The Pitfalls of Assuming Reporting Alone Mitigates Risks

In a recent accident report, I came across a statement that exemplifies a common fallacy, it read:
"Had this issue been reported beforehand, it would have been taken care of and the accident would not have materialized."

This type of counterfactual reasoning can lead us to believe that reporting a risk is sufficient to address and prevent it from becoming a reality. Reality tells a different story though. Have you ever reported a risk or an unsafe situation, only to witness it persist unchanged for months? It can leave us perplexed about why our concerns were seemingly ignored. Why is this so?

Organizations are complex systems, comprised of numerous interrelated components and processes. They constantly evolve and operate within an intricate web of dynamics. Consequently, the relationship between cause and effect is rarely straightforward, as various factors and emergent phenomena influence outcomes.
Communication is a fundamental operation that shapes and distinguishes social systems from their environment. It plays a crucial role in their self-organization. But communication within organizations is not a mere exchange of information; it's a selective process that creates meaning within a given context while excluding other possibilities.

When it comes to risk-related communication, it's the interpretation of the recipient that determines whether true communication occurs. The sender's intention to communicate alone is insufficient. Therefore, the receiver holds the power to validate or negate the act of communication.
Numerous strategies exist for risk reduction, such as strictly adhering to responsibilities, written documentation, selective disclosure, and involving others to foster collaboration. These measures, though important, can inadvertently create a false sense of reassurance and limit our ability to perceive the unexpected.

The prevailing impression of reporting risks can often lead to complacency on a small scale. Safety alerts and bureaucratic procedures can unintentionally narrow our focus, preventing us from "looking up and out" and recognizing potential dangers, such as systemic risks.

The inclination within communication systems to favor positive judgments of desired outcomes can increase the likelihood of unforeseen surprises after decisions are made. Organizations may find themselves constrained by a desire to reaffirm past choices rather than seeking innovative solutions to emerging problems. Safety practitioners can be tempted to fight a guerilla war to change this, but it's an uphill battle when fought alone. This is where the organizational network can do its magic.

Sources:

Luhmann, N. (1991), Soziologie des Risikos, Berlin: W. de Gruyter 

Luhmann, N. (2001), Was ist Kommunikation? In: Aufsätze und Reden, S. 94–110, Ditzingen: Phillip Reclam.