The Analysis of The Term Pilot Error - Essay Example

Pilot Error – Human Error The Significance and Implication of Change I. Introduction In general, like most land and sea accidents, those in aviation do not happen in isolation and they are likely to be the result of a chain of events. The term “pilot error” is “human error” believed to be a more realistic and specific term to determine the exact cause of the failure in an aircraft. The paper will present and discuss the significance and implication of the change and the extent of its application to the aviation industry. The negative and positive impact produced by the sudden change and the discovery of new elements in the “error chain”. II. Significance and Implication The term “pilot error” often used to express the cause of crash of an airworthy aircraft where the pilot is primarily or to some extent responsible. It is commonly interpreted as a mistake, misunderstanding, lapse in judgment, or failure to exercise due diligence by an aircraft operator during the performance of his duties. However, normally, pilots are not accountable for incidents caused by mechanical failures unless the failure occurred due to his negligence. In general, the cause of incident can only be declare as a “pilot error” if negligence on the part of the pilot is established. Therefore, the unsafe acts of operators or pilots in case of aviation can be either an “error” or a violation of the procedures (W4eigman et. al, 2005). According to Baron (2002), there is a human element which all of us have physical or mental control to alter, avert, or alleviate a situation and roughly 80% of all air crashes are in included in this category. The term “pilot error” was recently change to “Human Error” to realistically show that “anybody who acts in a support of capacity of a flight may contribute to the error chain” (Baron, 2002). Traditionally, human errors are distinguished by a negative assessment of incorrect behavior that must be avoided. Furthermore, this is the point where faults and errors are identified with reference to human objective or anticipation (Rauterberg and Felix., 1996). The NTSB (National Transportation Safety Board) put human errors in different categories such as unprofessional attitudes, visual perception misjudgment, pilot technique, in-flight judgment or decision, incorrect operation of equipments, and unidentified causes. According to Degani (1999), the term “pilot error” is a big whitewash. The phrase only stimulates the imagination and overpowers our logical thinking. If we are going to analyze the situation intensely, we will discover that there is no such thing as an error exclusively or solely committed by a pilot. The pilot does “not stand in the middle of nowhere and commit an error” (Degani, 1999). The truth is there are various contributing factor surrounding him such as complex instrumentation, procedures, members of the crew, the aircraft itself, and other influential factor affecting his actions. Pilot’s mistakes always occur with reason or caused by something beyond his control. The basic assumption of Rauterberg and Feloix (1996) is that human behavior cannot be erroneous. They argued that human decisions and the behavioral consequences of these decisions could be categorized afterwards as erroneous and faulty. However, from a logical point of view, each decisions are the paramount expectation into the immediate future satisfying actual constrains and restrictions. They added that an error is caused by internal and external factors such as lack of information or enthusiasm, insufficient knowledge or qualification, over confidence or under estimating the task, complexity of circumstances, non-ergonomically design of tools, wrong feedbacks and more etc (Rauterberg and Felix, 1996). Our society generally disciplined those who committed the erroneous acts and hardly ever look or consider the reason that sets off the incident. The reason probably is the fact that conducting such background investigation is a painstaking task and time consuming. After all, who would want to participate in something that would ruin their credibility and hard-earned reputation particularly after a disaster involving hundred of lives? The sad reality is, even if the accident was classified as mechanical failure, the roots go back to a human who made an error. This error included a deliberate infringement of the Federal Aviation Regulations, a judgment decision, and perhaps forced to save time and money (Baron, 2002). “Human beings by their very nature make errors” (Weigman et. al., 2005). However, in my own understanding, the term “pilot error” is not just a word to explain the cause of misfortune but a term directly pointing to the person responsible regardless of other factors surrounding the incident. The implicit hypothesis was that the person nearest to the failure was the cause and since the pilot was the human nearest to the accident who could have acted in a different way, it seemed understandable to conclude that the pilot was the cause of the failure (Woods and Cook, 2000). They are likely to identify direct operator errors as root causes because these are often assumed as direct precursors to an unfavorable events (Johnson and Holloway, 2003). On the other hand, if we truly care and look beyond the justification they fondly call “pilot error”; we will see the factors that actually influence his behavior. According to Degani (1999), some of the factors contributing to the failures are equipment fault, defect in cockpit design, poorly designed standard operating procedures, fatigue, and more. The study conducted by Johnson and Holloway (2003) for the United States shows “organizational issues” as a contributory cause of aviation accidents than individual human error