Micro incident analysis framework to assess safety and resilience in the operation of safe critical systems: A case study in a nuclear power plant

Journal of Loss Prevention in the Process Industries

Volumn 21, Issue 3, 2008, Pages 277-286

  Carvalho, Paulo V R ^a   dos Santos, Isaac L ^a   Gomes, José Orlando ^b   Borges, Marcos R S ^b  

^a INSTITUTO DE ENGENHARIA NUCLEAR   (Brazil)

^b FEDERAL UNIVERSITY OF RIO DE JANEIRO   (Brazil)

Author keywords

Micro incident; Nuclear power plant operation; Resilience; Safety

Indexed keywords

ADAPTIVE SYSTEMS; COMPUTER HARDWARE; NUCLEAR POWER PLANTS; SOCIETIES AND INSTITUTIONS;

MICRO INCIDENT; NUCLEAR POWER PLANT OPERATION;

ACCIDENT PREVENTION;

ACCIDENT PREVENTION; ADAPTIVE SYSTEMS; COMPUTER HARDWARE; NUCLEAR POWER PLANTS; SOCIETIES AND INSTITUTIONS;

EID: 43449132697     PISSN: 09504230     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.jlp.2007.04.005     Document Type: Article

References (25)

1. M. Bressolle F.B. Decortis B. Pavard P. Salembier Traitement cognitif et organisationnel des micro-incidents dans le domaine du contrôle aérien: analyse des boucles de régulation formelles et informelles 1996 Octarès Toulouse
2. P.V.R. Carvalho I.L. Santos M. Vidal Planning and improvisation in nuclear power plant operation Proceedings of the 16th world congress of the International Ergonomics Association—IEA 2006 IEA Maastricht
3. P.V.R. Carvalho M.C. Vidal I.L. Santos Nuclear power plant shift supervisor's decision-making during micro incidents International Journal of Industrial Ergonomics 35 7 2005 619 644
4. R. Cook C. Nemeth Taking things in one's stride: Cognitive features of two resilient performances E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK
5. K. Ericsson H. Simon Protocol analysis: Verbal reports as data 1993 Cambridge University Press Cambridge
6. Y. Fujita Resilient systems E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK
7. Gordon, S. E. (1995). Cognitive task analysis using complementary elicitation methods. In Proceedings of the human factors and Ergonomics Society 39th Meeting . San Diego, CA: HFES.
8. E. Hollnagel Barrier analysis and accident prevention 2004 Ashgate Aldershot, UK
9. E. Hollnagel D. Woods Joint cognitive systems: An introduction to cognitive systems engineering 2005 Taylor & Francis UK
10. International Atomic Energy Agency—IAEA. (1998). Developing safety culture in nuclear activities , Safety Reports Series No.11. Vienna: IAEA.
11. K. Krippendorff Content analysis. An introduction to its methodology 1980 Sage London, UK
12. S.P. Marshall Schemas in problem solving 1995 Cambridge University Press New York
13. D.M. Neves J.R. Anderson Knowledge compilation: Mechanisms for the automatization of cognitive skills J.R. Anderson Cognitive skills and their acquisition 1981 Lawrence Erlbaum Associates Hillsdale, NJ
14. C. Perrow Normal accidents 1984 Basic Books New York
15. J. Rasmussen Skills, rules and knowledge: Signals, signs and symbols and other distinctions in human performance models IEEE Transactions on Systems, Man and Cybernetics 13 1983 257 266
16. J. Rasmussen I. Svedung Proactive risk management in a dynamic society 2000 Swedish Rescue Services Agency Karlstad SW
17. J. Reason Managing the risks of organizational accidents 1997 Ashgate Aldershot, UK
18. J.A. Smith Evolving issues for qualitative psychology J.T.E. Richardson Handbook of qualitative research methods 1996 BPS Leicester, UK
19. S. Snook Friendly fire—the accidental shootdown of U.S. Black Hawks over Northern Iraq 2000 Princeton University Press New Jersey, USA
20. K. Weick Educational organizations as loosely coupled systems Administrative Science Quarterly 21 1976 1 19
21. R. Westrum Cultures with requisite imagination J. Wise P. Stager J. Hopkin Verification and validation in complex man–machine systems 1991 Springer Berlin
22. D.D. Woods How to design a safety organization: Test case for resilience engineering E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK
23. D.D. Woods R. Cook Incidents—markers of resilience or brittleness? E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK
24. D.D. Woods E. Hollnagel Prologue: Resilience engineering concepts E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK
25. J. Wreathall Properties of resilient organizations: An initial view E. Hollnagel D.D. Woods N. Leveson Resilience engineering. Concepts and precepts 2006 Ashgate Aldershot, UK