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Operator-centred local error management in air traffic control

Ternov, Sven LU ; Tegenrot, G and Akselsson, Roland LU (2004) In Safety Science 42(10). p.907-920
Abstract
Introduction: A large number of air traffic control occurrences take place without resulting in loss of separation between aircraft. Unfortunately such occurrences are seldom reported and therefore not used for disclosing system weaknesses, Such as inappropriate methods and procedures. The ATCC (Air Traffic Control Centre) Malmoe made a trial with local reporting of "learning occurrences". The trial was ATCO-(Air Traffic Controller) centred. The study objectives were to evaluate if ATCOs would start to report after a defined training and marketing effort, if they could identify system weaknesses, if concrete actions for safety improvement would be taken as a result of the trial and to what extent expert support was necessary. Method and... (More)
Introduction: A large number of air traffic control occurrences take place without resulting in loss of separation between aircraft. Unfortunately such occurrences are seldom reported and therefore not used for disclosing system weaknesses, Such as inappropriate methods and procedures. The ATCC (Air Traffic Control Centre) Malmoe made a trial with local reporting of "learning occurrences". The trial was ATCO-(Air Traffic Controller) centred. The study objectives were to evaluate if ATCOs would start to report after a defined training and marketing effort, if they could identify system weaknesses, if concrete actions for safety improvement would be taken as a result of the trial and to what extent expert support was necessary. Method and material: The trial period was eight months. The ATCO report would be made on a simple form, available on site. These reports would then be analysed in groups and the marketing and feedback efforts would be co-ordinated by the local flight safety group. Results: 43 reports were filed and analysed during the trial period. The initial motivational training and marketing was considered adequate. During the group discussions, the ATCOs identified system weaknesses within 40 of the reports. The resulting safety improvement actions included: the ATCC unit becoming more active in contacting the pilots and airline companies, the renaming of some waypoints (due to name similarities), the implementation of safer procedures when relieving ATCOs, the training of ATCOs in cockpit flight management systems, and the initiation of a research project primarily concerned with ATCO mental overload. Expert support was required in the beginning to help ATCOs focus on the system rather than on the individual. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
learning organisation, safety, air traffic control, system weakness
in
Safety Science
volume
42
issue
10
pages
907 - 920
publisher
Elsevier
external identifiers
  • wos:000225389600002
  • scopus:7044233734
ISSN
0925-7535
DOI
10.1016/j.ssci.2004.07.001
language
English
LU publication?
yes
id
77fc74ae-10ae-4742-812c-273f3b199077 (old id 259481)
date added to LUP
2007-11-03 09:25:14
date last changed
2017-03-05 04:07:52
@article{77fc74ae-10ae-4742-812c-273f3b199077,
  abstract     = {Introduction: A large number of air traffic control occurrences take place without resulting in loss of separation between aircraft. Unfortunately such occurrences are seldom reported and therefore not used for disclosing system weaknesses, Such as inappropriate methods and procedures. The ATCC (Air Traffic Control Centre) Malmoe made a trial with local reporting of "learning occurrences". The trial was ATCO-(Air Traffic Controller) centred. The study objectives were to evaluate if ATCOs would start to report after a defined training and marketing effort, if they could identify system weaknesses, if concrete actions for safety improvement would be taken as a result of the trial and to what extent expert support was necessary. Method and material: The trial period was eight months. The ATCO report would be made on a simple form, available on site. These reports would then be analysed in groups and the marketing and feedback efforts would be co-ordinated by the local flight safety group. Results: 43 reports were filed and analysed during the trial period. The initial motivational training and marketing was considered adequate. During the group discussions, the ATCOs identified system weaknesses within 40 of the reports. The resulting safety improvement actions included: the ATCC unit becoming more active in contacting the pilots and airline companies, the renaming of some waypoints (due to name similarities), the implementation of safer procedures when relieving ATCOs, the training of ATCOs in cockpit flight management systems, and the initiation of a research project primarily concerned with ATCO mental overload. Expert support was required in the beginning to help ATCOs focus on the system rather than on the individual.},
  author       = {Ternov, Sven and Tegenrot, G and Akselsson, Roland},
  issn         = {0925-7535},
  keyword      = {learning organisation,safety,air traffic control,system weakness},
  language     = {eng},
  number       = {10},
  pages        = {907--920},
  publisher    = {Elsevier},
  series       = {Safety Science},
  title        = {Operator-centred local error management in air traffic control},
  url          = {http://dx.doi.org/10.1016/j.ssci.2004.07.001},
  volume       = {42},
  year         = {2004},
}