Upgrade to Pro — share decks privately, control downloads, hide ads and more …

Procedures and the Varieties of Human Work

Procedures and the Varieties of Human Work

This talk outlines basic concepts in Safety-I and Safety-II, along with some of the Varieties and Archetypes of Human Work (https://humanisticsystems.com/2017/01/13/the-archetypes-of-human-work/). Examples from aviation are provided, along with tips for understanding and intervention, including 7 steps for designing for human work.

4561172f953bb75e01b70165aad3436c?s=128

StevenShorrock

June 04, 2019
Tweet

Transcript

  1. Supporting European Aviation Procedures and Human Work The Varieties of

    Human Work Steven Shorrock Senior Specialist Safety & Human Factors Network Manager Safety Unit EUROCONTROL Safety Forum, 4-5 June, Brussels
  2. Adapted from EUROCONTROL (2013). From Safety-I to Safety-II. A White

    Paper Accidents & incidents: obvious internally and externally, investigated in depth Normal, routine, day-to-day performance: not well understood, generally ignored Exceptional performance: obvious internally, hard to see externally, gratefully accepted
  3. Adapted from EUROCONTROL (2013). From Safety-I to Safety-II. A White

    Paper <0.0001% Commercial Aviation Accidents & incidents: obvious internally and externally, investigated in depth Normal, routine, day-to-day performance: not well understood, generally ignored Exceptional performance: obvious internally, hard to see externally, gratefully accepted
  4. Errors Unsafe Acts Failures Deviations Violations Non-compliance Carelessness Recklessness Accidents

    & incidents: obvious internally and externally, investigated in depth
  5. ? Accidents & incidents: obvious internally and externally, investigated in

    depth Normal, routine, day-to-day performance: not well understood, generally ignored Exceptional performance: obvious internally, hard to see externally, gratefully accepted
  6. Effective-as-designed? Effective-as-operated? Accidents & incidents: obvious internally and externally, investigated

    in depth Normal, routine, day-to-day performance: not well understood, generally ignored Exceptional performance: obvious internally, hard to see externally, gratefully accepted <0.0001% Commercial Aviation
  7. 7 ATCOs Rank C15 We are sufficiently involved in changes

    to procedures. 3 B18 Changes to the organisation, systems and procedures are properly assessed for safety risk. 11 C08 I receive sufficient safety-related refresher training. 12 C07r We often have to deviate from procedures. 15 B27 Other people in this organization understand how my job contributes to safety. 16 C19 The procedures associated with my work are appropriate. 16 C14r I often have to take risks that make me feel uncomfortable about safety. 18 C11 Adequate training is provided when new systems and procedures are introduced. 20 C04 The procedures describe the way in which I actually do my job. 32 C20 I have sufficient training to understand the procedures associated with my work. 43
  8. Photo: Naviair (All rights reserved) THE VARIETIES OF HUMAN WORK

    http://bit.ly/TVOHW www.humanisticsystems.com
  9. Image: Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/25wGrGQ

  10. Image: Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/28EShtU

  11. Image: Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/MYAVK4

  12. Work-as-Measured Work-as-Judged Work-as-Analysed Work-as-Observed Work-as-Simulated Work-as-Disclosed Work-as-Imagined Work-as-Prescribed Work-as-Done

  13. http://bit.ly/TAOHW1 HUMAN WORK THE ARCHETYPES OF www.humanisticsystems.com Photo: NATS -

    UK air traffic control CC BY-NC-ND 2.0
  14. Work-as-Imagined Work-as-Prescribed Work-as-Done The Messy Reality http://bit.ly/TAOHW1 Tell me about

    a situation where work-as-done is not as-prescribed and usually not as-imagined by others ” “
  15. USE OF MODE S DURING LOSS OF FLIGHT DATA Image:

    © EUROCONTROL
  16. USE OF RADAR WITHOUT A LICENCE Image: © EUROCONTROL

  17. http://bit.ly/TAOHW2 Tell me about a situation where work-as-done is as-prescribed

    and as-imagined by others. ” “ Congruence (as-imagined) Work-as-Imagined Work-as-Prescribed Work-as-Done
  18. PROCEDURES STANDARD OPERATING Image: Randomwire CC BY-NC-SA 2.0 http://flic.kr/p/7u6jhM

  19. http://bit.ly/TAOHW2 Congruence (not-as-imagined) Tell me about a situation where work-as-done

    is as-prescribed but not as-imagined by others. “ ” Work-as-Imagined Work-as-Prescribed Work-as-Done
  20. enter your presentation title 20 SETTING STANDARD PRESSURE

  21. DOUBLE Image: ©Steven Shorrock All Rights Reserved SHIFTING

  22. Ignorance and Fantasy http://bit.ly/TAOHW4 www.humanisticsystems.com Tell me about a situation

    where current work-as-imagined is not as-done “ ” Work-as-Imagined Work-as-Prescribed Work-as-Done
  23. enter your presentation title 23 THE LIGHTING CIRCUIT Photo: LRD615

    CC BY-SA 2.0 https://flic.kr/p/2kNCax
  24. Projection http://bit.ly/TAOHW5 www.humanisticsystems.com Tell me about a situation where work-as-imagined

    was projected into the future. It may or may not be as-done ” “ Work-as-Imagined Work-as-Prescribed Work-as-Done
  25. AFTER Photo: ResoluteSupportMedia CC BY 2.0 https://flic.kr/p/922V3P THE RUNWAY INCURSION

  26. http://bit.ly/TAOHW7 www.humanisticsystems.com Tell me about a situation where work-as-prescribed is

    not as-done “ ” Work-as-Imagined Work-as-Prescribed Work-as-Done Defunct
  27. 4/2 ENGINE PROCEDURES Photo: William Warby CC BY 2.0 https://flic.kr/p/8hDHDf

  28. Image: Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/2bkA8HS

  29. 29 1. Psychological safety must be cultivated to really understand

    work-as-done 2. Work must be understood in terms of local rationality - why the things we do make sense at the time 3. Protection is required for the goodwill use of creative expertise – policy, principles and philosophy UNDERSTANDING
  30. 30 1. Procedural solutions to systemic or isolated problems can

    make matters worse 2. Tightening procedural requirements can reduce necessary degrees of freedom 3. Human-centred design and systems methods are needed for procedure design INTERVENTION
  31. 1.Understand work-as-done (WAD) 2.Collaborate on work-as-imagined (WAI) 3.Co-design prototype work-as-prescribed

    (WAP) 4.Implement in work-as-done 5.Test WAI and WAP against WAD 6.Repeat above until WAI-WAP-WAD gap acceptable 7.Monitor WAI-WAP-WAD gap Image: Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/2ajEAFt DESIGNING FOR WORK-AS-DONE
  32. or www.bit.ly/HindSightMagazine steven.shorrock@eurocontrol.int Download Free at SKYbrary.aero