253 15 INSIGHTS INTO SAFETY REGULATION Barry Kirwan, Andrew Hale & Andrew Hopkins INTRODU... more 253 15 INSIGHTS INTO SAFETY REGULATION Barry Kirwan, Andrew Hale & Andrew Hopkins INTRODUCTION This final chapter attempts to draw some insights from the foregoing chapters, and make several fresh observations on the issue of safety regulation. The ...
... He speaks regularly to industry groups and at conferences about the lessons of Longford, and ... more ... He speaks regularly to industry groups and at conferences about the lessons of Longford, and of Moura. He has a BSc (Hons) and an MA from the ANU, and a PhD from the University of Connecticut. ... fi Joy Oh has degrees in medical biology and chemical technology. ...
Human factors (HF) in aviation and maritime safety occurrences are not always systematically anal... more Human factors (HF) in aviation and maritime safety occurrences are not always systematically analysed and reported in a way that makes the extraction of trends and comparisons possible in support of effective safety management and feedback for design. As a way forward, a taxonomy and data repository were designed for the systematic collection and assessment of human factors in aviation and maritime incidents and accidents, called SHIELD (Safety Human Incident and Error Learning Database). The HF taxonomy uses four layers: The top layer addresses the sharp end where acts of human operators contribute to a safety occurrence; the next layer concerns preconditions that affect human performance; the third layer describes decisions or policies of operations leaders that affect the practices or conditions of operations; and the bottom layer concerns influences from decisions, policies or methods adopted at an organisational level. The paper presents the full details, guidance and examples ...
1st International Conference on the Stability and Safety of Ships and Ocean Vehicles, Jun 7, 2021
The paper presents a comprehensive review of sixteen Safety Occurrence Reporting and Analysis Sys... more The paper presents a comprehensive review of sixteen Safety Occurrence Reporting and Analysis Systems (SORAS) adopted in safety critical domains such as aviation, maritime, railway, nuclear, and space operations. The aim of the review is the analysis of the taxonomies adopted within these systems, in order to derive the most relevant features useful to define the HF Taxonomy of the EU funded SAFEMODE project. SAFEMODE deals with the consideration of the human element in the safety of aviation and maritime operations. As a result of the review, five best-in-class taxonomies are identified: HERA, HFACS, TRACEr, HEIST, and NASA-HFACS. In conclusion, a proposal to combine their most relevant elements to define the specific SAFEMODE SHIELD HF Taxonomy for aviation and maritime domains is formulated and recommended for future incident and accident analysis efforts
5th IET International Conference on System Safety 2010, 2010
ABSTRACT Safety critical organizations modernize routinely their infrastructures in order to impr... more ABSTRACT Safety critical organizations modernize routinely their infrastructures in order to improve safety and productivity. However, such improvement might be compromised if new tools are not delivered, or fail to be adopted by operators, or worst introduce safety critical conditions. This research investigated the interactions between innovation processes introducing new operators' tools and the underlying organizational conditions. An application from the ATC domain, the MSAW, is taken as a main case study. Its development and history have been investigated within four European Air Navigation Service Providers. Findings indicated that the ability to set up the tool correlates to the presence of a safety net governance by which the organization develops the expertise to set up the tool over successive development cycles — no service provider encountered immediate acceptance of the tool. On the other hand opportunistic decisions to adopt the tool, misconceptions about its rationale, transfer of control over requirements and their implementation to manufacturer, hampered access to system parameters by ANSP personnel and increasingly rigid manufacturer-ANSP relationship in the down stream contract phase appear to relate to poor implementation of the tool and prevent prompt improvements.
Controlling and improving safety in organisations is achieved using a Safety Management System (S... more Controlling and improving safety in organisations is achieved using a Safety Management System (SMS). Notwithstanding the variety of components considered in SMS standards, including human factors and safety culture, safety management systems are sometimes observed by those at the ‘sharp end’ as being bureaucratic, distinct from actual operations, and being too focused on the prevention of deviations from procedures, rather than on the effective support of safety in the real operational context. The soft parts of advancing safety in organisations, such as the multitude of interrelations and the informal aspects in an organisation that influence safety, are only considered to a limited extent in traditional safety management systems. The research in Future Sky Safety Project 5 (FSS P5) focused on improving these human-related, informal organisational aspects. Since every organisation is unique, in the operations it conducts, its history, and its organisational culture, there cannot b...
