Sensemaking following surprise in the cockpit—a re-framing problem

Cognition, Technology and Work

Volumn 18, Issue 4, 2016, Pages 623-642

  Rankin, Amy ^a   Woltjer, Rogier ^a   Field, Joris ^b  

^a LINKÖPING UNIVERSITY   (Sweden)

^b NATIONAL AEROSPACE LABORATORY NLR   (Netherlands)

Author keywords

Cockpit operations; Re framing; Sensemaking; Surprise; Training

Indexed keywords

AUTOMATION; COCKPITS (AIRCRAFT); PERSONNEL TRAINING; TRAINING AIRCRAFT;

CONTROL STRATEGIES; FRAMING STRATEGIES; KNOWLEDGE AND EXPERIENCE; MANAGING UNCERTAINTY; SENSEMAKING; SENSEMAKING ACTIVITIES; SURPRISE; UNEXPECTED EVENTS;

FIGHTER AIRCRAFT;

EID: 84988418813     PISSN: 14355558     EISSN: 14355566     Source Type: Journal    
DOI: 10.1007/s10111-016-0390-2     Document Type: Article

References (63)

1. Bergström J, Dahlström N, Dekker SWA, Petersen K (2011) Training organizational resilience in escalating situations. In: Hollnagel E, Pariès J, Woods DD, Wreathall J (eds) Resilience engineering in practice: a guidebook. Ashgate Publishing Limited, Farnham
2. Billings CE (1997) Aviation automation: the search for a human-centered approach. Lawrence Erlbaum Associates, Mahwah
3. CAA (2013) Monitoring matters, Guidance on the Development of Pilot Monitoring Skills. Civil Aviation Authority, Sussex
4. Casner SM, Geven RW, Williams T (2013) The effectiveness of airline pilot training for abnormal events. Hum Factors 55(3):477–485
5. Christoffersen K, Woods DD, Blike GT (2007) Discovering the events expert practitioners extract from dynamic data streams: the modified unit marking technique. Cogn Technol Work 9(2):81–98
6. Clark HH (1996) Using language. Cambridge University Press, London
7. De Keyser V, Woods DD (1990) Fixation errors: failure to revise situation assessment in dynamic and risky teams. In: Colombo AG, de Bustamante AS (eds) Systems reliability assessment. Kluwer Academic Publisher, Dordrecht, pp 231–251
8. Dekker SWA, Dahlström N, Van Winsen R, Nyce J (2008) Crew resilience and simulator training in aviation. In: Hollnagel E, Nemeth CP, Dekker S (eds) Resilience engineering perspectives: vol 1 remaining sensitive to the possibility of failure. Ashgate, Aldershot
9. Dekker SWA, Lundström J (2006) From threat and error management (TEM) to resilience. Hum Factors Aerosp Saf 6(3):261–273
10. Dunbar K (1999) How scientists build models: InVivo science as a window on the Scientific Mind. In: Magnani L, Nersessian N, Thagard P (eds) Model-based reasoning in scientific discovery. Springer, US, pp 89–98
11. Endsley MR (2006) Situation awareness. In: Salvendy G (ed), Handbook of human factors and ergonomics (pp 528–542)
12. FAA (2013) Operational use of flight path management systems. Retrieved 9 Apr 2016, from http://www.faa.gov/aircraft/air_cert/design_approvals/human_factors/media/oufpms_report.pdfWG_Final_Report_Recommendations.pdf
13. Feltovich PJ, Hoffman RR, Woods DD, Roesler A (2004) Keeping it too simple: how the reductive tendency affects cognitive engineering. IEEE Intell Syst 19(3):90–94
14. Feltovich PJ, Spiro RJ, Coulson RI (1997) Issue of expert flexibility in contexts characterized by complexity and change. In: Feltovich PJ, Ford KM, Hoffman RR (eds) Expertise in context. AAAI/MIT press, Menlo Park, pp 125–146
15. Field J, Woltjer R, Rankin A (2015) Experimental investigation of flight crew strategies in handling unexpected events. In: Proceedings of the 18th international symposium on aviation psychology. Dayton, OH
16. Flanagan JC (1954) No the critical incident technique. Psychol Bull 51:327–358
17. Hoffman RR, Mcneese MD (2009) A history for macrocognition 3(2):97–110
18. Hoffman RR, Woods DD (2000) Studying cognitive systems in context: preface to the special section. Hum Factors: J Hum Factors Ergon Soc 42(1):1–7
19. Hollnagel E, Woods DD (1983) Cognitive systems engineering: new wine in new bottles. Int J Man Mach Stud 18:583–600
