Sir, – After a collision between two high-speed trains in Spain, human error is yet again rolled out as the cause.
The old view of human error is that a system is safe so long as every human does everything right every hour of every day, and every workday is exactly the same. Every human makes mistakes and to rely on humans working alone, as the last line of defence to keep a system safe, is an organisation failure.
The new view of human error is that the workplace is a constant trade-off between safety and other pressures (time, cost, quality, targets). Unless barriers are put in place to prevent human error causing harm, then harm will occur. It requires constantly learning to prevent failure.
It would be more honest for organisations to state “this crash was caused by an organisation failure which resulted in human error”. – Yours, etc,
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Dermot O’Rourke,
Lucan,
Dublin.