and a large number of reports shows bigger “systematic issues” in managerial and regulatory framework of aviation procedures (Johnson and Holloway, 2003). A thin line separates “pilot error” and “design error” which is sort of confusion between the things that help the pilot to do his work and the actual pilot’s mistakes. In aviation, pilots are working with devices such as map displays, VOR, checklist, etc. that would guide them in their flight. Convinced that navigation is more precise in our time but the question is do we really consider these devices a necessity to aid the pilot? The confusion arises when an incident takes place due to a failing device and consequently everybody is blaming the pilot for not surviving the situation well. The traditional finger pointing reactions by the public clearly implies that a pilot in any critical situation should able to do it with or without the aid. The fact that everyone makes errors the pilot, designers, engineers, mechanics, and controllers, and therefore the responsibility should not instantly point to one person (Degani, 1999). Johnson and Holloway (2003) say that there are important implications in the local and international initiatives targeting the reduction of “operator error”. Their analysis presented the difficulty in distinguishing “human error” as a cause in various incident reports. A group of investigators also argues that the change of error standpoint from blaming “operator error” to identifying the contribution of other elements led to tremendous adjustments in the method of their investigation. Furthermore, the absence of sufficient and detailed evidence makes it more difficult to sustain many of the criticism of the human error perspective. Many of the problems stemmed from the intricacy in deciding which particular cause relates to human error and in which situation is single operator failure or chain of related errors. In addition to an already complicated situation, they added that there are analytical biases when issues are grouped together and as a result, they are more likely to favor human error and managerial failures as the contributory factor. Hindsight biases weaken our ability to recognize the factors that influenced practitioner behavior (Woods and Cook, 2000). The regulations that administer the work of most accident investigation agencies do not openly distinguish between the ‘person’ or the ‘system’ view of failure (Johnson and Holloway, 2003). Apparently, these testimonies are confirmations of Degani (1999) arguments on people’s traditional disciplinary perception because their study reveals how deep-seated the ‘person’ approach within the incident and accident investigators. The relative reputation of human error perspective as a cause of accidents results in many important implications in the future of the aviation industry. It has encouraged many regulatory and research agencies to search new ways to lessen or totally remove human intervention from commercial aviation. One reason for the prominence of human error is that many investigatory agencies hinged on less accurate definitions of root causes. These are eminent through their arguments ‘if the probable cause X had not occurred then the mishap also would not have occurred’ (Johnson and Halloway, 2003). The results of the current study regarding human error points to several ways to reduce fatalities through enhanced automation system, display designs, improve checklists, and extensive training on aeronautical decision-making (Weigman, 2005). The study and development further encouraged researchers to investigate on how human performances are influenced by systematic factors. How these affects the understanding, relationship, and conduct of individuals in different work environment (Woods and Cook, 2000) III. Conclusion Changing the term “pilot error” to a more specific and detailed term resulted in a comprehensible facts about of aircraft accidents. The “human error” perspective is apparently just the beginning of a more serious research on the real cause of incidents because researchers are now considering “system errors” as the major contributor in the so called ‘error chain”. The positive implications produced by the change are the improvements in the aviation industry to circumvent further incidents. These are improving cockpit designs, pilot’s checklist, advanced navigation equipment, and intensive skills and management training. IV. References Baron Robert, 2002, “Human Error Vs Airborne Terrorism”, Airline Safety Editorial, online, 03/14/07, http://www.airlinesafety.com/editorials/HumanErrorVsTerrorism.htm Degani Asaf, 1999, “Pilot Errors in the 90’s: Still Alive and Kicking”, Flight Safety Foundation /National Business Aviation Association (FSF/NBAA), NASA Ames Research Center Moffett Field, CA Johnson and Holloway, 2003, “On the Over-Emphasis of Human ‘Error’ As A Cause of Aviation Accidents: ‘Systemic Failures’ and ‘Human Error’ in US NTSB and Canadian TSB Aviation Reports”, NASA Langley Research Center, Hampton, VA 23681-2199, USA Rauterberg and Felix, 1996, “Human Errors: Disadvantages and Advantages”, The 4th Pan Pacific Conference on Occupational Ergonomics, Swiss Federal Institute of Technology (ETH), Nelkenstrasse 11, CH-8092 Zürich, Switzerland Weigman et. al, 2005, “Human Error and General Aviation Accidents: A Comprehensive, Fine-Grained Analysis Using HFACS”, Aviation Human Factors Division , Institute of Aviation, University of Illinois, a Urbana-Champaign ,1 Airport Road , Avoy, Illinois 61874 Woods and Cook, 2000., “Perspectives on Human Error: Hindsight Biases and Local Rationality”, Cognitive Systems Engineering Laboratory, Institute for Ergonomics, The Ohio State University, Department of Anesthesia and Critical Care, University of Chicago Read More