Scott D Sagan, Princeton Studies in International History and Politics.
C 1993 Princeton University Press ISBN 0-691-03221-1
Many may wonder why a book on US military nuclear weapon safety has relevance to a health journal. The book’s first chapter sets the scene with a generic discussion of accidents and organisational learning. This discussion is viewed from two opposing theories, High-Reliability Organisation theory and Normal Accident theory.
In this day of quality assurance programs, such information has relevance to health care professionals who work in large organisations. Hopefully one would not identify health care as a hazardous technology but aspirations to emulate their focus on reliability are probably worthwhile.
High-Reliability Organisation theorists believe that serious accidents can be prevented through the design of organisations and their operation, citing US aircraft carrier operations as proof. Normal Accident theory claims accidents in high-risk industries, al though rare, are an inevitable and normal part of hazardous technology management. As one reads these two opposing views, the parallels with our health care system become obvious.
Rather than a simple ‘bash’ of all things nuclear or a cynical recounting of nu clear near mishaps, Sagan then ‘competitively tests’ these two theories against the US response to the Cuban missile crisis, the subsequent NORAD early warning organisation and the Thule B52 bomber accident. Later events such as the 1973 DEFCON 3 alert are used as benchmarks of learning (or the lack of it) from earlier nuclear weapon handling errors. By carefully choosing some of the more bizarre or notable events of American nuclear weapon history the book succeeds in making a fairly dry topic quite interesting. This was a worthwhile book to read.
So… if you have to know how a grizzly bear nearly caused an American nuclear strike on Cuba please read on.
