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NASA NTRS2010

The Importance of HRA in Human Space Flight: Understanding the Risks

Human performance is critical to crew safety during space missions. Humans interact with hardware and software during ground processing, normal flight, and in response to events. Human interactions with hardware and software can cause Loss of Crew and/or Vehicle (LOCV) through improper actions, or may prevent LOCV through recovery and control actions. Humans have the ability to deal with complex situations and system interactions beyond the capability of machines. Human Reliability Analysis (HRA) is a method used to qualitatively and quantitatively assess the occurrence of human failures that affect availability and reliability of complex systems. Modeling human actions with their corresponding failure probabilities in a Probabilistic Risk Assessment (PRA) provides a more complete picture of system risks and risk contributions. A high-quality HRA can provide valuable information on potential areas for improvement, including training, procedures, human interfaces design, and the need for automation. Modeling human error has always been a challenge in part because performance data is not always readily available. For spaceflight, the challenge is amplified not only because of the small number of participants and limited amount of performance data available, but also due to the lack of definition of the unique factors influencing human performance in space. These factors, called performance shaping factors in HRA terminology, are used in HRA techniques to modify basic human error probabilities in order to capture the context of an analyzed task. Many of the human error modeling techniques were developed within the context of nuclear power plants and therefore the methodologies do not address spaceflight factors such as the effects of microgravity and longer duration missions. This presentation will describe the types of human error risks which have shown up as risk drivers in the Shuttle PRA which may be applicable to commercial space flight. As with other large PRAs of complex machines, human error in the Shuttle PRA proved to be an important contributor (~12 percent) to LOCV. An existing HRA technique was adapted for use in the Shuttle PRA, but additional guidance and improvements are needed to make the HRA task in space-related PRAs easier and more accurate. Therefore, this presentation will also outline plans for expanding current HRA methodology to more explicitly cover spaceflight performance shaping factors.

Hamlin, Teri↗
NASA NTRS2014

Space Mission Human Reliability Analysis (HRA) Project

The purpose of the Space Mission Human Reliability Analysis (HRA) Project is to extend current ground-based HRA risk prediction techniques to a long-duration, space-based tool. Ground-based HRA methodology has been shown to be a reasonable tool for short-duration space missions, such as Space Shuttle and lunar fly-bys. However, longer-duration deep-space missions, such as asteroid and Mars missions, will require the crew to be in space for as long as 400 to 900 day missions with periods of extended autonomy and self-sufficiency. Current indications show higher risk due to fatigue, physiological effects due to extended low gravity environments, and others, may impact HRA predictions. For this project, Safety & Mission Assurance (S&MA) will work with Human Health & Performance (HH&P) to establish what is currently used to assess human reliabiilty for human space programs, identify human performance factors that may be sensitive to long duration space flight, collect available historical data, and update current tools to account for performance shaping factors believed to be important to such missions. This effort will also contribute data to the Human Performance Data Repository and influence the Space Human Factors Engineering research risks and gaps (part of the HRP Program). An accurate risk predictor mitigates Loss of Crew (LOC) and Loss of Mission (LOM).The end result will be an updated HRA model that can effectively predict risk on long-duration missions.

Boyer, Roger↗
NASA NTRS2013

HRA Aerospace Challenges

Compared to equipment designed to perform the same function over and over, humans are just not as reliable. Computers and machines perform the same action in the same way repeatedly getting the same result, unless equipment fails or a human interferes. Humans who are supposed to perform the same actions repeatedly often perform them incorrectly due to a variety of issues including: stress, fatigue, illness, lack of training, distraction, acting at the wrong time, not acting when they should, not following procedures, misinterpreting information or inattention to detail. Why not use robots and automatic controls exclusively if human error is so common? In an emergency or off normal situation that the computer, robotic element, or automatic control system is not designed to respond to, the result is failure unless a human can intervene. The human in the loop may be more likely to cause an error, but is also more likely to catch the error and correct it. When it comes to unexpected situations, or performing multiple tasks outside the defined mission parameters, humans are the only viable alternative. Human Reliability Assessments (HRA) identifies ways to improve human performance and reliability and can lead to improvements in systems designed to interact with humans. Understanding the context of the situation that can lead to human errors, which include taking the wrong action, no action or making bad decisions provides additional information to mitigate risks. With improved human reliability comes reduced risk for the overall operation or project.

