ABSTRACT
This chapter presents a taxonomy for describing malfunctions associated with human behavior that was developed for use in an industry other than medicine, but has potential for the medical arena. A taxonomy implies a decomposition or parsing of a continuous flow of behavior into elements and a categorization of recurrent elements. The taxonomy was developed for analysis of human operation of well-structured technical systems for which the acceptable task procedures are stable and well known. In the medical arena, the taxonomy will be most applicable for analysis of errors during the use of technical medical devices and equipment. The cognitive categories of the taxonomy will be inadequate for unstructured work situations such as medical diagnosis. If medical diagnosis is considered to be hypothesis generation and the subsequent therapy to be hypothesis testing, the concept of error becomes dubious. The taxonomy has been found to be very useful in guiding analyses of incident reports for understanding a complex work situation.
