ISBN: 0521314194
Buy on Amazon
Found in 1 comment on Hacker News
ethbro · 2019-08-22 · Original thread
Someone recommended Human Error by James Reason on HN: https://www.amazon.com/Human-Error-James-Reason/dp/052131419...

I'm not sure how comprehensive / modern it is (not my subfield), but I enjoyed it. And it provided at least one framework to think about error.

Specifically, that most errors can and should be categorized by the states necessary for their happening. Because the unique characteristics of each state (of which there are many) all suggest very different approaches to resolving or eliminating them. To bring it back to the example in question here, remediating the procedure to eliminate a lack of knowledge of failure cases or risk would not have prevented either of these accidents (both were well-informed). However, technical solutions to physically prevent unacceptably risky "bypass" procedures would have.