• Title, Summary, Keyword: human error

Search Result 1,239, Processing Time 0.032 seconds

A Methodology for Analyzing Human Error in Railway Operations (철도 인적오류 분석방법론 개발)

  • Kim, Dong-San;Baek, Dong-Hyun;You, Seoung-Ryul;Yoon, Wan-Chul
    • Proceedings of the KSR Conference
    • /
    • /
    • pp.1817-1827
    • /
    • 2009
  • Although human error is recognized as the primary cause of railway accidents and incidents, there have been limitations in finding the root causes of errors and developing effective corrective actions in the Korean railway industry, due to the absence of a systematic method and lack of professional knowledge and skills of investigators. Therefore, there has been a strong need for a systematic methodology for human error analysis. This paper introduces a methodology for analyzing human error m railway operations, called HEAR (Human Error Analysis and Reduction). HEAR is intended to help analysts identify the sequences and various levels of causes of operators' erroneous actions in railway accidents or incidents and make recommendations to eliminate or reduce the future possibility of similar errors and accidents. It was developed based on a thorough investigation of various techniques for human errors analysis and feedback from field investigators.

  • PDF

A Modification of Human Error Analysis Technique for Designing Man-Machine Interface in Nuclear Power Plants (원자력 발전소 주제어실 인터페이스 설계를 위한 인적오류 분석 기법의 보완)

  • Lee, Yong-Hui;Jang, Tong-Il;Im, Hyeon-Gyo
    • Journal of the Ergonomics Society of Korea
    • /
    • v.22 no.1
    • /
    • pp.31-42
    • /
    • 2003
  • This study describes a modification of the technique for human error analysis in nuclear power plants (NPPs) which adopts advanced Man-Machine Interface (MMI) features based on computerized working environment, such as LCOs. Flat Panels. Large Wall Board, and computerized procedures. Firstly, the state of the art on human error analysis methods and efforts were briefly reviewed. Human error analysis method applied to NPP design has been THERP and ASEP mainly utilizing Swain's HRA handbook, which has not been facilitated enough to put the varied characteristics of MMI into HRA process. The basic concepts on human errors and the system safety approach were revisited, and adopted the process of FMEA with the new definition of Error Segment (ESJ. A modified human error analysis process was suggested. Then, the suggested method was applied to the failure of manual pump actuation through LCD touch screen in loss of feed water event in order to verify the applicability of the proposed method in practices. The example showed that the method become more facilitated to consider the concerns of the introduction of advanced MMI devices, and to integrate human error analysis process not only into HRA/PRA but also into the MMI and interface design. Finally, the possible extensions and further efforts required to obtain the applicability of the suggested method were discussed.

Human Error Probability Assessment During Maintenance Activities of Marine Systems

  • Islam, Rabiul;Khan, Faisal;Abbassi, Rouzbeh;Garaniya, Vikram
    • Safety and Health at Work
    • /
    • v.9 no.1
    • /
    • pp.42-52
    • /
    • 2018
  • Background: Maintenance operations on-board ships are highly demanding. Maintenance operations are intensive activities requiring high man-machine interactions in challenging and evolving conditions. The evolving conditions are weather conditions, workplace temperature, ship motion, noise and vibration, and workload and stress. For example, extreme weather condition affects seafarers' performance, increasing the chances of error, and, consequently, can cause injuries or fatalities to personnel. An effective human error probability model is required to better manage maintenance on-board ships. The developed model would assist in developing and maintaining effective risk management protocols. Thus, the objective of this study is to develop a human error probability model considering various internal and external factors affecting seafarers' performance. Methods: The human error probability model is developed using probability theory applied to Bayesian network. The model is tested using the data received through the developed questionnaire survey of >200 experienced seafarers with >5 years of experience. The model developed in this study is used to find out the reliability of human performance on particular maintenance activities. Results: The developed methodology is tested on the maintenance of marine engine's cooling water pump for engine department and anchor windlass for deck department. In the considered case studies, human error probabilities are estimated in various scenarios and the results are compared between the scenarios and the different seafarer categories. The results of the case studies for both departments are also compared. Conclusion: The developed model is effective in assessing human error probabilities. These probabilities would get dynamically updated as and when new information is available on changes in either internal (i.e., training, experience, and fatigue) or external (i.e., environmental and operational conditions such as weather conditions, workplace temperature, ship motion, noise and vibration, and workload and stress) factors.

