PreAccident Investigation Podcast

PAPod 575 - Vancouver Workshop: A Case Study in Failure, Justice, and Resilience

Todd Conklin talks with Brent Sutton and Jeff Lyth about the upcoming HOP Workshop in Vancouver (Jan 28–29, 2026), centered on Redonda’s powerful firsthand story of patient safety, complex systems, restorative justice and resilience — lessons that translate across industries.
Day one features Redonda’s narrative and panel discussion; day two focuses on hands‑on learning and innovation. Please attend, this workshop will be amazingly good for the soul!
For tickets and details visit hopconference.com.

PAPod 574 - Margin for Safety: Lessons from 50 Years in the Cockpit

This episode explores human performance and aviation safety, contrasting airline procedures with general aviation risks. Guests discuss building safety margins, the importance of planning vs. acting, and how economic pressures can erode resilience.Highlights include treating near-misses as learning opportunities, practical tips for pilots to increase recoverability, and real-world examples from naval operations and long-term flying experience.

PAPod 573 - The Stability Trap: Why Safe Organizations Still Fail

Jay Allen interviews Todd Conklin about his new book, The Stability Trap, exploring why even safe, stable organizations can fail. They discuss the "drive to zero," complacency, pressures on middle management, wearables and data, and lessons from aviation and the pandemic.
The episode also covers how AI was used to reorganize the book’s ideas and help craft its ending, and offers practical reframes: treat safety as a capacity, see workers as system monitors, and retool systems to match capacity with risk. The book is available now.

PAPod 572 - The Stability Trap: Why Safety Success Can Lead to Failure

Host Todd introduces his new book, The Stability Trap, and shares a sneak peek episode created with an AI-generated interview. The episode explores why organizations that appear safe can still experience accidents and how success itself can erode safety capacity.The discussion outlines the core ideas: safety as the presence of capacity, the three R's (redefine safety, reframe the worker, relearn investigation), and a five-stage practical blueprint for leaders, safety professionals, frontline workers, supervisors, and system integration.Short and practical, the episode is a teaser for the book and invites listeners to reflect on whether their organizations maintain the resilience, confidence, and systems needed to recover when things go wrong.

PAPod 571 - Fail Fast, Learn Faster: A Conversation on Human Performance and Recovery

In this episode Todd Conklin joins Jowanza Joseph to explore modern safety thinking: why human error is normal, how context shapes behavior, and why leadership response and system recoverability matter more than blame.
They draw on examples from Los Alamos, AWS outages, SpaceX and everyday technology to show how organizations can design systems that tolerate failure and learn from it.
Listeners will get practical insights into the five principles of human performance and how to build resilient systems that fail safely and recover quickly.

PAPod 570 - Safety Differently Down Under: Todd Conklin in Auckland

Todd Conklin joins the Brisbane Safety Differently Book Lab in Auckland for a lively discussion about leadership, accountability, and learning from everyday work. The group explores why safety is the presence of control, how leaders should respond after incidents, and why learning is the new currency of safety.Todd shares stories about writing his books, engaging with workers, and practical steps leaders can take to build confidence and capacity while fostering a learning culture.

PAPod 569 - PART TWO: 11 Seconds: How a System, Not a Nurse, Failed

Part two of the RaDonda Vaught story examines what emerged after the event: investigation details, system design flaws, communication breakdowns, and the tiny timing error that mattered. RaDonda Vaught recounts how normalized overrides, software defaults, and organizational assumptions created conditions for failure.
The episode explores the chilling effects of criminalizing mistakes, the human cost across patients and providers, and the case for shifting from blame to system-focused learning and improvement.

PAPod 568 - PART ONE: Charged for a Mistake: The Nurse, the Error, and a System That Failed

In this episode, nurse RaDonda Vaught tells the detailed, context-rich story of a medication error at Vanderbilt that led to criminal charges. She walks through the events, system issues (including a recent EHR rollout and medication-dispensing delays), distractions, and decision points that contributed to the mistake.
RaDonda describes how workarounds, unclear documentation in radiology, drug supply changes, and interruptions combined to produce a tragic outcome, and she explains the immediate clinical response. The episode sets up a follow-up discussion about what was learned and how systems can be improved.

PAPod 567 - Open Questions 2025: From Metrics to Monitors — Rethinking Safety

Episode: an extended open Q&A from the Pre-Accident Investigation Conference in Santa Fe covering big-picture safety topics.Speakers discuss the limits of traditional metrics, the power of real-time monitoring, shifting focus from managing risk to maintaining control, validating controls in the field, learning teams, contractor relationships, and prioritizing high-information events. Anecdotes and practical guidance illustrate how organizations can learn without blame.

PAPod 566 - Blame Stops Improvement: How Blame Silences Learning

Todd Conklin explores how blame shuts down learning and prevents organizational improvement, arguing that blaming individuals creates a chilling effect that blocks thousands of future learning opportunities.He connects blame to misunderstandings about human error, emphasizes psychological safety, and urges leaders to ask "what failed" before asking "who failed," while sharing personal anecdotes and reflections.