• 간호행정학회지
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• 제19권1호
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• pp.28-38
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• 2013

Purpose: Human factor is one of the major causes of medication errors. The purpose of this study was to identify nurses' perception and experience of medication errors, examine the relationship of Dominance, Influence, Steadiness, Conscientiousness (DISC) behavior patterns and medication errors by nurses. Methods: A descriptive survey design with a convenience sampling was used. Data collection was done using self-report questionnaires answered by 308 nurses from one university hospital and two general hospitals. Results: The most frequent DISC behavioral style of nurses was influence style (41.9%), followed by steadiness style (23.7%), conscientiousness style (20.4%), and dominance style (14.0%). Differences in the perception and experience level of medication errors by nurses' behavioral pattern were not statistically significant. However, nurses with conscientiousness style had the lowest scores for in experience of medication errors and the highest scores for perception of medication errors. Conclusion: The results of this study show that identification of the behavior pattern of nurses and application of this education program can prevent medication errors by nurses in hospitals.

• 대한인간공학회지
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• 제34권1호
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• pp.29-43
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• 2015

Objective: The aim of this study is to develop management guidelines and a procedure for an anthropometric suitability assessment of the main control room (MCR) in nuclear power plants (NPPs). Background: The condition of the MCR should be suitable for the work crews in NPPs. The suitability of the MCR depends closely on the anthropometric dimensions and ergonomic factors of the users. In particular, the MCR workspace design in NPPs is important due to the close relationship with operating crews and their work failures. Many documents and criteria have recommended that anthropometry dimensions and their studies are one of the foremost processes of the MCR design in NPPs. If these factors are not properly considered, users can feel burdened about their work and the human errors that might occur. Method: The procedure for the anthropometric suitability assessment consists of 5 phases: 1) selection of the anthropometric suitability evaluation dimensions, 2) establishment of a measurement method according to the evaluation dimensions, 3) establishment of criteria for suitability evaluation dimensions, 4) establishment of rating scale and improvement methods according to the evaluation dimensions, and 5) assessment of the final grade for evaluation dimensions. The management guidelines for an anthropometric suitability assessment were completed using 10 factors: 1) director, 2) subject, 3) evaluation period, 4) measurement method and criteria, 5) selection of equipment, 6) measurement and evaluation, 7) suitability evaluation, 8) data sharing, 9) data storage, and 10) management according to the suitability grade. Results: We propose a set of 17 anthropometric dimensions for the size, cognition/perception action/behavior, and their relationships with human errors regarding the MCR design variables through a case study. The 17 selected dimensions are height, sitting height, eye height from floor, eye height above seat, arm length, functional reach, extended functional reach, radius reach, visual field, peripheral perception, hyperopia/myopia/astigmatism, color blindness, auditory acuity, finger dexterity, hand function, body angle, and manual muscle test. We proposed criteria on these 17 anthropometric dimensions for a suitability evaluation and suggested an improvement method according to the evaluation dimensions. Conclusion: The results of this study can improve the human performance of the crew in an MCR. These management guidelines and a procedure for an anthropometric suitability assessment will be able to prevent human errors due to inadequate anthropometric dimensions. Application: The proposed set of anthropometric dimensions can be integrated into a managerial index for the anthropometric suitability of the operating crews for more careful countermeasures to human errors in NPPs.

• 한국BIM학회 논문집
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• 제11권3호
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• pp.1-11
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• 2021

BIM is one of the means of reducing the economic loss caused by design errors. These features of BIM have led to increased use of BIM. With the increasing use of BIM, several studies have been conducted to analyze the performance of BIM. As the importance of BIM staff is emphasized in the performance analysis of BIM, the human resource allocation of BIM staff can become an important research issue. However, there are few studies to measure the workforce effectiveness of BIM staff. Ham et al (2020) measured BIM workforce efficiency using FCFS queue model rules. Since design errors can have different effects on the project depending on the type, there are design errors that must be dealt with first. Therefore, in this study, a priority queue was used to solve design errors with high priority first. The performance of BIM-based design verification was analyzed by quantitatively analyzing the performance of BIM staff when the priority rule was applied to the design error processing sequence.

