The frontier is somewhat thin between analyzing things for continous improvement in Agile and blaming people for failure. In this blog post, John Allspaw discusses how Etsy wants to consider mistakes, errors, slips or lapses with a perspective of learning. he explains how having blameless post-mortems on outages and accidents are part of this approach.
John Allspaw presents the concept of “Just Culture” where you make effort to balance safety and accountability. People should be able to give detailed account of problems without fear of punishment or retribution. People can explain why their actions made sense to them at the time, which help to understand the cause of the failure.
Here are some of the principles of the “Just Culture”:
* Encourage learning by having these blameless retrospectives on outages and accidents.
The goal is to understand how an accident could have happened, in order to better equip ourselves from it happening in the future
* Give people the authority to improve safety by allowing them to give detailed accounts of their contributions to failures.
* Encourage people who do make mistakes to be the experts on educating the rest of the organization how not to make them in the future.
* Accept that there is always a discretionary space where humans can decide to make actions or not.
The conclusion of the article is that “Failure happens. In order to understand how failures happen, we first have to understand our reactions to failure.”
Read the complete blog post on https://codeascraft.com/2012/05/22/blameless-postmortems/