The Post-Incident Guide


Dr. Laura Maguire
Nora Jones
Vanessa Huerta Granda


Thank you to all the Jeli Beans that helped support the launch of this guide, with long days put into section rewrites, editing, and re-reading for continuity, especially Daniela Hurtado, Emily Ruppe, MacKenzie Wardwell, Thai Wood, and Will Gallego.

Finally, we appreciate the support of all those who worked on this guide for review and feedback, this Guide would not have been possible without you:

  • Danesh Abeyratne
  • John Allspaw
  • Morgan Collins
  • Jessica DeVita
  • Alex Elman
  • Dara Garvin
  • Fred Hebert
  • Lorin Hochstein
  • Ryan Kitchens
  • Duck Lawn
  • Yanet Leon
  • Chris Mitchell
  • Courtney Nash
  • Tim Nicholas
  • Laura Nolan
  • Paul Osman
  • Nick Stenning
  • Noah Sussman
  • Chad Todd
  1. Nora Jones, “Introduction,” Learning from Incidents (blog), November 25, 2019,
  2. Gary Klein, Seeing What Others Don’t: The Remarkable Ways We Gain Insights (New York: Public Affairs, 2015).
  3. Vanessa Huerta Granda, “Making Sense out of Incident Metrics,” Learning from Incidents (blog), May 28, 2021,
  4. DD Woods, “Report from the SNAFUcatchers Workshop on Coping with Complexity.” Snafu Catchers (Columbus: The Ohio State University, 2017),
  5. Nancy Cooke, “Knowledge Elicitation,” (New Mexico State University).
  6. Sidney Dekker, The Field Guide to Understanding “Human Error” (Farnham: Ashgate Publishing, 2016).
  7. John Allspaw, “Incidents as We Imagine Them versus How They Actually Happen,” Adaptive Capacity Labs (blog), November 5, 2018,
  8. John C. Flanagan, “The Critical Incident Technique,” Psychological Bulletin 51, no. 4 (July 1954),
  9. Robert R. Hoffman, Beth Crandall, and Nigel Shadbolt, “Use of the Critical Decision Method to Elicit Expert Knowledge: A Case Study in the Methodology of Cognitive Task Analysis,” Human Factors 40, no. 2 (June 1, 1998): 254–276,
  10. J. Paul Reed, “‘Blameless’ Postmortems Don’t Work. Be Blame-Aware but Don’t go Negative,” TechBeacon, July 29, 2021,
  11. Sidney Dekker, The Field Guide to Understanding ‘Human Error’. (Boca Raton: CRC Press, 2014).
  12. Diane Vaughan, The Challenger Launch Decision: Risky Technology, Culture, and Deviance at NASA (Chicago: The University of Chicago Press, 2016).