There has been much talk in recent years about ‘never events’ and ‘zero harm’, similar to talk in the safety community about ‘zero accidents’. It sounds obvious: no one would want an accident. And we all wish that serious harm would not result from accidents. But as expressed and implemented top-down, never/zero is problematic for many reasons. In this post, I shall outline just a few, as I see them.
Again, a familiar smoke pattern has emerged from the ashes of a high-profile accident. The…
Following most major accidents, one phrase is almost guaranteed to headline in the popular press:…
Despite the pervasive and controversial nature of the notion of ‘human error’ in academia, industry…
This is a keynote address from Velocity Europe 2014 in Barcelona on 17 November. I…
Occupational Overuse Syndrome – Human Error Variant (OOS-HEV) is a condition involving the overuse of the…
In 2001: A Space Odyssey, there is a problem aboard Discovery One. The HAL 9000…
“Oh my God. I told those guys at safety that it was dangerous and one day we would lose concentration and pay for it. I already told those guys at safety that it was very dangerous! We are human and this can happen to us. This curve is inhuman!”
Humanistic Systems 