But What Do You Actually Do?
by Susan K. Parson, FAA Safety Briefing Editor
As one of my former bosses often observed, for many years the global approach to aviation accident investigation was find, fix, and fly. This approach was primarily directed to issues with the machine and/or the weather, two pieces of what turns out to be a three-part puzzle. It’s pretty easy to find and fix problems with the machine. Technology (e.g., radar, stormscope) and rules (e.g., stay away from thunderstorms!) could fix — sort of — accidents involving weather. The third piece, the human being, was not exactly ignored. But because it’s a lot harder to see, much less understand, the reasons for certain human actions and behaviors, the vague term“pilot error” was a catch-all.
The more we learn, though, the more we know how much we still need to learn about pilot error. It may be easy to see what the pilot actually did, but the why and the how are key to prevention. That’s where the human factors discipline comes in.
Investigating Human Factors
To learn more about what these specialists do, we queried Dr. Sabrina Woods, a frequent FAA Safety Briefing contributor who now works as a Human Factors Analyst in the Accident Investigation Division of the FAA’s Office of Accident Investigation and Prevention (AVP).
“The International Civil Aviation Organization’s Manual of Aircraft Accident and Incident Investigation details how human factors issues should be investigated post-accident,” she noted. The manual lists the objectives of human factors investigation as: (1) determining how breakdowns in human performance may have caused or contributed to an occurrence; (2) identifying safety hazards related to limitations in human performance; and (3) identifying ways to eliminate or reduce the consequences of faulty human actions or decisions.
Human factors work encompasses the “domains” of human, machine, and environment — the standard ingredients in the recipe for any accident or incident. Any human performance investigation must consider six different fields, keeping in mind that, like a kaleidoscope, these factors interact and combine in myriad ways. The elements that create any given situation include:
- Behavioral: 72-hour history, operator’s behavior, life habit patterns, and life events.
- Medical: general health, sensory acuity, drug/alcohol ingestion, and fatigue.
- Operational: training, experience, habit patterns, operational procedures, company policies, and culture.
- Task: information, perception, task components, workload, saturation, stimulus, and time.
- Equipment Design: workspace, man-machine interface, instrument display/design, controls layout and design, seat design/configuration, and alerting systems.
- Environmental: external conditions, internal conditions, illumination, noise, and vibration.
At the Scene
By law, the National Transportation Safety Board (NTSB) is responsible for determining probable cause for any accident or incident in the United States. Also by law, the FAA participates in the investigation. The FAA team includes human factors experts like Sabrina. “My primary job is to help the lead FAA investigator determine and analyze the human factors issues in the accident or incident,” she notes. “I might launch with the ‘go team,’ or help with transcriptions and witness interviews.”
The bulk of the work occurs after the on-site investigation concludes. “[Human factors] experts develop a human performance assessment so as to improve the safety risk management and mitigation process,” says Sabrina. Other duties include providing subject matter expertise on human factors-related safety recommendations, and leading human performance/human factors data analysis.
“Strong communication skills are a must,” she adds, to be an effective interface with fellow human factors specialists not just in the FAA, but also in the NTSB, with major industry stakeholders, and global counterparts in the human factors discipline.
We all benefit from the work that dedicated Human Factors Investigators do to improve aviation safety.
Susan K. Parson (susan.parson@faa.gov) is editor of FAA Safety Briefing and a Special Assistant in the FAA’s Flight Standards Service. She is a general aviation pilot and flight instructor.
