ABSTRACT
Human decisions, actions and assessments can be less obvious. The most popular recommendations to come out of 'human error' investigations are retraining people or rewriting a policy. The aim of a 'human error' investigation is to try to understand why it made sense for people to do what they did—against the background of their physical and psychological work environment. 'Human error' as explanation for accidents has become increasingly unsatisfying. The most popular recommendations to come out of 'human error' investigations are retraining people or rewriting a policy. Debriefings of mishap participants help construct the situation that surrounded people at the time and gets their view on that situation. Increasing the resolution of the timeline also reveals other things about, in this case, the coordination between the two persons. Conversation analysis uses an even finer-grained notation for systematically representing all kinds of aspects of talk.
