Preface; Introduction; Part I Errors and Complex Systems; Errors, Complex Systems, Accidents, and Investigations; Analyzing the Data; Equipment; Part II: Antecedents; The Operator; The Company; The regulator; Culture; Operator Teams; Part III: Sources of Data; Electronic Data; Interviews; Written Documentation; Part IV: Issues; Maintenance and Inspection; Situation Awareness and Decision Making; Automation; Case Study; Final Thoughts; References
Barry Strauch has lectured and taught human factors, accident investigation techniques, and human error to accident investigators, graduate students, and government and industry officials throughout the world. He is an adjunct faculty member of the psychology department of George Mason University in Fairfax, Virginia. He has been with the National Transportation Safety Board for more than 30 years as a human performance investigator, major aircraft accident investigator in charge, chief of the human performance division and, currently, National Resource Specialist - Human Factors. He has investigated accidents in all major transportation modes, involving vehicles ranging from passenger trains, to Boeing 747s, to nuclear attack submarines. He earned a PhD in educational psychology from the Pennsylvania State University and holds a commercial pilot certificate, with an instrument aeroplane rating.
"This is an extremely important book, one that literally can save
lives. For decades, I've argued that blaming an accident was on
"human error" is not helpful. It is necessary to understand the
root causes (invariably plural) and fix those, otherwise the errors
continue. Often the fault lies in design, either of the system or
the procedures, but there are a multitude of potential underlying,
causes. Barry Strauch's book discusses these issues and provides
detailed, valuable guidelines for investigating incidents with the
goal, not of finding blame, but of preventing future
recurrence."
—Don Norman, University of California, San Diego Design Lab
Author of "Design of Everyday Things"
Comments on previous edition: ’...essential reading for the
professional investigator and the serious student of the subject.
Strauch is commendably thorough. Do not be discouraged from buying
the book because you do not work in aviation. In fact, reading
about accidents in other industries we see the causes more clearly
as we are not involved.' Industrial Safety Magazine 'It is always
exciting to receive new books from Ashgate in the sure expectancy
of new findings and fresh interpretation...as hard to put down as a
crime detection thriller, with carefully researched case histories
revealing disastrous sequences of human error, maladministration
and criminal neglect far stranger than fiction. This is an
important and valuable book...' The RoSPA Occupational Safety and
Health Journal"This is an extremely important book, one that
literally can save lives. For decades, I've argued that blaming an
accident was on "human error" is not helpful. It is necessary to
understand the root causes (invariably plural) and fix those,
otherwise the errors continue. Often the fault lies in design,
either of the system or the procedures, but there are a multitude
of potential underlying, causes. Barry Strauch's book discusses
these issues and provides detailed, valuable guidelines for
investigating incidents with the goal, not of finding blame, but of
preventing future recurrence."
—Don Norman, University of California, San Diego Design Lab
Author of "Design of Everyday Things"
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