An UX talk about Human Errors, Errant Behavior and Design.
A small and humble talk presented at Codemotion 2014 in Rome: nothing new or disruptive, but some stuff "who knows why" usually ignored but so useful for UX folks and Developers as well.
Apidays New York 2024 - Scaling API-first by Ian Reasor and Radu Cotescu, Adobe
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You WRONG, You DIE #Codemotion 2014
1. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
YOU WRONG, YOU DIEAn UX talk about Human Errors, Errant Behaviors and Design
Hoang C. Huynh
ROME 11-12 April 2014
2. ROME 11-12 April 2014
Hi, Iâm Hoang!
I Am Learning German
I Am Easily Bored
I Love Technologies
I Design
Experiences
3. ROME 11-12 April 2014
Hi, Iâm Hoang!
I Am Learning German
I Am Easily Bored
I Love Technologies
I Design
Experiences
HOW PEOPLE WORK
4. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
USUALLY
5. ROME 11-12 April 2014
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- Hoang C. Huynh
WE CREATE STORIES
6. ROME 11-12 April 2014
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- Hoang C. Huynh
The only 'intuitive' interface is the
nipple. After that, it's all learned
Bruce Ediger, Consultant
- @Nipple.es
WE STRUGGLE WITH
INTUITIVENESS
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You Wrong, You Die
- Hoang C. Huynh
AND USABILITY ISSUES
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- Hoang C. Huynh
- @CW - Arrow
WE MUST BE
SOMEONE ELSE
9. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @CW - Arrow
WE MUST BE
SOMETHING ELSE
10. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
BUT âSOMETIMESâ
WE HAVE TO DESIGN
11. ROME 11-12 April 2014
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- Hoang C. Huynh
FOR PEOPLE WHO
ARE âVOLUNTEERSâ
AKA EMPLOYERS
12. ROME 11-12 April 2014
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- Hoang C. Huynh
- @Landmark - Captain Power and the Soldier of the Future
WE HAVE THE
POWER
TO BRING THEM
13. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Warner - Constantine
HELL
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You Wrong, You Die
- Hoang C. Huynh
- @Warner - Constantine
OR HEAVEN
15. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Failing to perform or omitting a task
Performing the task incorrectly
Performing an extra or non-required task
Performing tasks out of sequence
Failing to perform the task within the time limit associated with it
Failing to respond adequately to a contingency
DIFF METRICS
WE HAVE TO DEAL WITH
16. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Autismhelpers
WE CAN TALK ABOUT
TASK ANALYSIS
!
!
!
!
!
BUT IT WOULD BE
BORING AS HELL
17. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
#BOOBS
18. ROME 11-12 April 2014
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- Hoang C. Huynh
#KITTENS
19. ROME 11-12 April 2014
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- Hoang C. Huynh- Speakerâs name
20. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
THE HUMAN ERROR
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- Hoang C. Huynh
30 AD
Errare humanum est,
!
perseverare autem diabolicum,
et tertia non datur
Lucius Annaeus Seneca, Philosopher
22. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
1711
To err is human
!
To forgive, divine
Alexander Pope, Poet
23. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
50-70% of aviation disasters
44,000 â 98,000 deaths / year in US result from med errors
60-85% of shuttle incidents at NASA
92-95% of car crashes
70% of shipping accidents
HUMAN FAILURES
ARE SAID TO ACCOUNT FOR
24. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
1An inappropriate or undesirable human decision or behavior
that reduces or has the potential for reducing the
effectiveness, dependability or performance of a system
THE DEFINITION
25. ROME 11-12 April 2014
You Wrong, You Die
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1An inappropriate or undesirable human decision or behavior
that reduces or has the potential for reducing the
effectiveness, dependability or performance of a system
THE DEFINITION
2Something has been done that was "not intended by the actor,
not desired by a set of rules or an external observer or that led
the task or system outside its acceptable limitsâ.
It is a deviation from intention, expectation or desirability.
26. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
System FAULT
a characteristic
System ERROR
a state
System FAILURE
a behavior
HUMAN ERROR
⢠Development
⢠Operational
⢠Maintenance
HUMAN
SYSTEM
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- Hoang C. Huynh
- @Warner - Inception
AN ERROR IS NOT
AN ERROR UNTIL
IT IS AN ERROR
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- Hoang C. Huynh
- @Warner - Inception
WE NEED TO GO
DEEPER
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- Hoang C. Huynh
- Courtesy of Wikipedia
AN ERROR IS NEVER #WRONG BY PER SE
A DISASTER
30. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Fox - The Simpsons
AN ACCIDENT
#WRONG
31. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
#NSFW
- @DamnYouAutoCorrect
DUCKING
AUTO CUCUMBER!
A DISTRACTION
#WRONG
32. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @emilyrebekah
A WIN
The legend of Ivory soap: Back in the late 1800's Proctor and Gamble were
manufacturing their new White Soap with hope to compete in the fine soap market.
!
One day a line worker left the soap mixing machine on while he went to lunch and
when he got back from lunch the soap was extra frothy having incorporated more
air than normal into it. IT FLOATS! (EVEN THO ITâS A MADE UP STORY)
33. ROME 11-12 April 2014
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- Hoang C. Huynh
- @NSF DBA
34. ROME 11-12 April 2014
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- Hoang C. Huynh
The Three Mile Island accident was a partial nuclear meltdown
which occurred in one of the two Three Mile Island nuclear
reactors in Dauphin County, Pennsylvania, US, on March 28, 1979.
!
It was the worst accident in U.S. nuclear power plant history.
#WRONG
35. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- Courtesy of Wikipedia
The crash occurred at
Fairchild Air Force Base,
US, on 24 June 1994, when
the pilot of a USAF Boeing
B-52 Stratofortress, Arthur
Holland, flew the aircraft
beyond its operational
limits and lost control.
âRequesting permission for flyby!â
#WRONG
36. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Wikipedia / @Warner - Lord of the Rings
THE GIMLI GLIDER
This accident was caused by a human error in 1983. Fuel loading was miscalculated due to a
misunderstanding of the recently adopted metric system which replaced the imperial system.
#WRONG
37. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Gizmodo / Shutterstock/Ilja MaĹĄĂk
In the 2011, an All Nippon Airways passenger plane carrying 117 due to a human error continued to roll
until it reached 131.7 degrees to the left, leaving it almost belly-up.
#WRONG
38. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Gizmodo
39. ROME 11-12 April 2014
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NEARLY DEATH EXPERIENCE DOOR OPENING
- @Gizmodo
40. ROME 11-12 April 2014
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- Hoang C. Huynh
REGULATIONS
ORGANIZATIONS
TECHNOLOGY
INDIVIDUALS
THE SHARP END OF FAILURE
GROUPS
How comes that we blame
individuals first?
Blaming individuals is emotionally more satisfying than targeting institutions.
41. ROME 11-12 April 2014
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1969
To err is human
!
but to really foul things up
you need a computer.
Paul Ehrlich , Scientist
42. ROME 11-12 April 2014
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No scheme particularly useful
Partly because human error is complex
Schemes do not capture that complexity
Often the full facts are not available
Essentially,
all models are wrong,
but some are useful
George E. P. Box, Statistician
43. ROME 11-12 April 2014
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Discrete Action Classification
Errors of omission (not doing the required task)
Forgetting to do it
Ignoring to do it deliberately
!
Errors of commission (doing the wrong task)
!
Slips in which the operator has the correct intention, but carries out the
wrong execution
!
â˘Selection
â˘Sequence or wrong order of execution
â˘Timing: too fast/ too slow / too late
â˘Quantity: too much / not enough
Swain & Guttman 1983
THERPTechnique for Human
Error Rate Prediction
44. ROME 11-12 April 2014
You Wrong, You Die
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Skill based
controlled by sub-conscious behavior and stored patterns of behavior
errors usually errors of execution
!
Rule based
applies to familiar situations - stored rules are applied
errors involve recognizing the salient features of the situation
!
