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Introductory Letter
Introductory Letter
Swiss Re
At Swiss Re it gives us both a sense of
pleasure and commitment to participate
in the presentation of the key research
findings of Group Interaction in High
Risk Environments.
Pleasure, because of the involvement of
the Swiss Re Centre for Global Dialogue in
hosting the final conference of this important
5 year research project. And commitment,
because as a global leader in capital and
risk management we must observe the
development of risks in our communities,
economy and environment and foster a
broader awareness of potential hazards.
For us it is therefore important that these
concrete research findings on group interaction
are relevant far beyond the situations in which
they were observed. And that this White Book,
now allows us to communicate these hard-
won insights to our clients and the broader
insurance community.
In high risk situations the quality of
human interaction is critical to the minimizing
of human error. To err is indeed human. But as
our societies continue to create more complex
technological environments, we must enhance
our interaction and dialogue skills to ensure
that small mistakes do not spiral into major
systems failures.
Only with this consistent application and
training of safety related approaches will we
avoid or reduce the damage and injury caused
through poor or negligible behavior.
And progress in the on-going task Swiss Re
has set itself, of supporting the active prevention
of hazards and their ensuing harm, thereby Rudolf Kellenberger
contributing to the creation of a safer world. Deputy Chief Executive Officer, Swiss Re
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Contents
Introduction 8
Section 1
Recommendations to Enhance Predictability (Clarify the 12
what ifs to improve the predictability of the situation)
1: Ask early for the task later (Inquire early ask questions early 13
in the life of the team)
11: Prepare for the worst Use briefings to plan for contingencies 32
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Contents
Section 2
Recommendations to Improve Communication 34
(Be attentive to the quantity, style and complexity
of verbalization)
20: RNs talk more like MDs (i.e., concisely) and MDs listen more 50
like RNs (i.e., attentively)
Summary 54
Contributors 58
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Introduction:
Golden Rules of Group Interaction
in High Risk Environments:
Evidence based suggestions
for improving performance
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Introduction
10
Introduction
11
Introduction
References
Knaus, W.A., Draper, E.A., Wagner, D.P.
& Zimmerman, J.E. (1986). An evaluation
of outcome from intensive care in major
medical centers. Annals of Internal Medicine
104(3): 410418.
12
Section 1:
Enhance Predictability
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13
Recommendation 1: Actors
Training specialists and team members
Ask early for the task later
(Inquire early ask questions References
early in the life of the team) Ginnett, R. C. (1987). First Encounters of the
Close Kind: The Formation Process of Airline Flight
Reason Crews. Yale University: Doctoral dissertation.
Prior research has demonstrated that shared
mental models and predictable patterns Sexton, J.B. & Helmreich, R.L. (2002).
of behavior are imperative to laying the Using language in the cockpit: Relationships
groundwork for subsequent effective teamwork with workload and performance. In R.
and communication. Ginnett (1987) has Dietrich (Ed) Communication in High Risk
shown that initial crewmember interactions Environments. Linguistische Berichte Sonderheft
set the tone for the team and can predict 12: 5774. Buske Verlag: Hamburg.
subsequent team performance. In fact, a
GIHRE simulator study of 4 flights found GIHRE-book chapter: Threat
that the relationships between language use
and flight outcome measures were strongest
between language use in the first flight, and
subsequent (second, third and fourth flights)
performance and error measures.
Consequence
Sexton & Helmreich (2002) found that the
number of questions asked in the initial flight
was positively correlated to performance in
subsequent flights. In other words, crews
who asked a lot of questions initially (thereby
clarifying uncertainties) had higher subsequent
performance than crews who did not ask
questions. Asking questions was not correlated
to performance within the same flight, rather,
initial inquiry was correlated to subsequent
performance. It appears to be the case that
clarifying uncertainties is best accomplished in an
initial flight (thereby improving predictability)
rather than waiting to ask questions later.
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14
15
Consultations
16
Reason References
In routine situations, which are typically Kerr, S. and Jermier, J. M. (1978).
highly regulated by organizations, people Substitutes for Leadership: Their Meaning
do not need a leader to tell them what to do. and Measurement. Organizational Behavior
Depersonalized leadership in the form of and Human performance 22: 375403
standardized operating procedures (SOPs)
can substitute for personal leadership. Zaccaro, S., J., A. Rittman, L., et al. (2001).
