Error Management I

How do you define an error?

It’s a consequence of human involvement which causes deviation from intentions or expectations. In other words… it's down to us. Errors are skill-based failures that occur at the point of execution. An individual either does not possess the skills to perform a task or is undertaking a highly routine task that leaves him/her prone to slips and lapses.

What does an effective Error Management System look like?

It removes error-promoting situations, can improve defences and enables people to make effective risk-based decisions in all that they do within an organisation. The philosophy is to accept human error as normal in all organisational systems. It classifies the different human error types and their causes and can help build qualitative reporting trends. Most importantly, it enables organisations to understand therefore manage human-in-the-system risk.

What are the two types of active errors?

1. Unintended actions

• Slips (an attention failure - for example, getting into your partners car and attempting to turn the windscreen wipers on, only to carry out the same action that you would have done on your own car, and you turn the headlights on)
• Lapse (a memory failure) how many times have you intended to post a letter, popped it on the passenger seat and then arrived at your destination with it still there

2. Intended actions

• Mistakes are typically knowledge or rule-based and involve failures in planning or decision making. Either an individual does not possess the knowledge to undertake a task or there are issues with inadequate or ambiguous rules and procedures
• Violations are motivation-based and usually involve an intentional decision by an individual to deviate from the applicable rules and procedures