Profile picture
Steven Shorrock @StevenShorrock
, 3 tweets, 1 min read Read on Twitter
An engineer does not detect an alarm. This is classed as the ‘cause’. But no one assessed the risk of this or did an HF/ergonomics assessment of the task with reference to human performance. Two omissions/counterfactuals. Only the sharp end one is really considered ‘human error’.
The blunt end one is not considered ‘human error’ is not considered ‘causal’ and is not actually considered at all. We only consider human error to be sharp end behaviours. Everything else disappears into ‘context’ and so is not much considered (or remembered).
So human-error-as-cause prevails in the way that we think about unwanted events. We consider the events closest to the event more ‘causal’ and more erroneous, and hold those responsible for outcomes.
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Steven Shorrock
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member and get exclusive features!

Premium member ($3.00/month or $30.00/year)

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!