Normal Accidents

The beginning of 2021 could make you nostalgic for 2020. First an insurrection at the US Capitol. Then millions of Americans lost power and water as arctic temperatures blanketed the country. All the while, Covid-19 smoldered in the background. Happy New Year.

Everything is Normal

Charles Perrow, Yale sociologist and expert on complex organizations, wouldn’t be surprised. He knew that in complex systems, accidents are a feature, not a bug.

Inspired by the 1979 near-miss at Three Mile Island, Perrow began studying high-risk systems. His 1984 book Normal Accidents: Living with High-Risk Technologies influenced future thinking on risk and safety. While no Harry Potter, it provides a framework for characterizing risks in complex systems like nuclear power plants or spaceships. In an increasingly interconnected world, his conclusion is sobering: catastrophes are a natural by-product of highly complex systems. Ominously, Perrow believed that:

We have not had more serious accidents of the scope of Three Mile Island simply because we have not given them enough time to appear. But the ingredients for such accidents are there.

It’s a Relationships Business

Perrow’s risk assessment framework is a quadrant divided by interactions, linear versus complex, and coupling, loose versus tight. Assembly lines are linear systems. The production sequence is expected and familiar: A then B then C. Components only interact with the things…