Two Cases in High Reliability Organizing: a Hermeneutic Reconceptualization GERD VAN DEN EEDE ii Two Cases in High Reliability Organizing: a Hermeneutic Reconceptualization iii Two Cases in High Reliability Organizing: a Hermeneutic Reconceptualization Twee Gevalsstudies over Organiseren voor Hoge Betrouwbaarheid: Een Hermeneutische Reconceptualisatie PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Tilburg, op gezag van de rector magnificus, prof. dr. Ph. Eijlander, in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie in de aula van de Universiteit op vrijdag 18 december 2009 om 14.15 uur door Gerd Geeraard Paula Van Den Eede geboren op 7 juni 1970 te Dendermonde, België iv Two Cases in High Reliability Organizing: a Hermeneutic Reconceptualization Promotor: Prof. dr. P.M.A. Ribbers Copromotor: dr. B.A. Van de Walle Overige leden: Univ.-Prof. dr.-Ing. F. Fiedrich Prof. dr. T.J. Grant Dr. F. Hardeman Dr. A-F. Rutkowski Prof. dr. M. Turoff Prof. dr. D. Van Lindt . Table of Contents v Table of Contents TABLE OF CONTENTS ................................................................................................................................ V LIST OF FIGURES ......................................................................................................................................XII LIST OF TABLES .......................................................................................................................................XIII GLOSSARY AND LIST OF ACRONYMS .................................................................................................... XVII PREFACE................................................................................................................................................ XIX CHAPTER 1 INTRODUCTION ...................................................................................................................... 1 1 INTRODUCTION ....................................................................................................................................... 1 2 A PHENOMENOLOGICAL TAXONOMY OF RELIABILITY ........................................................................................ 3 2.1 Defining reliability ....................................................................................................................... 3 2.1.1 Average reliability ................................................................................................................................3 2.1.2 Variance of reliability ...........................................................................................................................4 2.1.3 Our definition ......................................................................................................................................4 2.2 Reliability decomposed ................................................................................................................ 5 2.2.1 Safety ..................................................................................................................................................5 2.2.2 Effectiveness ........................................................................................................................................8 2.2.3 Efficiency ........................................................................................................................................... 10 2.3 Methods for evaluating reliability .............................................................................................. 11 2.3.1 Cartesian reductionism – Risk equation .............................................................................................. 11 2.3.2 Reasonian holism ............................................................................................................................... 12 3 TRIANGULATION ................................................................................................................................... 14 3.1 Multidisciplinary ........................................................................................................................ 14 3.2 Systems thinking ........................................................................................................................ 14 3.3 Paradox ..................................................................................................................................... 16 3.4 Triangulation: multidisciplinary, system theoretic and paradoxical ............................................. 18 3.4.1 Study unreliability as well as reliability ................................................................................................ 18 3.4.2 HRT relevance .................................................................................................................................... 20 4 COMPLEXITY 21 4.1 Decomposing complexity ........................................................................................................... 21 4.2 Measuring complexity................................................................................................................ 23 4.3 Managing complexity ................................................................................................................ 23 5 COUPLING 27 5.1 Decomposing coupling ............................................................................................................... 27 5.2 Measuring coupling ................................................................................................................... 28 5.3 Loose Coupling Theory (LCT) ...................................................................................................... 28 5.3.1 In search of reliability ......................................................................................................................... 29 5.3.2 Relevance .......................................................................................................................................... 29 5.3.3 Identification ..................................................................................................................................... 30 5.3.4 Managing coupling ............................................................................................................................. 32 6 RESEARCH QUESTIONS............................................................................................................................ 34 6.1 Are the organizations HROs?...................................................................................................... 34 6.2 What constitutes high reliability? ............................................................................................... 35 7 STRUCTURE OF THIS DISSERTATION ............................................................................................................ 36 vi Two Cases in High Reliability Organizing: a Hermeneutic Reconceptualization CHAPTER 2 LITERATURE REVIEW ............................................................................................................. 37 1 INTRODUCTION ..................................................................................................................................... 37 2 NORMAL ACCIDENTS THEORY (NAT) ......................................................................................................... 38 2.1 Interactive complexity................................................................................................................ 39 2.2 Relevance .................................................................................................................................. 41 3 HIGH RELIABILITY THEORY (HRT) .............................................................................................................. 42 3.1 Definition .................................................................................................................................. 42 3.2 Two schools of thought: Berkeley and Michigan ......................................................................... 43 3.2.1 The Berkeley HRO School ................................................................................................................... 44 3.2.2 The Michigan HRO School .................................................................................................................. 44 3.3 HRO Research ............................................................................................................................ 49 4 CONTRASTING NAT AND HRT .................................................................................................................. 54 4.1 Critique from HRT on NAT .......................................................................................................... 56 4.1.1 Misreading......................................................................................................................................... 56 4.1.2 Static and univocal ............................................................................................................................. 57 4.1.3 Unfalsifiable ....................................................................................................................................... 57 4.1.4 Defeatism .........................................................................................................................................