A Human Error Approach to Aviation Accident Analysis

The Human Factors Analysis and Classification System

Author: Douglas A. Wiegmann,Scott A. Shappell

Publisher: Routledge

ISBN: 1351962353

Category: Technology & Engineering

Page: 184

View: 9204

Human error is implicated in nearly all aviation accidents, yet most investigation and prevention programs are not designed around any theoretical framework of human error. Appropriate for all levels of expertise, the book provides the knowledge and tools required to conduct a human error analysis of accidents, regardless of operational setting (i.e. military, commercial, or general aviation). The book contains a complete description of the Human Factors Analysis and Classification System (HFACS), which incorporates James Reason's model of latent and active failures as a foundation. Widely disseminated among military and civilian organizations, HFACS encompasses all aspects of human error, including the conditions of operators and elements of supervisory and organizational failure. It attracts a very broad readership. Specifically, the book serves as the main textbook for a course in aviation accident investigation taught by one of the authors at the University of Illinois. This book will also be used in courses designed for military safety officers and flight surgeons in the U.S. Navy, Army and the Canadian Defense Force, who currently utilize the HFACS system during aviation accident investigations. Additionally, the book has been incorporated into the popular workshop on accident analysis and prevention provided by the authors at several professional conferences world-wide. The book is also targeted for students attending Embry-Riddle Aeronautical University which has satellite campuses throughout the world and offers a course in human factors accident investigation for many of its majors. In addition, the book will be incorporated into courses offered by Transportation Safety International and the Southern California Safety Institute. Finally, this book serves as an excellent reference guide for many safety professionals and investigators already in the field.
Release

A Human Error Approach to Aviation Accident Analysis

The Human Factors Analysis and Classification System

Author: Professor Scott A Shappell,Professor Douglas A Wiegmann

Publisher: Ashgate Publishing, Ltd.

ISBN: 1409463036

Category: Transportation

Page: 182

View: 3904

This comprehensive book provides the knowledge and tools required to conduct a human error analysis of accidents. Serving as an excellent reference guide for many safety professionals and investigators already in the field.
Release

Human Factors Models for Aviation Accident Analysis and Prevention

Author: Thomas G.C. Griffin,Mark S. Young,Neville A. Stanton

Publisher: CRC Press

ISBN: 1317120108

Category: Transportation

Page: 226

View: 6088

The investigation and modelling of aviation accident causation is dominated by linear models. Aviation is, however, a complex system and as such suffers from being artificially manipulated into non-complex models and methods. This book addresses this issue by developing a new approach to investigating aviation accident causation through information networks. These networks centralise communication and the flow of information as key indicators of a system’s health and risk. This holistic approach focuses on the system environment, the activity that takes place within it, the strategies used to conduct this activity, the way in which the constituent parts of the system (both human and non-human) interact and the behaviour required. Each stage of this book identifies and expands upon the potential of the information network approach, maintaining firm focus on the overall health of a system. The book’s new model offers many potential developments and some key areas are studied in this research. Through the centralisation of barriers and information nodes the method can be applied to almost any situation. The application of Bayesian mathematics to historical data populations provides scope for studying error migration and barrier manipulation. The book also provides application of these predictions to a flight simulator study for the purposes of validation. Beyond this it also discusses the applicability of the approach to industry. Through working with a legacy airline the methods discussed are used as the basis for a new and prospective safety management system.
Release

Investigating Human Error: Incidents, Accidents, and Complex Systems

Author: Barry Strauch

Publisher: Routledge

ISBN: 1351926292

Category: Transportation

Page: 324

View: 1248

In this book the author applies contemporary error theory to the needs of investigators and of anyone attempting to understand why someone made a critical error, how that error led to an incident or accident, and how to prevent such errors in the future. Students and investigators of human error will gain an appreciation of the literature on error, with numerous references to both scientific research and investigative reports in a wide variety of applications, from airplane accidents, to bus accidents, to bonfire disasters. Features include: - an easy to follow step by step approach to conducting error investigations that even those new to the field can readily apply. - summaries of recent transportation accidents and human factors literature and relates them to the cause of human error in accidents. - an approach to investigating human error that will be of interest to both human factors psychology and industrial engineering students and instructors, as well as investigators of accidents in aviation, mass transportation, nuclear power, or any industry that is to the adverse effects of error. Based on the author's over 18 years of experience as an accident investigator and instructor of both aircraft accident investigation techniques and human factors psychology, it reviews recent human factors literature, summarizes major transportation accidents, and shows how to investigate the types of errors that typically occur in high risk industries. It presents a model of human error causation influenced largely by James Reason and Neville Moray, and relates it to error investigations with step by step guidelines for data collection and analysis that investigators can readily apply as needed.
Release

