This report goes beyond a characterization of human error as a causal factor of accidents. It discusses the larger system within which practitioners operate and show how "blunt end" factors such as organizational processes and technology design impact the cognition and behavior of those at the "sharp end." Examples from various domains are used to illustrate deficiencies in computerized devices, which can lead to breakdowns in interaction. such as mode error. Reasons are presented for why these deficiencies as "latent failures" can exist without giving rise to accidents. Also discussed is the role of outcome knowledge in the attribution of error.
Stored only when both papers are in the corpus — 393 citations exist upstream.