SH141: We cannot improve if we don't learn. We can't learn if we don't understand.


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Jan 21 2025 11 mins   6

When discussing diving incidents, it’s vital to shift away from blame and hindsight bias and instead foster a culture of open dialogue to understand why decisions made sense at the time. Often, divers are doing their best with the resources, training, and information available, but situational awareness and decision-making are shaped by incomplete data, personal experience, and environmental factors. Criticism without context or constructive feedback doesn’t improve safety or learning; instead, it deters people from sharing critical insights. By embracing a "just culture," the diving community can better explore the underlying factors behind incidents, address systemic issues, and create meaningful opportunities for growth and safety improvement.


Original blog: https://www.thehumandiver.com/blog/cannot-improve-do-not-understand


 


Links: Report of the death of CCR diver: https://cognitasresearch.files.wordpress.com/2015/05/dillon-2015-findings-in-the-inquest-into-the-death-of-philip-gray.pdf


 


Tags: English, Gareth Lock, Just Culture


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