Resilience Engineering Perspectives: Remaining sensitive to the possibility of failureErik Hollnagel, Christopher P. Nemeth, Sidney Dekker In the resilience engineering approach to safety, failures and successes are seen as two different outcomes of the same underlying process. This collection deals with issues such as measurements and models, the use of procedures to ensure safety, the relation between resilience and robustness, safety management, and the use of risk analysis. |
Contents
THE BIRTH OF | 3 |
THE NEED FOR TRANSLATORS AND FOR | 11 |
MEASURES OF RESILIENT PERFORMANCE | 29 |
UNEXAMPLED EVENTS RESILIENCE AND PRA | 49 |
SAFETY MANAGEMENT LOOKING BACK | 63 |
WHEN RESILIENCE DOES NOT WORK | 79 |
RULES MANAGEMENT AS SOURCE FOR LOOSE | 91 |
A | 101 |
APPENDIX | 190 |
RESILIENCE IN THE EMERGENCY | 193 |
A RESILIENCE | 211 |
WHAT WENT WRONG AT THE BEATSON | 225 |
RESILIENCE SAFETY AND TESTING | 237 |
DOES | 247 |
A Model of Crosschecking in a Collaborative | 254 |
ANALYSIS OF THE SCOTTISH CASE | 269 |
CREW RESILIENCE AND SIMULATOR TRAINING | 119 |
UNDERLYING CONCEPTS IN ROBUSTNESS | 127 |
STRESSSTRAIN PLOTS AS A BASIS | 143 |
DESIGNING RESILIENT CRITICAL | 159 |
List of Contributors | 299 |
| 325 | |
| 331 | |
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Common terms and phrases
accident action activity actual adaptive capacity adverse events agents analysis approach barrier Beatson Beatson Oncology Centre behaviour Chapter cognitive complex consequences coordination critical criticality accident cross-checking decision demands discussed dose effects emergency emergency department environment error example experience factors failure feedback Figure function healthcare Hollnagel human human reliability identified inappropriate act incident interaction investigation involved issue Johnston report knowledge learning Lund University measures methods module normal nuclear occur oncologist operations organisation overdose patients performance perspective Pineoblastoma planner practice practitioners prescriptions problem procedures radiation therapy radiographer radiotherapy region reliability requires resilience engineering response result risk assessment risk matrix risk scenarios role routine RTChart rules safe regulation model safety assessment Scottish Executive Scottish Parliament simulation situation socio-technical systems staff stakeholder strategy stress-strain Susan Deacon technical treatment plan uncertainty unexampled events upgrade x-region