Abstract
A meta methodology for holistically examining system failures is proposed, for the purpose of preventing further occurrence of these failures. Such a meta methodology should promote double loop learning to change mental models. It should have three key features to promote double loop learning, and the proposed methodology provides them. These features are (1) a common language for understanding system failures, (2) complementary methodological features to accommodate multiple participants in achieving engineering safety and (3) inclusion of the dynamic aspects of system failures in order to avoid the introduction of side effects by quick fixes. An application example in IT engineering demonstrates that the proposed meta methodology overcomes the shortcomings of current methodologies. The example also shows that the meta methodology proactively promotes double loop learning from previous system failures. Copyright © 2008 John Wiley & Sons, Ltd.
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Nakamura, T., & Kijima, K. (2009). System of system failures: Meta methodology for IT engineering safety. Systems Research and Behavioral Science, 26(1), 29–47. https://doi.org/10.1002/sres.919
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