Post-Incident
Reviews
Learning from Failure for Improved Incident Response
Author: Jason Hand
Publisher: O'Reilly Media
Published: August 2017
Pages: 108
Reading Time: 2 hours 15 minutes
About This Book
In this comprehensive guide, I challenge traditional approaches to incident analysis and present a modern framework for learning from failures. Post-Incident Reviews moves beyond simplistic root cause analysis to embrace the complexity of modern distributed systems and the crucial human elements involved in incident response.
Effective post-incident reviews today encourage team members to play a key role in continuously improving the system. Traditional techniques for conducting post-incident analyses don't work well in modern IT organizations, mainly because the command-and-control approach offers team members no incentive to explore the system and detect flaws when they occur.
What Makes This Book Essential
- ✦ Beyond Root Cause: Learn why traditional RCA falls short in complex systems and what to do instead
- ✦ Human-Centered Approach: Embrace human elements and create psychological safety for honest learning
- ✦ Practical Framework: Real case studies, templates, and guides you can implement immediately
- ✦ Continuous Improvement: Build cultures that sustain success through learning from failures
Core
Philosophy
Move Beyond Blame
Traditional command-and-control post-mortems create fear and discourage honest exploration. Blameless reviews foster psychological safety and genuine learning.
Continuous Improvement
Sustained success depends on making continuous improvement a core organizational value, not just a reactive process after incidents.
Embrace Complexity
Modern distributed systems are complex. Effective reviews examine complete incident lifecycles and systemic patterns, not just single root causes.
Table
of
Contents
Broken Incentives and Initiatives
Why traditional approaches fail to create learning cultures
Old-View Thinking
Understanding limitations of traditional post-incident methodologies
Embracing the Human Elements
The critical role of people, psychology, and organizational culture
Understanding Cause and Effect
Complexity in distributed systems and causal relationships
Continuous Improvement
Making improvement a core value, not just a reaction
Outage Case Study
Real-world incident analysis and lessons learned
Facilitating Improvements
Practical techniques for leading effective post-incident reviews
Defining Incidents and Lifecycle
Framework for understanding incident phases and progression
Conducting Post-Incident Reviews
Step-by-step guide to running effective review sessions
Templates and Guides
Ready-to-use resources for implementing reviews
Readiness
Preparing your organization for effective incident learning
Key
Concepts
Blameless Culture
Creating psychological safety where teams can learn without fear
Incident Lifecycle
Detection, response, remediation, analysis, and readiness phases
Systems Thinking
Understanding complexity and cause-effect relationships
Human Elements
Recognizing people as essential to system resilience
Timeline Analysis
Establishing accurate incident timelines and contributing factors
Action Items
Creating meaningful, actionable improvements with follow-through
Learning Culture
Building organizations that learn and improve from every incident
Documentation
Effective incident documentation and knowledge sharing
Team Empowerment
Encouraging teams to identify vulnerabilities and drive improvements
What You'll Learn
For Leaders
- → Why traditional post-mortem approaches fail in modern organizations
- → How to build psychological safety for honest incident analysis
- → Creating incentive structures that encourage learning
- → Making continuous improvement a core organizational value
For Practitioners
- → Practical techniques for facilitating effective reviews
- → Understanding cause and effect in complex distributed systems
- → Creating accurate timelines and identifying contributing factors
- → Using templates and guides to implement reviews immediately
The Incident Lifecycle Framework
The book introduces a comprehensive framework for understanding incidents across five key phases:
Detection
Identifying incidents early
Response
Mobilizing teams effectively
Remediation
Restoring service
Analysis
Learning from incidents
Readiness
Preparing for the future