Managing Maintenance Error

A Practical Guide

Author: James Reason,Alan Hobbs

Publisher: CRC Press

ISBN: 1351920510

Category: Technology & Engineering

Page: 200

View: 5449

Situations and systems are easier to change than the human condition - particularly when people are well-trained and well-motivated, as they usually are in maintenance organisations. This is a down-to-earth practitioner’s guide to managing maintenance error, written in Dr. Reason’s highly readable style. It deals with human risks generally and the special human performance problems arising in maintenance, as well as providing an engineer’s guide for their understanding and the solution. After reviewing the types of error and violation and the conditions that provoke them, the author sets out the broader picture, illustrated by examples of three system failures. Central to the book is a comprehensive review of error management, followed by chapters on:- managing person, the task and the team; - the workplace and the organization; - creating a safe culture; It is then rounded off and brought together, in such a way as to be readily applicable for those who can make it work, to achieve a greater and more consistent level of safety in maintenance activities. The readership will include maintenance engineering staff and safety officers and all those in responsible roles in critical and systems-reliant environments, including transportation, nuclear and conventional power, extractive and other chemical processing and manufacturing industries and medicine.
Release

Aircraft Accident Investigation

Author: Richard H. Wood,Robert W. Sweginnis

Publisher: N.A

ISBN: 9781892944177

Category: Aeronautics

Page: 516

View: 9484

This book covers all aspects of aircraft accident investigation including inflight fires, electrical circuitry, and composite structure failure. The authors explain basic investigation techniques and procedures required by the National Transportation Safety Board (NTSB) and the International Civil Aviation Organization (ICAO). There are also chapters on accident analysis, investigation management, and report writing. The appendices include the Code of Ethics and Conduct of the International Society of Air Safety Investigators.
Release

Human Performance on the Flight Deck

Author: Don Harris

Publisher: CRC Press

ISBN: 1351929682

Category: Technology & Engineering

Page: 384

View: 1976

Taking an integrated, systems approach to dealing exclusively with the human performance issues encountered on the flight deck of the modern airliner, this book describes the inter-relationships between the various application areas of human factors, recognising that the human contribution to the operation of an airliner does not fall into neat pigeonholes. The relationship between areas such as pilot selection, training, flight deck design and safety management is continually emphasised within the book. It also affirms the upside of human factors in aviation - the positive contribution that it can make to the industry - and avoids placing undue emphasis on when the human component fails. The book is divided into four main parts. Part one describes the underpinning science base, with chapters on human information processing, workload, situation awareness, decision making, error and individual differences. Part two of the book looks at the human in the system, containing chapters on pilot selection, simulation and training, stress, fatigue and alcohol, and environmental stressors. Part three takes a closer look at the machine (the aircraft), beginning with an examination of flight deck display design, followed by chapters on aircraft control, flight deck automation, and HCI on the flight deck. Part four completes the volume with a consideration of safety management issues, both on the flight deck and across the airline; the final chapter in this section looks at human factors for incident and accident investigation. The book is written for professionals within the aviation industry, both on the flight deck and elsewhere, for post-graduate students and for researchers working in the area.
Release

The Field Guide to Understanding Human Error

Author: Sidney Dekker

Publisher: CRC Press

ISBN: 1351889753

Category: Technology & Engineering

Page: 252

View: 3196

When faced with a human error problem, you may be tempted to ask 'Why didn't they watch out better? How could they not have noticed?'. You think you can solve your human error problem by telling people to be more careful, by reprimanding the miscreants, by issuing a new rule or procedure. These are all expressions of 'The Bad Apple Theory', where you believe your system is basically safe if it were not for those few unreliable people in it. This old view of human error is increasingly outdated and will lead you nowhere. The new view, in contrast, understands that a human error problem is actually an organizational problem. Finding a 'human error' by any other name, or by any other human, is only the beginning of your journey, not a convenient conclusion. The new view recognizes that systems are inherent trade-offs between safety and other pressures (for example: production). People need to create safety through practice, at all levels of an organization. Breaking new ground beyond its successful predecessor, The Field Guide to Understanding Human Error guides you through the traps and misconceptions of the old view. It explains how to avoid the hindsight bias, to zoom out from the people closest in time and place to the mishap, and resist the temptation of counterfactual reasoning and judgmental language. But it also helps you look forward. It suggests how to apply the new view in building your safety department, handling questions about accountability, and constructing meaningful countermeasures. It even helps you in getting your organization to adopt the new view and improve its learning from failure. So if you are faced by a human error problem, abandon the fallacy of a quick fix. Read this book.
Release

Behind Human Error

Author: Dr Leila Johannesen,Dr Nadine Sarter,Dr Richard Cook,Professor Sidney Dekker,Professor David D Woods

Publisher: Ashgate Publishing, Ltd.

