Human error reduction

Chapter 8, A Systematic Approach to the Management of Human Error, explains how the manager and safety professional can use human factors principles in the management of process safety. This chapter also provides a practical plan for a plant human error reduction program that will improve productivity and quality as well. 

The last area addressed by the systems approach is concerned with global issues involving the influence of organizational factors on human error. The major issues in this area are discussed in Chapter 2, Section 7. The two major perspectives that need to be considered as part of an error reduction program are the creation of an appropriate safety culture and the inclusion of human error reduction within safety management policies. 

In addition to their descriptive fimctions, TA techniques provide a wide variety of information about the task that can be useful for error prediction and prevention. To this extent, there is a considerable overlap between Task Analysis and Human Error Analysis (HEA) techniques described later in this chapter. HEA methods generally take the result of TA as their starting point and examine what aspects of the task can contribute to human error, hr the context of human error reduction in the CPI, a combination of TA and HEA methods will be the most suitable form of analysis. 

Petersen, P. (1984). Human Error Reduction and Safety Management. Goshen, New York Aloray Inc. 

Eiimination of specific human errors Reduction of hazardous materiais or conditions... 

Petersen, D. Human error reduction and safety management (3rd edition). New York Van Nostrand Reinhold, 1996. 

Several references were made in Chapter 3, Serious Injury Prevention, to human errors as the causal factors for accidents. And it was said that many serious injuries result from recurring but potentially avoidable human errors, and that organizational, cultural, technical, and management systems deficiencies often lead to those errors. Emphasizing human error reduction above the worker level, although proposed many years ago as a preventive measure, is not prominent in the work of safety professionals. 

Petersen presents an interesting proposal—that acquiring knowledge of how and where human errors occur and offering advice on human error reduction will open up the next frontier in safety management. That ties in well with the theme of this chapter. It also relates closely to my research which shows that human errors at some level are causal factors for many incidents resulting in serious injuries, particularly low-probability/serious-consequence events that have multiple, complex, and cascading causal factors. 

Encourages safety professionals to become more involved in human error reduction, particularly above the worker level. 

Comments on the relationship between behavioral safety, human error reduction, and serious injury prevention. 

This chapter is not a text on human error reduction. Selected publications are noted that provide the knowledge which safety professionals should have on the subject. They need not be concerned over a lack of resources. Enter the term human error reduction into a search engine and over 2,500,000 results will appear. Some of those results relate to workshops and symposia on human error reduction. 

As references are cited in this chapter, take note of those that have been published in recent years. Interest in human error reduction is warming up. The new literature relates to human errors as causal factors for injuries to employees injuries to users of personal products and damage to property and the environment. The amount of new literature indicates that human error reduction has acquired a new life. 

DEFINING HUMAN ERROR AND HUMAN ERROR REDUCTION... 

Then, human error reduction is to minimize the probability that decisions or oversights, made individually or accumulatively, and personnel actions or inactions, will bring about the occurrence of harmful incidents and exposures. 

Reason also brings to mind the antiquity of the literature on human error reduction. In his final chapter, he reviews THERP, (the technique for human error rate prediction). This methodology was developed by Alan Swain in 1963. 

Particular attention is given here to the Guidelines for Preventing Human Error in Process Safety, a 1994 publication. Although process safety appears in the book s title, the first two chapters provide an easily read primer on human error reduction. The content of those chapters was largely influenced by personnel with safety management experience at a plant or corporate level. 

Another of James Reason s books—Managing the Risks of Organizational Accidents—is a must read for safety professionals who want an education in human error reduction. It was published in 1997 and has been reprinted five times. Reason writes about how the effects of decisions accumulate over time and become the causal factors for incidents resulting in serious injuries or damage when all the circumstances necessary for the occurrence of a major event come together. This book was referenced in Chapter 3, Serious Injury Prevention, because it stresses the need to focus on decision making above the worker level to prevent major accidents. Reason writes this ... 

W. Johnson is the author of Human Error, Safety and Systems Development, a 2004 publication. It is another recently issued text indicating that a transition is taking place and that additional emphasis is being given to human error reduction. 

A few workshops on human error reduction that were located on the Internet are listed here. Although this author does not personally know of them, safety professionals interested in furthering their education may want to inquire into their suitability. For course descriptions, enter the company names into any search engine this will give you access to related promotional pieces. Readers with Internet skills better than mine may be able to locate yet other courses. 

AXIOM Technology Corporation Offers a course titled Human Error Reduction Workplace Accident Prevention. ... 

BEHAVIORAL SAFETY, HUMAN ERROR REDUCTION, AND SERIOUS INJURY PREVENTION... 

The following excerpts from Reason s Managing the Risks of Organizational Accidents bear directly on the history of behavioral safety, human error reduction, and the prevention of serious injuries. 

Typical safety management systems do not address human error reduction, particularly on an anticipatory basis. 

All this spells opportunity for safety professionals to acquire new knowledge with respect to human error reduction and to enhance their professional status. Human error reduction may very well become the frontier for the practice of safety. 

In Chapter 4, Human Error Reduction, I encouraged safety professionals to enfold human error reduction concepts into every facet of safety management systems and to focus on system deficiencies resulting from human errors that occur above the worker level. 

Embrey, D.E. (1986), SHERPA A Systematic Human Error Reduction and Prediction Approach, Paper Presented at the International Meeting on Advances in Nuclear Power Systems, Tennessee Knoxville. 

SHERPA Systematic Human Error Reduction and Prediction Approach... 

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