Development of an FAA-EUROCONTROL technique for the analysis of human error in ATM : final report.

Human error has been identified as a dominant risk factor in safety-oriented industries such as air traffic control (ATC). However, little is known about the factors leading to human errors in current air traffic management (ATM) systems. The first step toward prevention of human error is to develop an understanding of where it occurs in existing systems and of the system variables which contribute to its occurrence. This paper reports on the project to harmonize the Human Factors Analysis and Classification System (HFACS) and the Human Error Reduction in ATM (HERA) technique. Two groups of air traffic control subject-matter experts (SMEs) participated. The first group analyzed incident cases using each technique and identified the useful concepts from each technique for these cases. The second group evaluated the concepts identified by the first group. Based on these activities, the techniques were deemed to be compatible and harmonization proceeded. Elements from both techniques were retained and many were elaborated based on the SMEs’ feedback. The integrated approach, called JANUS, is currently undergoing beta testing by seven European nations and the US Federal Aviation Administration.

[1]  H. W. Heinrich,et al.  Industrial accident prevention : a safety management approach , 1980 .

[2]  B. Everitt,et al.  Statistical methods for rates and proportions , 1973 .

[3]  W. R. E. Murphy.  The Human Element in Traffic Control , 1931 .

[4]  David J. Schroeder,et al.  The Loss of Prescribed Separation between Aircraft: How Does It Occur? , 1982 .

[5]  Günter Spur,et al.  Introductory Overview , 1995, Information Management in Computer Integrated Manufacturing.

[6]  J. G. Hollands,et al.  Engineering Psychology and Human Performance , 1984 .

[7]  David C. Nagel,et al.  Human factors in aviation , 1988 .

[8]  R. Marteniuk.  Information processing in motor skills , 1976 .

[9]  John M. Flach,et al.  5 – Information Processing , 1988 .

[10]  D A Wiegmann,et al.  Human error analysis of commercial aviation accidents: application of the Human Factors Analysis and Classification system (HFACS). , 2001, Aviation, space, and environmental medicine.

[11]  Bert Ruitenberg,et al.  Air Traffic Control: Human Performance Factors , 1999 .

[12]  Richard E. Redding.  Analysis of Operational Errors and Workload in Air Traffic Control , 1992 .

[13]  David O'Hare,et al.  Cognitive failure analysis for aircraft accident investigation , 1994 .

[14]  Scott A. Shappell,et al.  The Human Factors Analysis and Classification System : HFACS : final report. , 2000 .

[15]  Sidney Dekker,et al.  The re-invention of human error , 2001 .

[16]  Jean-Michel Hoc,et al.  Work with technology: some fundamental issues , 1995 .

[17]  Scott A. Shappell,et al.  Human Factors Analysis of Postaccident Data: Applying Theoretical Taxonomies of Human Error , 1997 .

[18]  Richard S. Jensen,et al.  Pilot Judgment and Crew Resource Management , 1995 .

[19]  Scott A. Shappell,et al.  A Human Error Approach to Accident Investigation: The Taxonomy of Unsafe Operations , 1997 .

[20]  James Reason,et al.  Human Error , 1990 .

[21]  Jens Rasmussen,et al.  Human errors. a taxonomy for describing human malfunction in industrial installations , 1982 .

[22]  Donald Hameluck,et al.  Ergonomics in air traffic control , 1990 .

[23]  Marilyn Bohl,et al.  Information processing , 1971 .

[24]  Glen A. Gilbert,et al.  Air traffic control , 1973, Nature.

[25]  Mark D Rodgers.  An Examination of the Operational Error Database for Air Route Traffic Control Centers , 1993 .