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Old 29th Dec 2010, 10:52
  #14 (permalink)  
jolly girl
 
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I suggest HFACS because most of the HF events I have come in contact with have involved well-intentioned folks pushing the envelope to complete a mission. One of the strengths of HFACS is that is does allow investigation of contributors other than the individual actors involved in an incident - such as the physical and technological environment operations are conducted in, inappropriate planning by local management (scheduling, resource allocation, etc.), inadequate supervision (failure to provide adequate training, improper incentives, etc.) and resource management, climate and process at the corporate (or at least upper management) level. Personal readiness factors such as long-term physical and cognitive fatigue are included as well. Also, the HFACS schedule of errors and violations at the personal level folds in to Dekker and Hudson's models of Just Culture and schedules of responses to HF incidents (sourced earlier, if you need a copy PM me your e-mail). Both might be useful tools in the situation S76H describes.
J.
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