Print Friendly and PDF

Advanced Search Results Detail

Project ID: 10-1-05-1

Year: 2010

Date Started: 05/30/2010

Date Completed: 08/10/2012

Title: Using Escaped Prescribed Fire Reviews to Improve Organizational Learning

Project Proposal Abstract: Prescribed fire escapes continue to occur with regularity in all federal and state fire management agencies throughout the United States. By interagency policy, after an escape official reviews must be prepared. Paradigms guiding reviews have evolved over the past decade and now focus on organizational learning as opposed to individual accountability for all but the most serious accidents. In the absence of specific direction, a variety of innovative methodologies have been developed  including Facilitated Learning Analysis, After Action Reviews, and reviews based on High Reliability and Resiliency theory. Whatever review style or context reviewing agencies make the assumption that, once a review has been prepared, approved and sent out to field units, learning has or will occur. Yet, as David Garvin notes, a lesson is not learned just because the reason for an error or accident is known; true learning only occurs when individual behaviors change in the field. To date, there has been no comprehensive assessment to determine whether learning post-review is actually taking place, nor has anyone ascertained whether field practices were actually modified after an escape report is transferred to the field. In this proposal, we seek to understand whether and how any of the escaped prescribed fire reviews (EPFR) processes as currently designed and implemented by U.S. federal fire agencies actually promote organizational learning. We address three specific facets of this broad question: How current EPFR products compare against the tenets of organizational learning; How effectively current EFPR transfer of knowledge gained; and What aspects of organizational culture are needed to strengthen reviews. Since the challenge is less on the theoretical side - a tremendous amount of theoretical information exists about organizational learning and understanding error  and more on the cognitive side, we seek to answer these questions by engaging review participants in structured dialogues, and by comparing the theoretical and existing state-of-knowledge with existing review processes. We propose to present results in a variety of formats: a benchmark comparison of existing EFPR techniques against the precepts of organizational learning and understanding error; recommendations for improving EFPRs based on field and desk-based assessments (this will be field tested in at least one region); and six 6 minute podcasts covering various tips for organizing and conducting reviews that can be used by units and teams prior to and during reviews to maximize organizational learning.

Principal Investigator: Anne E. Black

Agency/Organization: Forest Service

Branch or Dept: RMRS-Rocky Mountain Research Station

Other Project Collaborators




Branch or Dept

Co-Principal Investigator

James Saveland

Forest Service

RMRS-Natural Resources Research Center

Co-Principal Investigator

David A. Thomas

Forest Service

RMRS-Human Factors & Risk Management RD&A

Federal Cooperator

James Saveland

Forest Service

RMRS-Natural Resources Research Center

Federal Fiscal Representative

Susan T. Major

Forest Service

RMRS-Rocky Mountain Research Station

Project Locations

Fire Science Exchange Network




Great Basin

Great Plains

Lake States

Oak Woodlands

Northern Rockies




Southern Rockies









Project Deliverables

Final Report view or print

("Results presented in JFSP Final Reports may not have been peer-reviewed and should be interpreted as tentative until published in a peer-reviewed source.")

  ID Type Title
view or print   1470 Government Publication Learning From Escaped Prescribed Fire Reviews: Workshop Flip-Chart Summary
view or print   1548 Government Publication Overview of Workshop Participants
view or print   1404 Government Publication Prescribed Fire Escapes: Are We Learning Anything?
view or print   1469 Government Publication Learning From Escaped Prescribed Fire Reviews: Workshop Discussion Summary
view or print   5312 Invited Paper/Presentation Learning from Escaped Prescribed Fire Reviews
view or print   5313 Invited Paper/Presentation Presentation to the US Fish and Wildlife Service’s National Meeting of Regional Fuels Planners
view or print go to website 4528 Invited Paper/Presentation International Webinar for Wildland Fire Lessons Learned Center, Feb 21, 2012, Delivered from: Missoula, MT
view or print   3716 Conference/Symposia/Workshop Learning From Escaped Prescribed Fire Reviews
view or print   4177 Invited Paper/Presentation Presentation and Discussion of Findings Relevant to Revisions of the Interagency Prescribed Fire Guide
    6635 Conference/Symposia/Workshop Pleasing Some of the People Some of the Time: How Authors, Subjects, and Readers Assess the Complex Landscape of Audience in Wildland Fire Incident Reviews
    6642 Conference/Symposia/Workshop Tips, Techniques, and Suggestions for Improving Learning from Escaped Prescribed Fire Reviews
view or print   5678 Conference/Symposia/Workshop Learning as a Shared Responsibility: Insights from a Series of Dialogic Workshops with Practitioners, Leaders, and Researchers
    5960 Invited Paper/Presentation Invited Presentation to the USFS National Fuels Group, Lakewood, CO
  go to website 5804 Website Project website. Access to project podcasts and related material is being created through a project specific webpage linked to the new Human Factors and Risk Management RD&A website.

Supporting Documents

There are no supporting documents available for this project.

Convert PDF documents to an html document using Adobe's online conversion tool.
Download Adobe Acrobat Reader