GIHRE Coordination found a negative Team leadership. The Leadership Quarterly
correlation between performance of cockpit 12: 451483.
crews and leadership behavior in highly
standardized situations. The more leadership GIHRE-book chapter: Leadership
behavior was observed the worse the & coordination
performance. This notion was also supported
by interview material. Anesthesia team
members expressed that they like clear
leadership behavior if the situation is
complex, unknown, or high workload, but
they dislike it during routine situations.
Consequence
A leader who does not have to actively engage a
technical task during standard / routine situations
is afforded the opportunity to observe and learn
about the team while SOPs accomplish the role of
guiding behavior. This opportunity to observe
the team at work and gain a better assessment
of the team and each individual member
can be critical during less routine or higher
workload situations, when the ability to
predict and understand the behaviors of others
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17
20
18
16
14
Percentage
12
10
8
6
4
2
0
Phase 1 high Phase 2 high Phase 3 high
standardization standardization standardization
# 3 Figure. Percent of leadership behavior present in teams performing well vs. poorly during
flight phases with varying standardization levels.
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18
Consequence
Leaders who fail to delegate during high
workload situations risk overload due to the
simultaneous burden of managing the task,
the team and the environment. In aviation,
medicine, or NPP, the notion of leadership
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19
20
21
4
% of words spoken
0
A (routine) B (abnormal) C (routine) D (abnormal)
Flight Segment
22
Consequence
Investigations of aircrew transcripts indicated
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23
Okay, ask him, uh, what kind of weather trends he has got going
there, if it is going down.
Problem Solvingcommunications by
position and performance
% of total communication
50
40
30
20
10
0
Low Mid High
Performance Performance Performance
Captain
First Officer
Second Officer
24
25
12
10
8
Percentage
# 7 Figure: Percent of implicit coordination by first officer in teams performing well vs. poorly.
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Consequences
Adaptive coordination behavior is a
significant contribution to effective teamwork
as emergency situations arise. Teams working
in a routine phase (with little coordination
effort) need to notice and adapt if something
threatening happens. There is a clear need for
explicit coordination, which helps to build
a common mental model of the situation
and to work out a strategy to cope with it.
If the team has a plan for contingencies (e.g.,
briefing), it doesnt necessarily need to spend
any more resources with time-consuming
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Flight phase
1 2 3
Take-off Preparation Approach
Clean approach and Landing
Average duration (min.) 3 10 3
Task load Low Low High
Standardization High Low High
Communication units (CU) overall 840 3514 1429
CU standardized communication 52% 9% 28%
CU explicit 66% 81% 60%
CU implicit 34% 19% 40%
CU leadership 2% 14% 3%
CU Heedful interrelating 2% 18% 19%
# 8 Table. Coordination patterns during different flight phases from GIHRE Coordination
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Consequence
The team coordinates its actions smoothly
and safely, because it anticipates high
workload situations and prepares itself for
them. Heedful interacting helps to prevent
individual members from experiencing
overload, because their fellow team members
notice symptoms of overload in time and help
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30
31
References
Dien, Y. (1998). Safety and application of
procedures, or how do they have to use
operating procedures in nuclear power
plants?. Safety Science 29: 179187.
32
Recommendation 11: present need for knowing the threats and possible
contingencies, establishing norms, and having a
Prepare for the worst:
formal opportunity to build the team. In commercial
Use briefings to plan aviation, we know that briefing content is a
for contingencies powerful predictor of subsequent performance
(Ginnett, 1987; Sexton & Helmreich, 2000).