20. Hollnagel E, Woods DD (2005) Joint cognitive systems: foundations of cognitive systems engineering. CRC Press, Taylor & Francis Group, Boca Ranton
21. ICAO (2013) Manual of evidence-based training (DOC9995). Montreal, QC
22. Klein DE, Woods DD, Klein G, Perry SJ (2016) Can we trust best practices? Six cognitive challenges of evidence-based approaches. J Cogn Eng Decis Making 10(3):244–254
23. Klein G, Calderwood R (1991) Decision models: some lessons from the field. IEEE Trans Syst Man Cybern 21(5):1018–1026
24. Klein G, Calderwood R, MacGregor D (1989) Critical decision method for eliciting knowledge. IEEE Trans Syst Man Cybern 19(3):462–472
25. Klein G, Klein DE, Hoffman RR, Hollnagel E (2003) Macrocognition. IEEE Intell Syst 18(3):81–85
26. Klein G, Moon B, Hoffman RR (2006) Makin sense of sensemaking. IEEE Intell Syst 21(4):70–73
27. Klein G, Pliske R, Crandall B, Woods DD (2004a) Problem detection. Cogn Technol Work 7(1):14–28
28. Klein G, Phillips JK, Rall EL, Peluso D (2007) A Data-Frame Theory of Sensemaking. In: Hoffman RR (ed) Expertise Out of Context. Erlbaum, Mahweh, NJ
29. Klein G, Snowden D, Pin C (2010a) Anticipatory thinking. In: Mosier KL, Fischer UM (eds) Informed by knowledge: expert performance in complex situations. Routledge, London, pp 1–10
30. Klein G, Wiggins S, Dominguez CO (2010b) Team sensemaking. Theor Issues Ergon Sci 11(4):304–320
31. Klein G, Woods DD, Bradshaw J, Hoffman RR, Feltovich PJ (2004b) Ten challenges for making automation a “Team Player” in joint human-agent activity. IEEE Intell Syst 19(6):91–95
32. Lanir Z (1986) Fundemental surprise. Decision Research, Eugene
33. Learmount D (2011) Airine pilot training revolution needed. Flight international. Retrieved from https://www.flightglobal.com/news/articles/airline-pilot-training-revolution-needed-363801/
34. Learmount D (2014) Analysis crew training follows the evidence. Flight international. Retrieved from https://www.flightglobal.com/search-results/analysis crew training follows the evidence/
35. Loukopoulos LD, Dismukes RK, Barshi I (2009) The multitasking myth: handling complexity in real-world operations. Ashgate, Farnham
36. Malakis S, Kontogiannis T (2013) A sensemaking perspective on framing the mental picture of air traffic controllers. Appl Ergon 44(2):327–339
37. Pliske R, Crandall B, Klein G (2004) Competence in weather forecasting. In: Koehler DJ, Harvey N (eds) Psychological exploration of competent decision making. Cambridge University Press, Cambridge, England, pp 297–315
38. Pruchnicki S, Woods DD (2013) Cognitive demands of staying in control on highly automated aircraft when faced with surprise. In: 5th resilience engineering symposium. Soesterberg, The Netherlands
39. Rankin A, Woltjer R, Field J, Woods DD (2013) Staying ahead of the aircraft and managing surprise in modern airliners. In: Proceedings of 5th resilience engineering symposium. Soesterberg, The Netherlands
40. Rankin A, Lundberg J, Woltjer R, Rollenhagen C, Hollnagel E (2014) Resilience in Everyday Operations: A Framework for Analyzing Adaptations in High-Risk Work. J Cogn Eng Decis Mak 8(1):78–97
41. Sarter NB, Woods DD, Billings CE (1997) Automation Surprises. In: Salvendy G (ed) Handbook of human factors/ergonomics, 2nd edn. Wiley, New York, pp 1926–1943
42. Varney M (2012) Evidence based training. In: AIAA modeling and simulation technologies conference. Minneapolis, Minnesota: AIAA 2012-4497, AIAA
43. Watts-Perotti J, Woods DD (2007) How anomaly response is distributed across functionally distinct teams in space shuttle mission control background: overview of anomaly response. Hum Factors 1(4):405–433
44. Weber DE, Mavin TJ, Roth W-M, Henriqson E, Dekker SWA (2014) Exploring the use of categories in the assessment of airline pilots’ performance as a potential source of examiners’ disagreement. J Cogn Eng Decis Making 8(3):248–264
45. Weick KE (1995) Sensemaking in organisations. Sage, Thousand Oaks
