What the Engineers' Silence Told Us about Fukushima Daiichi Nuclear Power Plant: Long Years of Realizing that Safety is Culture (1980-2011)

What the Engineers' Silence Told Us about Fukushima Daiichi Nuclear Power Plant: Long Years of Realizing that Safety is Culture (1980-2011)
The moment we asked the former executives who supported the organization from the dawn of the Fukushima Daiichi Nuclear Power Plant through its operation period about the fundamental safety issue of the cooling system, a deep silence fell over the place. Why did the executive level not fully understand the mechanism of the cooling system? This question was not so much about individual responsibility as it was about the organizational weaknesses of the Japanese nuclear industry at the time. After a moment of silence, he spoke a few words that carried the weight of his long years of experience.

From the 1980s to the 2000s, nuclear power plant operation sites became increasingly sophisticated and specialized areas were subdivided. A fault line of knowledge was created between the design and operating departments and management, and the field was caught between the burden of complex equipment operations and the demand for greater efficiency. Meanwhile, the management layer gradually began to make decisions based on abstract numbers and indicators, moving away from understanding the true nature of the equipment. This invisible distance gradually led to a diminishing safety culture.

Since 1991, the International Atomic Energy Agency (IAEA) has repeatedly emphasized the importance of safety culture, and at the core of this emphasis is the organizational characteristic of remaining sensitive to the voice of technology. In Japan, however, priorities such as stable power supply and cost efficiency were piling up, and the succession of onsite knowledge gradually weakened, and operation centered on procedure manuals became the norm. The National Diet of Japan Accident Independent Investigation Commission (NDCI), which is available on the Web, also points out that the background to the accident was the rapid generational change of engineers and the inadequate transfer of experience and knowledge.

The silence of the former executives included a conflict over how to explain these accumulated structural problems. Safety is not established by the robustness of the equipment alone, but is supported by a deep and continuing human understanding of the intentions and limitations of the technology. A lack of understanding of the cooling system can lead to misjudgment of the signs of abnormality and delay in judgment. Conversely, if there is respect for technology and a culture of continuous learning, it is possible to detect the signs of a serious accident from small changes. In other words, safety culture is not the knowledge itself, but the community's habit of maintaining the knowledge.

Various survey reports since 2011 have pointed to the stove-piped structure of the organization, an environment in which on-site concerns are not easily conveyed to upper management, and a disregard for specialized knowledge, highlighting long-term cultural issues in the Japanese nuclear industry. One comment made by a former engineer is emblematic of this structure.

The words, which came after a period of silence, illustrate the harsh reality that safety is determined more by how an organization handles technology than by the robustness of its facilities. The long years leading up to the realization that safety is a culture, not an institution, fostered by habits, not procedures, was the story of the Japanese nuclear industry from the 1980s to 2011.