The Field Guide to Understanding Human Error You can download The Field Guide to Understanding Human Error [Hardcover] from mediafire, rapishare, and mirror link
When faced with a human error problem, you may be tempted to ask 'Why didn't they watch out better? How could they not have noticed?'. You think you can solve your human error problem by telling people to be more careful, by reprimanding the miscreants, by issuing a new rule or procedure. These are all expressions of 'The Bad Apple Theory', where you believe your system is basically safe if it were not for those few unreliable people in it. This old view of human error is increasingly outdated and will lead you nowhere. The new view, in contrast, understands that a human error problem is actually an organizational problem. Finding a 'human error' by any other name, or by any other human, is only the beginning of your journey, not a convenient conclusion. The new view recognizes that systems are inherent trade-offs between safety and other pressures (for example: production). People need to create safety through practice, at all levels of an organization. Breaking new ground beyond its successful predecessor, "The Field Guide to Understanding Human Error" guides you through the traps and misconceptions of the old view. It explains how to avoid the hindsight bias, to zoom out from the people closest in time and place to the mishap, and resist the temptation of counterfactual reasoning and judgmental language. But it also helps you look forward. It suggests how to apply the new view in building your safety department, handling questions about accountability, and constructing meaningful countermeasures. It even helps you in getting your organization to adopt the new view and improve its learning from failure. So if you are faced by a human error problem, abandon the fallacy of a quick fix. Read this book.
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Essential reading for any safety investigator. An eye-opening way to transform your investigations by moving from the old-view to the new-view. I've used this book as a 'course book' for a seminar of 25 safety professionals to great effect. Plus there is a good guide to the role of a safety department too.
By Mr. Andrew Evans
We all are extremely good to forecast the past. When this simple principle is applied to human error, it is very easy blaming the human operator.
Dekker tries to put himself in the shoes of that human operator showing why an analysis that does not try to understand an event from that position is useless.
There is a very hard criticism to different kind of positions taken by people that do not make that effort.
If we try to make something as a "winzip on a summary" of the book, I think we could reach these conclusions:
When we have to analyze an event, it should be useful starting with this hipothesis: "People are not usually dumb, people are not usually crazy and people have not usually chosen the day of a big accident to make self-killing." This starting point could be enough to avoid many of the practices fairly critiziced by Dekker.
By Jose Sanchez Alarcos