flooding becomes more frequent as an event there may be little chance to implement key findings between incidents. Finally, there are many facets to any attempt to analyse a process of recovery after disasters such as these. Knowledge and understanding of these aspects are vital for emergency planners: promoting empathy, awareness and active learning.

8.10 Study questions You should now write approximately 300 words in answer to each of the questions below. This is an important exercise that will assist your comprehension of the material and aid your progress on the course. Your answers are intended to form part of your own course notes and should not be forwarded to the University. 1. Describe the ways in which the term ‘resilience’ may apply to both individuals and communities. 2. Through analysis of the quotes on pages 28-29, what themes emerge in relation to peoples’ experiences of the floods?

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3. What does knowledge and understanding of the concept of Social Capital bring to disaster management? 4. What impact does the Civil Contingencies Act 2004 have on the management of floods in the United Kingdom?

8.11 Guide to further reading You should now read the following: Article One: Medd et al. (2008) ‘Flood, vulnerability and resilience: a real-time study of local recovery following the floods of June 2007 in Hull’, in Samuels (ed.) Flood Risk Management: Research and Practice, London: Routledge. The article by Medd et al. conveys the human aspects of the aftermath of flooding. It is also useful to note the innovative qualitative methodology, a diary-based study, that is used here.

This chapter expands on/discusses the issues that pertain to the health and wellbeing of those affected by the floods in 2007. Article Three: Green, R., Bates, L. and Smyth, A. (2007) ‘Impediments to Recovery in New Orleans’ Upper and Lower Ninth Ward: One year after Hurricane Katrina’, Disasters, 31 (4): 311-335. This article reiterates the health and social aspects of flooding. There is also an interesting operational and environmental perspective. Also: For further guidance on the UK Government’s approach to disaster recovery, as well as additional case studies, please visit: http://www.cabinetoffice.gov.uk/ukresilience/response/recovery_guidance/generic_issues/ structures_processing.aspx [Date Accessed 18th August, 2009] For a comparative international framework and guidance documents visit the New Zealand government pages on recovery:

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Article Two: Chapter 25 of Pitt, M. (2008) Learning lessons from the 2007 floods: An independent review by Sir Michael Pitt.

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http://www.civildefence.govt.nz/memwebsite.nsf/srch/A6E85AE966C848B0CC256FFE001120E 9?OpenDocument [Date Accessed 18th August, 2009] Caveat: Please note that web site addresses – even those managed by government agencies – can change. If the site cannot be found through a search engine, the University of Leicester Library will be able to help. Please consult your Course Handbook.

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8.12 Bibliography Adamou, M. C. and Hale, A. (2003) ‘PTSD and the Law of Psychiatric Injury in England and Wales: Finally coming closer?’ The Journal of the American Academy of Psychiatry and the Law, 31 (3): 327-332. Barton, A. H. (1969) Communities in Disaster. A sociological analysis of collective stress situations. Garden City, NY: Doubleday & Co. Batty, D. (2008) ‘Flood Inquiry head says next disaster waiting to happen’, Guardian Online, (London), http://www.guardian.co.uk/environment/2008/jun/04/flood.review; accessed 18 August, 2009. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage Publications.

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Boin, A. and McConnell, A. (2007) ‘Preparing for Critical Infrastructure Breakdowns: The Limits of Crisis Management and the Need for Resilience’, Journal of Contingencies and Crisis Management, 15 (1): 50-59. Brunsma, D., Overfelt, D. and Picou, S. (2007) (eds.) The Sociology of Katrina: Perspectives on a modern catastrophe, Maryland: Rowman and Littlefield. Cabinet Office (2006) Hurricanes Katrina and Rita: A Perspective. A report produced by the Cabinet Office Civil Contingencies Secretariat, London: Civil Contingencies Secretariat. Cabinet Office (2009a) Emergency Response and Recovery: Non Statutory Guidance accompanying the Civil Contingencies Act 2004. Version Two (Updated July, 2009); available online at: http://www. cabinetoffice.gov.uk/ukresilience/preparedness/ccact/errpdfs.aspx; accessed 18 August, 2009. Cabinet Office (2009b) Identifying people who are vulnerable in a crisis: Guidance for Emergency Planners and Responders; available online at: http://www.cabinetoffice.gov.uk/ukresilience/ news/vulnerable.aspx; accessed 18 August, 2009. Clarke, R. (1985) Science and Technology in World Development, Oxford: Oxford University Press. Coffey, A. (1999) The Ethnographic Self: Fieldwork and the Representation of Identity, London: Sage Publications. Comfort, L. (2005) ‘Fragility in Disaster Response’, The Forum, 3 (3): 1-8; available online at: http:// www.bepress.com/forum; accessed 10 August, 2009. Convery, I. and Bailey, C. (2008) ‘After the Flood: the health and social consequences of the 2005 Carlisle Flood event’, Journal of Flood Risk Management, 1: 100-109. Coulthard, T. J., Frostick, L., Hardcastle, H., Jones, K., Rogers, D., Scott, M. and Bankoff, G. (2007) The 2007 floods in Hull. Final report by the Independent Review Body, 21st November; available online at: http://www.coulthard.org.uk/hullfloods/; accessed 18 July, 2009.

