Design is a key activity in ensuring the on-going safety of hazardous engineering infrastructure. Construction flaws and operational errors have been highlighted as causal factors in many disasters but getting the design right in the first place is also fundamental for avoiding accidents as we see across multiple domains including built environment (e.g. Grenfell Tower), aviation (e.g. Boeing 737 MAX), space exploration (e.g. Challenger) and nuclear (e.g. Chernobyl).
Design is fundamentally a social as well as technical activity and these cases show that one of the key challenges in producing a safe design is for individual designers to retain a sense of the link between their decisions and the possible future impact on people and the environment. When design work is separated from its long-term impact both spatially and temporally, it can be hard for office-bound engineers with a slew of short-term project priorities to retain a sense of chronic unease.
Production of design artefacts such as specifications, calculations and drawings is tightly controlled and the end of the design phase of any project marks an important bureaucratic milestone. Design itself is a messy and creative process. While some aspects are standardized, design also involves analysing, experimenting, tinkering, adjusting and debating with colleagues about the best way forward in any given case.
When the work of designers is complete, drawings, calculations and specifications are formally handed over to another part of the project for manufacturing or construction to begin. This marks an important change in the classification of any given object indicating it is no longer just an idea under development represented by a set of paper or electronic artefacts but is now ready to be converted into a stable, formal, agreed upon physical piece of equipment. Once approved for construction, its form becomes binding with remaining risk associated with its use in operations deemed to be acceptable and any change requiring formal consideration and approval.
So who makes the formal decision that design is over?
For many decades this has been an intensely bureaucratic trickle up process with a strong flavour of high reliability’s deference to expertise in the detailed arrangements. Artefacts of all kinds typically had at least three signatures to formalise them as complete – an originator acknowledging that the content was correct, a checker (or verifier) noting that they had confirmed the accuracy of the content and someone authorising the artefact’s use as part of a broader set. Different types of drawings, calculations and specifications were signed by engineers and project management personnel of different levels of seniority and coming from different disciplines with the project manager only able to sign off the entire project as ready for construction when each more detailed component had been confirmed as ready.
When I was a young engineer, this milestone was marked by an activity that was on the one hand bureaucratic, but on the other an important ritual. Forty years on, I can still vividly remember the first time I signed off on a set of drawings for a project making modifications to an offshore facility. I can no longer recall what the project was about technically but those of us with the authority to authorise aspects of the work as complete were assembled in a conference room with a large pile of full-size film drawings and literally required to sign every single one. Sometimes it took hours and this very act changed the nature of this daily encounter with risk providing time to sit still and reflect, often at the end of dashing around focusing on short term issues to bring the project to this stage. By making this mark on every page, we were taking responsibility for the work and confirming our confidence in its fitness for purpose.
A similar sensibility was invoked in Safety Case legislation here in Victoria, Australia that requires the Safety Case submitted to government to include a statement signed by the most senior company officer resident in this state that confirms the accuracy of the content. Under law, this person is already responsible, but I have seen the act of making that mark on paper focus people’s minds on the gravity and importance of an analysis of the potential impact of their facilities on the lives of the public who live nearby. I have seen busy CEOs hesitate and take stock, sometimes asking for more information before adding a wet signature to the front page.
Signing is a symbolic act with its very episodic and formal nature contributing to its effectiveness as marking a formal transition and fostering a sense of responsibility.
But times have changed. Today, sign off is virtual – the click of a button that can be done without leaving one’s desk and between responding to emails. How has this apparently minor process change impacted the way professionals think about their responsibility for their work? Do we need new rituals to drive home the implications of saying “my work is done”?
It is true that rituals are not always useful for risk management. Power warned many years ago that auditing can become a ritual of verification, retaining a symbolic value that gives comfort of control without necessarily making a real difference to outcomes but my sense is that losing the requirement for wet signatures is a ritual of responsibility that needs to be revamped and reinstated in a new form.