Knowledge based
occur in unique & unfamiliar situations
errors result from inadequate analysis or decision making
Performance / S.R.K Classification
Rasmussen 1982
45. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Skill based
- @Huffpost
#WRONG
46. ROME 11-12 April 2014
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- Hoang C. Huynh
Rule based
WHERE ARE THE TOILETTES?
On the right, over there
:| NoâŚ#WRONG
47. ROME 11-12 April 2014
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- Hoang C. Huynh
- @Marvel - The Avengers
Knowledge based (negative)
CAN YOU RUN A FLIGHT
DIAGNOSTIC ON THE MARK IV?
#MAYBEWRONG
Yes⌠butâŚ
48. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Knowledge based (positive)
âALL THE JAEGER ARE DIGITALâ
#WRONG! Gipsyâs Analog, Nuclear!
- @Warner Bros - Pacific Rim
49. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
"The division occurs at
the level of the intention:
!
A Person establishes an
intention to act.
!
If the intention is not
appropriate, this is a
mistake. If the action is
not what was intended,
this is a slip."
GEMSGeneric Error Modeling System
Reason 1990
50. ROME 11-12 April 2014
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Are an âexecution failureâ, where the operatorâs intentions are
correct but actions are not carried out properly
Slips, which occur in skills based performance
Also are an âexecution failureâ, but this time where an operator
forgets to do something, loses their place in a task, etc.
Lapses, which also occur in skills based performance
These are âplanning failuresâ, where an inappropriate set of actions
is carried out
Mistakes, which occur in rule and knowledge based performance
CLASSIFICATION
51. ROME 11-12 April 2014
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Skills Based Errors Rule Based Errors Knowledge Based
Errors
Main Error type Slips & Lapses RB mistakes KB mistakes
Activity type Routine actions Problems solving activities
Attention Often elsewhere Directed at problem related issues
Control mode Mainly automatic More conscious
Predictability Largely
predictable
variable
Frequency Common Uncommon
Opportunity Very high Very low
Detection Usually easy Difficult and often through intervention
52. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Skills Based Errors Rule Based Errors Knowledge Based
Errors
Main Error type Slips & Lapses RB mistakes KB mistakes
Activity type Routine actions Problems solving activities
Attention Often elsewhere Directed at problem related issues
Control mode Mainly automatic More conscious
Predictability Largely
predictable
variable
Frequency Common Uncommon
Opportunity Very high Very low
Detection Usually easy Difficult and often through intervention
Approximate data (Reason, 1990)
61% 28% 11%
53. ROME 11-12 April 2014
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Capture Slip: automatic activation of a well-learned routine that overrides the
current intended activity .
Omission Slip: Omissions due to interruption
Loss of Activation Slip: Ignoring the activation trigger for the intention
Description Slip: incomplete or ambiguous specification of intention that is similar
to a familiar intention.
Associative Activation Slip: activation of similar but incorrect schemas.
Perceptual Confusion Slip: activation of the correct schema with the wrong item
Reverse Schema Slip: reverse action schema overwrites forward action schema.
Cross-talk Slip: action components are exchanged between two or more
sequential or concurrent actions.
54. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Capture Slip
Omission Slip
Loss of Activation Slip
Description Slip
Associative Activation Slip
Reverse Schema Slip
Cross-talk Slip
Perceptual Confusion Slip
⢠Driving to the office on Saturday instead of home
⢠Forget to send and interrupted email
⢠Walking into a room without remembering the reason
⢠Slide the credit card into the hotel door instead of
the key card
⢠Tap a clearly non touchable touchscreen
⢠Washing hands with the hair gel instead of the soap
⢠Open the purse and putting it away before paying
⢠Start writing a document in mother tongue and
completing it in a foreign language
55. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Capture Slip
Omission Slip
Loss of Activation Slip
Description Slip
Associative Activation Slip
Reverse Schema Slip
Cross-talk Slip
Perceptual Confusion Slip
⢠Driving to the office on Saturday instead of home
⢠Forget to send and interrupted email
⢠Walking into a room without remembering the reason
⢠Slide the credit card into the hotel door instead of
the key card
⢠Tap a non touchable touchscreen
⢠Washing hands with the hair gel instead of the soap
⢠Open the purse and putting it away before paying
⢠Start writing a document in mother tongue and
completing it in a foreign language
56. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Capture Slip
Omission Slip
Loss of Activation Slip
Description Slip
Associative Activation Slip
Reverse Schema Slip
Cross-talk Slip
Perceptual Confusion Slip
⢠Driving to the office on Saturday instead of home
⢠Forget to send and interrupted email
⢠Walking into a room without remembering the reason
⢠Slide the credit card into the hotel door instead of
the key card
⢠Tap a non touchable touchscreen
⢠Washing hands with the hair gel instead of the soap
⢠Open the purse and putting it away before paying
⢠Start writing a document in mother tongue and
completing it in a foreign language
57. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Ansa
An old lady went
under surgery and got
a prosthesis in the
wrong leg⌠then she
got one in the right
one.. then she diedâŚ
!