Reason GIHRE-Aviation has demonstrated that sub-
Briefings have been demonstrated as an optimal briefing is a leading deficiency of simulator
effective means by which leaders can plan crews that consistently perform poorly across three
for contingencies, establish norms, discuss simulation scenarios. High performing crews
threats, and build the team all at the same displayed very good planning and contingency
time. There are two critical components of management and showed good situational
briefings: technical and interpersonal. In the awareness. In contrast poor performing
technical component, it is important for the crews had inadequate planning and
leader (be it a captain, surgical attending or insufficient situational awareness they
NPP shift manager) to cover the technical did not evaluate their plans as required
details of what will take place, set expectations by the changing situation.
and plan for contingencies. Regarding the Contingency planning (part of the
interpersonal component, which is often a technical component of briefing) was a
function of how the technical component is predominant behavior in crews that dealt
articulated, the leader must open channels successfully with technical problems.
of communication, empower team members In medicine, there is anecdotal evidence
to speak up and participate, and formally that operating room briefings (approximately
establish the team environment. In commercial 90 second discussion just prior to skin incision)
aviation, it is not uncommon to hear a captain are proving to be valuable. Operating room
tell the crew I only got 3 hours of sleep last briefings allow the multidisciplinary team
night and am feeling off today, please keep performing a surgical procedure to create
and eye on me and dont let me do anything shared mental model of the situation, plan
stupid. The phrase dont let me do anything for contingencies, and open up channels
stupid goes a long way to engage team of communication between physicians and
members in the process and empower them nurses, as well as between anesthesia and
to participate2. The delicate balancing act surgery personnel. These operating room
of the leader in a briefing is to display briefings have been associated with reductions
competence while disavowing perfection. in nurse turnover rates, reductions in perceived
workload, and increases in nurse input (James
Consequence DeFontes, MD personal communication
In technologically advanced and psychologically April 2003).
complex environments such as the operating room,
intensive care unit, or cockpit there is a clear and
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Actors
Safety specialists, training specialists, medical
school faculty and team members
References
GIHRE-book chapter: Structures
34
Section 2:
Improve Communication
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35
36
37
Consequence
Positive feedback during a difficult task
can help to build confidence in junior
team members, reduce stress, and to clarify
ambiguities. Feedback after the task is
completed, sometimes in the form of a
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39
40
41
42
43
1400
1200
Number of words spoken
1000
800
600
400
200
0
A (routine) B (abnormal) C (routine) D (abnormal)
Captain
First Officer
Second Officer
44
45
compatible
N400 latency at Pz (ms)
1000 L1
L2
800
600
400
100 400 700
46
Consequences
In a situation where verbal communication
is essential, additional tasks should be kept
as free as possible from language-like processes
such as reading written messages or digital
displays. Instead, information should be
presented using self-explanatory symbols
or signs such as arrows, which point into
the direction of action or analogue instead
of digital displays to avoid language-related
translation processes. As shown in # 18
Figure, there is less interference between
language perception and the visual processing
of a non-linguistic square than with
processing of the linguistic letter.
As described in Rule 16 semantic processing
during language perception is indicated
by the N400 component, a brain signal
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47
900
letter
N400 latency (ms)
700 square
500
300
100 700
SOA (ms )
# 18 Figure. While speaking, reaction times were slower for processing letters as compared
to processing shapes (measured in milliseconds).
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Consequence
Standardized terms can prevent communication
breakdowns under conditions of increased
task load in communication settings where
speakers and listeners are physically separated.
Conversely, informal speaking can contain
multiple ambiguous linguistic meanings that
can lead to misunderstandings. Linguistic
meanings that are used more commonly are
processed more rapidly and with fewer errors.
The use of standardized phraseology is
correlated with the risk of producing
incoherent verbal contributions under
conditions of non-standard high task load.
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50
51
90
80 90%
70
60
50
40
54%
30
20
10
0
RN rates ICU Physician ICU Physician rates RN
52
53
54
Summary
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Summary
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Summary
is so. When explicitly part of a corporate and to its specific environment. As regards
culture, as in the no risk no fun approach, responsibility for saf operation, the line
those reasons are easier to detect than if they extends from the individual operator to the
are part of the unwritten rules of the game. management processes and on to cultural
Such hidden shortcomings usually go factors. The traditional quantitative risk
undetected in routine safety audits, in which assessment approach based on figures from
individual processes are analyzed and individual the past is enhanced with a qualitative
operators are questioned. Particularly in cases component of analysis to offer a future-
when unsafe activity becomes established oriented indication of risk.
as a deliberate standard procedure, neither To conclude, the better we foresee the
management nor auditors are likely to hear potentially weak link in a safe operation, the
the whole story. So the safety auditor should more effectively its failure can be prevented.
routinely ask himself two questions: first, does And from the insurers point of view, the
the safety culture allow for unsafe shortcuts balance saved from each large loss avoided
and second, what might motivate or offer will more than cover the cost of risk and
benefit to somebody who were to take them? safety research.
