Major accidents, such as the 2014 Sewol ferry sinking in South Korea, rarely occur due to a single failure, nor exclusively due to human error. Technical and systemic factors in addition to human factors, contribute to a disaster. Applying the PCM (Perceptual Cycle Model) method, this work performs parallel analyses for the captain and crew’s decision-making during the Sewol sinking and identifies factors that contributed to the failure of passengers’ rescue. From this perspective, this article demonstrates that the PCM method is capable of proposing recommendations at all layers of the complex sociotechnical system in which the accident is inserted, since wrong decisions could be consequence of flaws and gaps at any level of the hierarchical structure. The proposed methodology also provides a holistic view of the decision-making that occurred within the Sewol's bridge, highlighting the strong influence of Asian social culture.

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Sociotechnical Systems and the Sewol Tragedy: How Culture and Structure Impact Decision-Making and Safety

  • Daniella C. Fernandes,
  • Moacyr M. Cardoso

摘要

Major accidents, such as the 2014 Sewol ferry sinking in South Korea, rarely occur due to a single failure, nor exclusively due to human error. Technical and systemic factors in addition to human factors, contribute to a disaster. Applying the PCM (Perceptual Cycle Model) method, this work performs parallel analyses for the captain and crew’s decision-making during the Sewol sinking and identifies factors that contributed to the failure of passengers’ rescue. From this perspective, this article demonstrates that the PCM method is capable of proposing recommendations at all layers of the complex sociotechnical system in which the accident is inserted, since wrong decisions could be consequence of flaws and gaps at any level of the hierarchical structure. The proposed methodology also provides a holistic view of the decision-making that occurred within the Sewol's bridge, highlighting the strong influence of Asian social culture.