ISBN: 1409486389

Category: Technology & Engineering

Page: 292

View: 439

Human error is so often cited as a cause of accidents. There is perception of a 'human error problem'. Solutions are thought to lie in changing the people or their role. The label 'human error', however, is prejudicial and hides more than it reveals about how a system malfunctions. This book takes you behind the label. It explains how human error results from social and psychological judgments by the system's stakeholders that focus only on one facet of a set of interacting contributors.
Release

Basic Guide to System Safety

Author: Jeffrey W. Vincoli

Publisher: John Wiley & Sons

ISBN: 1118904869

Category: Technology & Engineering

Page: 256

View: 1449

This book provides guidance on including prevention through design concepts within an occupational safety and health management system. Through the application of these concepts, decisions pertaining to occupational hazards and risks can be incorporated into the process of design and redesign of work premises, tools, equipment, machinery, substances, and work processes including their construction, manufacture, use, maintenance, and ultimate disposal or reuse. These techniques provide guidance for a life-cycle assessment and design model that balances environmental and occupational safety and health goals over the life span of a facility, process, or product. The new edition is expanded to include primer information on the use of safety assurance techniques in design and construction.
Release

Human Factors in Aviation

Author: Eduardo Salas,Florian Jentsch,Dan Maurino

Publisher: Academic Press

ISBN: 9780080923024

Category: Technology & Engineering

Page: 744

View: 5237

This edited textbook is a fully updated and expanded version of the highly successful first edition of Human Factors in Aviation. Written for the widespread aviation community - students, engineers, scientists, pilots, managers, government personnel, etc., HFA offers a comprehensive overview of the topic, taking readers from the general to the specific, first covering broad issues, then the more specific topics of pilot performance, human factors in aircraft design, and vehicles and systems. The new editors offer essential breath of experience on aviation human factors from multiple perspectives (i.e. scientific research, regulation, funding agencies, technology, and implementation) as well as knowledge about the science. The contributors are experts in their fields. Topics carried over from the first edition are fully updated, several by new authors who are now at the fore of the field. New material - which represents 50% of the volume - focuses on the challenges facing aviation specialists today. One of the most significant developments in this decade has been NextGen, the Federal Aviation Administration's plan to modernize national airspace and to address the impact of air traffic growth by increasing airspace capacity and efficiency while simultaneously improving safety, environmental impacts and user access. NextGen issues are covered in full. Other new topics include: High Reliability Organizational Perspective, Situation Awareness & Workload in Aviation, Human Error Analysis, Human-System Risk Management, LOSA, NOSS and Unmanned Aircraft System. Comprehensive text with up-to-date synthesis of primary source material that does not need to be supplemented New edition thoroughly updated with 50% new material and full coverage of NexGen and other modern issues Instructor website with test bank and image collection makes this the only text offering ancillary support Liberal use of case examples exposes readers to real-world examples of dangers and solutions
Release

Barriers and Accident Prevention

Author: Erik Hollnagel

Publisher: Routledge

ISBN: 1351955934

Category: Transportation

Page: 242

View: 9761

Accidents are preventable, but only if they are correctly described and understood. Since the mid-1980s accidents have come to be seen as the consequence of complex interactions rather than simple threads of causes and effects. Yet progress in accident models has not been matched by advances in methods. The author's work in several fields (aviation, power production, traffic safety, healthcare) made it clear that there is a practical need for constructive methods and this book presents the experiences and the state-of-the-art. The focus of the book is on accident prevention rather than accident analysis and unlike other books, has a proactive rather than reactive approach. The emphasis on design rather than analysis is a trend also found in other fields. Features of the book include: -A classification of barrier functions and barrier systems that will enable the reader to appreciate the diversity of barriers and to make informed decisions for system changes. -A perspective on how the understanding of accidents (the accident model) largely determines how the analysis is done and what can be achieved. The book critically assesses three types of accident models (sequential, epidemiological, systemic) and compares their strengths and weaknesses. -A specific accident model that captures the full complexity of systemic accidents. One consequence is that accidents can be prevented through a combination of performance monitoring and barrier functions, rather than through the elimination or encapsulation of causes. -A clearly described methodology for barrier analysis and accident prevention. Written in an accessible style, Barriers and Accident Prevention is designed to provide a stimulating and practical guide for industry professionals familiar with the general ideas of accidents and human error. The book is directed at those involved with accident analysis and system safety, such as managers of safety departments, risk and safety consultants, human factors professionals, and accident investigators. It is applicable to all major application areas such as aviation, ground transportation, maritime, process industries, healthcare and hospitals, communication systems, and service providers.
Release