Controller Action Reliability Assessment (CARA) is a human reliability assessment technique, whic... more Controller Action Reliability Assessment (CARA) is a human reliability assessment technique, which can be used to quantify human performance in the context of Air Traffic Management (ATM). This paper describes the CARA technique, including the data used for quantification, and the types of air traffic controller behaviours it quantifies, and the performance shaping factors it uses to modify task reliability. In order to evaluate CARA, it was applied in three actual ATM safety cases. The three safety cases related to an aircraft landing guidance system, a position/identity display for the air traffic control (ATC) aerodrome environment and an aerodrome procedure for low visibility conditions using future ATC systems. The performance of CARA in these applications is described.
ABSTRACT In order to deal with the increased traffic levels, the Air Traffic Management (ATM) sys... more ABSTRACT In order to deal with the increased traffic levels, the Air Traffic Management (ATM) system must take advantages of new technologies and procedures which will aid the Air Traffic Control Operators (ATCOs) in their complex job. New allocation of spacing tasks between controller and flight crew is envisaged as one possible option to improve air traffic management. Safety assurance requires full analysis of the possible consequences of new procedures; one method for achieving this is through Human Error Analysis (HEA). In order to carry out such a HEA, the spacing task had to be captured within a Task Analysis (TA) model. This paper covers the evaluation of three TA techniques that can be used as a precursor to HEA analysis – Hierarchical Task Analysis (HTA), STATEMATE and Integration Definition for Function Modelling (IDEF 0). Spacing Tasks New allocation of spacing tasks between the controller and flight crew is envisaged as one possible option to improve ATM. The motivation is neither to 'transfer problems' nor to 'give more freedom' to the flight crew. In essence, the purpose is to identify a more effective distribution of tasks which will be beneficial to all parties (Grimaud et al. 2001). The allocation of spacing tasks to the flight crew – denoted airborne spacing – is expected to increase controller availability and to improve safety. This in turn could enable better efficiency and/or, depending on airspace constraints, more capacity. Additionally, it is expected that flight crew would gain in awareness and anticipation by taking on active part in the management of their situation. Airborne spacing assumes new surveillance capabilities (e.g. Automatic Dependent Surveillance-Broadcast) with new airborne functions such as Airborne Separation Assistance System (ASAS).
253 15 INSIGHTS INTO SAFETY REGULATION Barry Kirwan, Andrew Hale & Andrew Hopkins INTRODU... more 253 15 INSIGHTS INTO SAFETY REGULATION Barry Kirwan, Andrew Hale & Andrew Hopkins INTRODUCTION This final chapter attempts to draw some insights from the foregoing chapters, and make several fresh observations on the issue of safety regulation. The ...
... He speaks regularly to industry groups and at conferences about the lessons of Longford, and ... more ... He speaks regularly to industry groups and at conferences about the lessons of Longford, and of Moura. He has a BSc (Hons) and an MA from the ANU, and a PhD from the University of Connecticut. ... fi Joy Oh has degrees in medical biology and chemical technology. ...
Human factors (HF) in aviation and maritime safety occurrences are not always systematically anal... more Human factors (HF) in aviation and maritime safety occurrences are not always systematically analysed and reported in a way that makes the extraction of trends and comparisons possible in support of effective safety management and feedback for design. As a way forward, a taxonomy and data repository were designed for the systematic collection and assessment of human factors in aviation and maritime incidents and accidents, called SHIELD (Safety Human Incident and Error Learning Database). The HF taxonomy uses four layers: The top layer addresses the sharp end where acts of human operators contribute to a safety occurrence; the next layer concerns preconditions that affect human performance; the third layer describes decisions or policies of operations leaders that affect the practices or conditions of operations; and the bottom layer concerns influences from decisions, policies or methods adopted at an organisational level. The paper presents the full details, guidance and examples ...