DeMott, Diana↗
NASA NTRSDate not supplied

Strategies for Quantifying Human Space Flight Performance in the Crew Health and Performance System

The Crew Health and Performance-Probabilistic Risk Assessment (CHP-PRA) team at NASA Glenn Research Center is planning a customized approach to quantify human spaceflight performance changes with respect to changes to the CHP system functions and capabilities. Using the Directed Acyclic Graphs (DAG) initiated by NASA’s Human Systems Risk Board (HSRB) [1], the team is surveying potential candidate models and novel strategies that generate metrics suitable for supporting decision making related to how the CHP system may influence human system performance risk. One such investigation includes classic Human Reliability Analysis (HRA) models. Traditionally, HRA methods estimate the occurrence of human errors and their impact on the success of an activity when designing and operating a system. While humans perceive, interpret, decide on, and carry out a course of action, the factors affecting performance and error likelihood are commonly referred to as performance shaping factors (PSFs). Originally developed to alleviate safety concerns related to nuclear power plant operations, HRA methods such as THERP [2] and CREAM [3] dismantle an activity into tasks, requiring elemental steps to be executed, and assess their failure due to predefined PSFs. In this study, we compare generic HRA methods and those that incorporate some human spaceflight aspects, such as sleep conditions (SCREAM [4]), with respect to how they may be adopted to capture performance with an intention to mitigate detrimental outcomes elucidated by the HSRB DAGs. We suggest strategies to quantify astronaut performance specific to spaceflight activities and illustrate how such concepts may help in optimizing the CHP system capabilities with respect to Artemis missions.

dag↗
NASA NTRS2016

Tailoring a Human Reliability Analysis to Your Industry Needs

Companies at risk of accidents caused by human error that result in catastrophic consequences include: airline industry mishaps, medical malpractice, medication mistakes, aerospace failures, major oil spills, transportation mishaps, power production failures and manufacturing facility incidents. Human Reliability Assessment (HRA) is used to analyze the inherent risk of human behavior or actions introducing errors into the operation of a system or process. These assessments can be used to identify where errors are most likely to arise and the potential risks involved if they do occur. Using the basic concepts of HRA, an evolving group of methodologies are used to meet various industry needs. Determining which methodology or combination of techniques will provide a quality human reliability assessment is a key element to developing effective strategies for understanding and dealing with risks caused by human errors. There are a number of concerns and difficulties in "tailoring" a Human Reliability Assessment (HRA) for different industries. Although a variety of HRA methodologies are available to analyze human error events, determining the most appropriate tools to provide the most useful results can depend on industry specific cultures and requirements. Methodology selection may be based on a variety of factors that include: 1) how people act and react in different industries, 2) expectations based on industry standards, 3) factors that influence how the human errors could occur such as tasks, tools, environment, workplace, support, training and procedure, 4) type and availability of data, 5) how the industry views risk & reliability, and 6) types of emergencies, contingencies and routine tasks. Other considerations for methodology selection should be based on what information is needed from the assessment. If the principal concern is determination of the primary risk factors contributing to the potential human error, a more detailed analysis method may be employed versus a requirement to provide a numerical value as part of a probabilistic risk assessment. Industries involved with humans operating large equipment or transport systems (ex. railroads or airlines) would have more need to address the man machine interface than medical workers administering medications. Human error occurs in every industry; in most cases the consequences are relatively benign and occasionally beneficial. In cases where the results can have disastrous consequences, the use of Human Reliability techniques to identify and classify the risk of human errors allows a company more opportunities to mitigate or eliminate these types of risks and prevent costly tragedies.

DeMott, D. L.↗
NASA NTRS2019

SCREAM: Space-based Cognitive Reliability Error Analysis Method

Given both ground-based performance shaping factors (PSFs) collected by the U.S. Nuclear Regulatory Commission (USNRC) and potential space-based PSFs collected by JSC's HH&P, this year's task is to determine how to combine them for future human reliability analysis (HRA) of space missions. All HRA to date for space missions have been based on ground data (i.e. 1-G environment). There is no space-based HRA approach. The target of this project to produce a "first of its kind" HRA approach for space missions. As humans go beyond Earth orbit and missions become longer, human performance and reliability is expected to degrade. The questions become by how much, when, and what, leading to defining the overall effect on crew risk. Knowing this information earlier rather than later will help us mitigate this risk by vehicle design, crew training, and operational workarounds.

Boyer, Roger L.↗
NASA NTRS1997

Health Risk Appraisal Use at Headquarters

Specific topics which relate to the NASA Health Risk Appraisal (HRA) include: (1) What is a HRA?; (2) Risk factors; (3) Program use at NASA Headquarters; (4) An alternative approach; (5) Group HRA reports; and (6) Future considerations and conclusion.