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Delderfield, E. R. (1981) The Lynmouth Flood Disaster, Exmouth: ERD Publications. Department of Environment, Food and Rural Affairs (2008) The Government’s Response to Sir Michael Pitt’s Review; available online at: http://www.defra.gov.uk/environ/fcd/floods07/Govtresp topitt.pdf; accessed 18 August, 2009. Dynes, R. R. (2005) Community social capital as the primary basis for resilience (#327) University of Delaware, Disaster Research Center; available online at: http://dspace.udel.edu:8080/dspace/ handle/19716/1621; accessed 1 October, 2009. Easthope, L. (2009) Transcribed Interview notes for Technologies of Recovery: Plans and Situated Realities, Doctoral Studies, Lancaster University, United Kingdom. Easthope, L. and Coles, C. (2009) ‘Post-Disaster Housing’, Proceedings of the Federal Emergency Management Agency Higher Education Conference. May 31-June 5, Washington: Federal Emergency Management Agency.

Environment Agency (2007) Our Review of the 2007 Floods; available online at: http://www. environmentagency.gov.uk/research/library/publications/33891.aspx; accessed 4 July, 2009. Erikson, K. (1994) A New Species of Trouble, New York: WW Norton and Company. Eyre, A. (2006) Literature and Best Practice Review and Assessment: Identifying People’s Needs in Major Emergencies and Best Practice in Humanitarian Response, Department for Culture, Media and Sport; available online at: http://www.cabinetoffice.gov.uk/media/132790/ha_literature_review.pdf; accessed 10 August, 2009. Federal Emergency Management Agency (2009) Joint Housing Solutions Group; available online at: https://asd.fema.gov/inter/hat/public/aboutJHSG.htm; accessed 11 August, 2009. Fothergill, A. (1999) ‘An Exploratory Study of Woman Battering in the Grand Forks Flood Community: Responses and Policies’, International Journal of Mass Emergencies and Disasters, 17 (1): 79-98. Friedman, B. J. (1986) Role Conflict and Role Abandonment in Disasters: A Need for Empirical Reorientation, University of Delaware, Disaster Research Center; available online at: http:// dspace.udel.edu:8080/dspace/handle/19716/483?mode=simple; accessed 21 August, 2009.

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Edge, A. and Adam, D. (2009) ‘Q&A: Copenhagen climate change conference, 2009’, The Guardian, (London), May 1; available online at: http://www.guardian.co.uk/environment/: accessed 2 November, 2009.

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Giddens, A. (1998) ‘Risk Society: The Context of British Politics’, in J.Franklin (ed.) The Politics of Risk Society, Cambridge: Polity Press: 23-34. Green, R., Bates, L. and Smyth, A. (2007) ‘Impediments to Recovery in New Orleans’ Upper and Lower Ninth Ward: One year after Hurricane Katrina’, Disasters, 31 (4): 311-335.

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Hammersley, M. and Atkinson, P. (2007) (3rd ed.) Ethnography: Principles in Practice, London: Routledge. Handmer, J. (1997) ‘Flood warnings, and flood hazard management in Britain’, in J. Handmer (ed.) Flood Warning: Issues and practice in total system design, London: Middlesex University Flood Hazard Research Centre: 3-12. Harris, P. (2004) ‘Torrent that tore out Village’s Hart’, Daily Mail, (London), 18 August. Humber Local Resilience Forum (2007) Initial Debrief Report June 2007 Flooding; available online at: http://archive.cabinetoffice.gov.uk/pittreview/_/media/assets/www.cabinetoffice.gov.uk/ flooding_review/humber_lrf_report%20pdf.pdf; accessed 1 September, 2009. Isham, J. (1999) ‘The Effect of Social Capital on Technology Adoption: Evidence from Rural Tanzania’, paper presented at the Annual Meeting of the American Economic Association, New York, United States of America.

