Exploring safety critical decision-making

Inadequate handling of conflicting goals has repeatedly been identified as a causal or contributing factor in accidents. This paper documents a workshop approach designed to allow participants to explore the boundaries towards unacceptable risk and the forces driving actors towards that boundary. Participants with diverse professional backgrounds discussed a specific, actual event involving a trade-off between a certain economic loss and the risk of a much larger loss. The discussions revealed that none of the participants had entered the workshop with a comprehensive understanding of all aspects of the incident. The participants expressed being surprised by: the comprehensive list of possible outcomes, decision options, events that were identified during the discussions, and the difficulties encountered when trying to formulate a specific criteria. The results emphasize the value of discussions on specific incidents / scenarios in order to bring the boundaries of unacceptable risk to the fore.