SH284: LEODSI and PETTEOT: A Systems Approach for Understanding How Diving Really Works

Counter-Errorism in Diving: Applying Human Factors to Diving · Jun 3, 2026 · 12m

When something goes wrong in diving, people often ask “who made the mistake?”, but that question usually oversimplifies what really happened and stops us from learning. The Learning from Emergent Outcomes framework (LEODSI) takes a different approach by looking at diving as a system, where outcomes are shaped by many interacting factors rather than one person’s actions. It examines seven key elements—people, environment, tasks, equipment, external pressures, organisation, and time—to understand how decisions made sense in the moment and how conditions combined to produce the result. Instead…