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Merits of using a socio-technical system perspective and different industrial accident investigation methods on accidents following natural hazards: A case study on pluvial flooding of a Swedish railway tunnel 2013
Karlstad University, Faculty of Health, Science and Technology (starting 2013). (Centrum för klimat och säkerhet)ORCID iD: 0000-0002-7065-3491
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Climate and Safety. (Centrum för klimat och säkerhet)
2015 (English)In: International Journal of Disaster Risk Reduction, E-ISSN 2212-4209, Vol. 13, p. 189-199Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2015. Vol. 13, p. 189-199
Keywords [en]
Feedback, Accident investigation, Socio-technical system, Flooding, Railway tunnel
National Category
Social Sciences Interdisciplinary
Research subject
Risk and Environmental Studies
Identifiers
URN: urn:nbn:se:kau:diva-37760DOI: 10.1016/j.ijdrr.2015.06.004ISI: 000368928000018OAI: oai:DiVA.org:kau-37760DiVA, id: diva2:848603
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2018-09-21Bibliographically approved
In thesis
1. Managing knowledge sharing of extreme weather induced impacts on land transport infrastructure: Case study of the Swedish Transport Administration
Open this publication in new window or tab >>Managing knowledge sharing of extreme weather induced impacts on land transport infrastructure: Case study of the Swedish Transport Administration
2016 (English)Licentiate thesis, comprehensive summary (Other academic) [Artistic work]
Abstract [en]

Extreme weather events and effects of climate change are threats to the transport sector’s functionality and safety. Risk management in this context implies a necessity to focus on the connection between near-term experiences and coping strategies on one hand, and long-term adaptation analyses on the other. How learning from past events and subsequent knowledge sharing can be adopted is a question that needs to be explored, discussed and tested. A systematic approach to lessons learned calls for measures of investigation, reporting, planning, implementation and evaluation. A qualitative case study approach was used in this thesis. In the first paper the practices of accident investigation in operation and maintenance were inventoried within the Swedish Transport Administration (STA). Three accident investigation methods were applied and tested on a cloudburst event, causing flooding in a railway tunnel in Sweden. In the second paper, semi-structured interviews, documents, and archival records were used as means for penetrating deeper into the attitudes and understanding of lessons learned concerning extreme weather events within a procured public-private partnership. The results of the two studies showed weak signals of feedback on lessons learned. Partly, these weak signals could be traced back to weak steering signals. Various obstacles impeded learning curves from lessons learned. The obstacles were of both hard and soft values, e.g. resources in time and equipment, systematic investigation methods, incentives for lessons learned, education and knowledge, values, norms and attitudes towards how and why identified problems should be solved. Successful knowledge sharing requires that close attention is paid to such obstacles and that an adaptive approach is adopted.

Abstract [sv]

Den pågående och framtida klimatförändringen sätter press på aktörer att möta risker som associeras med klimatförändring. Syftet med denna avhandling är att bidra med kunskap om lärande och kunskapsöverföring inom offentlig förvaltning av landtransportinfrastruktur. Eftersom lärande och kunskapsöverföring är grundläggande för planering och beslutsfattande om strategier och åtgärder som främjar ett robust transportsystem. Målet för detta arbete är att belysa lärande och kunskapsöverföring inom och mellan olika organisationer i det svenska samhället. Det socio-tekniska systemperspektivet - som används som analysram i båda studierna ger en djupare förståelse för bakomliggande faktorer. En kvalitativ ansats, som omfattar intervjuer, deltagande observationer och dokumentanalys, har används i detta licentiatarbete. I den första studien belyses möjligheten att använda sig av industriella utredningsmetoder på naturolyckor i en svensk kontext av en översvämning i en järnvägstunnel. De industriella utredningsmetoderna visade sig vara användbara för utredning av konsekvenser efter skyfall, med olika metodologiska fördelar och nackdelar. Den andra studien utforskar hur Trafikverkets verksamhetsområde Underhåll arbetar med lärande kopplat till väderextremer; hur de fångar upp erfarenheter och kunskap som finns hos kontrakterade entreprenörer, samt hur entreprenörerna uppfattar att lärande och erfarenhetsåterföring sker. Resultatet från båda studierna visar på både svaga styrsignaler och svaga återkopplingssignaler, vilket medför svaga lärandekurvor. Olika hinder sågs ligga bakom med svaga styr- och återkopplingssignaler bl.a. resurser i tid och processer, systematik i utredning av naturolyckor, incitament att lära av varandra, utbildning och kunskap, värderingar normer och attityder till hur och varför identifierade problem ska lösas. Ett adaptivt förhållningssätt innebär att man behöver ta hänsyn till dessa hinder på ett systematiskt sätt.

Abstract [en]

The agreement in Paris in 2015 was an historic manifestation that society has to work with both mitigation and adaptation to achieve a reduction of the adverse effects of climate change. One way to achieve adaptation is through the integration of present coping strategies. A first step is to study the existing processes and routines that support short-term coping. This licentiate thesis targets different aspects of learning as a strategy for coping and building adaptive capacity. Road infrastructure and maintenance in relation to extreme weather are used as the physical context and the Swedish Transport Administration as a case to study. Paper I shows the possibility to apply industrial accident investigation methods to an extreme weather event and get useful insights into underlying root causes. Paper II shows the intra- and interrelated patterns that exist in public-private partnerships (PPP) in Sweden. The paper describes a parallel of systems with infrequent overlaps regarding lessons learned.  In both papers the socio-technical perspective approach was used to highlight aspects of learning from and investigating damage due to extreme weather at different tiers in society. The socio-technical perspective provides an understanding of how decisions and legislation that affect our actions and behavior today may have been taken in different time and space settings. This thesis contributes to concept and theory building regarding the socio-technical system approach.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2016. p. 44
Series
Karlstad University Studies, ISSN 1403-8099 ; 2016:18
Keywords
lessons learned, risk management, climate change adaptation, accident investigation method, extreme weather events, natural hazard, land transport infrastructure, maintenance, lärande, kunskapsåterföring, risk hantering, klimatanpassning, olycksutredningsmetod, naturolyckor, landtransport infrastruktur, underhåll
National Category
Climate Research
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-41115 (URN)978-91-7063-696-7 (ISBN)
Presentation
2016-05-10, 21A244, Universitetsgatan 2, Karlstad, 09:00 (English)
Opponent
Supervisors
Funder
Swedish Transport Administration
Note

