From The Ergoweb® Learning Center

Lessons from the BP Oil Spill

People all over the world watch helplessly as the oil spill in the Gulf of Mexico goes from bad to worse. Since the initial explosion and fire, which killed 11 people and injured 17 others before the first drop of oil hit the sea, I’ve been left with a "we told you so" feeling.

You see, BP has a well documented history of risk management problems. Here’s a sampling of articles we’ve published, spawned by BP’s 2005 Texas City refinery explosion that killed 15 people and injured 170.

Appearing in Ergonomics Today™ (Complimentary Access — no subscription required):

Factors Cited in Texas Explosion Point to Ergonomic Issues, August 29, 2005
In an unprecedented move, the US Chemical Safety and Hazard Investigation Board (CSB) issued an urgent recommendation on August 17 that requests BP create an independent panel to review the safety culture at the company’s North American operations.

Experts Not As Quick as BP to Blame Workers for March 23 Refinery Explosion, November 11, 2005
Experts outside the company see other causes, some that add up to a failure to observe fundamental ergonomics principles.

BP North America Issues Final Report on Deadly Refinery Explosion, December 19, 2005
British Petroleum (BP) recently laid most of the blame for a deadly explosion at one of its five refineries in the United States on circumstances some experts could interpret as corporate failings at the macroergonomic level.

Safety and the Energy Industry – Continents Apart?, January 18, 2006
Is Safety a Dirty Word in the Energy Industry? A Look At the Obstacles to Reform

Appearing in The Ergonomics Report™ (Subscription Required):

Investigations Into Deadly BP Refinery Explosion Uncover Repeated Problems, November 9, 2005
The Ergonomics Report™ reviewed several of the interim investigations in November and talked to experts to see if the blame is misplaced.

Inquiry Into BP Refinery Explosion Blames Corporate Culture, January 22, 2007
The report of the Baker Panel, investigating the explosion at a BP refinery in Texas in 2005, was released in January. It points the finger where it doesn’t often point – at the executive suite.

Robust Probe Finds British Petroleum Safety Culture Lacking, February 11, 2007
The decision makers at British Petroleum forgot about the inherent dangers of processing crude oil. The panel led by former US Secretary of State James Baker said this and more about the safety culture and processes at the company in a strikingly robust report released in January.

These articles point to a systematic breakdown in corporate decision making, risk management, and corporate culture. Professional ergonomists, who are trained to take a systems viewpoint, recognize these as macroergonomic concerns.

These kinds of accidents are predictable, and therefore preventable. Had BP taken effective steps to improve, this most recent disaster likely would not have occurred, or at least the outcome wouldn’t have been so severe.

"We told you so!"

Ah, but little good comes from saying "we told you so." It won’t fix what’s broken, and it only raises the ire of those at blame, puts them in a defensive posture, and does little to motivate them to get on with the important work of dealing with the root causes and remediating the damage.

I was reminded of this when I read Workplace Safety is the Leading Edge of a Culture of Accountability, by David Maxfield, writing in The article focuses on accountability, presenting a case that:

… once accountability for safety is reached, companies can leverage that learning to improve quality, production, cost control and customer service.

He goes on to explain the nuts and bolts of effective accountability, and how companies might build a culture of accountability.


Some leaders believe accountability is all about blame and punishment. Find the guilty party and punish him or her.

Blame and punishment will always occur, but that’s not the makings for an effective culture of accountability. There’s already a frenzy of politicians, pundits, lawyers and corporate apologists pointing fingers of blame, and that’s sure to continue for a long time to come. Unfortunately, none of that will fix BP’s internal problems, nor the underlying root causes of the accident.

Maxfield starts his article with an example that’s familiar to ergonomists:

“What do you want me to do, save money or save lives? You can’t have it both ways.” This quote comes from a frustrated manager who feels whipsawed by these competing values. Of course he knows the company line, “Safety comes first,” but then he adds, “But we’re not in business to be safe. We’re in business to build product.”

Actually, you can have it both ways, and you’ll find that you’ll be more successful at building product — or extracting, refining and selling petroleum based products in BP’s case — if you follow these philosophically simple, albeit operationally challenging steps:

  1. Management Leadership
  2. Respect for People (employees, customers, suppliers, stakeholders, communities)
  3. A Scientific Approach to Continuous Improvement (e.g., Plan-Do-Check-Act, Standardized Methods)
  4. Cross-Functional Cooperation and Teamwork
  5. Training, Knowledge and Skill Development
  6. Responsibility and Accountability (throughout the organization)

These characteristics are the makings of any effective, sustainable world-class organization. We could add a few things to the list, but these are the basic essential ingredients. If one or more of these features goes missing, the organization will certainly underperform, or worse, find itself in a position like BP.

Readers familiar with the Toyota Production System, which influenced what is more generally known as Lean Manufacturing (or Lean Enterprise, or Lean Journey), will recognize much of this terminology. Only those companies that have truly embraced Lean, and are enjoying the fruits of that journey, will recognize Respect for People as the key feature for success. Without it, Lean is merely a set of methods and "flavors of the month"; with it, Lean can become a systematic formula for success.

I’ve worked with companies on the Lean Journey and presented at various conferences to deliver this message: Ergonomics is Respect for People, it’s essential for any company wishing to improve, and it’s the secret sauce that makes it possible to have it your way — better quality, higher productivity, satisfied customers, stronger financial performance, and safer and more satisfying work (apologies to the fast food industry for plagiarizing their ads).

I’m not talking about ergonomics as solely an MSD prevention strategy, I’m talking about ergonomics in its broad sense (organizational, physical and cognitive ergonomics). But even a successful MSD ergonomics process/program incorporates these same essential ingredients, and provides a blueprint for, and a shining example of, a world class process.

There are two extreme approaches that companies may choose: 

  1. Forge ahead with little respect for people and waste enormous amounts of cash and resources to cover-up their mistakes and the messes they willingly create;
  2. Or do it right the first time, minimize errors and mistakes, take responsibility for any mistakes or messes they do create, and understand and address root causes so future mistakes don’t occur.

Start with ergonomics — Continuous Improvement and Respect for People — It’s really that simple.

BP can’t go back and undo the damage it’s already done, but if they survive this debacle, they can take these lessons forward. The many other companies that admit and accept that they are accidents waiting to happen should also take heed.

Macroergonomic problems lead to far worse outcomes than a poor safety record and could spell the death of an entire company, not just the employees, shareholders, suppliers and citizens — and even ecosystems — who happen to be direct victims in the latest system failure.