Appendix E
Biographies of Authors

James P. Bagian has extensive experience in the fields of human factors in aviation and patient safety. He was chosen as the first director of the Department of Veterans Affairs’ National Center for Patient Safety in 1998. A former astronaut, Dr. Bagian flew on two Space Shuttle missions and supervised the recovery of Challenger following the explosion in 1986. He also led the development of the Space Shuttle Escape System now in use. Dr. Bagian holds a B.S. in mechanical engineering from Drexel University and an M.D. from Thomas Jefferson University. He is a member of the National Academy of Engineering and is on the faculty of the Uniformed Services University of Health Sciences and University of Texas Medical Branch. Dr. Bagian received the American Medical Association 2001 Dr. Nathan S. Davis Award for outstanding public service in the advancement of public health and the Association of American Medical Colleges first annual Innovations Award in 2001. In 2002, he received the Frank Brown Berry Prize in Federal Healthcare, which recognizes a military or federal physician who has made a significant contribution to health care in the United States.

John S. Carroll is professor of behavioral and policy sciences at the Sloan School of Management, Massachusetts Institute of Technology (MIT). He received a B.S. in physics from MIT and a Ph.D. in social psychology from Harvard. Prior to joining the faculty of the Sloan School in 1983, he taught in the psychology departments of Carnegie-Mellon University and Loyola University of Chicago and was a visiting associate professor at the Graduate School of Business, University of Chicago. Professor Carroll has published four books and



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Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence Appendix E Biographies of Authors James P. Bagian has extensive experience in the fields of human factors in aviation and patient safety. He was chosen as the first director of the Department of Veterans Affairs’ National Center for Patient Safety in 1998. A former astronaut, Dr. Bagian flew on two Space Shuttle missions and supervised the recovery of Challenger following the explosion in 1986. He also led the development of the Space Shuttle Escape System now in use. Dr. Bagian holds a B.S. in mechanical engineering from Drexel University and an M.D. from Thomas Jefferson University. He is a member of the National Academy of Engineering and is on the faculty of the Uniformed Services University of Health Sciences and University of Texas Medical Branch. Dr. Bagian received the American Medical Association 2001 Dr. Nathan S. Davis Award for outstanding public service in the advancement of public health and the Association of American Medical Colleges first annual Innovations Award in 2001. In 2002, he received the Frank Brown Berry Prize in Federal Healthcare, which recognizes a military or federal physician who has made a significant contribution to health care in the United States. John S. Carroll is professor of behavioral and policy sciences at the Sloan School of Management, Massachusetts Institute of Technology (MIT). He received a B.S. in physics from MIT and a Ph.D. in social psychology from Harvard. Prior to joining the faculty of the Sloan School in 1983, he taught in the psychology departments of Carnegie-Mellon University and Loyola University of Chicago and was a visiting associate professor at the Graduate School of Business, University of Chicago. Professor Carroll has published four books and

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Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence numerous articles in several areas of social and organizational psychology. Much of his research has been focused on individual and group decision making, the relationship between cognition and behavior in organizational contexts, and the processes that link individual, group, and organizational learning. Professor Carroll is a fellow of the American Psychological Society. Linda Connell is the director of the National Aeronautics and Space Administration (NASA) Aviation Safety Reporting System, program manager/director of the NASA/Veterans Affairs Patient Safety Reporting System, and, since 1981, a research psychologist for NASA Ames Research Center. Ms. Connell has participated in numerous studies with domestic and international research teams exploring human-factors issues in aviation and other environments. She completed her bachelor’s degree in nursing at the University of Colorado and her master’s degree in experimental psychology at San Jose State University. Her graduate thesis on psychophysiological countermeasures to jet lag was completed at the NASA Ames Human Research Facility. William R. Corcoran is president of the Nuclear Safety Review Concepts Corporation in Windsor, Connecticut, founded in 1993. The organization’s motto is “Saving lives, pain, assets, and careers through thoughtful inquiry.” His company provides root-cause training, mentoring, advice, leadership, and assistance to a variety of high-hazard industries, including nuclear power, natural gas, electricity transmission/distribution, and fossil-fuel power generation. Dr. Corcoran is author of The Phoenix Handbook (Nuclear Safety Review Concepts Corporation, 1998), a comprehensive guide to root-cause analysis, and editor of “The Firebird Forum,” an electronic newsletter on root-cause organizational learning. He has served on more than a dozen off-site safety review committees for nuclear plants and chaired the American Nuclear Society Nuclear Reactor Safety Division. His work on critical safety functions has influenced the industry’s emergency procedures. Robert A. Frosch earned a Ph.D. in physics from Columbia University in 1952. From 1951 to 1963, as director of Hudson Laboratories at Columbia, he did research on ocean acoustics. From 1963 to 1966, he was director for nuclear test detection, then deputy director of the U.S. Department of Defense Advanced Research Projects Agency. From 1966 to 1973, Dr. Frosch was assistant secretary of the Navy (Research and Development). In 1973, he became assistant executive director for the United Nations Environment Programme, and in 1975, he became associate director for applied oceanography at the Woods Hole Oceanographic Institution. From 1977 to 1981, he was administrator of National Aeronautics and Space Administration. In 1981, he became president of the American Association of Engineering Societies, and in 1982, he was vice president of General Motors Corporation (GM) in charge of research laboratories. Dr. Frosch

