Accident investigation: From searching direct causes to finding in-depth causes - Problem of analysis or/and of analyst?

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• 作者：Yves Dien^a ; ^{yves.dien@edf.fr} ; Nicolas Dechy^b ; ¹ ; Eve Guillaume^c
• 关键词：Accident ; Industrial safety ; Organisational analysis ; Event root-cause
• 刊名：Safety Science
• 出版年：2012
• 期刊代码：155_09257535
• 类别：et
• 出版时间：July, 2012
• 卷：50
• 期：6
• 页码：1398-1407
• 文件大小：437 K

摘要

Current operating feedback systems in industry show some limits since, in numerous industrial companies, the numbers of events do not decrease anymore and similar events seem to recur. Our assumption is that weaknesses come mainly from analysis methodology used. After a description of analysis methodology history, we focus on interest of applying an organisational analysis of events, familiar to scholars but not yet applied in industry, and we describe its main characteristics after defining what we mean by 鈥渙rganisation鈥? Then we highlight roles of analysts who are not neutral in using event analysis method, assuming that these roles could be a block to progress of event analyses.