Safety Management Systems in Aviation

Author: Alan J. Stolzer,John J. Goglia

Publisher: Routledge

ISBN: 1317059832

Category: Transportation

Page: 396

View: 4501

Although aviation is among the safest modes of transportation in the world today, accidents still happen. In order to further reduce accidents and improve safety, proactive approaches must be adopted by the aviation community. The International Civil Aviation Organization (ICAO) has mandated that all of its member states implement Safety Management System (SMS) programs in their aviation industries. While some countries (the United States, Australia, Canada, members of the European Union and New Zealand, for example) have been engaged in SMS for a few years, it is still non-existent in many other countries. This unique and comprehensive book has been designed as a textbook for the student of aviation safety, and as an invaluable reference tool for the SMS practitioner in any segment of aviation. It discusses the quality management underpinnings of SMS, the four components, risk management, reliability engineering, SMS implementation, and the scientific rigor that must be designed into proactive safety. The authors introduce a hypothetical airline-oriented safety scenario at the beginning of the book and conclude it at the end, engaging the reader and adding interest to the text. To enhance the practical application of the material, the book also features numerous SMS in Practice commentaries by some of the most respected names in aviation safety. In this second edition of Safety Management Systems in Aviation, the authors have extensively updated relevant sections to reflect developments since the original book of 2008. New sections include: a brief history of FAA initiatives to establish SMS, data-driven safety studies, developing a system description, SMS in a flight school, and measuring SMS effectiveness.
Release

Human Performance and Limitations in Aviation

Author: R. D. Campbell,Michael Bagshaw

Publisher: John Wiley & Sons

ISBN: 1405147342

Category: Technology & Engineering

Page: 208

View: 6384

Human error is cited as a major cause in over 70% of accidents, and it is widely agreed that a better understanding of human capabilities and limitations - both physical and psychological - would help reduce human error and improve flight safety. This book was first published when the UK Civil Aviation Authority introduced an examination in human performance and limitations for all private and professional pilot licences. Now the Joint Aviation Authorities of Europe have published a new syllabus as part of their Joint Aviation Requirements for Flight Crew Licensing. The book has been completely revised and rewritten to take account of the new syllabus. The coverage of basic aviation psychology has been greatly expanded, and the section on aviation physiology now includes topics on the high altitude environment and on health maintenance. Throughout, the text avoids excessive jargon and technical language. "There is no doubt that this book provides an excellent basic understanding of the human body, its limitations, the psychological processes and how they interact with the aviation environment. I am currently studying for my ATPL Ground Exams and I found this book to be an invaluable aid. It is equally useful for those studying for the PPL and for all pilots who would like to be reminded of their physiological and psychological limitations." –General Aviation, June 2002
Release

Handbook of Aviation Human Factors, Second Edition

Author: John A. Wise,V. David Hopkin,Daniel J. Garland

Publisher: CRC Press

ISBN: 9780805859065

Category: Technology & Engineering

Page: 704

View: 6131

A complete examination of issues and concepts relating to human factors in simulation, this book covers theory and application in space, ships, submarines, naval aviation, and commercial aviation. The authors examine issues of simulation and their effect on the validity and functionality of simulators as a training device. The chapters contain in depth discussions of these particular characteristics and issues. They also incorporate theories pertaining to the motivational aspects of training, simulation of social events, and PC based simulation.
Release

Beyond Aviation Human Factors

Safety in High Technology Systems

Author: Daniel E. Maurino,James Reason,Neil Johnston,Rob B. Lee

Publisher: Routledge

ISBN: 1351955691

Category: Transportation

Page: 181

View: 7117

The authors believe that a systematic organizational approach to aviation safety must replace the piecemeal approaches largely favoured in the past, but this change needs to be preceded by information to explain why a new approach is necessary. Accident records show a flattening of the safety curve since the early Seventies: instead of new kinds of accident, similar safety deficiencies have become recurrent features in accident reports. This suggests the need to review traditional accident prevention strategies, focused almost exclusively on the action or inaction’s of front-line operational personnel. The organizational model proposed by the authors is one alternative means to pursue safety and prevention strategies in contemporary aviation; it is also applicable to other production systems. The model argues for a broadened approach, which considers the influence of all organizations (the blunt end?) involved in aviation operations, in addition to individual human performance (the sharp end?). If the concepts of systems safety and organizational accidents are to be advanced, aviation management at all levels must be aware of them. This book is intended to provide a bridge from the academic knowledge gained from research, to the needs of practitioners in aviation. It comprises six chapters: the fundamentals, background and justification for an organizational accident causation model to the flight deck, maintenance and air traffic control environments. The last chapter suggest different ways to apply the model as a prevention tool which furthermore enhances organizational effectiveness. The value of the organizational framework pioneered by Professor Reason in analyzing safety in high-technology production systems is felt by his co-authors to have an enduring role to play, both now and in coming decades. Applied now in this book, it has been adopted by ICAO, IFATCA, IMO, the US National Transportation Safety Board, the Transportation Safety B
Release

