Breaking Casandra's Curse: Understanding Unsafe Mental Models to Build a Safe Systems Engineering Culture

Abstract

Modern safety management practice is a robust and generally effective discipline. Most modern accidents in complex systems are due to poor safety culture undermining a robust safety management approach. This paper examines the challenge of improving safety culture in the design, development and operation of complex systems. Based upon the authors’ experience in defence, aerospace, transportation, information services and healthcare, this paper describes 18 mental models that can undermine the organisations safety management system. The paper describes 5 underpinning factors that lead to these incorrect mental models. It also describes an approach to persuading key decision makers to adopt a safer approach.