Alto42
Understanding Organisational Failure
MIKE'S PUBLICATIONS
Books Published
[Click on cover to see a synopsis]
Journal of Contingency and Crisis Management titled "Normal chaos: a new research paradigm for understanding practice". It was published on line in October 2017 and printed in January 2018.
ABSTRACT
Our key point is this: If practitioners always have to work in imperfect ways with imperfect tools, with imperfect understanding using imperfect information and within imperfect systems where the degree of control available is limited, how do they cope, managerially (that is, "deal effectively" with the issues before them)? As researchers, we believe the answer to that question is not known and, accordingly, we recommend a new research paradigm for understanding practice more generally. We call that paradigm, normal chaos.
Tower of Babel; Mike's latest article has been published in the Institute of Risk Management's recent RM Professional magazine. The article, aimed at practitioners, describes the many ways the word 'risk' is used and offers a matrix balancing 7 dimensions of risk against 5 uses of the word. Mike invites readers to determine in which of these ways 'risk' is being used whenever it comes up in their conversations. In doing so, practitioners should gain a greater understanding of the complexity of the term and greater clarity in its use.
Mike's been blogging: first to raise the level of debate on the conduct of inquiries and their value to society read it here and secondly on the subject of critical success factors read it here.
Mike's latest blog notes that we delude ourselves that the world is ordered, and suggests it may serve us better to be realistic that it is in fact chaotic with only small oases of order read it here. Mike's also blogged about the 'Plowman Effect': how seemingly valid decisions can lead us away from where we want to be read it here.
Book Chapters Published
"Foresight Saga, pursuing insight through chaos and disaster"
Doctor of Business Administration; Thesis (2011) - "Conceptualisation in Preparation for Risk Discourse: A Qualitative Step toward Risk Governance"
Key points from the thesis are described on a Cranfield video
Mikes' doctoral work was featured in an article entitled "Signs that spell danger" by Carly Chynoweth published in the Sunday Times on 22 Jan 12. A copy can be found at:
As part of his doctoral research Mike focused on how academic work may be used by practitioners. He presented a paper to the First International Conference on Engaged Management Scholarship, 2011 entitled "The Plurality of Scholarship: Developing a Focus for the DBA". It can be found at:
Viability of Multi-skilling; In searching for organisational flexibility organisations seek to multi-task their staff requiring them to have a multitude of skills. However, we have to ask, how viable is this approach? Mike's Business Masters research considered how to produce a lean organisation of the right size to compete in the market, while avoiding being either overstaffed or conversely "anorexic". In the paper he offered a risk management tool which would enable managers to examine the functional flexibility required by their organisation, and the ability of their workforce to provide it, in order to determine the probability of allocated tasks being carried out to a specified performance standard and to maximise their organisation's potential.
"It Should Never Happen Again:
The failure of Inquiries & Commissions to Enhance Risk Governance"
The book is now available from Gower Publishing.
In his first book, Mike questions the value of public inquiries. Every day, we hear about another inquiry being set up, or why the last one failed. Time and money is spent on inquiries and on implementing their recommendations, but they do not lead to the learning they should.
Based on research into high profile inquiries and commissions, It Should Never Happen Again focuses on the gaps between what is known, what knowledge is used by practitioners and by those who judge them. It contrasts the judicial perspective of those who inquire; the academic perspective of those who know; and the practical perspective of those who are required to act.
The difference between these perspectives creates barriers that impede others from learning from inquiries. Crucially, inquiry outcomes do not assist the leadership of organisations to improve risk governance. Mike offers new models for understanding risk and its governance.
Practical Offerings
There are two practical offerings that readers may wish consider.
The first is a suggestion of what should be included in the Terms of Reference for any inquiry. These are set out in the table below:
For political reasons, recommendations of public inquiries or inquests often accepted, at their time of being published with little critique or debate. However as we can see from the series of inquiries into the events at Hillsborough on 15 April 1989, many fail to survive the test of time. This books suggests a series of test that should be applied to any recommendation before it is adopted.
In brief, for recommendations to be justified they must:
Finally, I suggest that recommendations also need to be structured so that they:
- the action required, and how success should be judged,
- who is responsible,
- how the system will affect and be affected by the changes,
- the relationships and interaction between recommendations,
- the risks involved in taking these actions.
-
Contain applicable corrective action or indicate deficiencies in knowledge (in this latter case further research may be recommended).
-
Be based on reasoning that flows directly from and is cross-referenced to the findings.
-
Show a clear design strategy (rather than being just a list of individual actions) which explains how the future will be improved rather than just explaining the past.
-
Show a thorough understanding of the system (preferably referring to a model of the system) and how how the recommendation will not encourage further sub-optimisation of the system or other unintended consequences.
-
Derive from the integrity and credibility (expertise) of investigators: this goes back to the Adams’ Model where, if we cannot see, feel, touch or measure, we have to trust the person or people giving the advice.
