How a cockpit calculates its speeds and why errors while doing this are so hard to detect

Henriqson, Éder; Winsen, Roel van; Saurin, Tarcísio Abreu; Dekker, Sidney

doi:10.1007/s10111-010-0161-4

Cited by 20 publications

(22 citation statements)

References 21 publications

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“…There is also the issue of shared (or distributed) cognition in teams [44], for which further factors (communication, coordination, cooperation, trust, cohesion) contribute to breakdown [45]. Interactions between agents will not necessarily conform to rules and prescription [46], and even cross-checking, which is a team interaction, is not infallible. Complex interactions occur between teams which in the flight setting are known to be affected by delegated roles (e.g.…”

Section: Cognitive Processes and Sociotechnical Interactionsmentioning

confidence: 99%

“…System failure can occur due to the interactions, even if all the components on their own are functional. As there is degree of autonomy in most aircraft, the pilot's ability to interact effectively with the system without losing too much control or situational awareness is extremely important so that in an emergency event the pilot is still able to effectively take manual control of the aircraft [11,15,49] or transition from one level of control (autopilot) to another (manual) [37], with incomplete information [46], or mode confusion [50] (dissonance between the mental model of the operator and the actual state of the technical system). The sociotechnical interactions on the flight desk are still not fully understood, particularly with respect to how they are affected by cultural influences [15], the representations of the hardware state to the pilot [46], and how the pilot builds mental awareness of the environment [51].…”

Section: Cognitive Processes and Sociotechnical Interactionsmentioning

confidence: 99%

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Aviation Human Error Modelled as a Production Process

Pons¹,

Dey

2015

TOERGJ

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As technology systems have become more complex, so it is increasingly difficult for human operators to comprehend how the system is behaving. There is a need to better understand the causes of human-error in the context of the situational variables. The specific case under examination is the process of landing an aircraft. This paper applies a production engineering perspective. By production-process, we refer to the set of actions that are necessary to move a system from one state to a desired new state. Such processes involve mechanisms for taking inputs and converting them to the desired outputs, under certain controls and constraints. Human error is thus treated as a constraint on the processes. A novel process methodology is developed to represent how technical systems, situational variables, external factors, and human error evolve over time in a process. The applicability is demonstrated with a dataset of case studies. In parallel, a new categorization of human errors is derived for this situation. The method permits cases to be examined individually, and also collectively for patterns. The results show that the initial landing approach is often the point of error initiation. For the specific case of landing accidents the methodology identifies that the failure causality was the lack of attention to establish procedure at the very start of descent, followed by persistent disregard of disconfirmatory evidence at the initial landing approach, especially under conditions of poor visibility. The paper makes a methodological contribution as well as suggesting new insights for how human error occurs at landing.

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Section: Cognitive Processes and Sociotechnical Interactionsmentioning

confidence: 99%

Section: Cognitive Processes and Sociotechnical Interactionsmentioning

confidence: 99%

Aviation Human Error Modelled as a Production Process

Pons¹,

Dey

2015

TOERGJ

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“…Two seminal papers investigating cognition involved in navigating modern, multi-crew aircraft developed a joint cognitive system approach while focusing on how a cockpit calculates and remembers speed (Henriqson et al 2011;Hutchins 1995b). These studies showed how the memory tasks of the cockpit are accomplished by functional, joint cognitive systems that transcend the boundaries of the individual actors (Hutchins 1995b).…”

Section: Introductionmentioning

confidence: 99%

“…Whereas human agents have to interpret representations, the automated systems take inputs at face value. Errors are said to occur because (a) representations tend to be partial and incomplete when the cockpit is taken as the unit of analysis, (b) inherently flexible interpretation is required, (c) interactions are coordinated on the fly rather than following a canonical process, and (d) there are inadequacies in the preventive control of failures (Henriqson et al 2011).…”

Section: Introductionmentioning

confidence: 99%

“…This ethnographic study was designed to describe aspects of the cockpit joint cognitive systems that have been left out in previous work (Henriqson et al 2011;Hutchins 1995b); these aspects are not covered in the original theory but require its reformulation. We use the notion of kinetic melody and the associated experience of flow to focus on phenomena related to the internal structures that pilots may develop ''to coordinate with predictable structure in the task environment'' (Hutchins 1995b).…”

Section: Introductionmentioning

confidence: 99%

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How a cockpit forgets speeds (and speed-related events): toward a kinetic description of joint cognitive systems

Roth

Mavin

Munro³

2014

Cogn Tech Work

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Two seminal papers investigating the cognition involved in navigating modern, multi-crew aircraft developed a joint cognitive system approach while focusing on how a cockpit calculates and remembers speed (Henriqson et al. in Cogn Technol Work 13:217-231, 2011; Hutchins in Cogn Sci 19(3):265-288, 1995b). Although the joint cognitive systems approach constituted an advance over more traditional approaches focusing on individual pilot performances, both fall short of describing the cockpit joint cognitive system. Based on extensive ethnographic dataincluding recorded modified think-aloud protocols, debriefing sessions following (recorded) simulator biannual simulator assessments, and simulator performances followed by stimulated recall using simulator recordings-we show that a considerable amount of flying involves bodily and embodied knowledge sequentially and temporally organized in flows (kinetic melodies). These become apparent when pilots are asked to fly multiple aircraft (mixed-fleet flying), where the flow patterns from one cockpit are triggered in a physically and cognitively different cockpit. Focusing on embodied flows (kinetic melodies) allows us to highlight how cockpits forget speeds and how they fail to calculate the required speeds and speed-related events.

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