A High Reliability Organization (HRO)-based Retrospective Analysis of Boeing 737 Max Crashes

2020 ◽  
Vol 64 (1) ◽  
pp. 851-855
Author(s):  
Yalda Khashe ◽  
Soraya Levy
Keyword(s):  
Retrospective Analysis ◽  
High Reliability ◽  
Organizational Factors ◽  
Aviation Industry ◽  
Regulatory Agencies ◽  
High Reliability Organization ◽  
Preventative Measures ◽  
Regulatory Systems ◽  
Passenger Safety ◽  
Human And Organizational Factors

The two crashes of Boeing 737 Max aircrafts within the small span of half a year resulted in tremendous loss of life, money, and public trust in the regulatory systems responsible for ensuring passenger safety within increasingly automated aviation systems. However, these two instances of catastrophic system failure provide experts in the fields of human and organizational factors with the opportunity to transform the aviation industry, propelling it into a period of innovative automation technologies, replete with a groundbreaking reverence for system reliability, safety, and preparedness for failure. By applying the key principles of High Reliability Organization (HRO) to a retrospective analysis of the concurrent Boeing 737 Max crashes, we aim to identify relationships between defining HRO characteristics and preventative measures that Boeing, human workers, and regulatory agencies could have followed before and during the accidents’ occurrences.

scholarly journals Human and Organizational Factors of Positive Train Control Safety System The Application of High Reliability Organizing in Railroad

2019 ◽  
Vol 63 (1) ◽  
pp. 1824-1828 ◽  
Author(s):  
Yalda Khashe ◽  
Najmedin Meshkati
Keyword(s):  
High Reliability ◽  
Organizational Factors ◽  
Safety System ◽  
Train Control ◽  
Positive Train Control ◽  
Safety Recommendations ◽  
Human And Organizational Factors

On August 20, 1969, two Penn Central commuter trains collided head-on near Darien, Connecticut, killing four and injuring 43. That tragedy 45 years ago began the NTSB's call for development and implementation of Positive Train Control (PTC) systems. Since then, the NTSB has issued almost 50 PTC-related safety recommendations and has included PTC on its Most Wanted List every year from its inception in 1990 until enactment of the RSIA. Unfortunately, despite some progress in the four decades since that original recommendation, PTC preventable train collisions still occur. In this paper, we identify human and organizational factors that affect a successful PTC implementation and evaluate the application of High Reliability Organizing (HRO) characteristics in the implementation of this safety system.

scholarly journals Veränderte Kompetenzanforderungen an Mitarbeitende infolge zunehmender Automatisierung – Eine Arbeitsfeldbetrachtung

2021 ◽  
Author(s):  
Michèle Rieth ◽  
Vera Hagemann
Keyword(s):  
High Reliability ◽  
High Reliability Organizations ◽  
High Reliability Organization

ZusammenfassungBasierend auf einer Arbeitsfeldbetrachtung im Bereich der Flugsicherung in Österreich und der Schweiz liefert dieser Artikel der Zeitschrift Gruppe. Interaktion. Organisation. (GIO) einen Überblick über automatisierungsbedingte Veränderungen und die daraus resultierenden neuen Kompetenzanforderungen an die Beschäftigten im Hochverantwortungsbereich. Bestehende Tätigkeitsstrukturen und Arbeitsrollen verändern sich infolge zunehmender Automatisierung grundlegend, sodass Organisationen neuen Herausforderungen gegenüberstehen und sich neue Kompetenzanforderungen an Mitarbeitende ergeben. Auf Grundlage von 9 problemzentrierten Interviews mit Fluglotsen sowie 4 problemzentrierten Interviews mit Piloten werden die Veränderungen infolge zunehmender Automatisierung und die daraus resultierenden neuen Kompetenzanforderungen an die Beschäftigten in einer High Reliability Organization dargestellt. Dieser Organisationskontext blieb bisher in der wissenschaftlichen Debatte um neue Kompetenzen infolge von Automatisierung weitestgehend unberücksichtigt. Die Ergebnisse deuten darauf hin, dass der Mensch in High Reliability Organizations durch Technik zwar entlastet und unterstützt werden kann, aber nicht zu ersetzen ist. Die Rolle des Menschen wird im Sinne eines Systemüberwachenden passiver, wodurch die Gefahr eines Fähigkeitsverlustes resultiert und der eigene Einfluss der Beschäftigten abnimmt. Ferner scheinen die Anforderungen, denen sie sich infolge zunehmender Automatisierung gegenüberstehen sehen, zuzunehmen, was in einem Spannungsfeld zu ihrer passiven Rolle zu stehen scheint. Die Erkenntnisse werden diskutiert und praktische Implikationen für das Kompetenzmanagement und die Arbeitsgestaltung zur Minimierung der identifizierten restriktiven Arbeitsbedingungen abgeleitet.

