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Investigating experience feedback in Swedish authorities: An empirical study of experience feedback practice in 21 Swedish authorities
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology. (Filosofi)
KTH, School of Architecture and the Built Environment (ABE), Philosophy and History of Technology. (Filosofi)ORCID iD: 0000-0002-4671-758X
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This article focuses on practical experience feedback. Results from two interview studies are reported. In the first, experience feedback in different sectors in Sweden was investigated through interviews with 21 Swedish authorities involved in accident prevention. A result from this investigation was that the participating authorities in practice have a functioning experience feedback despite lack of systematic routines and methods. Yet, only four of the 21 participating authorities work with the whole experience feedback process. These four authorities have one common denominator; they have an experience feedback that is turning more inwards than outwards. All of the participating authorities have a need to improve and systematize the dissemination of experiences, knowledge and results. An improved dissemination can in fact affect other procedures such as the reporting of occurred accidents. Focus in this second study was on practical communication procedures, and how the authorities communicate results, knowledge and experiences within their own organisations, with other authorities, and with external parties. It is concluded that a more proactive approach would be valuable for the learning process.

Keyword [en]
experience feedback, learning from accidents and incidents, communication, accident prevention
Identifiers
URN: urn:nbn:se:kth:diva-27211OAI: oai:DiVA.org:kth-27211DiVA: diva2:375890
Note
QC 20101209Available from: 2010-12-09 Created: 2010-12-09 Last updated: 2010-12-10Bibliographically approved
In thesis
1. Learning from accidents: Experience feedback in practice
Open this publication in new window or tab >>Learning from accidents: Experience feedback in practice
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Experience feedback from accidents is important for preventive work in companies, authorities and other organisations. This thesis focused on experience feedback from accidents that take place in everyday life, in our neighbourhoods, in our workplaces, in our schools, in traffic and transportation.

Essay I is an overview of the literature on learning from accidents and incidents. The focus in this essay is on literature that evaluates the effectiveness and usefulness of different methods in accident investigations. Conclusions drawn from this literature review are that the dissemination of results and knowledge from accident investigations must be improved, and experience feedback systems should be integrated into overall systems of risk management.

Essay II is based on an evaluation of the investigation board for workplace accidents (HAKO) that was carried out on commission of the Swedish Work Environment Authority. It was concluded that the accident reports published by HAKO had a high qualitative level but the dissemination of results from the investigations was weak.

Essay III investigates twenty-eight supervision cases from eleven Swedish local Environment and Health Administrations. The overall goal of the study was to find out how, and to what extent, experience feedback occurs in Swedish municipalities. Two major problems relevant for the experience feedback have been found; namely that the inspectors do not have enough guidance on how to interpret the law and that they would like more information on what happens to legal cases that they have handed over to the public prosecutors and the police.

Essay IV is a document study of incident reports from two municipal fire and rescue services. The overall purpose of this study was to investigate if information from the rescue services could be used to improve experience feedback in sectors where it is weak or non-existent. In the 1120 incident reports that were studied, we found 217 proposals for improvement but these proposals were not used for experience feedback. It is concluded that the reports contain valuable information but this information is not used to prevent future accidents.

Essay V investigates experience feedback in Swedish authorities working with accident prevention. The essay is based on two interview studies. In the first study, 21 Swedish authorities participated, and several of these authorities seem to have a functioning experience feedback despite the lack of systematic routines and methods. Yet, only four of the 21 authorities actually handle the whole experience feedback process. These four have at least one common denominator; they have an experience feedback that is turning more inwards than outwards. The second study was a follow-up study of some of the results from the first study, concerning the dissemination of results from experience feedback.

Place, publisher, year, edition, pages
Stockholm: KTH, 2010. vi, 42 p.
Series
Theses in philosophy from the Royal Institute of Technology, ISSN 1654-627X
Keyword
Experience feedback, learning from accidents, incidents, near-accidents, CHAIN model, communication, dissemination
National Category
Philosophy
Identifiers
urn:nbn:se:kth:diva-27212 (URN)978-91-7415-772-7 (ISBN)
Public defence
2010-12-17, D3, Lindstedtsvägen 5, KTH, Stockholm, 10:00 (English)
Opponent
Supervisors
Note
QC 20101209Available from: 2010-12-09 Created: 2010-12-09 Last updated: 2010-12-09Bibliographically approved

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