Answers can only be found if adherence
to operating and communication processes is
controllable, and will only prove useful if they
divulge information about the corporate code
of conduct and safety rules in everyday practice.
Given large corporate clients enormous
risk potentials and their huge demands for
cover, insuring them has almost become a
business in its own right. Risk pricing is not
only based on statistics and loss history, but
largely on potential losses, thus as insurers
call it on the risk quality understood to
be a measure for the loss propensity within
a given safety culture.
For this reason, insurers of high risk
operations are well advised to closely examine
corporate safety culture and its underlying
safety management systems. The change
from the linear cause-consequence relationship
model to the complex interactive way of
approaching risks has induced a paradigm Marcel Brge
shift in risk analysis branching out from Head of Risk Engineering and Training,
the physical process plant to the corporation Swiss Re
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Summary
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Contributors
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Contributors
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Contributors
and received her Ph.D. at the Georgia Institute Safety Foundation Distinguished Service Award
of Technology in Atlanta, USA, in 1987. in 1994 and Human Factors award in 2004.
Main research interests are the effects of He was Chair of the Foundations Icarus
automation, safety management and safety Committee. He received Laurels from Aviation
culture, computer-supported co-operation, Week and Space Technology in 1994 and 2002
planning in organizations, multimedia for his research into human factors in aviation.
learning, and the relationship between He is a fellow of the Royal Aeronautical
work and personal identity. Society, the American Psychological
Association, and the American Psychological
Ruth Husler Society. His research has been supported
Ruth Husler is a research and teaching by the National Science Foundation, NASA,
assistant at the Department of Work and the Agency for Healthcare Research and
Organisational Psychology at the University Quality, and the Daimler-Benz Foundation.
of Bern, Switzerland. She received her masters He has more than two hundred publications
degree in Psychology at the University of and is author, with Ashleigh Merritt, of Culture
Bern in 2000. For four years she has been at Work in Aviation and Medicine: National,
working in the field of aviation psychology, Organizational, and Professional Influences.
starting with her master thesis on the
measurement of Crew Resource Management Annette Hohlfeld
(CRM) behavior at Swissair. She is currently Since her masters work, a main focus of
working in the GIHRE-aviation part of Annette Hohlfelds work at the Humboldt-
the Collegium. Another project links her University, has been language impairment
to the Department of Anaesthesiology at and language development. Whereas her
the University Hospital in Basel, in which master thesis mainly focuses on language
a CRM measurement tool for full surgical impairment, her doctoral dissertation, which
teams is developed and validated. The subjects was completed in 2001, compares language
of her doctoral thesis are the work strategies processing in normal and aphasic speakers.
of pilots and their effect on performance in Her interest in psycholinguistics as well as
high workload situations. in its methodology brought her into contact
with the GIHRE Collegium. Within this
Robert Helmreich project she has investigated how language
Robert Helmreich is professor of psychology perception changes when the perceiver has
at The University of Texas at Austin. He to solve another parallel task.
received BS, MS, and Ph.D. degrees from
Yale University. He is director of University Barbara Klampfer
of Texas Human Factors Research Project Barbara Klampfer, PhD, is Human Factors
which investigates human performance and Manager at StateRail in Sydney, Australia.
threat and error management in aviation She received her masters degree in
and medicine. Helmreich received the Flight Psychology at the University of Salzburg in
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Contributors
1995, where she also did postgraduate work at the Free University Berlin for a thesis on
on Training Conception and Methodology. the construction of social reality through
From 1997 to 2002 she worked as a research linguistic interaction. She joined the
assistant at the Swiss Federal Institute of Collegium on Group Interaction in High
Technology, Zurich. Since 1997, she holds Risk Environments in 2001 and is currently
a Private Pilot License. From 1997 to 1999, working on her Ph.D. dissertation on
she worked with a project dealing with conversational aspects of understanding
incident analysis based on in-flight data in the cockpit within the general framework
under grants from Swissair Flight Safety of the subproject Linguistic Factors.
