Abstract

ABSTRACTObjective: Determine barriers and facilitators to effective voluntary reporting system (VRS) operation.Background: As human error accounts for a larger portion of accidents and incidents in high-risk industries, federal agencies that define regulations and guidelines promote various safety management techniques, including more robust safety data collection. VRSs aim to identify and address “near misses” (errors identified before resulting in negative outcomes) through employee disclosure of committed errors and violations. Despite their value, VRSs are underutilized.Method: A literature review was conducted to understand successful safety management practices and challenges, and define reporting requirements for accidents, incidents, and near misses (which rely on voluntary disclosure). Variations in the policies, processes, and utility of several VRSs were explored, and common themes were identified. Interviews were then conducted with VRS developers, users, and managers to further explore these themes.Results: The literature review narrowed the focus to confidential, nonpunitive VRSs for process and product safety concerns, such as the Aviation Safety Action Program (ASAP). Common themes exposed 8 categories of barriers and facilitators to effective VRS operation, participation, and use of report data. The literature review verified and elaborated on these barriers, and offered solutions (facilitators) based on personal observations and experiences.Conclusion: Consistent themes associated with effective and ineffective VRS operation can be used to improve VRS participation and the effectiveness of error prediction and prevention capabilities.

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