The Field Guide to Human Error Investigations, Third Edition.
Dekker S. Aldershot, UK: Ashgate Publishing; 2014. ISBN: 9781472439048.
This revised and reorganized book provides a primer on how human error causes mishaps and often illustrates deeper troubles within a system. Both the old view of human error that places blame on the individual and the new view that identifies most human failures as merely a symptom of systems-level problems are presented. This view of human error has led to the application of root cause analyses andhuman factors engineering in health care. New chapters discuss the importance of safety culture and provide recommendations on improving the failure investigation process.
External Inquiry into the adverse incident that occurred at Queen's Medical Centre, Nottingham, 4th January 2001.
Toft B. London, England: Department of Health; 2001.
Using a multi-method, user centred, prospective hazard analysis to assess care quality and patient safety in a care pathway.
Dean J, Hutchinson A, Hamilton Escoto K, Lawson R. BMC Health Serv Res. 2007;7:89.
Human error: models and management.
Reason J. BMJ. 2000;320:768-770.
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National Patient Safety Agency, the Medical Defence Union and Medical Protection Society. London, England: NPSA; 2005