For instance, we may conduct a blameless post-mortem after every incident to gain the best understanding of how the accident occurred and agree upon what the best countermeasures are to improve the system, ideally preventing the problem from occurring again and enabling faster detection and recovery. By doing this, we create organizational learning. As Bethany Macri, an engineer at Etsy who led the creation of the Morgue tool to help with recording of post-mortems, stated, “By removing blame, you remove fear; by removing fear, you enable honesty; and honesty enables prevention.”
