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Accident theory and models
Published in Urban Kjellén, Eirik Albrechtsen, Prevention of Accidents and Unwanted Occurrences, 2017
Urban Kjellén, Eirik Albrechtsen
The Swiss cheese model originally illustrated the use of multiple layers of barriers based on the principle of defence in depth to prevent accidents in highly hazardous, complex production systems. The barriers were of the type we know from Haddon’s strategies (Section 4.4), which intervene in energy transfer. In later developments, the concept of a barrier has been given a wider interpretation and includes almost any type of measure to prevent accidents. A typical example is the Australian Transportation Safety Bureau (ATSB) model developed for use as a practical tool in investigations (ATSB 2007). Here, the barrier metaphor is used for conditions such as procedures, training, and supervision.
The social organization of errors and the manifestation of rework: learning from narratives of practice
Published in Production Planning & Control, 2022
Peter E. D. Love, Jane Matthews
The paradigm shift from a person to a systems approach led to the creation of Reason’s (1990, 2000) Swiss Cheese Model, which forms the foundations of human error theory (Parker and Lawton 2003; Armitage 2009). According to Reason’s (1990, 2000) Swiss Cheese Model, a series of barriers prevent hazards from causing human losses. Each barrier contains holes akin to unintended weaknesses– hence the Swiss cheese metaphor. The holes (weaknesses) in the barriers open and close at random. When all holes are aligned by chance, the hazard reaches a person and causes harm. But it goes without saying that the Swiss Cheese Model has become the dominant paradigm for managing safety risks and analyzing errors resulting in accidents in safety-critical industries (Mitropoulos, Abdelhamid, and Howell 2005; Perneger 2005; Read et al. 2021).
How unsafe acts occur: an automatic text mining study
Published in Maritime Policy & Management, 2022
Xin Shi, Dong Xu, Hui Zhuang, Chen Liu
The aforementioned process highlighted several key methodological points, which we discuss as follows. The Swiss cheese model was selected as the conceptual model because it can be well adapted to analyzing how a wide variety of factors influencing the occurrence of unsafe acts and accidents (Shappell and Wiegmann 2000; Salmon, Cornelissen, and Trotter 2012). As indicated in Figure 1 which was presented by Shappell and Wiegmann (2000), unsafe acts can be analyzed from the four levels of organizational influence, unsafe supervision, preconditions for unsafe acts, and unsafe acts themselves; each hole in each level represents an error point, if the error points (the holes in the cheese) in the four levels (the four slices of cheese) are connected by a straight line (the accident occurrence chain), an accident immediately occurs (Reason 1997). On the basis of the four-level taxonomy of the Swiss cheese model, Shappell and Wiegmann (2000) proposed the Human Factors Analysis and Classification System (HFACS) for clarifying the specific causal factors leading to unsafe acts and accidents. Several researchers, such as Chauvin et al. (2013) and Zhang et al. (2019), have applied the HFACS to the maritime domain and slightly modified the HFACS by adding one more level called ‘external factors.’
A model for establishing resilience safety culture for the construction industry
Published in International Journal of Occupational Safety and Ergonomics, 2023
No safety hazards mean no safety accidents. HPP is designed for safety hazards. The Swiss cheese model (SCM) implies that organizations should set defense barriers for hazards to prevent them from reaching accidents [14]. Accidents will occur when the holes (i.e., failures) in each defense barrier line up. The SCM reveals that accidents can be prevented by the implementation of HPPs that aim at detecting defense failures and controlling hazards before potential hazards pass through the passage created by combined failures. Consequently, HPP is one of the basic elements in resilience safety culture development in construction industry.