Decision errors: These “thinking” errors represent conscious, goal-intended behavior that proceeds as designed, yet the plan proves inadequate or inappropriate for the situation. These errors typically manifest as poorly executed procedures, improper choices, or simply the misinterpretation and/or misuse of relevant information.
Skill-based errors: Highly practiced behavior that occurs with little or no conscious thought. These “doing” errors frequently appear as breakdown in visual scan patterns, inadvertent activation/ deactivation of switches, forgotten intentions, and omitted items in checklists. Even the manner or technique with which one performs a task is included.
Perceptual errors: These errors arise when sensory input is degraded, as is often the case when flying at night, in poor weather, or in otherwise visually impoverished environments. Faced with acting on imperfect or incomplete information, aircrew run the risk of misjudging distances, altitude, and descent rates, as well as of responding incorrectly to a variety of visual/vestibular illusions.
Routine violations: Often referred to as “bending the rules,” this type of violation tends to be habitual by nature and is often enabled by a system of supervision and management that tolerates such departures from the rules.
Exceptional violations: Isolated departures from authority, neither typical of the individual nor condoned by management.The question which arises is, if the root cause of most errors/violations is the human being then isn’t it better to fix the cause rather than creating engineering controls for every error that the human makes? It is important to determine why normal procedures failed to work or the reasons for failure of standard operating procedures to trap the error or error prevention. it will be more fruitful to concentrate our effort on revising the SOP’s and retraining humans to ensure behavioral control. The hierarch of controls depicts the effectiveness of controls from highly effective to least effective. Elimination of the hazard is the best means but may not be prudent for the bottom line or the financial viability of the enterprise. Replacing the hazard may not be possible every time since it may be the essential part of the business. An aircraft itself may be an hazard, or other equipment used onboard or attached to the aircraft may be an hazard that cannot be replaced. Isolation can be effective for activities like e.g. isolate passengers when refueling the aircraft, but there are procedures to ensure safety with passengers on board while refueling is carried out. This is to ensure commercial interests are not compromised without lowering the safety standards. Administrative controls is about changing the way people work. It is one of the least effective control but the most challenging one to implement. Organizations must ensure that a safety culture prevails in the organisation. A safety culture is the way people do their business without any oversight. The aim of any organisation is to establish a generative safety culture where safety comes in naturally as against the pathological culture where people don’t care as long as they are not caught. An organisation with a highly effective safety culture will spend less time on finding ways to reduce errors and losses. They will need least amount of controls for error prevention and will therefore be more financially, commercially efficient. Safety culture maturity model Implementing a safety culture is a long term strategy which has several stages. Quality and safety both pay in the long run but one has to stay invested in them to reap the benefits. Losses are prevented at every stage and hazards are actively identified and risk mitigated.