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Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence retired from GM in 1993 and joined the John F. Kennedy School of Government of Harvard University. He is a member of Phi Beta Kappa and Sigma Xi, the National Academy of Engineering, and the American Academy of Arts and Sciences and a Foreign Member of the Royal Academy of Engineering. Yacov Y. Haimes, professor of systems and information engineering at the University of Virginia, is founding director (1987) of the University of Virginia Center for Risk Management of Engineering Systems and Lawrence R. Quarles Professor in the School of Engineering and Applied Science. As a member of the faculty at Case Western Reserve University for 17 years, he was chair of the Systems Engineering Department. During a sabbatical year in 1977–1978, as a AAAS/AGU Congressional Science Fellow, he joined the staff of the Executive Office of President Carter, and later the staff of the House Science and Technology Committee. Dr. Haimes is the recipient of several major awards in his field, including the Distinguished Achievement Award from the Society for Risk Analysis; the Georg Cantor Award from the International Society on Multiple Criteria Decision Making; the Norbert Weiner Award from IEEE Systems, Man and Cybernetics; and the Warren A. Hall Medal from the Universities Council on Water Resources. He is also a fellow of many professional societies and was president of the Society for Risk Analysis. Dr. Haimes has published more than 200 articles and technical papers and is the author/coauthor of six books and editor of 20 volumes. His most recent book is Risk Modeling, Assessment, and Management (John Wiley & Sons, 1998, 2nd ed. 2004). Christopher A. Hart became the assistant administrator for the Federal Aviation Administration (FAA) Office of System Safety in 1995. Reporting directly to the FAA administrator, the Office of System Safety provides data, analytical tools and processes, safety risk assessments, and other assistance to support numerous FAA and worldwide aviation safety programs; spearheads industry-wide safety activities, such as the Global Aviation Information Network (GAIN); and helps identify key safety issues and emerging trends that affect aviation safety. Mr. Hart has a law degree from Harvard Law School and a master’s degree (magna cum laude) in aerospace engineering from Princeton University. He is a member of the District of Columbia Bar Association and the Lawyer-Pilots Bar Association and a pilot with commercial, multi-engine, and instrument ratings. Dennis C. Hendershot is a senior technical fellow in the Process Hazard Assessment Department of the Rohm and Haas Company Engineering Division in Croydon, Pennsylvania. He has been involved with the development and application of hazard analysis, risk management, and safety engineering tools, with particular emphasis on inherently safer design, process hazard analysis, and quantitative risk analysis. He received a B.S. in chemical engineering from Lehigh

