What is the post-mortem problem? Why incident post-mortems fail and how to fix them

Incident post-mortems, crucial in incident management, often fail due to being perceived as compliance tasks rather than human-focused narratives. Successful post-mortems should be written promptly after an incident while details are fresh, employing storytelling rather than log-style recounting to make them memorable and actionable. A blameless approach focuses on systemic issues rather than individual fault, and follow-up actions should be concrete, owned, and integrated into existing workflows to avoid being forgotten. The Swiss cheese model is recommended over single root cause analysis to understand incident causation, emphasizing multiple contributing factors. AI can assist in drafting timelines but should not replace human analysis, which is critical for learning. Building a post-mortem culture involves creating quick, honest write-ups for even minor incidents, engaging with them actively, and ensuring learnings are accessible and shared across the organization.

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