The old and new view on human error
In the field of Resilience Engineering, safety professors like Sidney Dekker and Erik Hollnagel frequently explain concepts by grouping the idea of a ‘human error’ into two categories, the old view and the new view.
Old view
The “old view” blames people, the individuals who “caused” an accident as the problem. Under this view, complex systems are generally considered to be well-designed and completely safe, if not for the behavior of humans doing unsafe things: The ‘human errors’.
Subsequently, the old view focuses on minimizing mistakes by these humans. When accidents happen and people make mistakes, or deviate from official processes or procedures, the focus is on their behavior.
To address the problem, old view methodologies try to improve safety through the introduction of more regulation, training or punishment (deterrence) to prevent recurrence.
In order to not have safety problems, people should do as they are told. They should be compliant with what managers and planners have figured out for them. Indeed, managers and others above them are smart—they have put in place those treatises, those prescriptive procedures, those safety rules.
All the dumb operators or practitioners need to do is follow them, stick to them! How hard can that be?
Apparently it can be really hard. But the reason is also clear: it is because of people’s negative attitudes which adversely affect their behaviors. So more work on their attitudes (with poster campaigns and sanctions, for example) should do the trick.
This view, the Old View, is limited in its usefulness. In fact, it can be deeply counterproductive. It has been tried for decades, without noticeable effect.
– Sidney Dekker in The field guide to understanding human error.
New view
The “new view” on ‘human error’ takes a different look at safety problems. Instead of marking human behavior as the culprit in accidents, it considers this ‘human error’ as merely a symptom of deeper underlying issues within the organization.
This “new view” makes us take a step back to look at the larger picture when it comes to incident analysis. It acknowledges that we operate in highly complex socio-technical systems where our behavior is governed strongly by our environment, which is nearly always dynamic, constantly evolving and frequently ambiguous or contradictory.
In the New View, the behavior which we call ‘human error’ is not a cause of trouble. It is the consequence, the effect, the symptom of trouble deeper inside your organization. The New View assumes that people do not come to work to do a bad job. So when there are bad outcomes, you must look beyond those people, at the conditions in which they worked at the time.
You and your organization may well have helped create those conditions. Leave those conditions in place, and the same bad outcome may happen again—no matter how many sanctions you impose, posters you put up or safety attitude campaigns you launch.
– Sidney Dekker in The field guide to understanding human error.
References
- Dekker, Sidney. “The field guide to understanding human error” 3rd edition, extended, re-organized, simplified. Boca Raton, FL London New York: CRC Press, 2014.
- Hollnagel, Erik. “NO View of Human Error” Accessed February 28, 2021.