Identify 3 causes of the incident within 15-20 minutes.
List the causes under the relevant category: Technology/design, Human performance, Environment, Task.
Identify potential solutions to help prevent a repeat incident.

Humans and Risk - Human Error Statistics

Estimates of human error as a percentage of all failures:

Jet transport: 65-85%
Air traffic control: 90%
Maritime vessels: 80-85%
Chemical industry: 80-85%
Nuclear power plants (US): 70% (Reason, 2006)

Key Point: Human performance dominates risks in hazardous industries

Humans and Risk - Human Error in Construction

Thousands of deaths, accidents, and disabilities result from occupational accidents within the construction industry every year.
The International Labour Organization reports 60,000 fatalities annually worldwide, with over 30% due to falls from heights (FFH) [1].
Fall-related injuries are the second most common and the primary cause of fatalities in the industry, with over 29 deaths recorded every year in Australia [2].
Ensuring worker safety on sites has become a priority, with researchers developing new strategies to minimize risks.
To guarantee the success of accident prevention strategies, it is crucial to understand the factors that play a key role in causing them [3].
Despite new technologies, standards, and strategies, the root cause of accidents is attributable to unsafe behaviours and human error [4].
An average of 23% of falls are associated with laborers choosing not to wear PPE, suggesting that workers' behaviours and attitudes towards safety measures play a major role in accident causation [5].

Key Point: Human performance dominates risks in Civil Engineering

Activity 2 – Roles of Humans in Risk Management

Humans are risk perceivers – people that identify and form viewpoints about risks.
Humans are risk analysers – people that determine the significance of the risk and whether it needs to be actioned or not.
Humans are risk controllers – people who are exposed to the risk and implement actions intended to address the risk to an acceptable level.
Humans are also risk communicators – people who disseminate information about risks and their acceptability as well as about risk management actions and their effectiveness.

Risk Communication Model

The risk communication model includes various elements:

Sender: Content, Structure, Format
Message: Attention, Comprehension, Motivation, Ability to act
Receiver: Attention, Comprehension, Motivation, Ability to act

Activity 3 – Factors Affecting Risk Perception

Factors influencing risk perception:

The attributes of the person: Experience, skills, knowledge, motivation, preferences, abilities, and cognitive biases that shape perception, including sensitization or desensitization to the risk.
The attributes of the risk: Observability, controllability, level of involvement, likelihood, severity, and irreversibility of outcomes, as well as whether the persons affected will be voluntarily and involuntarily impacted.
The attributes of the situation: The culture and risk appetite of the organization. Other attributes include the social and technical complexity, the normality, and time pressures.

Designing for Humans

"People do what they want to do."
"Trying to force change people’s behaviour is less effective."
Rather than expecting humans to adapt to the design, incorporate the human in the design so “normal” human performance will lead to successful outcomes.
"Take advantage of people’s behaviour."
"Look at the outcome; get people to do what you want them to do."

Examples of Designing for Humans

Urinals at Amsterdam Schiphol Airport feature an etched image of a fly, which reduces cleaning costs by 20% or more.

Humans and Risk – Two Sides of Human Performance

Downside: Human “error” is the label given to human performance associated with adverse outcomes (e.g., Bhopal and Samarco).
Upside: Human performance adaptively and successfully solves problems and resolves adverse situations.
Promote the upside by creating systems that help humans successfully manage all situations.
Prevent the downside by creating systems with protections against hazards and threats.
Consider the whole system from a human interaction perspective.
Have a balanced defensive/offensive approach.

Detecting and Assessing Risk

To design to help humans successfully identify, assess, and manage risks requires initiatives that help humans detect and assess the situation to identify risks and the need to act on them.
It also requires initiatives that help humans correctly decide how best and when to best respond to the risks.

