The essential mission of risk management is to “anticipate and prevent or mitigate harms that may be avoidable.†The detailed, ed retrospective analysis of risk management failures is a crucial aspect of learning from mistakes and making the requisite changes to avoid or mitigate future failures. This type of analysis seeks to provide a precise accounting of the situation as it existed before the catastrophic failure occurred, included what was known, or reasonably should have been known, by the main actors in the events, about relevant information and alternative strategies for risk reduction. (Thus it is not a case of adding blame after the fact for mistakes that could not have been foreseen by anyone.)
A series of articles published in The New York Times since March 2011 is indispensable for understanding what when wrong, and why. For a full list of all articles, go to: The New York Times, “Times Topicsâ€:
EARTHQUAKE, TSUNAMI AND NUCLEAR CRISIS
http://topics.nytimes.com/top/news/international/countriesandterritories/japan/index.html
The following Times articles are of particular interest:
1. “Japanese Rules for Nuclear Plants relied on Old Science,†by Norimitsu Onishi and James Glanz, 26 March 2011:
The offshore breakwaters protecting Japan’s nuclear plants – all of which face the sea – were designed to protect against the risk of typhoons, but not the risk of tsunamis. In general, this article’s review of Japan’s approach to nuclear safety concludes: “Japan is known for its technical expertise. For decades, though, Japanese officialdom and even parts of its engineering establishment clung to older scientific precepts for protecting nuclear plants,… failing to make use of advances in seismology and risk assessment since the 1970s.â€
2. “Culture of Complicity tied to stricken Nuclear Plant,†by Norimitsu Onishi and Ken Belson, 26 April 2011:
This article details the long-term web of complicity among industry officials, politicians, and government regulators which ensured that dissenting views on risk management were systematically excluded from consideration. “Influential bureaucrats tend to side with the nuclear industry – and the promotion of it – because of a practice known as amakudari, or descent from heaven. Widely practiced in Japan’s main industries, amakudari allows senior bureaucrats, usually in their 50s, to land cushy jobs at the companies they once oversaw.â€
3. “Japanese Officials ignored or concealed Dangers,†by Norimitsu Onishi and Martin Fackler, 16 May 2011:
During decades of successfully battling against lawsuits filed by civilians against the nuclear industry in Japan, industry officials and academics regarded as friendly to the industry systematically covered up deficiencies in the siting of the plants, seismological records, the existence of fault lines, and the viability of the safety measures at the plants.
4. “’Safety Myth’ left Japan ripe for Nuclear Crisis,†by Norimitsu Onishi, 24 June 2011:
The use of robots for emergency measures at nuclear plants – especially when radiation levels are very high – is standard in the industry around the world, but not in Japan, despite the fact that it is the world’s leader in robotic technologies. Why not? Hiroyuki Yoshikawa, a robotics expert, explained: “The [nuclear] plant operators said that robots, which would premise an accident, were not needed. Instead, introducing them would inspire fear [among the public], they said. That’s why they said that robots couldn’t be introduced.â€