• 한국안전학회지
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• 제21권3호
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• pp.137-142
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• 2006

Quantification of error possibility, in an HRA process, should be performed so that the result of the qualitative analysis can be utilized in other areas in conjunction with overall safety estimation results. And also, the quantification is an essential process to analyze the error possibility in detail and to obtain countermeasures for the errors through screening procedures. In previous studies for the quantification of error possibility, nominal values were assigned by the experts' judgements and utilized as corresponding probabilities. The values assigned by experts' experiences and judgements, however, require verifications on their reliability. In this study, the validity of new error possibility values in new MCR design was verified by using the Onisawa's model which utilizes fuzzy linguistic values to estimate human error probabilities. With the model of error probabilities are represented as analyst's estimations and natural language expression instead of numerical values. As results, the experts' estimation values about error probabilities are well agreed to the existing error probability estimation model. Thus, it was concluded that the occurrence probabilities of errors derived from the human error analysis process can be assessed by nominal values suggested in the previous studies. It is also expected that our analysis method can supplement the conventional HRA method because the nominal values are based on the consideration of various influencing factors such as PSFs.

• 대한인간공학회지
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• 제34권2호
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• pp.103-113
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• 2015

Objective: This study proposes a systematic process to present the analysis methods and solutions of organizational root causes to human errors on the railroad. Background: In fact, organizational root cause such as organizational culture is an important factor in the safety concerns on human errors in the nuclear power plant, railroad and aircraft. Method: The proposed process is as follows: 1) define analysis boundary 2) select human error taxonomy 3) perform accident analysis 4) draw root causes with FGI 5) review root causes analysis with survey 6) chart analysis of root causes, and 7) propose alternatives and solutions. Results: As a result, root causes of the organizations like railroad and nuclear power plant came from the educational problems, violations, payoff system, safety culture and so forth. Conclusion: The proposed process does predict potential railroad accident through retrospect error analysis by building new human error taxonomies and problem solution. Application: This study would contribute to examination of the relationship between human error-based accidents and organizational root causes.

• 한국안전학회지
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• 제12권4호
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• pp.161-168
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• 1997

Most plants producing semiconductors use a lot of chemicals, hazardous materials, and explosive gases. Though those materials are hazardous too much, some works still have to be done manually by human workers. However, according to a historical survey, more than half industrial accidents of those plants resulted from human errors or malfunctions. Thus, this research aimed 1) to diagnose shifting hazardous materials of semiconductor plants, 2) to estimate failure probability of human workers through human reliability analysis, and 3) to find out the tasks on which educational emphasis should be put. Through personal interview and visiting working spots, shifting tasks were analyzed, and modelled into a 24-step work, and after that, THERP and ETA was applied. During the shifting work, estimated human failure probability under the assumption of independency, 2.3004E-05, underestimated that probability 8. l008E-05 which could be calculated under the assumption of dependency. And this analysis showed that gas leakage from an old cylinder occupies 78.27% in the case of independent failures whereas gas leakage from a new cylinder occupies 75.06% in the case of dependent failures. So it was concluded that dependency assumption may gloss real situations. In addition, confirming gauge of regulators and closing valves turned out to be the most important tasks than purge tasks.

• 한국안전학회지
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• 제22권1호
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• pp.61-66
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• 2007

Car crashes are the leading cause of death for persons of every age. Specially, human-related factor has been known to be the primary causal factor of such crashes than vehicle-and environmental-related factors. There are various studies to analyze driver's behavior and characteristics in driving for reducing the car crashes in many areas of car engineering, psychology, human factor, etc. However, there are almost no studies which analyze mainly the human errors in driving and estimate their probabilities in terms of human reliability analysis. This study estimates the probability of human error in driving, i.e. driver error probability. First, fifty driver errors are investigated through DBQ (Driver Behavior Questionnaire) revision and the error likelihoods in driving are collected which are judged by skillful drivers using revised DBQ. Next, these likelihoods are converted into driver error probabilities using the results that verbal probabilistic expressions are changed into quantitative probabilities. Using these probabilities we can improve the warning effects on drivers by indicating their driving error likelihoods quantitatively. We can also expect the reduction effects of car accident through controlling especially dangerous error groups which have higher probabilities. Like these, the results of this study can be used as the primary materials of safety education on drivers.

