ABSTRACT
Real work is full of responsibility-authority mismatches. Where people have formal responsibility for the outcome of their work, but do not have full authority over the actions and decisions that take them to that outcome. The question is not whether the work of the people whose errors one want to understand contained these mismatches (because it most likely did). The responsibility-authority mismatch brings us back to the basic goal conflicts that drive most safety-critical and time-critical work. Such work consists of holding together a tapestry of multiple competing goals, of reconciling them as best as possible in real-time practice. Holding people accountable is fine. Holding people accountable without proving that they were actually in control over the situation happens a lot. The Old View lives by it, actually. Hunting down individuals stifles the flow of information about these sorts of conditions that expose systems to risk. Accountability does not need to mean holding people responsible in the traditional sense.
