3 ms·

Please consider reading Sidney Dekker's books, The Field Guide to Understanding Human Error[1] and Drift Into Failure[2] [1] - https://www.amazon.com/Field-Gui

Please consider reading Sidney Dekker's books, The Field Guide to Understanding Human Error[1] and Drift Into Failure[2] [1] - https://www.amazon.com/Field-Guide-Understanding-Human-Error/dp/1472439058 https://www.amazon.com/Field-Guide-Understanding-Human-Error... [2] - https://www.abebooks.com/servlet/BookDetailsPL?bi=31235811635&searchurl=sortby%3D17%26tn%3DDrift%2BInto%2BFailure&cm_sp=snippet-_-srp1-_-title1 https://www.abebooks.com/servlet/BookDetailsPL?bi=3123581163...

jonathanyc 4y ago
For those of us who aren’t familiar, can you link something in the book to the OP?
- tra3 4y ago
  Working my way through it. It starts by talking about the bad apple theory but then debunks it; > The Bad Apple Theory. It maintains that: • Complex systems would be fine, were it not for the erratic behavior of some unreliable people (Bad Apples) in it. • ‘Human errors’ cause accidents: more than two-thirds of them. • Failures come as unpleasant surprises. They are unexpected and do not belong in the system. Failures are introduced to the system through the inherent unreliability of people. > • Getting rid of Bad Apples tends to send a signal to other people to be more careful with what they do, say, report or disclose. It does not make ‘human errors’ go away, but does tend to make the evidence of them go away; evidence that might otherwise have been available to you and your organization so that you could learn and improve. > • Putting in more rules, procedures and compliance demands runs into the problem that there is always a gap between how work is imagined (in rules or procedures) and how work is done. > Getting technology to replace unreliable people is an attractive idea, and is wide-spread. But technology introduces new problems as well as new capacities. Rather than replacing human work, it changes human work. New technology may lead to new kinds of ‘human errors’ and new pathways to system breakdown.
kqr 4y ago
And the CAST Handbook by Nancy Leveson is really good in the sort of area of systems theoretic accident analysis. (It's available for free online.)

jonathanyc 4y ago

For those of us who aren’t familiar, can you link something in the book to the OP?

tra3 4y ago
Working my way through it. It starts by talking about the bad apple theory but then debunks it; > The Bad Apple Theory. It maintains that: • Complex systems would be fine, were it not for the erratic behavior of some unreliable people (Bad Apples) in it. • ‘Human errors’ cause accidents: more than two-thirds of them. • Failures come as unpleasant surprises. They are unexpected and do not belong in the system. Failures are introduced to the system through the inherent unreliability of people. > • Getting rid of Bad Apples tends to send a signal to other people to be more careful with what they do, say, report or disclose. It does not make ‘human errors’ go away, but does tend to make the evidence of them go away; evidence that might otherwise have been available to you and your organization so that you could learn and improve. > • Putting in more rules, procedures and compliance demands runs into the problem that there is always a gap between how work is imagined (in rules or procedures) and how work is done. > Getting technology to replace unreliable people is an attractive idea, and is wide-spread. But technology introduces new problems as well as new capacities. Rather than replacing human work, it changes human work. New technology may lead to new kinds of ‘human errors’ and new pathways to system breakdown.

kqr 4y ago

And the CAST Handbook by Nancy Leveson is really good in the sort of area of systems theoretic accident analysis. (It's available for free online.)