Borcherding, Donald↗
NASA NTRS1973

Hypersonic wing test structure design, analysis, and fabrication

An investigation to provide the analyses, data, and hardware required to experimentally validate the beaded panel concept and demonstrate its usefulness as a basis for design of a Hypersonic Research Airplane (HRA) wing is reported. Combinations of the beaded panel structure, heat shields, channel caps and corrugated webs for ribs and spars were analyzed for the wing of a specified HRA to operate at Mach 8 with a lifespan of 150 flights. Detailed analyses were conducted in accordance with established design criteria and included aerodynamic heating and load predictions, transient structural thermal calculations, extensive NASTRAN computer modeling, and structural optimization. Optimum beaded panel tests at 922 K (1200 F) were performed to verify panel performance. Close agreement of predicted and actual critical loads permitted use of design procedures and equations for the beaded panel concept without modification.

Plank, P. P.↗
NASA NTRS1975

Hypersonic wing test structure design, analysis, and fabrication

An investigation was conducted to provide the analyses, data, and hardware required to experimentally validate the beaded panel concept and demonstrate its usefulness as a basis for design of a hypersonic research airplane (HRA). Combinations of beaded panel structure, heat shields, channel caps, and corrugated webs for ribs and spars were analyzed for the wing of a specified HRA to operate at Mach 8 with a life span of 150 flights. Detailed analyses, conducted in accordance with established design criteria, included aerodynamic heating and load predictions, transient structural thermal calculations, extensive NASTRAN computer modeling, and structural optimization. After geometry was established for the total wing, part of the wing (85 sq ft) was designed, fabricated, and assembled into a test structure to experimentally verify the structural adequacy of the beaded panel design concept.

Plank, P. P.↗
NASA NTRS2010

The Importance of Human Reliability Analysis in Human Space Flight: Understanding the Risks

HRA is a method used to describe, qualitatively and quantitatively, the occurrence of human failures in the operation of complex systems that affect availability and reliability. Modeling human actions with their corresponding failure in a PRA (Probabilistic Risk Assessment) provides a more complete picture of the risk and risk contributions. A high quality HRA can provide valuable information on potential areas for improvement, including training, procedural, equipment design and need for automation.

Hamlin, Teri L.↗
NASA NTRS2017

Human Reliability Assessments: Using the Past (Shuttle) to Predict the Future (ORION)

NASA uses two HRA assessment methodologies. The first is a simplified method which is based on how much time is available to complete the action, with consideration included for environmental and personal factors that could influence the human's reliability. This method is expected to provide a conservative value or placeholder as a preliminary estimate. This preliminary estimate is used to determine which placeholder needs a more detailed assessment. The second methodology is used to develop a more detailed human reliability assessment on the performance of critical human actions. This assessment needs to consider more than the time available, this would include factors such as: the importance of the action, the context, environmental factors, potential human stresses, previous experience, training, physical design interfaces, available procedures/checklists and internal human stresses. The more detailed assessment is still expected to be more realistic than that based primarily on time available. When performing an HRA on a system or process that has an operational history, we have information specific to the task based on this history and experience. In the case of a PRA model that is based on a new design and has no operational history, providing a "reasonable" assessment of potential crew actions becomes more problematic. In order to determine what is expected of future operational parameters, the experience from individuals who had relevant experience and were familiar with the system and process previously implemented by NASA was used to provide the "best" available data. Personnel from Flight Operations, Flight Directors, Launch Test Directors, Control Room Console Operators and Astronauts were all interviewed to provide a comprehensive picture of previous NASA operations. Verification of the assumptions and expectations expressed in the assessments will be needed when the procedures, flight rules and operational requirements are developed and then finalized.

DeMott, Diana L.↗
NASA NTRS2016

Human Reliability Assessments: Using the Past (Shuttle) to Predict the Future (Orion)

