Tuesday, October 5, 2010

BP Gulf Oil Spill and its Accident Investigations Report

In a press release dated September 19, 2010, BP confirmed that “Well kill operations on the MC252 well in the Gulf of Mexico is completed”. Before that on September 8th, 2010 BP published its internal investigation of this accident. BP made several documents available at its website that includes a “Full Investigation Report”, slide presentation and summary report along with several appendices.

Despite all the detailed charts, figures and illustrations in these reports and the investigation into a wide variety of different factors, surprisingly there was no mention in any way of human factors issues and the terms “human factors”, "work organization” or “human performance” were never even mentioned. Interestingly the report uses terms such as “failure” (89 instances) but never terms such as "error" (once to describe measurement error range) or “mistake” (0 instance) which is quite astonishing for an accident investigation report.

During a hearing on the Gulf of Mexico spill in Washington, Sunday, Sept. 26, 2010. Najmedin Meshkati, a human factors expert and professor at the Viterbi School of Engineering at the University of Southern California, highlighted the lack of human factors approach in the BP report and wondered why BP named its report an accident investigation when it left critical elements out. He asked BP to turn over information on shift duration and worker fatigue.

"How could you call this great work accident investigation ... and not address human performance issues and organizational issues and decision-making issues?" Meshkati asked.

It is sad to observe how human factors issues are so easily neglected in such a major accident that might have lasting effects on our environment. Still a long way to go…

BP internal investigation
Experts question BP's take on Gulf oil spill
Published in The Applied Human Factors and Ergonomics International NEWS, October 2010

No comments: