Juan Monsalve

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The question, according to Sidney Dekker, is not Who is to blame? It is not even Where, precisely, is the line between justifiable blame and an honest mistake? because this can never be determined in the abstract. Rather, the question is, Do those within the organization trust the people who are tasked with drawing that line? It is only when people trust those sitting in judgment that they will be open and diligent.8
Black Box Thinking: Why Some People Never Learn from Their Mistakes - But Some Do
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