• 산업경영시스템학회지
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• 제24권67호
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• pp.103-110
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• 2001

The BOM(Bill Of Material) contains various important information for establishing production scheduling and purchasing process. For effective and efficient constructing of the BOM, some methods, such as, conventional BOM, Modular BOM and Generic BOM are developed. Many companies input the BOM information with manual process. During this process, no one can avoid human errors, that is input error and to omit input necessary Information. We must to remove the possibility of these human errors, and to construct BOM effectively. To do this, we try to take the BOM from CAD data automatically We have developed a supporting system for extracting BOM from AutoCAD files.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2018년도 추계학술대회
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• pp.558-561
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• 2018

선박의 항해관련사고의 가장 큰 원인이 당직 항해사의 인적 과실에 있다는 사실은 해양사고 예방을 위한 당직 항해사의 당직 패턴분석이 필요한 가장 큰 이유이다. 대부분의 관련연구들은 설문지나 면담 등 간접적인 연구방법을 통하여 항해사의 인적 과실과 관계된 항해당직 패턴을 연구해왔다. 이 같은 연구방식은 객관성이 결여되는 점을 보완해야한다는 문제점이 있었다. 본 연구에서는 웨어러블 센서를 이용하여 항해 당직자의 당직 패턴을 직접적으로 분석하여 항해사 인적 요소 분석 연구의 객관성 결여 문제를 개선하고자하였다. 선박의 특수한 환경을 고려하여 3-D 프린터를 활용하여 제작한 적외선 방식의 위치 항해사 위치 측정기를 활용하여 실제 항해환경에서 항해사의 위치를 측정하였다. 그 결과, 당직항해사가 당직의 상당한 시간을 통합항해장비(Integrated Navigation System)에 의존하고 있다는 점을 객관적으로 확인할 수 있었다. 이 같은 통합항해장비 의존성에 대한 연구를 통해 인적 과실 절감방안을 연구할 필요성을 확인할 수 있었다.

• 한국안전학회지
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• 제37권3호
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• pp.52-59
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• 2022

Conventionally, all the unsafe acts by human beings in relation to industrial accidents have been regarded as unintentional human errors. Exceptionally, however, in the cases with fatalities, seriously injured workers, and/or losses that evoked social issues, attention was paid to violating related laws and regulations for finding out some people to be prosecuted and given judicial punishments. As Heinrich stated, injury or loss in an accident is quite a random variable, so it can be unfair to utilize it as a criterion for prosecution or punishment. The present study was conducted to comprehend how categorizing intentional violations in unsafe acts might disrupt conventional conclusions about the industrial accident process. It was also intended to seek out the right direction for countermeasures by examining unsafe acts comprehensively rather than limiting the analysis to human errors only. In an analysis of 150 industrial accident cases that caused fatalities and featured relatively clear accident scenarios, the results showed that only 36.0% (54 cases) of the workers recognized the situation they confronted as risky, out of which 29.6% (16 cases) thought of the risk as trivial. In addition, even when the risks were recognized, most workers attempted to solve the hazardous situations in ways that violated rules or regulations. If analyzed with a focus on human errors, accidents can be attributed to personal deviations. However, if considered with an emphasis on safety rules or regulations, the focus will naturally move to the question of whether the workers intentionally violated them or not. As a consequence, failure of managerial efforts may be highlighted. Therefore, it was concluded that management should consider unsafe acts comprehensively, with violations included in principle, during accident investigations and the development of countermeasures to prevent future accidents.