Emergency Mismanagement of the Lahaina Wildfire 

As part of our ongoing study of human failure, we’re looking at the mismanagement of the Lahaina Wildfire. Wildfires happen all the time, but this was a particularly interesting case where the problem may have been made worse by management ineptitude. I say “may have” because it is not completely clear at the moment exactly […]

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How Not To Fail: Alarm Systems

This is an interesting story of how not to fail using alarm systems. A case like this is interesting to us from a number of perspectives, including alarms, employee training, and “doubtsourcing”. This is sort of like “outsourcing” but not really. I have a few dog years’ experience in Quality Management, I have had past […]

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How Not to Fail: The Davenport Building Collapse

We’re going to take on the project of understanding How Not to Fail with regard to the Davenport Building Collapse. This tragic event happened a few days ago, and the community is still trying to face the aftermath, because of the loss. We’re doing this in our ongoing effort to understand human failure. I will […]

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Chocolate Factory Explosion: How to Avoid Disaster

Today we’re writing about the Reading Chocolate Factory explosion, and how to avoid disaster. Due to the tragic loss of life I will refrain from making too many Willy Wonka jokes. Also keep in mind that there have been no real public announcements yet pending the investigation. The politicians and talking heads are just now […]

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The Case of the “Unsafety Shoes” (Part 2)

This is the second part of the unpredictably long story involving “safety shoes”, as required by various companies. Based on a few minutes of research, there is an excellent probability right now that everybody’s safety shoes are undocumented and not auditable. Here is Part One. (Link) Disclaimer: If your research is different from any of […]

ISO9001: Why Your Corrective Actions Aren’t Working

I am in 50 businesses a year, and the most common and serious problem I see is lack of an effective corrective action program. Your corrective actions aren’t working for a reason. The corrective action program is the most important thing in ISO. Without it, you don’t change anything. Nothing improves.

How to Spot a Fake ISO Certificate

We need to talk about this. One of the reasons people go through all of the ISO registration stuff in the first place is to lower the consumer’s risk. When a consumer buys a article or does a service, he or she benefits from some assurance from a third party that it is all legal […]