HUMAN FACTORS INVESTIGATION IN MARITIME INCIDENT ANALYSIS FOR IMPROVED SHIP SAFETY: AN INNOVATIVE APPROACH BASED ON SYSTEM THEORY

摘要

The complexity of Human Factors interactions with ship safety will be addressed within the field of maritime accident analysis by means of the Causal Analysis using System Theory (CAST). This is a specific tool within the more comprehensive System-Theoretic Accident Model and Processes (STAMP) approach, already applied in other fields like aviation, defence, healthcare with significant outcomes in terms of safety enhancements. CAST can provide a framework to understand the entire accident process and identify the most important systemic causal factors, including the systemic socio-technical ones, since it provides the capability to spot weakness in existing safety control structure in order to possibly implement advances. In this perspective, the application to the Herald of Free Enterprise accident will be discussed, with focus on CAST effectiveness in assessing the complex Human Factors interaction with the ship safety control structure and in providing input to continuously enhance the ship safety and the ship resilience by design.