A l l e g e d l y , t h e y
switched table side
before the surgery,
they were in hurry
and they forgot to
turn the patient as
wellâŚ
58. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Our behavior is
regulated by the
activation and
deactivation of
schemas
EXECUTE
ORDER 66
- @Disney - Star Wars
59. ROME 11-12 April 2014
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- Hoang C. Huynh
- @PlankingPhotos
Any schema comes
with an activation
trigger, a primary goal
and an indefinite
number of subgoals
60. ROME 11-12 April 2014
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- @PlankingPhotos
Any schema comes
with an activation
trigger, a primary goal
and an indefinite
number of subgoals
WHAT HAPPENS WHEN THE PRIMARY GOAL IS
TRIGGERED BEFORE THE COMPLETION OF THE
SUB GOALS ?
61. ROME 11-12 April 2014
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- Hoang C. Huynh
- @PlankingPhotos
YOU FORGET THE
ORIGINALS IN THE
MACHINE
#WRONG
62. ROME 11-12 April 2014
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- Hoang C. Huynh
- @PlankingPhotos
YOU FORGET YOUR
CREDIT CARD IN THE
READER
#WRONG
63. ROME 11-12 April 2014
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- Hoang C. Huynh
- @PlankingPhotos
YOU FORGET YOUR
CHANGE IN THE
VENDING MACHINE
#WRONG
64. ROME 11-12 April 2014
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- Hoang C. Huynh
John Davidson holds the
unfortunate distinction of
being the first person in the
worldwide Millionaire franchise
to win nothing at all. He
appeared as a contestant on
J a n u a r y 1 0 , 1 9 9 9 , b u t
answered his ÂŁ1,000 question
incorrectly.
WHEN EVERYTHING COMES TOGETHER YOU
WILL EPICALLY #FAIL
65. ROME 11-12 April 2014
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EPIC FAIL
TRIGGER
DISASTER / ACCIDENT
EVENT
DEFENSES
LATENT /ACTIVE
FAILURES
MISSED OPPORTUNITIES
ABSENT DEFENSES
UNSAFE ACTS
REASONâs SWISS CHEESE MODEL
66. ROME 11-12 April 2014
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#SOWRONGSPEAKING ABOUT DISASTERS
67. ROME 11-12 April 2014
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THE ICEBERG
COLLISION
SHIPWRECK
NO AIDS
NO RESCUE
LACK OF BOATS
HIGH SEA
LOW VISIBILITY
TITANIC
#SOWRONGFAULT TREE ANALYSIS
68. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
- @Fox - The Simpsons
DESIGN
FOR ERRORSand Design for Failure or Design for Recovery
69. ROME 11-12 April 2014
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- Hoang C. Huynh
Human error is in OUR NATURE
It might happen everyone, at any time, in any context.
!
IT IS INEVITABLE.
!
Some errors are PREVENTABLE
through better system design of
equipment, procedures and work
environment.
(BTW RECOVERY AND RESILIENCE are
MUCH BETTER than prevention)
!
Human error might not be an
accident cause in itselfâŚit might
be caused by MULTIPLE FACTORS
#WRONG
70. ROME 11-12 April 2014
You Wrong, You Die
- Hoang C. Huynh
Avoidance and Prevention
Design the system so that certain classes of human error are eliminated, by
implementing procedures, training, safety awareness and UI design where
people arenât distracted or overwhelmed, but arenât bored either
!