Theory of Situational Awareness

Endsley, M. R. (1995). Toward a Theory of Situation Awareness in Dynamic Systems. Human Factors, 37(1), 32–64. \frac{https://doi.org/10.1518/001872095779049543}

Designing for Unexpected Deviations

In unexpected situations, people can respond in different ways.
Designs need to:
- Promote those that will lead to success.
- Prevent the response strategies that will lead to failure.
- Tolerate the use of other strategies so that they will not lead to adverse outcomes.

Activity 4 – Human-Centered Design for the Tanker Filling Depot

What approaches would we employ to manage the risk if we conduct a ‘people analysis’?

A ‘People Analysis’ of the Tanker Filling Operation

SITUATION ASSESSMENT:
- Perception of elements of the environment
- Comprehension of perceived elements
- Projection looking ahead into the near future
STRATEGY EXECUTION:
- Decide how to respond and then execute an action

Task: Situation Assessment

Identify what elements need to be perceived, how they need to be comprehended, and what type of projection would be useful in ensuring safe operations for the tanker filling.
Identify ways to change the design to enhance the situation assessment associated with the tanker filling.

Task: Situation Assessment - Examples

Level 1 – Perception: Operators should perceive when fuel is flowing/stopped, tanker level is full, loss of containment (liquid and vapour), and loss of control of flow/pressure.
- Enhancements: Flashing lights, level indicators, vapour monitoring and alarms.
Level 2 – Comprehension: Determine if the system is within specified operating parameters, outside but safe, or outside and needs action.
- Enhancements: Flow, pressure, and temperature alarms, and shut-off systems.
Level 3 – Projection: Anticipate and prepare for shutdown in a timely manner when the system is safe.
- Enhancements: Time-to-fill planned vs actual display.

Task 2: Strategies Exercise

Examples of generic and actual strategies, possible reasons, unwanted events/consequences, and design recommendations for tanker filling operations.

Generic Strategy	Actual Strategies	Possible Reasons	Unwanted Event / Consequence	Promote, Tolerate, or Prevent?	Design Recommendations
Avoidance	Operator doesn’t stop filling	Forgets, Distracted by other tasks	Overfill, Loss of containment	Tolerate	Automate filling (level sensing, auto slowdown/shutoff), Conservative max. programable fill times requiring frequent restart
Avoidance	Don't start the tank fill	Forgets, Distracted by other tasks	Operational delays	Tolerate	None proposed
Arbitrary	Operator grabs any nozzle to start filling tank	Doesn’t know there are different fuels	Incorrect fuel delivered	Prevent	Install distinct nozzle shapes so incompatible fuels cannot be supplied, Require independent verification for each fill exercise
Imitation	Operator assumes the same fill time as previous tasks	Filling usually takes 30 minutes, This rule has ‘never failed’	Overfill, Loss of containment	Tolerate	Automate filling (level sensing, auto slowdown/shutoff), Conservative max. programable fill times requiring frequent restart
Intuitive	Does not consider ignition risk when spill occurs	Unaware of past events like Buncefield, Not aware of properties of the fuels being handled	Ignition, Fire in case of overfill	Prevent	Alarms to detect explosive atmospheres coupled with trained emergency response processes, Emergency responses regularly practiced

Activity 5 - Importance of Good Situation Awareness

If you don’t expect something to be there you probably won’t see it when it is there, and if you focus your attention on something specific you miss other things.
Is this relevant to the civil engineering profession?

Humans and Risk – Lecture Summary

Humans are risk perceivers, risk analysers, risk controllers, and risk communicators. Understanding these roles and the factors that can impact how humans perform them is fundamental to developing effective risk management practices.
Attributes of the person (e.g., experience), attributes of the situation (e.g., org risk appetite), and attributes of the risk (e.g., severity) affect how people perceive risks.
Human performance dominates the successful or unsuccessful management of risk.
Good situation awareness requires a person to have perceptual awareness of the current situation, comprehension of the current situation, and projection of the future status.
We need to stop thinking we can get humans to do things “the one right way” and start doing better designs so “normal/typical” human performance will lead to successful outcomes (not failures).

Note