The Futility of the Centralised Safety Management System?

Originally posted on December 1, 2019 @ 3:35 PM

imageWhenever I run the MiProfile diagnostic ( in organizations it always turns out that over 60% of people state that they do not understand the Safety Management System (SMS). With data from over 300 organizations and 60,000 participants over 15 years of running the cultural diagnostic, people state that the SMS is incomprehensible. Indeed, we spend so much time constructing these elaborate and sophisticated systems that are simply not ‘used’ nor comprehended. Indeed, it is a foundation of human fallibility through bounded rationality (Simon that humans cannot optimize in decision making but rather ‘satisfice’ (Gigerenzer) decisions with what is available in their environment at the time. The more we construct incomprehensible systems the less they can be understood or used and the more ‘tick and flick’ becomes the game.

It is a myth of STEM attribution and computationalism that decision making is centralized. Similarly, computing mythology drives the notion that the brain is the central decision maker for human action, when it is not. All the research shows that this is simply not the case. Much research in neurophenomenology by Varela,, Fuchs , Chalmers (;  Claxton (Intelligence in the Flesh) and many others demonstrate that the human mind is embodied not driven by the brain as a central controlling computer-like agency. The implications for this are profound in the way we think about tackling risk and developing safety management systems.

What if decision making was not founded in the brain but was founded in social affordance? What if the construct of our social environment triggered decisions not the projection that the brain ‘stores’ resemblances from which we ‘select’ choices? What if we thought about the workplace more as a decision making ‘network’ or ‘colony’ in a similar way to how we understand how a hive of bees make decisions? What if our collective intuitive knowing was the basis for decisions not the computer-attributed model of ‘recall’ and ‘memory’?

Extensive experiments by neurophenomenologists and cognitivists (eg. Langton, Goodwin, Saunders, Farmer, Lapedes, Packard, Wendroff, Wolfram, Bourgine, Varela and many more) have shown that humans work collectively and intuitively more like a bee or ant colony than a collection of individuals following a central decision maker. All this research shows that complex systems have emerging properties that are not located in any one place, central repository or individual but rather emerge ‘between’ all agents in the colony. That is, human groups and organisations operate more like an ecological organism than a mechanical system. Similarly, this is how we ought to understand culture. It is only under the delusion of the reductionist paradigm that we dream up the idea of a central controlling power.

As part of my own research within the MiProfile process many CEOs claim high levels of frustration at their ‘lack of power’ and inability to influence activities and work on the front line. Many CEOs get frustrated by the way organisations naturally create distance between them and the front line, relegating them to executive meetings and bureaucracy that renders them powerless and ineffective. This often makes CEOs clutch for easy fix promises, immature discourse (eg. Mums for Safety  ) and tokenistic safety mantras ( ), as if this discourse and language can somehow create a narrative that controls the actions of workers/people. All of our research shows that many CEO initiatives do the opposite. In MiProfile results we see increased skepticism, cynicism and pessimism by workers on the front line regarding CEOs and managers being ‘out of touch with the real world’ clearly amplified by the nonsense discourse of zero. Workers who face high risk each day know that zero is nonsense.

In SPoR ( we have found that the best way to work with people tackling risk on the front line where the literacy levels are low, is not through text-based bureaucratic systems but through semiotics. Of course, STEM-only thinking and Safety don’t know much about semiotics and so we see some pretty poor approaches to signs, sign systems, iconic thinking and symbolic thinking in the risk and safety sector (;;

We have found through the MIProfile diagnostic that most of the curves, pyramids and matrices in safety ( simply alienate people on the front line as ‘safety gobbledygook’.

When decisions have to be made minute by minute in real time under the pressure of production, economic value and immediacy, very little of what was signed off on a SWMS is used. In reality, most decision making is heuristic and intuitive ( In SPoR we find that a semiotic strategy with workers is far more powerful than text-based strategies because of the way semiotics penetrates the unconscious. When you desire that workers approach risk in a certain way, they don’t recall reams of text or matrix gymnastics but make decisions intuitively and semiotically. This is in concert much more with the latest research in neurophenomenology than masses of centralized systems that simply don’t ‘work’ nor make any connection with the fundamentals of Due Diligence ( ).

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