Detection
Make it easier for the operator and others to spot errors by designing systems
and work environments where people are able to understand what is
happening and the consequences of an action
!
Tolerance
Ensure that individual errors are unlikely to lead to system failure and minimise
potential for deliberate violations by making sure rules are well designed and
well understood
!
Recover
Ensure Undo capability, confirmation
DESIGN YOUR SYSTEM
71. ROME 11-12 April 2014
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- Hoang C. Huynh
DISC LOCK REMINDER
STRATEGIES
72. ROME 11-12 April 2014
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- @FOX - Futurama
AUTOMATE
( YES WE ARE DOOMED )
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- @unsplash
FORCING FUNCTIONS
INTERLOCKS LOCKINS LOCKOUTS
Force certain sequences of
events, e.g. the Credit Card
recollection on ATMs is
forced before the withdraw
of money.
These stop you for
carrying out a certain
action in a particular
context, e.g. you
cannot exit a editing
s o f t w a r e w i t h o u t
validating the save
prompt
S t o p y o u f o r d o i n g
something. e,g, the stairs
to the basement of a tall
b u i l d i n g a r e u s u a l l y
differently designed or
have a gate to stop people
continuing to the basement
when evacuating.
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- @Unsplash
Distractions
Incomplete or incorrect data
Boredom
Inadequate resources
Cognitive overload
Stress
Illness
Time pressure
TAKE IN CONSIDERATION
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â˘Pursue second stories beneath the surface to discover multiple contributors.
â˘Escape the hindsight bias
â˘Understand work as performed at the sharp end of the system
â˘Search for systemic vulnerabilities
â˘Study how practice creates safety
â˘Search for underlying patterns
â˘Examine how changes create new vulnerabilities
â˘Used new technology to support and enhanced human expertise
â˘Tame complexity through new forms of feedback
Be aware of possible influencing situational factors.
Be aware of the hindsight bias of the retrospective analyst.
ADD THESE TO YOUR UX CHECKLIST
Woods & Cook (2002)
76. ROME 11-12 April 2014
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- Hoang C. Huynh
PREVENT FEEDBACK WTF?
77. ROME 11-12 April 2014
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- Hoang C. Huynh
TONIGHT WE DINE
IN HELL
- @Warner - 300
78. ROME 11-12 April 2014
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TONIGHT WE DINE
IN HELL
BUT TOMORROW, IâM
THINKING MCDONALDS- @Warner - 300
79. ROME 11-12 April 2014
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General
That button launches all of our
nuclear missiles!
President Hathaway
Well which button gets me a latte?
Advisor
That would be the other one, sir.
President Hathaway
What idiot designed this thing?
President Hathaway
You did, sir.
- @Dreamworks - Monsters VS Aliens
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- Hoang C. Huynh
NEARLY DEATH EXPERIENCE DOOR OPENING
- @Gizmodo
81. ROME 11-12 April 2014
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- @Aetheros
Twitter: @aetheros
Linkedin: in/hchuynh
Web: huynh.cc/blog
Slides will be available also
on slideshare/aetheros
THANK YOU
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Sources
http://www.slideshare.net/rezazarei125/human-error
http://www.slideshare.net/johnrooksby/cs5032-l5-human-error-1
http://www.slideshare.net/johnrooksby/cs5032-lecture-2-failure-11609657
http://www.slideshare.net/dominicfurniss/human-error-lecture
Reason, J. (1990). Human Error. Cambridge University Press.
Norman, D.A. (1981). Categorization of action slips. Psychological Review, 88, 1-15.
http://en.wikipedia.org/wiki/Human_error
http://wikiofscience.wikidot.com/quasiscience:error
Francesco Di Nocera, Ergonomia cognitiva, Carocci, Roma, 2011
Donald Norman, La caffettiera del masochista, Giunti, Milano, 1990
Donald Norman, Emotional design, Apogeo, Milano, 2004
http://www.slideshare.net/Yehoshua7/schneider-electric-nuclear-navy-and-reducing-human-error