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Johnson, C. L., Tunstall, S. M. and Penning-Rowsell, E. C. (2005) ‘Floods as Catalysts for Policy Change: Historical Lessons from England and Wales’, International Journal of Water Resources Development, 21 (4): 561-575. Law, J. and Singleton, V. (2004) A Further Species of Trouble? Disaster and Narrative; available online at: http://www.lancs.ac.uk/fass/sociology/papers/law-singleton-further-species-of-trouble.pdf; accessed 15 July, 2009. Lomborg, B. (2009) ‘Man-made global warming is real: The solutions being touted are not’, The Spectator, 5 December. Manitoba Emergency Measures Organization (2009) Community Impact Assessment; available online at: http://www.gov.mb.ca/emo/community/recover/cia.html; accessed 18 August, 2009. Manyena, S. B. (2006) ‘The concept of resilience revisited’, Disasters, 30 (4): 433-450. Medd, W., Mort, M., Sims, R., Twigger-Ross, C., Walker, G. and Watson, N. (2008) Flood, vulnerability and urban resilience: a realtime study of local recovery following the floods of June 2007 in Hull; available online at: http://www.lec.lancs.ac.uk/cswm/Hull%20Floods%20Project/HFP_ home.php; accessed 20 July, 2009. Medd, W., Mort, M., Sims, R., Twigger-Ross, C., Walker, G. and Watson, N. (2008) ‘Flood, vulnerability and resilience: a real-time study of local recovery following the floods of June 2007 in Hull’, in Samuels (ed.) Flood Risk Management: Research and Practice, London: Routledge. Monbiot, G. (2007) Heat: How to Stop the Planet Burning, London: Penguin Books. Moser, C. (1996) Confronting Crisis: A Comparative Study of Household Responses to Poverty and Vulnerability in Four Poor Urban Communities. Environmentally Sustainable Development Studies and Monographs Series 8, Washington, D.C.: World Bank.

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National Resources Defence Council (2009) ‘The Consequences of Global Warming’; available online at: http://www.nrdc.org/globalWarming/; accessed 3 November, 2009. Narayan, D. (1995) Designing Community-Based Development. Social Development Paper 7, Washington, D.C.: World Bank. Nelson, F. (2009) ‘Global warming: the truth’, The Spectator, 5 December. New Zealand Government Ministry of Civil Defence and Emergency Management (2009) Disaster Impact Assessment; available online at: http://www.civildefence.govt.nz/memwebsite.nsf/wpg_ URL/For-the-CDEM-Sector-Publications-Disaster-Impact-Assessment?OpenDocument; accessed 18 August, 2009. Oxfam International (2007) South Asia Floods, 2007; available online at: http://www.oxfam.org/en/ programs/emergencies/southasia_floods_07/update_070806; accessed 4 July, 2009.

Roberts, P. (2005) ‘What Katrina means for Emergency Management’, The Forum, 3 (3); available online at: http://www.bepress.com/forum Rodgers, L. (2007) ‘Victims tell of insurance worries’, BBC News, October 10; available online at: http://news.bbc.co.uk/1/hi/uk/7037183.stm; accessed 18 August, 2009. Ronan, K. R. and Johnston, D. M. (2005) Promoting Community Resilience in Disasters: The Role for Schools, Youth and Families, New York: Springer. Rowell, A. (1996) Green Backlash: Global Subversion of the Environment Movement, London: Routledge. Schafft, K. (1998) ‘Grassroots Development and the Reconfiguration of Local Political Institutions: Local Minority Self-Governance as a Political and Economic Resource for Hungary’s Roma Population’, paper presented at the Graduate Student Conference on International Affairs, George Washington University, Washington, D.C., United States of America. The Economist (2009) ‘The green slump’, The Economist, 5-11 December.

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Pitt, M. (2008) Learning lessons from the 2007 floods: An independent review by Sir Michael Pitt; available online at: http://archive.cabinetoffice.gov.uk/pittreview/_/media/assets/www.cabinet office.gov.uk/flooding_review/pitt_review_full%20pdf.pdf; accessed 4 July, 2009.

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The Observer (2009) ‘Copenhagen is only the start of climate change’, The Observer, (London), 1 November. Tindale, S. (1998) ‘Procrastination, Precaution and the Global Gamble’, in J. Franklin (ed.) The Politics of Risk Society, Cambridge: Polity Press: 54-69. Varshney, A. (2000) Ethnic Conflict and Civic Life: Hindus and Muslims in India, New Haven: Yale University Press.

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Wisner, B., Blaikie, P., Cannon, T. and Davis, I. (2004) (2nd ed.) At Risk: Natural hazards, people’s vulnerability and disasters, London: Routledge. Woodman, P. and Kumar, V. (2009) A Decade of Living Dangerously, London: Chartered Management Institute. Woollacott, M. (1998) ‘Risky Business, Safety’, in J. Franklin, (ed.) The Politics of Risk Society, Cambridge: Polity Press: 47-49. Woolcock, M. and Narayan, D. (2000) ‘Social Capital: Implications for Development Theory, Research and Policy’, The World Bank Research Observer, 15 (2): 225-249.

