The Challenges of an Error Reporting System

Third, you will need to determine what type of data collection instrument will be used. An example of a popular error reporting instrument is the Maintenance Error Decision Aid (MEDA) developed and distributed by Boeing. MEDA was developed to capture a large amount of data to describe the conditions that not only existed at the time of the error but also the conditions that existed before the error was committed. While its focus is on airline maintenance operations, MEDA is a tool that can also be modified and adapted to other types of operations. In some cases you may want or need to develop your own error reporting instrument based on your organization’s specific requirements. Once the error form has been developed, you will need to determine and convey your error reporting thresholds to employees. In other words, what is reportable? You probably don’t want to hear about someone breaking a latch on their lunchbox, but you most certainly would want to hear about a string of similar errors that employees are making while operating a drill press.

Fourth, you will need to develop an ERS database. For smaller organizations, the database can be fairly simple and created with simple programs such as Microsoft Excel. However, larger organizations may require more powerful stand-alone software that can be custom designed for your specific needs. The importance of a good database cannot be overemphasized since this will provide you with search ability, trending analysis, and graphics that will help tremendously with your data analysis. Remember, your database will need to be kept up to date for maximum effectiveness.

Fifth, in addition to maintaining the ERS database, the person in charge of the ERS will also be responsible for error investigations, which may be delegated to other trained individuals. It should be mentioned that error investigations in this context are conducted not to assign blame or punish employees, but rather to try to determine why an error occurred so that the same type of error does not recur. Remember, this is all part of the previously mentioned just culture.

Sixth, provide feedback to employees. This is one of the most important parts of the ERS and yet many organizations stop short at this stage. The concept is very simple: take all of the information that is obtained through the collection and investigation of error reports, and then let your employees know what has been happening and what is being done to reduce workplace errors. For certain reasons, many organizations seem to overlook and/or omit this important part of the ERS. However, in order to gain credibility, buy-in, and show genuine concern, the safety team must offer feedback to employees on a consistent basis. This feedback can come in many forms and creativity can certainly catch more attention. Some methods for presenting feedback include safety meetings, bulletin board announcements, e-mails, monthly newsletters, or a combination of these. The main point is that feedback lets employees know that the errors they are taking time to report are actually being addressed and acted upon. This goes a long way in the preservation of an effective ERS.

In summary, ERS will become a reality very soon. For those organizations that have an interest in developing an effective ERS it is hoped that this article, while very fundamental, provides some useful guidelines. Keep in mind that a healthy safety culture includes a formal ERS. The purpose of an ERS is not to punish, but instead promote a culture of learning and continuous improvement by surfacing the errors that could precipitate a very expensive safety lesson.

Robert Baron is the president and chief consultant of The Aviation Consulting Group in Myrtle Beach, SC. TACG offers human factors and safety management systems training and consulting. For more information visit www.tacgworldwide.com.

References

Eiff, G. (1999). Organizational safety culture. Proceedings of the 10th International Symposium on Aviation Psychology (pp. 1-14). Columbus, OH: Department of Aviation.

Global Aviation Information Network. (2004, September). A roadmap to a just culture: Enhancing the safety environment. Available at http://www.eurocontrol.int/eec/public/standard_page/safety_doc_just_culture_roadmap.html