1st International Conference on the Stability and Safety of Ships and Ocean Vehicles, Jun 7, 2021
The paper presents a comprehensive review of sixteen Safety Occurrence Reporting and Analysis Sys... more The paper presents a comprehensive review of sixteen Safety Occurrence Reporting and Analysis Systems (SORAS) adopted in safety critical domains such as aviation, maritime, railway, nuclear, and space operations. The aim of the review is the analysis of the taxonomies adopted within these systems, in order to derive the most relevant features useful to define the HF Taxonomy of the EU funded SAFEMODE project. SAFEMODE deals with the consideration of the human element in the safety of aviation and maritime operations. As a result of the review, five best-in-class taxonomies are identified: HERA, HFACS, TRACEr, HEIST, and NASA-HFACS. In conclusion, a proposal to combine their most relevant elements to define the specific SAFEMODE SHIELD HF Taxonomy for aviation and maritime domains is formulated and recommended for future incident and accident analysis efforts
5th IET International Conference on System Safety 2010, 2010
ABSTRACT Safety critical organizations modernize routinely their infrastructures in order to impr... more ABSTRACT Safety critical organizations modernize routinely their infrastructures in order to improve safety and productivity. However, such improvement might be compromised if new tools are not delivered, or fail to be adopted by operators, or worst introduce safety critical conditions. This research investigated the interactions between innovation processes introducing new operators' tools and the underlying organizational conditions. An application from the ATC domain, the MSAW, is taken as a main case study. Its development and history have been investigated within four European Air Navigation Service Providers. Findings indicated that the ability to set up the tool correlates to the presence of a safety net governance by which the organization develops the expertise to set up the tool over successive development cycles — no service provider encountered immediate acceptance of the tool. On the other hand opportunistic decisions to adopt the tool, misconceptions about its rationale, transfer of control over requirements and their implementation to manufacturer, hampered access to system parameters by ANSP personnel and increasingly rigid manufacturer-ANSP relationship in the down stream contract phase appear to relate to poor implementation of the tool and prevent prompt improvements.
Controlling and improving safety in organisations is achieved using a Safety Management System (S... more Controlling and improving safety in organisations is achieved using a Safety Management System (SMS). Notwithstanding the variety of components considered in SMS standards, including human factors and safety culture, safety management systems are sometimes observed by those at the ‘sharp end’ as being bureaucratic, distinct from actual operations, and being too focused on the prevention of deviations from procedures, rather than on the effective support of safety in the real operational context. The soft parts of advancing safety in organisations, such as the multitude of interrelations and the informal aspects in an organisation that influence safety, are only considered to a limited extent in traditional safety management systems. The research in Future Sky Safety Project 5 (FSS P5) focused on improving these human-related, informal organisational aspects. Since every organisation is unique, in the operations it conducts, its history, and its organisational culture, there cannot b...
Controller Action Reliability Assessment (CARA) is a human reliability assessment technique, whic... more Controller Action Reliability Assessment (CARA) is a human reliability assessment technique, which can be used to quantify human performance in the context of Air Traffic Management (ATM). This paper describes the CARA technique, including the data used for quantification, and the types of air traffic controller behaviours it quantifies, and the performance shaping factors it uses to modify task reliability. In order to evaluate CARA, it was applied in three actual ATM safety cases. The three safety cases related to an aircraft landing guidance system, a position/identity display for the air traffic control (ATC) aerodrome environment and an aerodrome procedure for low visibility conditions using future ATC systems. The performance of CARA in these applications is described.
ABSTRACT In order to deal with the increased traffic levels, the Air Traffic Management (ATM) sys... more ABSTRACT In order to deal with the increased traffic levels, the Air Traffic Management (ATM) system must take advantages of new technologies and procedures which will aid the Air Traffic Control Operators (ATCOs) in their complex job. New allocation of spacing tasks between controller and flight crew is envisaged as one possible option to improve air traffic management. Safety assurance requires full analysis of the possible consequences of new procedures; one method for achieving this is through Human Error Analysis (HEA). In order to carry out such a HEA, the spacing task had to be captured within a Task Analysis (TA) model. This paper covers the evaluation of three TA techniques that can be used as a precursor to HEA analysis – Hierarchical Task Analysis (HTA), STATEMATE and Integration Definition for Function Modelling (IDEF 0). Spacing Tasks New allocation of spacing tasks between the controller and flight crew is envisaged as one possible option to improve ATM. The motivation is neither to 'transfer problems' nor to 'give more freedom' to the flight crew. In essence, the purpose is to identify a more effective distribution of tasks which will be beneficial to all parties (Grimaud et al. 2001). The allocation of spacing tasks to the flight crew – denoted airborne spacing – is expected to increase controller availability and to improve safety. This in turn could enable better efficiency and/or, depending on airspace constraints, more capacity. Additionally, it is expected that flight crew would gain in awareness and anticipation by taking on active part in the management of their situation. Airborne spacing assumes new surveillance capabilities (e.g. Automatic Dependent Surveillance-Broadcast) with new airborne functions such as Airborne Separation Assistance System (ASAS).
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