Establishing the Importance Institution for Prevention of Human Error (인적오류 예방을 위한 제도의 상대적 중요도 분석)

  • Moon, Woo-Choon;Kim, Woong-Yi
    • Journal of Advanced Navigation Technology
    • /
    • v.17 no.4
    • /
    • pp.377-385
    • /
    • 2013
  • Since the late 1950s, concerted efforts to reduce the accident rate in aviation have yielded unprecedented levels of safety. Although, the overall accident rate has declined considerably over the years, unfortunately reductions in human error-related accidents in aviation have failed to keep pace with the reduction of accidents due to environmental and mechanical factors. Today, a very large percentage of all aviation are attributable, directly or indirectly, to some form of human error. As a result of many study, a range of prevention of human error have been developed. but each of kind is lack of a precision, effectiveness and seem to be considered for aspect of deficiency as an systematic accessibility. So, we're going to analysis the most effective and systematic prevention of human error and study on consolidating method for human error and aviation safety. In this study, several alternatives for the prevention of human errors a priority to understand and solve problems by identifying the implications for human error to be presented.

A Study on the Analysis and Prevention of the Human-related Marine Accidents (인적 요인을 중심으로 한 해양사고 분석 및 예방 연구 (예부선 사고사례를 중심으로))

  • Kim, Hong-Tae;Na, Sung
    • Journal of Korea Ship Safrty Technology Authority
    • /
    • /
    • pp.25-36
    • /
    • 2009
  • Despite the development of the various navigational equipment, such as GPS, ARPA, ECDIS, AIS, VDR, and hull monitoring system, marine accidents are still a leading concern in shipping industry. For all accidents over the reporting period, approximately 60 to 80% of the accidents was involved in human error. It means that in each case, some events which were associated with human error initiated an accident, and those failures of human performance led to the failure to avoid an accident or mitigate it's consequences. However, the improvement and the effort on the maritime human error are still limited in an elementary step. The objective of this paper is to propose a modified Human Factors Analysis and Classification System (HFACS) model in order to analyse the collision accidents of tug-barge ship.

  • PDF

Qualitative Human Error Assessment for Gas Facilities (가스시설에서의 정성적 인적오류 평가)

  • Yoon Ik-Keun;Ha Jong-Mann;Oh Shin-kyu
    • Journal of the Korean Institute of Gas
    • /
    • v.2 no.3
    • /
    • pp.70-77
    • /
    • 1998
  • This study proposes a method to facilitate the identification of human error in calling out such qualitative risk assessment in Gas plants. The main idea of this method is based on the scheme of existing qualitative risk assesment technique. The guidewords and tabular worksheet are suggested to be compatible in human error analysis. By using this method developed, the maintenance procedure of Governor system in gas valve station was analyzed to discover the human error in maintenance tasks. As a consequence, certain human errors were identified and the suggested approches proved to be adequate technique for the human error analysis.

  • PDF

A Hybrid Modeling Tool for Human Error Control of in Collaborative Workflow (협업 워크플로우에서의 인적오류 제어를 위한 하이브리드 모델링 도구)

  • 이상영;유철중;장옥배
    • Journal of KIISE:Computing Practices and Letters
    • /
    • v.10 no.2
    • /
    • pp.156-173
    • /
    • 2004
  • Business process should support the execution of collaboration process with agility and flexibility through the integration of enterprise inner or outer applications and human resources from the collaborative workflow view. Although the dependency of enterprise activities to the automated system has been increasing, human role is as important as ever. In the workflow modelling this human role is emphasized and the structure to control human error by analysing decision-making itself is needed. Also, through the collaboration of activities agile and effective communication should be constructed, eventually by the combination and coordination of activities to the aimed process the product quality should be improved. This paper classifies human errors can be occurred in collaborative workflow by applying GEMS(Generic Error Modelling System) to control them, and suggests human error control method through hybrid based modelling as well. On this base collaborative workflow modeling tool is designed and implemented. Using this modelling methodology it is possible to workflow modeling could be supported considering human characteristics has a tendency of human error to be controlled.

