A Cognitive Human Error Analysis with CREAM in Control Room of Petrochemical Industry


Background: The cognitive human error analysis technique is one of the second-generation techniques used to evaluate human reliability; it has a strong, detailed theoretical background that focuses on the important cognitive features of human behavior.

Objectives: The aim of this study was to assign task and jobs crisis using analysis of cognitive human error with CREAM. Finally, based on the results, the major causes of error were detected.

Methods: This cross-sectional study was conducted on 53 people working in an olefin unit. It is one of the most important control rooms located in a special economic zone in Assaluyeh petrochemical industry. In this study, first a job analysis was conducted and the sub-tasks and conditions affecting the performance of the staff were determined. Then, the control mode coefficient and control mode type, as well as the possibility of total error were determined. Finally, the cognitive functions and type of cognitive error related to each sub-task were identified.

Results: Among the six evaluated occupational tasks, the tasks performed by board-man and site-man had the highest values of total human error in terms of transitory overall error coefficient (0.056 and 0.031, respectively). In addition, the following results were obtained on the basis of the extended CREAM: execution failure (31.72%), interpretation failure (29.20%), planning failure (14.63%), and observation failure (24.39%).

Conclusions: Common Performance Conditions (CPCs), empowerment, and the time available for work were among the most important factors that reduced occupational performance. To optimize a communication system, it is necessary to arrange the priority of tasks, hold joint meetings, inform the staff about the termination of work permits, hold training sessions, and measure the pollutants.