Ten Questions About Human Error

A New View of Human Factors and System Safety

Author: Sidney Dekker

Publisher: CRC Press

ISBN: 1410612066

Category: Technology & Engineering

Page: 240

View: 4312

Ten Questions About Human Error asks the type of questions frequently posed in incident and accident investigations, people's own practice, managerial and organizational settings, policymaking, classrooms, Crew Resource Management Training, and error research. It is one installment in a larger transformation that has begun to identify both deep-rooted constraints and new leverage points of views of human factors and system safety. The ten questions about human error are not just questions about human error as a phenomenon, but also about human factors and system safety as disciplines, and where they stand today. In asking these questions and sketching the answers to them, this book attempts to show where current thinking is limited--where vocabulary, models, ideas, and notions are constraining progress. This volume looks critically at the answers human factors would typically provide and compares/contrasts them with current research insights. Each chapter provides directions for new ideas and models that could perhaps better cope with the complexity of the problems facing human error today. As such, this book can be used as a supplement for a variety of human factors courses.
Release

Human Factors Methods and Accident Analysis

Practical Guidance and Case Study Applications

Author: Paul M. Salmon,Neville A. Stanton,Michael Lenné,Daniel P. Jenkins,Laura Rafferty,Guy H. Walker

Publisher: CRC Press

ISBN: 1317120124

Category: Technology & Engineering

Page: 216

View: 8395

This book provides an overview of, and practical guidance on, the range of human factors (HF) methods that can be used for the purposes of accident analysis and investigation in complex sociotechnical systems. Human Factors Methods and Accident Analysis begins with an overview of different accident causation models and an introduction to the concepts of accident analysis and investigation. It then presents a discussion focussing on the importance of, and difficulties associated with, collecting appropriate data for accident analysis purposes. Following this, a range of HF-based accident analysis methods are described, as well as step-by-step guidance on how to apply them. To demonstrate how the different methods are applied, and what the outputs are, the book presents a series of case study applications across a range of safety critical domains. It concludes with a chapter focussing on the data challenges faced when collecting, coding and analysing accident data, along with future directions in the area. Human Factors Methods and Accident Analysis is the first book to offer a practical guide for investigators, practitioners and researchers wishing to apply accident analysis methods. It is also unique in presenting a series of novel applications of accident analysis methods, including HF methods not previously used for these purposes (e.g. EAST, critical path analysis), as well as applications of methods in new domains.
Release

The Human Contribution

Unsafe Acts, Accidents and Heroic Recoveries

Author: James Reason

Publisher: CRC Press

ISBN: 1351888110

Category: Technology & Engineering

Page: 310

View: 6821

This book explores the human contribution to the reliability and resilience of complex, well-defended systems. Usually the human is considered a hazard - a system component whose unsafe acts are implicated in the majority of catastrophic breakdowns. However there is another perspective that has been relatively little studied in its own right - the human as hero, whose adaptations and compensations bring troubled systems back from the brink of disaster time and again. What, if anything, did these situations have in common? Can these human abilities be ’bottled’ and passed on to others? The Human Contribution is vital reading for all professionals in high-consequence environments and for managers of any complex system. The book draws its illustrative material from a wide variety of hazardous domains, with the emphasis on healthcare reflecting the author’s focus on patient safety over the last decade. All students of human factors - however seasoned - will also find it an invaluable and thought-provoking read.
Release

Human Factors in Aviation

Author: Earl L. Wiener,David C. Nagel

Publisher: Gulf Professional Publishing

ISBN: 0127500316

Category: Technology & Engineering

Page: 684

View: 2487

Human Factors in Aviation, written for the widespread aviation community--engineers, scientist, pilots, managers, government personnel, and others--is also be of interest to those in nonaviation fields. The authors/contributors were chosen not only as experts in their fields, but because they could write for a wider audience than they customarily address. The organization of the book takes the reader from the general to the specific, first covering broad issues, then the more specific topics of pilot performance, human factors in aircraft design, and vehicles and systems. The physiological and medical aspects are well documented also.
Release