Crew Resource Management. Report(2000 words)- Using the model designed Essay

Crew Resource Management. Report(2000 words)- Using the model designed by Professor James Reason, write a report on the - Essay Example and information about the dangers of Pump A had been misplaced, through the change of staffing which occurred overnight, thus the cause of the explosion when Pump A was turned on and gas began to leak out of the network of piping on the rig. Professor James Reason developed a model known as the Reason Error Prevention Model or the Swiss Cheese Model which suggests that gaps in process or management can lead to on-the-job hazards or accidents (in an environment such as Piper Alpha), with these gaps requiring closure in order to provide effective management and successful adherence to process guidelines. This report identifies certain managerial and process breakdowns which occurred in 1988 on Piper Alpha in order to highlight how better to manage organisational risks, especially in an environment prone to dangerous hazards. Reason’s model suggests that human error is a natural evolution in any business environment and should be considered when creating a leadership or management model. Lack of concentration, carelessness or forgetfulness are human failings and are going to be present in the organisational design, thus leading to undesirable business outcomes. Further, Reason claims that â€Å"adverse events are the product of latent conditions (pathogens) within the organisational system† (Reason, 2008, p.7; Jeffries, 2005). By this, Reason means that even the most detailed and sophisticated management models, maintaining a strong focus on safety and adherence to policy, can still be interrupted by humans or organisational pathogens and lead to workplace hazards. At Piper Alpha, the disaster cost the company $1.4 billion in USD (Peterson, 1991). The pathogen which existed during this time period was failure for safety workers and managers to perform follow-up with on-duty managers after changing shifts overnight. Even though the permit system had been established to ensure that machinery experiencing maintenance was isolated and closed off, shift leaders did