Paper 2 ingick i licentiatuppsatsen som manuskript, nu publicerat.

Available from: 2016-04-21 Created: 2016-03-22 Last updated: 2019-06-25Bibliographically approved
2. Organizational Lessons Learned: Natural Hazards Affecting Critical Infrastructure
Open this publication in new window or tab >>Organizational Lessons Learned: Natural Hazards Affecting Critical Infrastructure
2018 (English)Doctoral thesis, comprehensive summary (Other academic) [Artistic work]
Abstract [en]

This thesis focuses on an issue often presented as a solution – albeit a debated one ­– namely learning, specifically lessons learned from natural hazard events. Empirically, this thesis examines flooding and avalanches in a Swedish context, centering on systematic feedback mechanisms and learning from extreme events. Opportunities to and constraints affecting learning and knowledge sharing are discussed.

The thesis comprises four papers, collectively contributing a description of aspects of learning and feedback in a case study setting of the Swedish Transport Administration (STA) [Trafikverket], and providing an understanding of the present level of knowledge and awareness of climate change related natural hazards, as well as how knowledge sharing may give incentives and understanding for change. The notion of social learning is that individuals, groups, and organizations (and ultimately society) can learn from one another in a context, i.e. fostering mutual change. The goal of learning and using feedback is to create an opportunity to address changes in a thoughtful and explicit manner. At the same time, there is an implicit idea that learning occurs automatically somehow, which is problematized on the basis of the cases in the articles.

An interdisciplinary approach was adopted to obtain understanding of lessons learned related to natural hazards affecting critical infrastructure in Sweden. Interdiciplinarity refers to the use of theories from different research fields to achieve synergies in the search for explanations and useful understanding. The different objectives and aims of each paper have increased understanding of mechanisms related to aspects of feedback, learning and knowledge sharing after natural hazard impacts. Each paper also provides examples of opportunities and constraints to feedback mechanisms and learning in a collective context.

Abstract [sv]

Denna avhandling fokuserar på ett problem som ofta presenterats som en lösning, nämligen lärande. Mer specifikt fokuserar avhandlingen på lärande från naturolyckor och återkopplingsmekanismer inom och mellan organisationer

Empiriskt undersöker denna avhandling översvämningar och laviner i ett svenskt sammanhang. Fokus är på att öka förståelse av hur lärdomar relaterade till naturolyckor påverkar kritisk infrastruktur i Sverige: hur dessa fenomen förstås, och hur kunskapsåterföring av erfarenheter används i det som kallas ”lessons learned”.

Målet med att lära och använda feedback är att skapa möjlighet att möta negativa förändringar som extrema väderhändelser på ett genomtänkt och explicit sätt. Samtidigt finns det en implicit tanke att inlärning sker med viss automatik, vilket problematiseras, baserat på fallen i artiklarna. Möjligheter och utmaningar för lärande och kunskapsöverföring i kontexten extrema väderhändelser i Sverige problematiseras. Fyra artiklar bidrar med en beskrivning av aspekter av lärande och återkoppling i Trafikverket, och dess entreprenörer. Avhandlingen ger en uppfattning om kunskapsnivå och förståelse för klimatrelaterade naturolyckor, samt hur återhämtningsförmåga (resiliens) kan byggas utifrån kunskapsöverföring och lärande.

Abstract [en]

The Sendai Framework for Action (2015) and the agreement in Paris in 2015 (COP, 2015) were historic manifestations that society has to work with both mitigation and adaptation to achieve a reduction of the adverse effects of climate change. One way to achieve adaptation is through the integration of present coping strategies. A first step is to study the existing processes and routines that support short-term coping. This thesis targets different aspects of knowledge sharing and learning as a strategy for building adaptive and coping capacity. The Swedish Transport Administration provides cases of extreme events for the studies. Paper I deals with the possibility to apply industrial accident investigation methods to an extreme weather event and get useful insights into underlying root causes. Paper II displays the intra- and interrelated patterns that exist in public-private partnerships (PPP) in Sweden. Paper II describes parallel systems with infrequent overlaps regarding lessons learned. Paper III discusses collective learning approaches, in which obstacles and opportunities are identified. Furthermore, incentives to bounce forward in the aftermath are discussed from a collective learning approach. Paper IV reviews the concept of organizational memory building as a means for change.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2018. p. 70
Series
Karlstad University Studies, ISSN 1403-8099 ; 2018:41
Keywords
natural hazards, critical infrastructure, feedback, lessons learned, collective learning, memory building
National Category
Climate Research
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-69357 (URN)978-91-7063-877-0 (ISBN)978-91-7063-972-2 (ISBN)
Public defence
2018-11-09, RiskLab, 21A259, Universitetsgatan 2, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Transport Administration
Available from: 2018-10-19 Created: 2018-09-21 Last updated: 2018-10-19Bibliographically approved

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Rydstedt Nyman, MonikaJohansson, Magnus

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