Author Except for the Foreword, this Unit has been authored by Lucy Easthope who is a member of the external team of the Civil Safety and Security Unit (CSSU), Institute of Life Long Learning, University of Leicester, United Kingdom. Aspects of the case study and the photographs are taken from research conducted by her as part of her doctorate studies at the Division of Medicine, Lancaster University. Additional material supplied by Dr Hugh Deeming and the people of Toll Bar, Yorkshire.


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READING ‘Flood, vulnerability and resilience: a real-time study of local recovery following the floods of June 2007 in Hull’ Medd, W. et al. (2008) In Samuels (ed.) Flood Risk Management: Research and Practice, London: Routledge. Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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READING ‘Health and wellbeing’ Pitt, M. (2008) Chapter 25 of Learning lessons from the 2007 floods: An independent review by Sir Michael Pitt.

Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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READING ‘Impediments to recovery in New Orleans’ Upper and Lower Ninth Ward: one year after Hurricane Katrina’ Green, R., Bates, L. and Smyth, A. (2007) Disasters, 31 (4): 311-335. Following the Interim Decision of the Copyright Tribunal (announced on 13th December 2001), permission to make this copy is being obtained directly from the copyright owner.


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Module 1 Theories of Risk and Crisis This module serves as an introduction to the course and to the subject area of risk, crisis and disaster management, and it is also a conceptual tool box for the rest of the course. In particular, it introduces a range of theoretical perspectives on the concepts of risk and crisis such as how risk is assessed and managed. The overarching aim of the module is to identify different perspectives and examine the extent to which they inform practice and ultimately to lay a foundation upon which future modules will build.

MODULE 1

MSc in Emergency Planning Management

MSc in Emergency Planning Management

Module 2 Managing Risk and Crisis

MODULE 1

In this module some contemporary debates about security are explored. It brings together broad developments in theories of risk in the social sciences with risk issues of relevance to security managers. It also examines the relationship between these different perspectives on risk and a general theory of security. An attempt is made to highlight the relationship between the theory and practice of risk management and security.

(updated February 2012)

Module 3 Research Methods in Risk, Crisis and Disaster Management

Theories of Risk & Crisis

This Module aims to provide students with comprehensive knowledge and understanding of methodological issues in investigation studies research. The Module introduces students to research methodology on both a theoretical and practical level. Students are encouraged to analyse critically the process of social scientific enquiry and to examine the relationship between research problems, theoretical perspectives and methodological approaches.

Module 5 Models of Risk, Crisis and Disaster This module addresses the possibility that risks, crises and disasters may be understood in different ways by different people. An air crash, for example, may be understood primarily as a potential blow to profitability by an aircraft manufacturer, as a case for investigation by the relevant police service and national accident investigation bureau, as a destabilizing influence on the stock market by brokers and investors and as a human tragedy by the tabloid press (for whom disasters provide many column-inches of material) and relatives, partners and friends of the victims. Thus the same event may be ‘constructed’ or experienced differently by different parties. This module examines how parties with different ‘investments’ (reputational, financial, emotional etc.) in crises and disasters may experience them in quite different ways.

Module 6 Emergency Planning Management This module looks at the ‘front line’ management of risks, crises and disasters. The emphasis is on practical risk, crisis and disaster management, from risk assessments produced by Britain’s Health and Safety Executive to the factors that need to be considered by emergency planners when drafting an evacuation plan. The module aims to be as eclectic as possible, including, for example, a unit on the identification and management of post-traumatic stress disorder.

The course material is and remains the property of the University (and must be immediately returned to the University upon request at any time) and is either the copyright of the University or of third parties who have licensed the University to make use of it. The course material is for the private study of the student to whom it is sent and any unauthorised use, copying or resale is not permitted. Unauthorised use may result in the course being terminated. The course material was created in the academic year 2011/2012 Civil Safety and Security Unit • University of Leicester • 14 Salisbury Road • Leicester • LE1 7QR

THEORIES OF RISK AND CRISIS

In this module a number of case studies of crises and disasters are examined. The case studies act as heuristics ‑ vehicles for exploring some of the issues and concepts introduced in modules one and two. Such issues include the impact of personality on crisis and disaster management, the influence of cultural factors and national preferences on crisis and disaster management techniques, and the impact on disaster investigations of paradigmatic interpretations of evidence. The rationale for the module is that important lessons can be learned from the detailed, objective analysis of past crises and disasters. The unit also provides an insight into the politics of the 1974 Health and Safety at Work Act, which set up the United Kingdom’s Health and Safety Executive, and into subsequent legislation on the regulation of developments close to hazardous complexes.

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Module 4 Case Studies of Crises and Disasters

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EPM Module 1