NASA (National Aeronautics and Space Administration) Johnson Space Center (JSC) Safety and Mission Assurance (S&MA) uses two human reliability analysis (HRA) methodologies. The first is a simplified method which is based on how much time is available to complete the action, with consideration included for environmental and personal factors that could influence the human's reliability. This method is expected to provide a conservative value or placeholder as a preliminary estimate. This preliminary estimate or screening value is used to determine which placeholder needs a more detailed assessment. The second methodology is used to develop a more detailed human reliability assessment on the performance of critical human actions. This assessment needs to consider more than the time available, this would include factors such as: the importance of the action, the context, environmental factors, potential human stresses, previous experience, training, physical design interfaces, available procedures/checklists and internal human stresses. The more detailed assessment is expected to be more realistic than that based primarily on time available. When performing an HRA on a system or process that has an operational history, we have information specific to the task based on this history and experience. In the case of a Probabilistic Risk Assessment (PRA) that is based on a new design and has no operational history, providing a "reasonable" assessment of potential crew actions becomes more challenging. In order to determine what is expected of future operational parameters, the experience from individuals who had relevant experience and were familiar with the system and process previously implemented by NASA was used to provide the "best" available data. Personnel from Flight Operations, Flight Directors, Launch Test Directors, Control Room Console Operators and Astronauts were all interviewed to provide a comprehensive picture of previous NASA operations. Verification of the assumptions and expectations expressed in the assessments will be needed when the procedures, flight rules and operational requirements are developed and then finalized.

DeMott, Diana↗
NASA NTRS2017

Human Reliability Assessments: Using the Past (Shuttle) to Predict the Future (Orion)

NASA (National Aeronautics and Space Administration) Johnson Space Center (JSC) Safety and Mission Assurance (S&MA) uses two human reliability analysis (HRA) methodologies. The first is a simplified method which is based on how much time is available to complete the action, with consideration included for environmental and personal factors that could influence the human's reliability. This method is expected to provide a conservative value or placeholder as a preliminary estimate. This preliminary estimate or screening value is used to determine which placeholder needs a more detailed assessment. The second methodology is used to develop a more detailed human reliability assessment on the performance of critical human actions. This assessment needs to consider more than the time available, this would include factors such as: the importance of the action, the context, environmental factors, potential human stresses, previous experience, training, physical design interfaces, available procedures/checklists and internal human stresses. The more detailed assessment is expected to be more realistic than that based primarily on time available. When performing an HRA on a system or process that has an operational history, we have information specific to the task based on this history and experience. In the case of a Probabilistic Risk Assessment (PRA) that is based on a new design and has no operational history, providing a "reasonable" assessment of potential crew actions becomes more challenging. To determine what is expected of future operational parameters, the experience from individuals who had relevant experience and were familiar with the system and process previously implemented by NASA was used to provide the "best" available data. Personnel from Flight Operations, Flight Directors, Launch Test Directors, Control Room Console Operators, and Astronauts were all interviewed to provide a comprehensive picture of previous NASA operations. Verification of the assumptions and expectations expressed in the assessments will be needed when the procedures, flight rules, and operational requirements are developed and then finalized.

DeMott, Diana L.↗
NASA NTRS2017

Lost in Translation: the Case for Integrated Testing

The building of a spacecraft is complex and often involves multiple suppliers and companies that have their own designs and processes. Standards have been developed across the industries to reduce the chances for critical flight errors at the system level, but the spacecraft is still vulnerable to the introduction of critical errors during integration of these systems. Critical errors can occur at any time during the process and in many cases, human reliability analysis (HRA) identifies human error as a risk driver. Most programs have a test plan in place that is intended to catch these errors, but it is not uncommon for schedule and cost stress to result in less testing than initially planned. Therefore, integrated testing, or "testing as you fly," is essential as a final check on the design and assembly to catch any errors prior to the mission. This presentation will outline the unique benefits of integrated testing by catching critical flight errors that can otherwise go undetected, discuss HRA methods that are used to identify opportunities for human error, lessons learned and challenges over ownership of testing will be discussed.

Young, Aaron↗
NASA NTRS2018

A Prognostic Launch Vehicle Probability of Failure Assessment Methodology for Conceptual Systems Predicated on Human Causal Factors

