How Organisations Fail
Why do groups of capable, well-meaning people make decisions that none of them would make alone, and how can organisations learn instead of repeating them?
Most organisational failures are not caused by stupidity or bad intent. They come from intelligent people inside structures that hide warnings, reward conformity and make small risks feel normal.
This path begins with the psychology of groups and then studies failures in depth: the Cuban missile crisis, the long folly of Vietnam, the Challenger disaster and accidents in complex technical systems. In each, the cause turns out to be a pattern that could recur elsewhere. The last three books turn from diagnosis to remedy: understanding error without blame, building psychological safety and designing institutions that learn.
The essay on enterprise software describes how an institution’s trust in its own system produced one of the worst miscarriages of justice in British history, and the ideas of Groupthink and Sunk Costs and the Escalation of Commitment are companions to this path.
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Janis studied the Bay of Pigs, Pearl Harbor and Vietnam and found cohesive groups suppressing doubt in a recognisable pattern. The term entered everyday language; the book is better than the summary.
- Read it for
- The symptoms of groupthink and the counter-examples where similar groups decided well.
- Carry forward
- When did someone last disagree openly in our most senior meeting, and what happened to them?
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The Cuban missile crisis seen through three lenses: a single rational actor, organisations following routines and individuals bargaining. Each explains different facts.
- Read it for
- The three models, and how organisational routines constrain what leaders can actually choose.
- Carry forward
- Which of our options exist only because a department already knows how to do them?
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Tuchman defines folly as a policy pursued against a group’s own interest, when a feasible alternative existed and was urged at the time. Her cases run from Troy to Vietnam.
- Read it for
- The criteria for folly, and the recurring role of wooden-headedness and self-deception.
- Carry forward
- Is anyone inside our organisation already warning against the course we are on?
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The Challenger Launch Decision
Vaughan’s study overturned the story of managers ignoring engineers. She found that accepting small risks had become normal through years of reasonable-looking decisions.
- Read it for
- The normalisation of deviance, and how culture and structure shaped a fatal decision.
- Carry forward
- What risk have we accepted so often that we no longer see it as a risk?
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Perrow argued that in systems that are both complex and tightly coupled, some accidents are inevitable, whatever the operators do.
- Read it for
- Interactive complexity and tight coupling, and their implications for how systems should be designed.
- Carry forward
- Where in our operations could a small failure cascade before anyone can intervene?
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The Field Guide to Understanding 'Human Error'
Dekker shifts the question from who made the error to why the action made sense to them at the time, which is where learning starts.
- Read it for
- The old and new views of human error, and why blame prevents learning.
- Carry forward
- When something goes wrong here, do we ask who failed or what made failure likely?
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Edmondson’s research on psychological safety explains why some teams report errors and raise concerns and others stay silent, and what leaders do to create the difference.
- Read it for
- The evidence from hospitals and companies, and the leader’s role in framing work as learning.
- Carry forward
- What does it cost someone here to say “I don’t know” or “I made a mistake”?
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Ends with systems that learn. Syed contrasts aviation, which investigates every failure openly, with fields that hide their errors, and draws lessons for any organisation.
- Read it for
- Closed loops, marginal gains and the design of institutions that learn from failure.
- Carry forward
- Where is our black box, and who reads it?
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