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Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence University and an M.S. in chemical engineering from the University of Pennsylvania. Mr. Hendeshot is a fellow of the American Institute of Chemical Engineers (AIChE) and is currently on the AIChE Board of Directors. He is a past chair of the AIChE Safety and Health Division and the AIChE Loss Prevention Programming Committee. He serves on the editorial review boards of Process Safety Progress, Chemical Engineering Progress, and Journal of Loss Prevention in the Process Industries. He has been active in the Center for Chemical Process Safety (CCPS), as a member and chair of the Risk Assessment Subcommittee, chair of the Hazard Evaluation Procedures Subcommittee, a member of the Inherently Safer Process Subcommittee, member and chair of the Undergraduate Education Subcommittee, and a member of the CCPS Managing Board. Mr. Hendershot is a member of the Division of Chemical Health and Safety and the Division of Environmental Chemistry of the American Chemical Society. Lisette Kanse is a postdoctoral research fellow at the Key Centre for Human Factors and Applied Cognitive Psychology at the University of Queensland in Brisbane, Australia. She has just completed her Ph.D. at the Eindhoven University of Technology, focusing on the processes involved in recovering from failures. She has also worked as a consultant in safety management and human factors at several chemical process plants and in the rail sector. Dr. Kanse’s research interests include safety management, failure recovery, human factors, incident reporting and investigation, and organizational learning. Elisabeth Paté-Cornell is the Burt and Deedee McMurtry Professor in the School of Engineering and has been chair of the Department of Management Science and Engineering at Stanford University since its creation in January 2000. From 1978 to 1981, she was assistant professor of civil engineering at Massachusetts Institute of Technology, and from 1981 to 1999, she was a faculty member at Stanford in the Department of Industrial Engineering and Engineering Management. Her primary areas of teaching and research are engineering risk analysis and risk management, decision analysis, and engineering economy. Her recent research has focused on the inclusion of organizational factors in probabilistic risk analysis models with application to the management of the protective tiles on the space shuttle, offshore platforms, and anesthesia during surgery. She is currently working on the trade-offs between management and technical failure risks with application to the design of space systems, and on probabilistic methods of threat analysis. Dr. Pate-Cornell is a member of the National Academy of Engineering (NAE) and NAE Council, the President’s Foreign Intelligence Advisory Board, the Air Force Science Advisory Board, and the California Council on Science and Technology. She is a past president and fellow of the Society for Risk Analysis. She is currently an elected member of the Stanford University Senate.

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Accident Precursor Analysis and Management: Reducing Technological Risk Through Diligence Martin B. Sattison is manager of the Risk, Reliability, and Regulatory Support Department at the Idaho National Engineering and Environmental Laboratory (INEEL). He has been associated with the Nuclear Regulatory Commission’s Accident Sequence Precursor (ASP) Program for 10 years as the lead analyst, project manager, and program manager for the development of the Standardized Plant Analysis Risk Models currently used for the ASP Program. Dr. Sattison has had 25 years of experience in the nuclear field and 20 years of experience in probabilistic risk assessment (PRA). He was a member of the International Space Station PRA Peer Review Committee and is currently a consultant to the National Aeronautics and Space Administration on the Space Shuttle PRA. In addition, he recently assisted with the Columbia accident investigation. Michal Tamuz is an organizational sociologist with research interests in risk management, improving patient safety, organizational learning, and decision making. She developed an interest in how organizations cope with uncertainty when she lived in Israel and is currently studying how hospitals and hospital pharmacies learn from medication errors, as part of a study at the University of Texas on translating safety practices from aviation to health care. Her research focuses on near-accident reporting in an array of high-hazard industries, such as aviation, chemical manufacturing, nuclear power, and blood banks. In her research, she explores how organizations learn under conditions of ambiguity and scarcity of experience. Dr. Tamuz received a Ph.D. in sociology from Stanford University. She is a faculty member at the Center for Health Services Research and an associate professor in the Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Ron Westrum is professor of sociology and interdisciplinary technology at Eastern Michigan University. A graduate of Harvard and the University of Chicago, he is the author of numerous articles and three books, the most recent on the culture of the China Lake Naval Weapons Laboratory. Dr. Westrum, who specializes in the study of corporate cultures relevant to system safety, is a frequent speaker on systems safety in the aviation, medical, and nuclear industries and has been a consultant to many large organizations, including General Motors and Lockheed Martin. Tjerk van der Schaaf has been an associate professor of human factors in risk control, Faculty Technology Management, Department of Human Performance Management, Eindhoven University of Technology, for the past seven years. He has also been coordinator, Eindhoven Safety Management Group; assistant professor of human error and industrial safety; and researcher in the Psychology Department, TNO-Institute of Human Factors, Soesterberg, The Netherlands. Dr. van der Schaaf has a Ph.D. from Eindhoven University of Technology.

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