Create an improved method to calculate reliability of a conceptual launch vehicle system prior to fabrication by using historic data of actual root causes of failures. While failures have unique "proximate causes", there are typically a finite amount of common "root causes". Heretofore launch vehicle reliability evaluation typically hardware-centric statistical analyses, while most root causes of failures are been shown to be human-centric. A method based on human-centric root causes can be used to quantify reliability assessments and focus proposed actions to mitigate problems. Existing methods have been optimistic in their projections of launch vehicle reliability compared to actuals. Hypothesis: reliability of a conceptual launch vehicle can be more accurately evaluated based on a rational, probabilistic approach using past failure assessment teams' findings predicated on human-centric causes."Human Reliability Analysis Methods Selection Guidance for NASA"Chandler F.T., et al., NASA HQ/OSMA study group, July 2006. Outside HRA experts from academia, other federal labs, and the private sector. 50 system reliability methods considered, fourteen selected for further study, four finally selected as best suited for human spaceflight. Probabilistic Risk Analysis (PRA) + Human Reliability Analysis (HRA) enabled incorporating effects and probabilities of human errors. While four down-selected methods deemed appropriate for failure assessment, it did not appear that these methods could be concisely applied to perform major system-wide assessment of probability of failure of a conceptual design without becoming unwieldy."Engineering a Safer World", Detailed, comprehensive study external to NASA Leveson N. G., MIT, 2011.Systems-Theoretic Accident Model and Processes (STAMP). All-encompassing accident model based on systems theory analyzed accidents after they occurred and created approaches to prevent occurrence in developing systems not focused on failure prevention per se, but rather reducing hazards by influencing human behavior through use of constraints, hierarchical control structures, and process models to improve system safetySystem Theoretic Process Analysis (STPA) addresses predictive part of problem (a "hazard analysis"). Includes all causal factors identified in STAMP: "...design errors, software flaws, component interaction accidents, cognitively complex human decision-making errors, and social organizational and management factors contributing to accidents" can guide design process rather than require it to exist before-hand did not appear capable of concise application for system-wide assessment of probability of failure of a conceptual design without becoming unwieldy.

Williams, Craig H.↗
NASA NTRS2014

Human Reliability and the Cost of Doing Business

Most businesses recognize that people will make mistakes and assume errors are just part of the cost of doing business, but does it need to be? Companies with high risk, or major consequences, should consider the effect of human error. In a variety of industries, Human Errors have caused costly failures and workplace injuries. These have included: airline mishaps, medical malpractice, administration of medication and major oil spills have all been blamed on human error. A technique to mitigate or even eliminate some of these costly human errors is the use of Human Reliability Analysis (HRA). Various methodologies are available to perform Human Reliability Assessments that range from identifying the most likely areas for concern to detailed assessments with human error failure probabilities calculated. Which methodology to use would be based on a variety of factors that would include: 1) how people react and act in different industries, and differing expectations based on industries standards, 2) factors that influence how the human errors could occur such as tasks, tools, environment, workplace, support, training and procedure, 3) type and availability of data and 4) how the industry views risk & reliability influences ( types of emergencies, contingencies and routine tasks versus cost based concerns). The Human Reliability Assessments should be the first step to reduce, mitigate or eliminate the costly mistakes or catastrophic failures. Using Human Reliability techniques to identify and classify human error risks allows a company more opportunities to mitigate or eliminate these risks and prevent costly failures.

DeMott, Diana↗
NASA NTRS2017

And the Humans Save the Day or Maybe They Ruin It: The Importance of Humans in the Loop

Flying a mission in space requires a massive commitment of resources, and without the talent and commitment of the people involved in this effort we would never leave the atmosphere of Earth. When we use the phrase "humans in the loop", it could apply to almost any endeavor since everything starts with humans developing a concept, completing the design process, building or implementing a product and using the product to achieve a goal or purpose. Narrowing the focus to spaceflights, there are a variety of individuals involved throughout the preparations for flight and the flight itself. All of the humans involved add value and support for program success. The purpose of this paper focuses on how a Probabilistic Risk Assessment (PRA) accounts for the human in the loop for potential missions using a technique called Human Reliability Analysis (HRA). Human actions can increase or decrease the overall risk via initiating events or mitigating them, thus removing the human from the loop doesn't always lower the risk.

DeMott, Diana↗
NASA NTRS2017

And the Human Saves the Day or Maybe They Ruin It, The Importance of Humans in the Loop

Flying a mission in space requires a massive commitment of resources, and without the talent and commitment of the people involved in this effort we would never leave the atmosphere of Earth as safely as we have. When we use the phrase "humans in the loop", it could apply to almost any endeavor since everything starts with humans developing a concept, completing the design process, building or implementing a product and using the product to achieve a goal or purpose. Narrowing the focus to spaceflight, there are a variety of individuals involved throughout the preparations for flight and the flight itself. All of the humans involved add value and support for program success. The paper discusses the concepts of human involvement in technological programs, how a Probabilistic Risk Assessment (PRA) accounts for the human in the loop for potential missions using a technique called Human Reliability Analysis (HRA) and the tradeoffs between having a human in the loop or not. Human actions can increase or decrease the overall risk via initiating events or mitigating them, thus removing the human from the loop doesn't always lowers the risk.

DeMott, Diana L.↗