Learning from accident investigations – A cross-country comparison
(2010) The 10th International Probabilistic Safety Assessment & Management Conference (PSAM)- Abstract
- This paper compares all accident investigation reports covering railway accidents issued by the national investigation boards in Sweden, Norway and Denmark during a two-year period (2008-2009). By using content analysis, units of text describing attributed causes have been selected and categorized as belonging to one of three hierarchical levels; the micro level (technical malfunctioning and human actions), meso level (organizational actions and factors in the physical environment), and
macro level (inter-organizational and regulatory factors). In addition, attributed causes on each level have been further categorized as belonging to different ‘types’ of causes. In a similar manner the recommendations described in all studied... (More) - This paper compares all accident investigation reports covering railway accidents issued by the national investigation boards in Sweden, Norway and Denmark during a two-year period (2008-2009). By using content analysis, units of text describing attributed causes have been selected and categorized as belonging to one of three hierarchical levels; the micro level (technical malfunctioning and human actions), meso level (organizational actions and factors in the physical environment), and
macro level (inter-organizational and regulatory factors). In addition, attributed causes on each level have been further categorized as belonging to different ‘types’ of causes. In a similar manner the recommendations described in all studied reports have been divided into different classes. The results show that the majority of attributed causes in all three countries belong to the micro level, and about
half of all recommendations aim at human factors aspects. Furthermore, the diversity in different ‘types’ of causes differs between the countries. The analysis has been followed up by interviews with
the investigation boards. Based on these interviews, it can be concluded that the structure, mandate and traditions of the investigation boards influences the outcome of the investigations in such way that a broader mandate gives rise to a higher potential for accidents to be examined from multiple perspectives. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2374810
- author
- Cedergren, Alexander LU and Petersen, Kurt LU
- organization
- publishing date
- 2010
- type
- Chapter in Book/Report/Conference proceeding
- publication status
- published
- subject
- keywords
- Accident investigations, Investigation boards, Learning
- host publication
- Proceedings 10th International Probabilistic Safety Assessment & Management Conference.
- pages
- 11 pages
- conference name
- The 10th International Probabilistic Safety Assessment & Management Conference (PSAM)
- conference location
- Seattle, United States
- conference dates
- 2010-06-07 - 2010-06-11
- external identifiers
-
- scopus:84873598544
- language
- English
- LU publication?
- yes
- id
- a9e00da0-8b5e-45da-8e7d-db8bcd9a7d4c (old id 2374810)
- date added to LUP
- 2016-04-04 14:26:01
- date last changed
- 2022-01-30 02:00:59
@inproceedings{a9e00da0-8b5e-45da-8e7d-db8bcd9a7d4c,
abstract = {{This paper compares all accident investigation reports covering railway accidents issued by the national investigation boards in Sweden, Norway and Denmark during a two-year period (2008-2009). By using content analysis, units of text describing attributed causes have been selected and categorized as belonging to one of three hierarchical levels; the micro level (technical malfunctioning and human actions), meso level (organizational actions and factors in the physical environment), and<br/><br>
macro level (inter-organizational and regulatory factors). In addition, attributed causes on each level have been further categorized as belonging to different ‘types’ of causes. In a similar manner the recommendations described in all studied reports have been divided into different classes. The results show that the majority of attributed causes in all three countries belong to the micro level, and about<br/><br>
half of all recommendations aim at human factors aspects. Furthermore, the diversity in different ‘types’ of causes differs between the countries. The analysis has been followed up by interviews with<br/><br>
the investigation boards. Based on these interviews, it can be concluded that the structure, mandate and traditions of the investigation boards influences the outcome of the investigations in such way that a broader mandate gives rise to a higher potential for accidents to be examined from multiple perspectives.}},
author = {{Cedergren, Alexander and Petersen, Kurt}},
booktitle = {{Proceedings 10th International Probabilistic Safety Assessment & Management Conference.}},
keywords = {{Accident investigations; Investigation boards; Learning}},
language = {{eng}},
title = {{Learning from accident investigations – A cross-country comparison}},
year = {{2010}},
}