-
Be peer reviewed; to learn we have to trust, we therefore need to see that an opinion is not only fully justified but has also been fully tested.
-
Involve and communicate with the appropriate stakeholders; again we see tension between the need and desire to learn and any political or judicial goals that the inquiry may attract. It is clear that learning and enacting lessons can only be enhanced by engagement with the other relevant stakeholders.
-
Articulate (1) the perspective adopted, (2) any conflicts of interests and (3) sources of bias or any other analytical limitations. As has already been said, trust in those giving advice is a very important factor as to whether the advice will be heeded. Whatever can be done to build that trust would be worthwhile.
-
Are self-contained (as many people will only read the recommendations); that is, they can be understood as a stand-alone statement when extracted from the context of the report. They are clear and unambiguous about:
-
Differentiate between Macro, Mezzo and Micro recommendations.
-
Rank priorities.
-
Set realistic time limits for response and “follow-through” which indicate that they appreciate the size of the task involved.
While applicability may be easy to see in hindsight, the application in foresight is much more difficult. If those conducting inquiries condemn practitioners for any perceived failure of foresight, they should be prepared to recommend how the lesson learnt may be applied more generally and the danger of unintended consequences need to be eliminated.
The Practical Pursuit of Foresight: Disaster Incubation Theory reimagined
Public inquiries often blame those involved in the events with having committed failures of foresight. This begs the question as to whether it is possible to prevent such failures of foresight. Alternatively, the question is whether perfect foresight is possible. To try to answer this question I looked at devising a method to help us think about and therefore promote strategic foresight in order to examine what this might involve. The starting point was to look for an existing method for analysing disaster causation that might be used to promote foresight. In the end I decided to use Barry Turner's Disaster Incubation Theory.
The six stages of Barry Turner's Disaster Incubation Theory takes the following shape:
The book explains how the model was developed from that proposed by Turner to what is shown below:
In addition to the model derived from Turner's work, the book discusses the issues that need to be addressed and the questions that need to be asked in order to develop foresight. In terms of the issues, the book recommends that organisations need to define what is critical because we do not have the time or other resources to examine every possible pitfall faced by the organisation. This is based on the notion of critical success factors where, in this instance, criticality is based on the harm that may befall not only the organisation as a whole but also the level at which it may occur. This enables us to see where an occurrence may be catastrophic at one level within an organisation but may have little effect on the organisation overall. This provides us with the critical success factor and the hierarchy as the first two dimensions of our thinking. Central to the notion of failure of foresight is a failure to learn (failure of hindsight) from past experience: it is often the case that while we may know of lessons from the past, we fail to incorporate those lesson into our practices and operational routines: this has been labelled a failure of active learning. In order to mitigate this potential source of failure, the recommended process explicitly makes those engaged think about the learning process. It therefore divides Operations into four parts. These parts being "learn" where lessons are collected from previous experience, "anticipate" where the organisation anticipates how and where these lessons from the past may be useful, "adapt" where the organisation adapts its routines and procedures to incorporate the lessons and "enact" where management ensures the new ways of working are adopted and used within the organisation.
The three dimensions of critical success factors, hierarchy and operations are structured as a catalytic cube to promote thinking about each problem space.
In support of the analytical process, the book offers seven questions designed to focus those involved on the key sources of failure. The seven questions are a further distillation of the twenty questions developed during my doctoral research that, in turn, were derived from over 250 ideas developed within related academic literature. The seven areas for questioning suggest that those engaged in preventing failures of foresight need to think about:
• What key individuals actually care about as this will guide their thinking and priorities and will be hidden sources of tension if they are not made explicit.
• Whether the team in place is fit for the task ahead or really quite dysfunctional.
• What has changed since the systems and processes to be used were set up and whether they were still fit for purpose.
• Whether the structure of the organisation facilitates or hinders effective communications.
• Whether all implicit or explicit assumptions used as organisational heuristics remain valid.
• Whether the natural momentum generated by everyday factors are working towards or against the espoused desired outcome.
• What the unintended consequences of the planned course of action might be.
After all these ideas are explained in the first five chapters, the final chapter of the book provides a working example based on the Yom Kippur war. It is used to illustrate how difficult foresight is in practice. What did become clear during work preparing this book was that the world was much less stable than many assume. This produced the idea of comparing a "perfect world paradigm" to the idea of chaos being the norm (normal chaos): this idea will be explored in more detail in my next book. In the end I throw out a challenge to commentators or the heads of inquiries who criticise practitioners for having a failure of foresight. The challenge for them is, before they offer such glib criticism, to show not only how, without hindsight and in the context that the failure occurred, such a failure was possible to avoid but also that it would have been reasonable to give it the priority necessary above all the other issues that faced those involved at the time.
This book entitled "The Practical Pursuit of Foresight: Disaster Incubation Theory Reimagined" was published by Gower in October 2015.