| Document
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Author Ian Pemberton & Domonic Mooney |
| Abstract This study involved conducting a cognitive task analysis (CTA) based learning review of a serious accident that occurred at a British Sugar manufacturing plant in the UK. Exploration of the cognitive work, through the use of cognitive task analysis (CTA), delivered deeper understanding of the contributing factors to the accident, and helped to extend significantly the learning beyond that gained through the existing accident investigation. The results of the CTA interviews also provided content for scenario-based training, called decision-making exercises (DMX), which were shown to be effective in developing the tacit cognitive skills that contributed to this accident. This study provides convincing evidence that a CTA-based approach can help extend learning from serious accidents, both in terms of understanding contributory cognitive human factors, as well as providing rich content for cognitive tacit skills training for technical and non-technical skills routinely involved in serious accidents and fatalities (SIFs). |
