Human error assessment and reduction

technique
Human error assessment and reduction technique (HEART) is a technique used in the field of human
reliability assessment (HRA), for the purposes of evaluating the probability of a human error occurring
throughout the completion of a specific task. From such analyses measures can then be taken to reduce the
likelihood of errors occurring within a system and therefore lead to an improvement in the overall levels of
safety. There exist three primary reasons for conducting an HRA; error identification, error quantification and
error reduction. As there exist a number of techniques used for such purposes, they can be split into one of two
classifications; first generation techniques and second generation techniques. First generation techniques work
on the basis of the simple dichotomy of 'fits/doesn't fit' in the matching of the error situation in context with
related error identification and quantification and second generation techniques are more theory based in their
assessment and quantification of errors. HRA techniques have been utilised in a range of industries including
healthcare, engineering, nuclear, transportation and business sector; each technique has varying uses within
different disciplines.

HEART method is based upon the principle that every time a task is performed there is a possibility of failure
and that the probability of this is affected by one or more Error Producing Conditions (EPCs) – for instance:
distraction, tiredness, cramped conditions etc. – to varying degrees. Factors which have a significant effect on
performance are of greatest interest. These conditions can then be applied to a "best-case-scenario" estimate of
the failure probability under ideal conditions to then obtain a final error chance. This figure assists in
communication of error chances with the wider risk analysis or safety case. By forcing consideration of the
EPCs potentially affecting a given procedure, HEART also has the indirect effect of providing a range of
suggestions as to how the reliability may therefore be improved (from an ergonomic standpoint) and hence
minimising risk.

Contents
Background
HEART methodology
Worked example
Context
Assumptions
Method
Result
Advantages
Disadvantages
See also
References
External links

Background
HEART was developed by Williams in 1986.[1] It is a first generation HRA technique, yet it is dissimilar to
many of its contemporaries in that it remains to be widely used throughout the UK. The method essentially
takes into consideration all factors which may negatively affect performance of a task in which human
reliability is considered to be dependent, and each of these factors is then independently quantified to obtain an
overall Human Error Probability (HEP), the collective product of the factors.

HEART methodology
1. The first stage of the process is to identify the full range of sub-tasks that a system operator would be
required to complete within a given task.

2. Once this task description has been constructed a nominal human unreliability score for the particular task is
then determined, usually by consulting local experts. Based around this calculated point, a 5th – 95th
percentile confidence range is established.

3. The EPCs, which are apparent in the given situation and highly probable to have a negative effect on the
outcome, are then considered and the extent to which each EPC applies to the task in question is discussed and
agreed, again with local experts. As an EPC should never be considered beneficial to a task, it is calculated
using the following formula:

Calculated Effect = ((Max Effect – 1) × Proportion of Effect) + 1

4. A final estimate of the HEP is then calculated, in determination of which the identified EPC's play a large
part.

Only those EPC's which show much evidence with regards to their affect in the contextual situation should be
used by the assessor.[2]

Worked example

Context

A reliability engineer has the task of assessing the probability of a plant operator failing to carry out the task of
isolating a plant bypass route as required by procedure. However, the operator is fairly inexperienced in
fulfilling this task and therefore typically does not follow the correct procedure; the individual is therefore
unaware of the hazards created when the task is carried out

Assumptions

There are various assumptions that should be considered in the context of the situation:

the operator is working a shift in which he is in his 7th hour.

there is talk circulating the plant that it is due to close down
it is possible for the operator's work to be checked at any time
local management aim to keep the plant open despite a desperate need for re-vamping and
maintenance work; if the plant is closed down for a short period, if the problems are unattended,
there is a risk that it may remain closed permanently.

Method
A representation of this situation using the HEART methodology would be done as follows:

From the relevant tables it can be established that the type of task in this situation is of the type (F) which is
defined as 'Restore or shift a system to original or new state following procedures, with some checking'. This
task type has the proposed nominal human unreliability value of 0.003.

Other factors to be included in the calculation are provided in the table below:

Factor Total HEART Effect Assessed Proportion of Effect Assessed Effect

Inexperience x3 0.4 (3.0-1) x 0.4 + 1 =1.8
Opposite technique x6 1.0 (6.0-1) x 1.0 + 1 =6.0
Risk Misperception x4 0.8 (4.0-1) x 0.8 + 1 =3.4
Conflict of Objectives x2.5 0.8 (2.5-1) x 0.8 + 1 =2.2
Low Morale x1.2 0.6 (1.2-1) x 0.6 + 1 =1.12

Result

The final calculation for the normal likelihood of failure can therefore be formulated as:

0.003 x 1.8 x 6.0 x 3.4 x 2.2 x 1.12 = 0.27

Advantages
HEART is very quick and straightforward to use and also has a small demand for resource
usage [3]
The technique provides the user with useful suggestions as to how to reduce the occurrence of
errors[4]
It provides ready linkage between Ergonomics and Process Design, with reliability
improvement measures being a direct conclusion which can be drawn from the assessment
procedure.
It allows cost benefit analyses to be conducted
It is highly flexible and applicable in a wide range of areas which contributes to the popularity of
its use [3]

Disadvantages
The main criticism of the HEART technique is that the EPC data has never been fully released
and it is therefore not possible to fully review the validity of Williams EPC data base. Kirwan
has done some empirical validation on HEART and found that it had "a reasonable level of
accuracy" but was not necessarily better or worse than the other techniques in the study.[5][6][7]
Further theoretical validation is thus required.[2]
HEART relies to a high extent on expert opinion, first in the point probabilities of human error,
and also in the assessed proportion of EPC effect. The final HEPs are therefore sensitive to
both optimistic and pessimistic assessors
The interdependence of EPCs is not modelled in this methodology, with the HEPs being
multiplied directly. This assumption of independence does not necessarily hold in a real
situation.[2]
See also
The curse of expertise
Threat and error management
Expert witnesses in English law
Winner's curse
Sports Illustrated cover jinx

References
1. WILLIAMS, J.C. (1985) HEART – A proposed method for achieving high reliability in process
operation by means of human factors engineering technology in Proceedings of a Symposium
on the Achievement of Reliability in Operating Plant, Safety and Reliability Society (SaRS).
NEC, Birmingham.
2. Kirwan, B. (1994) A Guide to Practical Human Reliability Assessment. CPC Press.
3. Humphreys. P. (1995). Human Reliability Assessor's Guide. Human Reliability in Factor's
Group.
4. "Archived copy" (https://web.archive.org/web/20090510091203/https://www.hf.faa.gov/Portal/S
howProduct.aspx?ProductID=90). Archived from the original (http://www.hf.faa.gov/Portal/Show
Product.aspx?ProductID%3D90) on 2009-05-10. Retrieved 2008-08-27.
5. Kirwan, B. (1996) The validation of three human reliability quantification techniques - THERP,
HEART, JHEDI: Part I -- technique descriptions and validation issues. Applied Ergonomics.
27(6) 359-373.
6. Kirwan, B. (1997) The validation of three human reliability quantification techniques - THERP,
HEART, JHEDI: Part II - Results of validation exercise. Applied Ergonomics. 28(1) 17-25.
7. Kirwan, B. (1997) The validation of three human reliability quantification techniques - THERP,
HEART, JHEDI: Part III -- practical aspects of the usage of the techniques. Applied Ergonomics.
28(1) 27-39.

External links
HEART technique for Quantitative Human Error Assessment (http://www.synergy-ergs.com/hea
rt.php)
Human error analysis and reliability assessment - Michael Harrison (http://www.laas.fr/IFIPWG/
Workshops&Meetings/46/05-Harrison.pdf)

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