In his 2018 book, Risk-Based Thinking – Managing the Uncertainty of Human Error in Operations, Muschara has a passage that hits a home run in how human error is viewed in American society and why this view of human error is so difficult to break through… (p.39)
|
Society at large conflates error with sin. Error is not a choice and is always unintentional. Error tends to break things—sin, on the other hand, tends to break relationships and erode trust. Sin for the most part is intentional, mostly born out of personal pride and selfishness. Everyone, especially line managers, must realize that there is no ill will associated with human error—it’s not a moral issue! Many people—including managers in high-hazard industries—believe workers should always be able to judge between good and bad, right and wrong, and correct and incorrect. But this perspective is a flawed—and dangerous— assumption within the context of a complex, technology-intensive operation. Good baseball players fail to reach base around 60 to 70 percent of the times they enter the batter’s box, and all good baseball teams work around that fact. Consequently, there is a tendency to misunderstand human error at work, especially when serious consequences ensue. Frequently, industry line managers count errors as a measure of bad or unprofessional performance and set goals of “zero errors.” It’s common to not realize the occurrence of an earlier error until after suffering some damaging consequences. Other times we recognize mistakes without sustaining any unwanted outcomes, and we exclaim to ourselves, “Whew! That was a close one!” (near hit or close call). |