A funny thing happens when engineers make mistakes and feel safe when giving details about it: they are not only willing to be held accountable, they are also enthusiastic in helping the rest of the company avoid the same error in the future. They are, after all, the most expert in their own error. They ought to be heavily involved in coming up with remediation items.
So technically, engineers are not at all “off the hook” with a blameless PostMortem process. They are very much on the hook for helping Etsy become safer and more resilient, in the end. And lo and behold: most engineers I know find this idea of making things better for others a worthwhile exercise.
What does it mean to have a ‘blameless’ Post-Mortem?
Does it mean everyone gets off the hook for making mistakes? No.
Well, maybe. It depends on what “gets off the hook” means. Let me explain.
Having a Just Culture means that you’re making effort to balance safety and accountability. It means that by investigating mistakes in a way that focuses on the situational aspects of a failure’s mechanism and the decision-making process of individuals proximate to the failure, an organization can come out safer than it would normally be if it had simply punished the actors involved as a remediation.
Having a “blameless” Post-Mortem process means that engineers whose actions have contributed to an accident can give a detailed account of:
what actions they took at what time,
what effects they observed,
expectations they had,
assumptions they had made,
and their understanding of timeline of events as they occurred.
…and that they can give this detailed account without fear of punishment or retribution.
Why shouldn’t they be punished or reprimanded? Because an engineer who thinks they’re going to be reprimanded are disincentivized to give the details necessary to get an understanding of the mechanism, pathology, and operation of the failure. This lack of understanding of how the accident occurred all but guarantees that it will repeat. If not with the original engineer, another one in the future.