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Healthcare systems are complex in that they are diverse in both structure (e.g. nursing units, pharmacies, emergency departments, operating rooms) and professional mix (e.g. nurses, physicians, pharmacists, administrators, therapists) and made up of multiple interconnected elements with adaptive tendencies in that they have the capacity to change and learn from experience.
Reason was born on 1 May 1938. [1] He wrote books on human error, [2] including such aspects as absent-mindedness, aviation human factors, maintenance errors, and risk management for organizational accidents. [3] In 2003, he was awarded an honorary DSc by the University of Aberdeen.
In the field of human factors and ergonomics, human reliability (also known as human performance or HU) is the probability that a human performs a task to a sufficient standard. [1] Reliability of humans can be affected by many factors such as age , physical health , mental state , attitude , emotions , personal propensity for certain mistakes ...
The first fully developed theory of a just culture was in James Reason's 1997 book, Managing the Risks of Organizational Accidents. [2] In Reason's theory, a just culture is postulated to be one of the components of a safety culture. A just culture is required to build trust so that a reporting culture will occur.
Some researchers have argued that the dichotomy of human actions as "correct" or "incorrect" is a harmful oversimplification of a complex phenomenon. [16] [17] A focus on the variability of human performance and how human operators (and organizations) can manage that variability, may be a more fruitful approach. Newer approaches, such as ...
Erik Hollnagel, "The Elusiveness of "Human Error"", 2005; Human error: models and management – James Reason British Medical Journal 2000;320:768–70 (Internet Archive) Human factors view of accident causation
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1. The first stage of the process is to identify the full range of sub-tasks that a system operator would be required to complete within a given task.