This episode looks at how diving accidents are often explained in simple ways that blame individuals, instead of exploring the deeper systems and pressures that shape what really happens. It explains that investigations are not just about facts, but about meaning, comfort, and fear after someone has died, which often leads to stories that focus on “human error” instead of learning. Using real examples, it shows how simple explanations may feel reassuring, but they don’t make diving safer. Real prevention comes from understanding how people, training, culture, pressure, equipment, and organisations interact in complex ways. The key message is that safety doesn’t come from finding someone to blame — it comes from changing the conditions that shape decisions and behaviour, so future dives are genuinely safer, not just easier to explain.

Original blog: https://www.thehumandiver.com/post/what-is-the-purpose-of-an-investigation

Links: Dekker’s four competing purposes: https://www.tandfonline.com/doi/abs/10.1080/1463922X.2014.955554

Fatal maritime collision investigation: https://www.gov.uk/maib-reports/collision-between-ro-ro-passenger-vessel-scottish-viking-and-prawn-trawler-homeland-off-st-abb-s-head-scotland-with-loss-of-1-life

Non-fatal maritime collision investigation: https://dmaib.com/reports/2014/kraslava-and-atlantic-lady-collision-on-1-november-2014

Blog about Linnea Mills: https://www.thehumandiver.com/blog/linnea-mills-death-hf-systems-lens

If Only… documentary: https://www.thehumandiver.com/ifonly

Learning from Emergent Outcomes course: https://www.thehumandiver.com/lfeo

References:

Dekker: The psychology of accident investigation: epistemological, preventive, moral and existential meaning-making. 2015. Another link. https://research-repository.griffith.edu.au/items/d0de2c1f-08f8-43b2-9d30-2a4ff6baea09/full

MAIB Report: https://www.gov.uk/maib-reports/collision-between-ro-ro-passenger-vessel-scottish-viking-and-prawn-trawler-homeland-off-st-abb-s-head-scotland-with-loss-of-1-life

DMAIB Report: https://dmaib.com/reports/2014/kraslava-and-atlantic-lady-collision-on-1-november-2014

A fellow graduate from Lund University wrote about this “Why do we ask why? Finding meaning after a violent loss.”

Tags: English| Learning, Incidents & Just Culture