Overview modeling approches part 1
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This document provides an overview of sequential accident modeling approaches. It discusses domino, fault tree, and events and causal factors charting models. These sequential models describe accidents as a linear sequence of events. While useful for identifying direct causes, they do not account for latent factors or variability in sociotechnical systems. The document also reviews academic literature on accident modeling and comparisons of investigation methods.
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Summary of Selected Accident Modeling Papers
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penPOWER offers a fully open, royalty-free CPU architecture for custom chip design.
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Ideal for developers, architects, and teams wanting to scale MuleSoft projects with AI efficiency
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Overview modeling approches part 1
- 2. SOCIO-TECHNICAL SYSTEMS Socio-technical system The interactions between people and their behavior with technology while occupying society's complex infrastructures. Examples: Power plants, national healthcare system, space missions, stock market , aviation systems. What happens when they go wrong
- 3. THE NEED TO MODEL ACCIDENTS Accidents in these types of organizations are: have a high cost, decrease efficacy and can lead to serous harm or death of humans. If the source of the accident is identified the potential accidents can be eliminated. To obtain this information must effectively represent the system in which the accident occurred and the accident itself. Accident Models.
- 4. ACADEMIC LITERATURE I Understanding Accidents - From Root Causes to Performance Variability (Hollnagel, 2002) Key points: Discusses the general modeling approaches and identifies each what approach shows or highlights. Main types of Accident model. (Hollnagel, 2002)
- 5. ACADEMIC LITERATURE I The suitability of these approaches focusing on the human aspects of Sociotechnical systems. Humans actions are not black and white and can only be judge in hindsight. People do what they think is right at the time. Different degrees of being right not just correct or fail. (Amalberti, 1996)
- 6. ACADEMIC LITERATURE I In the sequential model an element is either correct or has failed, but human actions are not like this Human actions are better suited to the epidemiological model as it allows for latent conditions , it takes into account that action may contribute to accident over time. The systemic model is built on the concept of variability and does not focus on failures. This is perfect for representing variability of human action.
- 7. ACADEMIC LITERATURE II Comparison of some selected methods for accident investigation (Sklet, 2004) Key points: Compares a selection of accident investigation methods, theses methods are commonly used and widely acknowledge in academic and accident investigating community. Methods compared in article
- 8. ACADEMIC LITERATURE II Details Framework of comparison highlighting the strengths and weakness of each technique. 7 categories Whether the methods give a graphical description of the event sequence or not? Can give overview of events Allows for clear communication Easy to see broken link To what degree the methods focus on safety barriers? Analysis of protective elements in the the system
- 9. ACADEMIC LITERATURE II The level of scope of the analysis. Which levels of Rasmussens classification of sociotechnical systems (Rasmussen, 1997) does the method model. (Rasmussen, 1997)
- 10. ACADEMIC LITERATURE II What kind of accident models that has influenced the methods? sequential model, epidemiological model, systemic model Whether the different methods are inductive, deductive, morphological or non-system-oriented? The way in which the method looks at the accident e.g. does reason from the general to the specific.
- 11. ACADEMIC LITERATURE II Whether the different methods are primary or secondary methods? Primary Method Self contained, stand alone method. Secondary Method used in conjunction with other method to provide special input. The need for education and training in order to use the methods. Novice no experience or training is needed. Specialist In between Novice and expert. Expert Formal education and training is needed.
- 12. ACADEMIC LITERATURE II Each method is briefly detailed, the comparison is analyzed and discussed. Characteristics of different methods. (Sklet, 2004) Conclusion: no one accident investigation technique is perfect and that to be most effective they must be used in conjunction.
- 13. ACADEMIC LITERATURE III Models of accident causation and their application: Review and reappraisal (Lehto, 1991) Key points Categorizes and compares 54 different accident causing models. A fairly comprehensive at the time of publication list categorized and cited. Conclusion: modeling methods are to narrow and a better model is need to take into account human and technological interaction.
- 16. SEQUENTIAL ACCIDENT MODELS Simplest form of accident modeling. Describes the accident as a series of events that occur in a particular order. Events occur along a linear timeline. Analysis: Identifies specific cause and broken links in accident chain. Goal is to eliminate broken links.
- 17. DOMINO MODEL OF ACCIDENT CAUSATION (Ferry, 1988) 5 factors in the accident sequence 1. Social environment Factors effect an individuals perception of risk 2. Fault of the person Human error 3. Unsafe acts or environment faulty equipment, hazards in the environment 4. Accident 5. Injury
- 18. DOMINO MODEL OF ACCIDENT CAUSATION Domino Diagram Time
- 19. FAULT TREE ANALYSIS (H淡yland & Rausand, 1994) Graphical representation of normal events, system failures, human errors and environmental factors. Logic gate are used to construct chains of events. Used to identify sequences off failure. Advantages: Root cause can be easily be identified. Human readable easy to communicate events that lead to accident.
- 20. FAULT TREE ANALYSIS Simple fault tree for a fire breakout
- 21. EVENTS AND CAUSAL FACTORS CHARTING (Department of Energy, 1999) Diagram used to show the events of the accident in chronological order. Primary events the main sequence of events that lead to the accident are drawn in a horizontal line. Secondary events Placed above or below each primary event that it directly relates to. Conditions influencing the events Passive and describe states, place above relevant events.
- 22. EVENTS AND CAUSAL FACTORS CHARTING (Department of Energy, 1999)
- 23. SEQUENTIAL ACCIDENT MODELS SUMMARY Advantages: Human readable, easy to communicate chain of events. Can identify root cause or break in chain of events that lead to accident. Good starting of point. Disadvantages: Does not take into account latent factors. Inadequate to model the variability of Sociotechnical systems.
- 24. SEQUENTIAL ACCIDENT MODELS SUMMARY More modeling techniques: Event tree analysis. Management and Oversight Risk Tree (MORT). Sequential Timed Events Plotting (STEP). Man, Technology and Organization (MTO)-analysis. TRIPOD Links last accessed 29/06/12
- 25. REFERENCES Amalberti, R. (1996). La conduite des systkmes ri risques. Paris: PUF. Department of Energy. (1999). DOE Workbook, Conducting Accident Investigations . Washington,: Department of Energy. Ferry, T. (1988). Modern Accident Investigation and Analysis. Second Edition. New York: Wiley. H淡yland, A., & Rausand, M. (1994). System reliability Theory: Models and Statistical Methods. New York: Wiley. Hollnagel, E. (2002). Understanding accidents-from root causes to performance variability. Human Factors and Power Plants, 2002. Proceedings of the 2002 IEEE 7th Conference on , (pp. 1 - 1-6 ). Lehto, M. (1991). Models of accident causation and their application: Review and reappraisal. journal of engineering and technology management , 173. Rasmussen, J. (1997). Risk management in a dynamic society: a modelling problem. Safety Sci. , 183213. Sklet, S. (2004). Comparison of some selected methods for accident investigation. Journal of hazardous materials , 29-37.