TVA is developing an extensive organizational intervention in response to the fly ash spill at the Kingston Fossil Plant, an event that TVA Chairman Duncan has characterized as " . . . a wakeup call” to address weaknesses in the way TVA operates.  What's interesting to us is that TVA's culture is frequently mentioned in the consultant's report on the event.  Although the report's use of "culture" refers to broad organizational history and evolution, and not "safety culture" as we normally use it, some of the observations and lessons are like those found in assessments of safety-challenged nuclear organizations.

The consultants identified some familiar suspects as contributing to the event: organizational silos with split responsibilities for the ash ponds, lack of collaboration and communication between the silos, periodic reorganizations that further clouded responsibilities, no application of lessons learned from similar incidents elsewhere, no effective QA/QC, and an organization that reacted to specific problems rather than searching for root causes and other potential problems.  The proposed fixes are also familiar to anyone who has been involved in a similar organizational analysis: more proactive planning and analysis, budget increases, more focus on remediation and some reorganization.

The consultants described TVA's legacy culture as one where new programs get a starting push, experience initial success, then slide toward complacency and mediocrity over time.  We hope it's different this time.

The link to the TVA press release describing their proposed fixes is here.  The TVA page also includes links to the consultants' report and other related materials.