Inspectioneering Journal

Learning from the Past: Not Letting the Pendulum Swing to the Opposite Extreme in Our Mechanical Integrity Programs

Part 1

By Greg Alvarado, Chief Editor at Inspectioneering. This article appears in the September/October 2008 issue of Inspectioneering Journal.
This article is part 1 of a 2-part series.
Part 1 | Part 2


It has been over 3 years since the fatal blast at the BP Texas City Refinery on March 23, 2005. The explosion resulted in the loss of 15 lives, more than 170 injuries, and countless lives forever changed.

Historical memory can be an odd thing.

It is important to preserve as accurate an account as possible if we are to learn from the past. We must protect ourselves from rationalizing the past to justify movement toward “normalization of abnormalities”. This concept was explained well by Mr. Don Holmstrom, a lead investigator for the U.S. Chemical Safety and Hazard Investigation Board (CSB). In a statement released for the BP Independent Safety Review Panel, in which Mr. Holstrom presented a summary of the BP incident findings, he stated:

One of my aspirations is that all industrial managers treat safety and major accident prevention with the same degree of seriousness and rigor that is brought to financial transactions. Few people would operate a major corporation today without a strict system of financial controls and auditing, where everyone within the corporation recognizes the severe consequences for noncompliance. (Paragraph 20)

That same standard of diligence is not always applied to risk management and safety. If you get away with a flawed safety decision one day or repeatedly, far from facing penalty you may actually end up rewarded, perhaps from boosting production. You may come to believe that what was thought to be unsafe is actually safe, based on your experience. It is a phenomenon that is sometimes called 'normalization of abnormalities'. (Paragraph 21)

The panel was charged with performing an independent investigation of the 2005 BP incident and was headed by James A. Baker III, former US Secretary of State.

This content is available to registered users and subscribers

Register today to unlock this article for free.

Create your free account and get access to:

  • Unlock one premium article of your choosing per month
  • Exclusive online content, videos, and downloads
  • Insightful and actionable webinars
Interested in unlimited access? VIEW OUR SUBSCRIPTION OPTIONS

Current subscribers and registered users can log in now.

Comments and Discussion

There are no comments yet.

Add a Comment

Please log in or register to participate in comments and discussions.

Inspectioneering Journal

Explore over 20 years of articles written by our team of subject matter experts.

Company Directory

Find relevant products, services, and technologies.

Training Solutions

Improve your skills in key mechanical integrity subjects.

Case Studies

Learn from the experience of others in the industry.


Inspectioneering's index of mechanical integrity topics – built by you.

Industry News

Stay up-to-date with the latest inspection and asset integrity management news.


Read short articles and insights authored by industry experts.

Expert Interviews

Inspectioneering's archive of interviews with industry subject matter experts.

Event Calendar

Find upcoming conferences, training sessions, online events, and more.


Downloadable eBooks, Asset Intelligence Reports, checklists, white papers, and more.

Videos & Webinars

Watch educational and informative videos directly related to your profession.


Commonly used asset integrity management and inspection acronyms.