Department and the Swiss Reinsurance Her main research interests include
Company. Her doctoral thesis focused on the conversation analysis and ethnomethodology,
influence of automation on minor incident. interactional linguistics, speech act theory,
In 2002 she received her PhD from the Swiss theory of (social) action, qualitative research
Federal Institute of Technology. From 1999 methods, language and gender, Bourdieus
to 2003 she worked as the scientific project social theory and constructivism.
head in the GIHRE-aviation project.
Capt. Werner Naef
Manfred Krifka Werner Naef, born 1947, started studying
Manfred Krifka is currently Professor engineering at the Swiss Federal Institute
of General Linguistics at the Humboldt of Technology in Zurich in 1966. In 1969
University, Berlin, and director of the Zentrum he graduated as air force pilot and consequently
fr Allgemeine Sprachwissenschaft, Berlin. joined Swissair as an airline pilot. He has been
He was professor of linguistics at the a captain with Swissair since 1981 and has
University of Texas at Austin, 19902000, held several positions as Training Captain,
and fellow of the Center for Advanced Study Instructor and Check pilot, Deputy Fleet
in the Behavioral Sciences, Stanford, 19956. Chief Pilot and member of the pilot selection
His main interests are the syntax, semantics team. Between 1976 and 1981, he received
and pragmatics of natural languages, and postgraduate training in psychotherapy and
language typology. He has worked, in consequently became responsible for the
particular, on aspect, measure constructions, Human Aspects Development / Crew Resource
questions and information structure and is Management Training at Swissair. He was
the editor of two major journals, Linguistics a board member of the European Assoc. for
and Philosophy and Theoretical Linguistics, Aviation Psychology, acted as delegate of
an open peer review journal. the AEA (Assoc. of Europe. Airlines) in the
Web site: http://amor.rz.hu-berlin.de/~h2816i3x/ European Joint Aviation Authorities Human
Factors Steering Group and held a post as
Silka Martens the Swiss Civil Aviation Authoritys Human
Silka Martens received her diploma in Factors expert. He is an EAAP-registered
sociology and her M.A.-degree in linguistics aviation human factors specialist. Werner
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Contributors
Naef served for 32 years in the Swiss air force extend his research approach on response
as pilot, squadron commander and chief of preparation and motor control by means of
operations control air transport. At the brink psychophysiological methods. His research
of Swissairs financial breakdown he started scope encompasses motor control under
up a training company with two more micro-gravity, language processes and clinical
partners, specializing in team and skill syndromes such as Parkinson and apraxia.
training for potential high risk work The major focus of his interest, however, is
situations. He became heavily involved response preparation under high task load,
in simulator training for rail and for trauma particularly in multiple task situations and
surgeons. In late 2003 he started at Air New with conflicting task demands including
Zealand in Auckland as Human Factors time pressure. Jrg Sangals regards human
Investigator, still involved in rail simulator communication as a special form of multi-
training in Australia. tasking. With this intention in mind,
he joined the GIHRE Collegium in order
Sascha Neuper to apply his research to real-life high-
Sascha Neuper, born in 1970, received his risk environments.
diploma in psychology at the Ruhr-Universitt
Bochum for a thesis on the effect of deadline Florian Schwarz
instructions on stroop interference. He joined Florian Schwarz received his M.A. in
the Collegium on Group Interaction in High Linguistics and Philosophy from the
Risk Environments in 2001 and is currently Humboldt University in 2003. From 2001
working on his Ph.D. dissertation within to 2003 he was a member of the GIHRE
the general framework of the project. He Linguistic Factors project. This project looked
experimentally investigates whether different at the communication between crew members
question types can be disturbed differentially in the cockpit, applying analytic tools from
under high workload conditions. His main linguistic pragmatics to real life situations.
interests in experimental research on human His interests in theoretical linguistics include
behavior are methodology, attention, language formal semantics and pragmatics of natural
processing and expectation effects. language, information structure, and syntax.
He is currently pursuing a PhD in theoretical
Jrg Sangals linguistics at the University of Massachusetts.
