Human Error, Safety and Systems Development


Book Description

th HESSD 2009 was the 7 IFIP WG 13.5 Working Conference in the series on Human Error, Safety and Systems Development which looks at integration of usability, human factors and human–computer interaction within system - th velopment. This edition was jointly organized with the 8 TAMODIA event on Tasks, Models and Diagrams for User Interface Development. There is an obvious synergy between the two previously separated events, as a rigorous, - gineering approach to user interface development can help in the prevention of human error and the maintenance of safety in critical interactive systems. Following the tradition of HESSD events, the papers in these proceedings address the problem of developing systems that support human interaction with complex, safety-critical applications. The last 30 years have seen a signi?cant reduction in the accident rates across many di?erent industries. Given these achievements, why do we need further research in this area? Recent accidents in a range of industries have increased concern over the design, management and control of safety-critical systems. Therefore, any system that involves human lives in its functioning is subject to safety-criticalaspects. Contributions such as the one by Holloway and Johnson (2004) report that over 80% of accidents in aeronautics are attributed to human error.




To Err Is Human


Book Description

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine




The Field Guide to Human Error Investigations


Book Description

This title was first published in 2002: This field guide assesses two views of human error - the old view, in which human error becomes the cause of an incident or accident, or the new view, in which human error is merely a symptom of deeper trouble within the system. The two parts of this guide concentrate on each view, leading towards an appreciation of the new view, in which human error is the starting point of an investigation, rather than its conclusion. The second part of this guide focuses on the circumstances which unfold around people, which causes their assessments and actions to change accordingly. It shows how to "reverse engineer" human error, which, like any other componant, needs to be put back together in a mishap investigation.




Guidelines for Preventing Human Error in Process Safety


Book Description

Almost all the major accident investigations--Texas City, Piper Alpha, the Phillips 66 explosion, Feyzin, Mexico City--show human error as the principal cause, either in design, operations, maintenance, or the management of safety. This book provides practical advice that can substantially reduce human error at all levels. In eight chapters--packed with case studies and examples of simple and advanced techniques for new and existing systems--the book challenges the assumption that human error is "unavoidable." Instead, it suggests a systems perspective. This view sees error as a consequence of a mismatch between human capabilities and demands and inappropriate organizational culture. This makes error a manageable factor and, therefore, avoidable.




Human-Centered and Error-Resilient Systems Development


Book Description

This book constitutes the refereed proceedings of the IFIP WG 13.2/13.5 Joint Working Conferences: 6th International Conference on Human-Centered Software Engineering, HCSE 2016, and 8th International Conference on Human Error, Safety, and System Development, HESSD 2016, held in Stockholm, Sweden, in August 2016. The 11 full papers and 14 short papers presented were carefully reviewed and selected from 32 submissions. The papers cover various topics such as integration of software engineering and user-centered design; HCI models and model-driven engineering; incorporating guidelines and principles for designing usable products in the development process; usability engineering; methods for user interface design; patterns in HCI and HCSE; software architectures for user interfaces; user interfaces for special environments; representations for design in the development process; working with iterative and agile process models in HCSE; social and organizational aspects in the software development lifecycle; human-centric software development tools; user profiles and mental models; user requirements and design constraints; and user experience and software design.




Managing the Risks of Organizational Accidents


Book Description

Major accidents are rare events due to the many barriers, safeguards and defences developed by modern technologies. But they continue to happen with saddening regularity and their human and financial consequences are all too often unacceptably catastrophic. One of the greatest challenges we face is to develop more effective ways of both understanding and limiting their occurrence. This lucid book presents a set of common principles to further our knowledge of the causes of major accidents in a wide variety of high-technology systems. It also describes tools and techniques for managing the risks of such organizational accidents that go beyond those currently available to system managers and safety professionals. James Reason deals comprehensively with the prevention of major accidents arising from human and organizational causes. He argues that the same general principles and management techniques are appropriate for many different domains. These include banks and insurance companies just as much as nuclear power plants, oil exploration and production companies, chemical process installations and air, sea and rail transport. Its unique combination of principles and practicalities make this seminal book essential reading for all whose daily business is to manage, audit and regulate hazardous technologies of all kinds. It is relevant to those concerned with understanding and controlling human and organizational factors and will also interest academic readers and those working in industrial and government agencies.




Process Safety Management and Human Factors


Book Description

Process Safety Management and Human Factors: A Practitioner's Experiential Approach addresses human factors in process safety management (PSM) from a reflective learning approach. The book is written by engineers and technical specialists who spent the last 15-20 years of their professional career looking at behavioral-based safety, human factor research, and safety culture development in organizations. It is a fundamental resource for operational, technical and safety managers in high-risk industries who need to focus on personal and occupational safety management to prevent safety accidents. Real-life examples illustrate how a good, effective understanding of human factors supports PSM and positive impacts on accident occurrence. - Covers the evolution and background of process safety management - Shows how to integrate and augment process safety management with operational excellence and health, safety and environment management systems - Focuses on human factors in process safety management - Includes many real-life case studies from the collective experience of the book's authors




Safety Differently


Book Description

The second edition of a bestseller, Safety Differently: Human Factors for a New Era is a complete update of Ten Questions About Human Error: A New View of Human Factors and System Safety. Today, the unrelenting pace of technology change and growth of complexity calls for a different kind of safety thinking. Automation and new technologies have resu




Ergonomics and Human Factors in Safety Management


Book Description

Accident prevention is a common thread throughout every aspect of our society. However, even with the most current technological developments, keeping people safe and healthy, both at workplaces and at other daily activities, is still a continual challenge. When it comes to work environments, ergonomics and human factors knowledge can play an important role and, therefore, must be included in, or be a part of, the safety management as a cross-disciplinary area concerned with the understanding of actual work situations and potential variables. This multidisciplinary approach will ultimately ensure the safety, health, and well-being of all collaborators. The main goal of this book is to present theories and models, and to describe practices to foster and promote safer work and working environments. This book offers: · Examples of field practices that can be reproduced in other scenarios · Applications of new methods for risk assessment · Methods on how to apply and integrate human factors and ergonomics in accident prevention and safety management · Coverage of human factors and ergonomics in safety culture · New methods for accident analysis This book is a compilation of contributions from invited authors organized in three main topics from eleven countries and is intended to cover specific aspects of safety and human factors management ranging from case studies to the development of theoretical models. Hopefully, the works presented in the book can be an inspiration for translating research into useful actions and, ultimately, making a relevant and tangible contribution to the safety of our daily and work settings.




A Human Error Approach to Aviation Accident Analysis


Book Description

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.