The post-mortem problem

Post-mortems are required, time-consuming, and widely disliked — but they’re also one of the biggest opportunities to improve reliability.

In this webinar, we talked about how to run post-mortems that actually lead to learning and improvement. This covered why most post-mortems fall flat, how to structure them effectively, and walk through a real example to show what good looks like in practice. The goal: fewer wasted hours, better outcomes, and post-mortems that actually matter.

We discussed:

• Why post-mortems often fail to drive learning or change, and what their real purpose should be beyond documenting what broke.
• What “good” looks like in practice: a simple, engineer-friendly structure with clear timelines, contributing factors, and meaningful outcomes.
• How to run post-mortems that actually drive improvement, with common pitfalls to avoid and a practical example of best practices in action.