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The Field Guide to Understanding Human Error / Edition 2

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Overview

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 This old view of human error is increasingly outdated and will lead you nowhere.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 aquick fix. Read this book.

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Product Details

  • ISBN-13: 9780754648260
  • Publisher: Ashgate Publishing, Limited
  • Publication date: 6/30/2006
  • Edition description: REV
  • Edition number: 2
  • Pages: 252
  • Sales rank: 138,932
  • Product dimensions: 6.00 (w) x 8.60 (h) x 0.70 (d)

Table of Contents

1 The bad apple theory 1
2 The new view of human error 15
3 The hindsight bias 21
4 Put data in context 29
5 "They should have ..." 39
6 Trade indignation for explanation 45
7 Sharp of blunt end? 59
8 You can't count errors 65
9 Cause is something you construct 73
10 What is your accident model? 81
11 Human factors data 93
12 Build a timeline 101
13 Leave a trace 119
14 So what went wrong? 135
15 Look into the organization 159
16 Making recommendations 173
17 Abandon the fallacy of a quick fix 183
18 What about people's won responsibility? 195
19 Making your safety department work 205
20 How to adopt the new view 215
21 Reminders for in the rubble 225
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