Dr. Jrg Sangals is assistant lecturer and
researcher at the department of biological Bryan Sexton
psychology and psychophysiology at the Dr. Bryan Sexton is an assistant professor
Humboldt-University at Berlin. After his at The Johns Hopkins University School
doctoral dissertation in 1997 on the learning of Medicine, and is the Director of Safety
of tool transformations at the Leibniz Research Attitudes Research at The University of
Centre for Working Environment and Human Texas Center of Excellence for Patients Safety
Factors in Dortmund, he came to Berlin to Research and Practice. He has spent the past
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Contributors
12 years conducting research in safety-critical for the International Atomic Energy Agency
team environments, splitting his time (IAEA), the Nuclear Regulatory Commission
between the cockpit, the OR, and the ICU. (NRC) of the United States, the Swiss
This work has taken him from studying pilot Regulatory Body (HSK), and the OECD
communication and flight safety in the cockpit Halden Reactor Project. Main topics of
(through direct observations of pilot behavior research and development are errors of
and simulator studies), to investigations commission, cognitive errors, organizational
of patient safety and group dynamics in safety and incident evaluations. His Ph.D.
medicine. Currently, he is investigating was done on the evaluation of operational
the links between attitudes, behaviors, experience regarding human reliability
and outcomes in aviation and medicine. together with the Institute of Ergonomics
of the University of Technology Munich.
Werner Sommer Since 1999 he has also been working at the
Prof. Dr. Werner Sommer (born 1952) received Institute in the fields of human factors for
his diploma in Psychology from the University automobile, occupational safety and aviation.
of Wrzburg in 1976. He obtained both In 2002 he moved to EUROCONTROL,
his doctoral degree (1982) and his Dr. habil. the European organization for the safety of
(1991) at the University of Konstanz. air navigation. Currently he is responsible for
In 1995 he was appointed professor of SHAPE (Solutions for Human Automation
Biological Psychology and Psychophysiology Partnerships in European ATM), which deals
at the department of Psychology at the with the effects of new automated systems
Humboldt-University Berlin. His general on the performance of controllers. Since 2003
research interest is the investigation of human he has been a member of the German Reactor
information processing by recording electrical Safety Commission.
brain potentials. Currently, he is engaged in
studies on movement preparation, dual task Enik Zala-Mezo
processing, language perception, processing In 1989 Enik Zala-Mezo obtained a Masters
facial information, and the significance of degree in Psychology at Kossuth University
specific brain potentials. (Debrecen, Hungary) with a thesis focusing
on the Psychology of Decision-Making.
Oliver Strter While at Kossuth University, she also worked
Dr. Oliver Strter studied engineering as a teaching and research assistant in the
psychology and worked for GRS (Gesellschaft fields of Social and Organisational Psychology.
fr Anlagen und Reaktorsicherheit), the In 2000 she completed a doctoral dissertation
German Nuclear Regulatory Body, from 1992 in the department of Organisational
till 2002. At GRS he developed methods Psychology. The topic was how subjective
for incident investigation and reliability judgments about organizational justice are
assessment regarding human impact on the formed. Adopting an interdisciplinary
safety of nuclear installations. He counseled approach, she drew on research carried out in
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Contributors
Swiss Re Contributors
Marcel Buerge
Marcel Buerge is a chemical engineer by
education. Having spent ten years in the
chemical process and engineering industries,
Marcel joined Swiss Re as a risk engineer,
assessing process and environmental risks.
He is currently head of Swiss Res Risk
Engineering Service Center. This unit is
charged with enhancing risk awareness for
man-made risks and supporting corporate
non-life business underwriting with a multi-
disciplinary team of engineers and scientists
experienced in risk assessment methods,
risk exposure analysis and industrial
safety management.
Ernst G. Zirngast
Ernst G. Zirngast received his degree in
mechanical engineering at the Technikum
Winterthur. He spent many years working for
the Sulzer corporation in Winterthur, Mexico,
USA and the UK. In 1996 he joined Swiss
Res Risk Engineering Services in Zrich as
a risk expert for oil and petrochemical plants.
His areas of interest include topics such as
process safety management, application of
work psychology, emotional intelligence,
and safety culture.
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