Learning from incidents

Message from John Haynes AFSM, Executive Director Strategy, Planning and Risk

At CFA we strongly support the learning opportunities that arise from analysing incidents attended by CFA members. 


Through this lessons management process, we strive to positively change behaviour.

Our Lessons Management Centre (LMC) was set up in 2018 to collect and analyse lessons to embed a lessons-learned culture across CFA. The LMC analyses observations from incidents, looks for trends and makes recommendations for improvement. The aim is to increase firefighter safety and reduce organisational risk.

The LMC encourages CFA members to share lessons in a no-blame environment.  

Part of the LMC’s role is to develop case studies, identify learning opportunities and share the outcomes. This wouldn’t be possible without ongoing support from operational members (both staff and volunteers) at regional, district and brigade levels.

The value of case studies

Research shows that people’s day-to-day experiences, as they confront challenges on the job, are rich sources of learning.

Have you ever learned something while doing a job and thought ‘I wish I’d known that beforehand’? How often do you choose a particular strategy or process at an incident because it worked well the last time? We are constantly learning from our experiences.

Case studies allow us to share with others what we have learned, instead of keeping the knowledge within a crew or brigade. Case studies allow people to learn from a mistake without having to live through it themselves.

This provides a unique opportunity to address areas for improvement, increase awareness of safety issues and to sustain good practice.

Storytelling is a powerful way to pass on historical information and general lessons. Our case studies allow us to tell the stories of real CFA members and the incident that taught them something important.

Case studies such as those in the ‘Learning from Experience’ section of Brigade magazine and on our intranet are developed as soon as practical after an incident to capture information on what went well and what could be improved. 

Because of their importance to CFA, from this month the LMC will produce monthly case studies which will be added to the growing online catalogue and promoted in the weekly enewsletter. We will also continue to include case studies in Brigade magazine twice a year.

I encourage you to regularly check out the LMC pages on the intranet and read the latest case studies.

Also, if you recently completed a debrief/after action review, or have a story from an incident you’d like to share, get in touch with the LMC: 03 9262 8467 or email lessons-management-centre@cfa.vic.gov.au

Author: John Haynes