Human Error Analysis in a Permit to Work System: A Case Study in a Chemical Plant

  • Jahangiri, Mehdi;Hoboubi, Naser;Rostamabadi, Akbar;Keshavarzi, Sareh;Hosseini, Ali Akbar
    • Safety and Health at Work
    • /
    • v.7 no.1
    • /
    • pp.6-11
    • /
    • 2016
  • Background: A permit to work (PTW) is a formal written system to control certain types of work which are identified as potentially hazardous. However, human error in PTW processes can lead to an accident. Methods: This cross-sectional, descriptive study was conducted to estimate the probability of human errors in PTWprocesses in a chemical plant in Iran. In the first stage, through interviewing the personnel and studying the procedure in the plant, the PTW process was analyzed using the hierarchical task analysis technique. In doing so, PTWwas considered as a goal and detailed tasks to achieve the goal were analyzed. In the next step, the standardized plant analysis risk-human (SPAR-H) reliability analysis method was applied for estimation of human error probability. Results: The mean probability of human error in the PTW system was estimated to be 0.11. The highest probability of human error in the PTW process was related to flammable gas testing (50.7%). Conclusion: The SPAR-H method applied in this study could analyze and quantify the potential human errors and extract the required measures for reducing the error probabilities in PTW system. Some suggestions to reduce the likelihood of errors, especially in the field of modifying the performance shaping factors and dependencies among tasks are provided.

A Study on the Risk Assessment System for Human Factors (휴먼에러를 중심으로 한 위험요인 도출 방법론에 관한 연구)

  • Jung, Sang Kyo;Chang, Seong Rok
    • Journal of the Korean Society of Safety
    • /
    • v.29 no.3
    • /
    • pp.79-84
    • /
    • 2014
  • Human error is one of the major contributors to the accidents. A lot of risk assessment techniques have been developed for prevention of accidents. Nevertheless, most of them were interested in physical factors, because quantitative evaluation of human errors was difficult quantitatively. According to lack of risk assessment techniques about human errors, most of industrial risk assessment for human errors were based on data of accident analysis. In order to develop an effective countermeasure to reduce the risk caused by human errors, a systematic analysis is needed. Generally, risk assessment system is composed of 5 step(classification of work activity, identification of hazards, risk estimation, evaluation and improvement). This study aimed to develop a risk identification technique for human errors that could mainly be applied to industrial fields. In this study, Ergo-HAZOP and Comprehensive Human Error Analysis Technique were used for developing the risk identification technique. In the proposed risk identification technique, Ergo-HAZOP was used for broad-brush risk identification. More critical risks were analysed by Comprehensive Human Error Analysis Technique. In order to verify applicability, the proposed risk identification technique was applied to the work of pile head cutting. As a consequence, extensive hazards were identified and fundamental countermeasures were established. It is expected that much attention would be paid to prevent accidents by human error in industrial fields since safety personnel can easily fint out hazards of human factors if utilizing the proposed risk identification technique.

A basic study on human error proneness in computerized work environment (전산화된 작업환경에서 인간의 오류성향에 관한 기초연구)

  • Jeong, Gwang-Tae;Lee, Yong-Hui
    • Journal of the Ergonomics Society of Korea
    • /
    • v.19 no.1
    • /
    • pp.1-9
    • /
    • 2000
  • This study was performed to investigate some characteristics on human error proneness in the computerized work environment. Our concerning theme was on human error likelihood according to personal temperament. Two experiments were performed. The first experiment was to study the effect of field- independence/dependence on error likelihood. The second experiment was on error proneness. These experiments were performed in information search task. which was most frequent task in computerized work environment such as the control room of nuclear power plant. Ten subjects were participated in this study. Analyzed results are as follows. Field-independence/dependence had a significant effect in both information search time and error frequency. Error proneness had a significant effect in both factors, too. And, a positive correlation was found between error frequency and information search time. These results will be utilized as a basis to study operator's error proneness in the computerized control room of nuclear power plant. later on.

  • PDF