Public safety investigations—A new evolutionary step in safety enhancement?

A historical overview highlights the evolutionary nature of developments in accident investigations in the transport industry. Based on a series of major events outside transportation, the concept of accident investigations has broadened to other domains and to a widening of the scope of the investigation. Consequently, existing investigation boards are forced to adapt their mandates, missions and methods. With the introduction of social risk perception and application of the concept of safety investigation in the public sector, a change of focus towards the aftermath and non-technical issues of a more generic nature emerges. This expansion has also gained the interest of social sciences and public governance, generating new underlying models and theories on risk and responsibility. The evolutionary development of safety investigations is demonstrated by the various organisational forms which shaped accident investigations in different countries. Underneath these organisational differences, a need for a common methodology and a reflection on fundamental notions is discussed. In particular differences among human operator models, the allocation of responsibilities in design concepts and methodological issue are elaborated. The needs and opportunities for a transition from accident prevention towards systems change are indicated. At present, the situation is ambiguous. An encompassing inventory can only provide a general oversight over emerging trends and lacks analytic rigor on specific topics. The societal dimensions, institutional changes at the level of governance and control and the powers that advocate or challenge investigations are not yet fully described.