ABSTRACT
Introduction: Occupational health and safety management systems are widely used as a systematic approach to managing occupational health and safety. However, sometimes they are restrictive and underspecified to deal with dynamic workplace demands. Rasmussen used a model of boundaries to conceptualize this dynamic model of safety, where the space of possibilities lay within 3 boundaries and workers used various means to stay within the boundaries to remain both productive and safe at work. Methods: This study applied the Rasmussen model of boundaries to understand the factors that formed the boundaries, the gradients, and countergradients in a biomedical laboratory. Results: The most central goal was to be the first to publish, and this formed the boundary to scientific output failure; the boundary to unacceptable workload and boundary to functionally acceptable performance were the other 2 boundaries in line with the Rasmussen model. The workers had developed methods (mental risk assessment, teamwork, and experience and familiarity) of working, which ensured they remained productive and safe. This can be described as resilient performance, where resilience is not something that a system has but something it does to adjust their performance when faced with expected or unexpected changes. Discussion and Conclusion: A customized portfolio of rule-based non negotiable instructions and a risk assessment-based approach would be best suited for a biomedical laboratory. The workers have learned resilient performance on their own and unknowingly are already practicing this. It is now time to formally incorporate such practices into the safety systems of biomedical laboratories.
ABSTRACT
BACKGROUND: The air traffic management (ATM) system has historically coped with a global increase in traffic demand ultimately leading to increased operational complexity. When dealing with the impact of this increasing complexity on system safety it is crucial to automatically analyse the losses of separation (LoSs) using tools able to extract meaningful and actionable information from safety reports. Current research in this field mainly exploits natural language processing (NLP) to categorise the reports,with the limitations that the considered categories need to be manually annotated by experts and that general taxonomies are seldom exploited. METHODS: To address the current gaps,authors propose to perform exploratory data analysis on safety reports combining state-of-the-art techniques like topic modelling and clustering and then to develop an algorithm able to extract the Toolkit for ATM Occurrence Investigation (TOKAI) taxonomy factors from the free-text safety reports based on syntactic analysis. TOKAI is a tool for investigation developed by EUROCONTROL and its taxonomy is intended to become a standard and harmonised approach to future investigations. RESULTS: Leveraging on the LoS events reported in the public databases of the Comisión de Estudio y Análisis de Notificaciones de Incidentes de Tránsito Aéreo and the United Kingdom Airprox Board,authors show how their proposal is able to automatically extract meaningful and actionable information from safety reports,other than to classify their content according to the TOKAI taxonomy. The quality of the approach is also indirectly validated by checking the connection between the identified factors and the main contributor of the incidents. CONCLUSIONS: Authors' results are a promising first step toward the full automation of a general analysis of LoS reports supported by results on real-world data coming from two different sources. In the future,authors' proposal could be extended to other taxonomies or tailored to identify factors to be included in the safety taxonomies.
ABSTRACT
In a socio-technical work domain, humans, device interfaces and artefacts all affect transformations of information flow. Such transformations, which may involve a change of auditory to visual information & vice versa or alter semantic approximations into spatial proximities from instruments readings, are generally not restricted to solely human cognition. This paper applies a joint cognitive system approach to explore a socio-technical system. A systems ergonomics perspective is achieved by applying a multi-layered division to transformations of information between, and within, human and technical agents. The approach uses the Functional Resonance Analysis Method (FRAM), but abandons the traditional boundary between medium and agent in favour of accepting aircraft systems and artefacts as agents, with their own functional properties and relationships. The joint cognitive system perspective in developing the FRAM model allows an understanding of the effects of task and information propagation, and eventual distributed criticalities, taking advantage of the functional properties of the system, as described in a case study related to the cockpit environment of a DC-9 aircraft. Practitioner Summary: This research presents the application of one systemic method to understand work systems and performance variability in relation to the transformation of information within a flight deck for a specific phase of flight. By using a joint cognitive systems approach both retrospective and prospective investigation of cockpit challenges will be better understood. Abbreviations: ATC: air traffic control; ATCO: air traffic controller; ATM: air traffic management; CSE: cognitive systems engineering; DSA: distributed situation awareness; FMS: flight management system; FMV: FRAM model visualize; FRAM: functional resonance analysis method; GF: generalised function; GW: gross weight; HFACS: human factors analysis and classification system; JCS: joint cognitive systems; PF: pilot flying; PNF: pilot not flying; SA: situation awareness; SME: subject matter expert; STAMP: systems theoretic accident model and processes; VBA: visual basic for applications; WAD: work-as-done; WAI: work-as-imagined; ZFW: zero fuel weight.
