The root cause of ability and inability to assemble and install components using written manual with or without diagrams among non-native English speakers: Root cause analysis

AEROS Conference 2017

Shukri, S. Ahmad^1 ; Millar, R.^2 ; Gratton, G.^3 ; Garner, M.^4 ; Mohd Noh, H.^1

Universiti Kuala Lumpur-Malaysian Institute of Aviation Technology, Kampung Jenderam Hulu, Dengkil, Selangor, Malaysia^1

The University of Aberdeen, King's College, Aberdeen

AB24 3FX, United Kingdom^2

Brunel University, London, Uxbridge

UB8 3PH, United Kingdom^3

University of Roehampton, London

SW15 4JD, United Kingdom^4

关键词: Aircraft maintenance;    Communication media;    Contributory factors;    Human errors;    Probability of success;    Root cause analysis;    Second phase;    Third phase;   

Others  :  https://iopscience.iop.org/article/10.1088/1757-899X/270/1/012036/pdf
DOI  :  10.1088/1757-899X/270/1/012036

来源: IOP

【 摘 要 】

Documentation errors and human errors are often claimed to be the contributory factors for aircraft maintenance mistakes. This paper highlights the preliminary results of the third phase of a four-phased research on communication media that are utilised in an aircraft maintenance organisation. The second phase has looked into the probability of success and failure in completing a task by 60 subjects while in this third phase, the same subjects have been interviewed immediately after completing the task by using Root Cause Analysis (RCA) method. It is discovered that the root cause of their inability to finish the task while using only written manual is the absence of diagrams. However, haste is identified to be the root cause for the incompletion of the task when both manual and diagram are given to the participants. It is observed that those who are able to complete the task is due to their reference to both manual and diagram, simultaneously.