scholarly journals A Matrix FMEA Analysis of Variable Delivery Vane Pumps

Energies ◽  
2021 ◽  
Vol 14 (6) ◽  
pp. 1741
Author(s):  
Joanna Fabis-Domagala ◽  
Mariusz Domagala ◽  
Hassan Momeni
Keyword(s):  
Risk Analysis ◽  
Failure Modes ◽  
High Reliability ◽  
Matrix Analysis ◽  
Hydraulic Systems ◽  
Vane Pump ◽  
End Effects ◽  
Root Cause ◽  
Preventative Measures ◽  
Fmea Analysis

Hydraulic systems are widely used in the aeronautic, machinery, and energy industries. The functions that these systems perform require high reliability, which can be achieved by examining the causes of possible defects and failures and by taking appropriate preventative measures. One of the most popular methods used to achieve this goal is FMEA (Failure Modes and Effects Analysis), the foundations of which were developed and implemented in the early 1950s. It was systematized in the following years and practically implemented. It has also been standardized and implemented as one of the methods of the International Organization for Standardization (ISO) 9000 series standards on quality assurance and management. Apart from wide application, FMEA has a number of weaknesses, which undoubtedly include risk analysis based on the RPN (Risk Priority Number), which is evaluated as a product of severity, occurrence, and detection. In recent years, the risk analysis has been very often replaced by fuzzy logic. This study proposes the use of matrix analysis and statistical methods for performing simplified RCA (Root Cause Analysis) and for classification potential failures for a variable delivery vane pump. The presented methodology is an extension of matrix FMEA and allows for prioritizing potential failures and their causes in relation to functions performed by pump components, the end effects, and the defined symptoms of failure of the vane pump.

scholarly journals OPTIMIZATION OF PRODUCTION TECHNICAL SYSTEMS BY MEANS OF STRUCTURAL-PARAMETRIC MODELING

2021 ◽  
pp. 81-88
Author(s):  
Gennadii Virchenko ◽  
Nazar Lynok
Keyword(s):  
Geometric Modeling ◽  
High Reliability ◽  
Low Cost ◽  
Production Equipment ◽  
Parametric Modeling ◽  
Oil Refining ◽  
Aviation Industry ◽  
Scientific School ◽  
Technical Systems ◽  
Kyiv Polytechnic Institute

The modern life of people is characterized by constant interaction with various technical systems. These are various buildings (residential, industrial and social purposes), means of transport (cars, ships and planes), production equipment, household appliances (television sets, computers, telephones, washing machines, and refrigerators), etc. A significant number of requirements, often contradictory, both individual and general, are made to the above objects. The first take into account the specifics of these products, and the second are universal in nature. Relevant examples are the immobility of structures, good transport controllability, accuracy of equipment, high-quality images of TVs, computers, etc. This is on the one hand. On the other hand, high reliability, long service life, low cost, etc. The operation of technical facilities is based on processes of various natures. But they also have common properties. These include geometric parameters of shape, size, position and time. In other words, everything around us is located in a certain space and happens in time. Such an extensive theoretical foundation was made to confirm the basic generalizing role of geometric models, including dynamic ones, in the modern automated development of many types of industrial products. The material presented above shows that the search of optimal variants, which are compromise for the existing conflicting requirements, of various technical objects is now an urgent problem of social development. One of the progressive directions of computer geometric modeling, developed by the scientific school of the Igor Sikorsky Kyiv Polytechnic Institute, is structural-parametric shaping. This methodology is quite universal, it is productively applied in the aviation industry, it has been introduced into general mechanical engineering, the oil refining industry, in the manufacture of composite materials, and begins to adapt to the needs of construction. The main purpose of this publication is to expand the scope of this approach through the further development of some of its theoretical provisions.  

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