46. Weick KE, Sutcliffe KM, Obstfeld D (2005) Organizing and the process of sensemaking. Organ Sci 16(4):409–421
47. Woltjer R, Field J, Rankin A (2015) Adapting to the unexpected in the cockpit. In: Proceedings of the 6th resilience engineering association symposium. Lisbon, Portugal: REA
48. Woods DD, Branlat M (2011) How adaptive systems fail. In: Hollnagel E, Paries J, Woods DD, Wreathall J (eds) Resilience engineering in practice. Ashgate, Aldershot, pp 127–143
49. Woods DD, Hollnagel E (2006) Joint cognitive systems engineering: patterns in cognitive systems engineering. CRC Press, Taylor & Francis Group, Boca Raton
50. Woods DD, Patterson ES (2000) How unexpected events produce an escalation of cognitive and coordinative demands. In: Hanckock PA, Desmond P (eds) Stress workload and fatigue. Lawrance Erlbaum, Hillsdale, pp 290–302
51. Woods DD, Sarter NB (2000) Learning from automation surprises and “Going Sour” accidents. In: Sarter NB, Amalberti R (eds) Cognitive engineering in the aviation domain. Lawrance Erlbaum Associates, Hillsdale, pp 327–353
52. Woods DD, Sarter NB (2010) Capturing the dynamics of attention control from individual to distributed systems: the shape of models to come. Theor Issues Ergon Sci 11(1–2):7–28
53. Zsambok CE, Klein G (1997) Naturalistic decision making. Lawrence Erlbaum Associates, Publishers, Mahwah
54. Aeronautica Civil of the Republic of Colombia (ACRC) (1996, November 6). (1995) Controlled Flight Into Terrain, American Airlines flight 965, Boeing 757–223, N651AA, Near Cali, Colombia, December 20 Santafe de Bogota, DC. Aeronautica Civil of the Republic of Colombia, Colombia
55. Air Accidents Investigation Branch (AAIB) (1999, April). AAIB Bulletin: Loss of altitude following takeoff, Airbus A310, 5Y-BFT on November 8, 1998. AAIB Bulletin No: 4/99. Ref: EW/C98/11/01. Aldershot, Hampshire, UK: Air Accidents Investigation Branch
56. Air Accidents Investigation Branch (AAIB) (2001, June). AAIB Bulletin: AIRPROX, Airbus A330 CGGWD, Airbus A340 TC-JDN on 2 October 2000. AAIB Bulletin No: 6/2001. Ref: EW/C2000/10/2. Aldershot, Hampshire, UK: Air Accidents Investigation Branch
57. Air Accidents Investigation Branch (AAIB) (2004, December). AAIB Bulletin: Acceleration to speed well above VMO, Airbus A320-232, G-TTOA on 15 April 2004. AAIB Bulletin No: 12/2004. Ref: EW/G2004/04/14. Aldershot, Hampshire, UK: Air Accidents Investigation Branch
58. National Transportation Safety Board (AAIB) (2002, October 23). Probable Cause of Loss of control on landing incident, JetBlue Airways as Flight 88, Airbus A320-232, N509JB, Jamaica, New York, January 21, 2001. Probable Cause Aviation NTSB/NYC01IA068. File No. 12437. Washington, DC: National Transportation Safety Board
59. Bureau d’enquêtes et d’analyse (BEA) (2012) Final report on the accident on the 1st June 2009 to the Airbus A330-200, Registered F-GZCP, Operated by Air France, flight AF447 Rio de Janeiro-Paris. BEA, Le Bourget
60. Komite Nasional Keselamatan Transportasi (KNKT) [National Transportation Safety Committee], 2015, Aircraft Accident Investigation Report PT. Indonesia Air Asia, Airbus A320-216; PK-AXC, Karimata Strait, 28 December 2014. Report KNKT.14.12.29.04. Ministry of Transportation, Jakarta, 2015
61. Dutch Safety Board (DSB) (2010). Crashed During Approach, Boeing 737–800, Near Amsterdam Airport, 25 February 2009. May 2010, The Hague, Netherlands
62. Australian Transport Safety Bureau (ATSB), 2013, Final Investigation: In-flight upset 154 km west of Learmonth, WA, 7 October 2008, VH-QPA, Airbus A330-303. ATSB Transport Safety Report Aviation Occurrence Investigation AO-2008-070 – 27 June 2013. Australian Transport Safety Bureau: Canberra
63. Transport Safety Board of Canada (TSB) (2008) Aviation investigation report A08W0007 encounter with wake turbulence, Air Canada, Airbus A319-114 C-GBHZ, Washington State, United States, 10 January 2008. Ottawa, ON, Transport Safety Board of Canada