Back to the Basics

Process safety has come a long way—strong systems, solid programs, smart people. Yet the biggest incidents we still see often come down to one thing: not following the basics.

Investigations almost always land on the human element. Someone skips a step. Someone doesn’t follow a procedure. Instead of blaming people, maybe we should ask why the procedure didn’t work for them.

After several widespread power outages in Houston, I self-installed a 26-kilowatt whole-house generator. I spent hours digging through hundreds of pages of technical manuals trying to verify the correct wiring. Then I found a three-minute YouTube video that explained everything perfectly. You could say I didn’t follow procedures - but I was able to verify the wiring, and the generator works great.

As Baker Hughes’ Marcin Nazaruk noted in Drilling Contractor (2020), most procedural “violations” stem from poor usability—procedures that are hard to find, out of date, or written for a world that doesn’t match the one in front of the operator. In his survey:

62% said following procedures exactly would make the job take too long.
50% said procedures were hard to locate.
45% said the procedures were out of date.

72% percent of workers said they’d rather rely on their own experience than the written procedure. Hard to blame them.

Look around at some of our control-of-work systems. We’ve built mountains of paperwork: fifty signatures on a permit, jobs color-tagged to death, ten-page JSAs listing every hazard ever imagined. Each new rule was meant to prevent the last incident, but together they’ve turned into a CYA maze.

And still, when something goes wrong, we point to the worker. Maybe it’s time we look at the systems we’ve built and ask if they’ve become too complicated to follow.

Maybe the next step isn’t adding more layers of control, but cutting through the noise—getting back to what people actually need to do the job safely. That’s at the heart of Human and Organizational Performance (HOP) thinking: learning, simplifying, and building systems people can actually use.

Clarity beats volume. When procedures make sense and fit real work, people don’t have to choose between getting it done and doing it right.

Looking for answers? Your frontline workers can tell you what you need to do - just have to listen to them in a blame-free environment.

I’m honored to serve as the incoming 2026 Chair of the AFPM Human and Organizational Performance (HOP) Subgroup, and I’ll be focusing on simplification and getting back to the basics that keep people safe.