行为安全“2-4”模型及其在煤矿安全管理中的应用

Behavior-based accident causation: the “2-4”model and its safety implications in coal mines

通过观察事故统计得知,几乎100%的生产安全事故是责任事故,且是由于事故单位的"管理漏洞"所引起。理论分析得知,应用古典、近代及已有的现代事故致因链不能够精确定位"管理漏洞"的具体位置和内容,事故预防困难。根据组织行为学原理,并研究国内外已有事故致因链发现并提出了行为安全"2-4"模型这个新型现代事故致因链。在该模型中,将事故的原因首先分解为组织行为、组织成员个人行为两个层面,然后再将组织行为继续细化分解为指导行为、运行行为,将个人行为细化分解为习惯性行为、一次性行为4个行为阶段,分别对应事故的根源、根本、间接、直接原因,具体内容分别是安全文化,安全管理体系,安全知识、意识和习惯,不安全动作和不安全状态。煤矿事故案例分析证实,应用该模型,且把"安全管理"表达为"行为控制"之后,可以将导致事故发生的关键原因"管理漏洞"、"管理缺欠"理解为"行为控制缺欠",并可将其精确定位在"2"个层面、"4"个行为阶段的其中一个或几个上面,据此即可制定有效、明确的事故预防措施。

The literature demonstrates that nearly 100% of the accidents are caused by the ＂management loopholes＂ liability. However,the accidents are neither accurately specified by the classical accident causation chain models of Heinrich and others, nor by the contemporary causation chain theories. Based on organizational behavior and accident causation theories, a new accident causation chain,the behavior-based ＂2-4＂ model,is proposed. In the ＂2-4＂ mod- el, the accident causation chain consists of two separated levels, namely, organizational and individual behavior, and two stages as guiding behavior and operational behavior at organizational level, and two stages as habitual behavior and act at individual level, which respectively covers from root, radical, indirect to direct reasons of an accident. More spe- cifically ,they include the organizational safety culture, safety management system, personal safety knowledge, safety consciousness, safety habits, personal unsafe act and unsafe conditions. When the management loopholes are empha- sized as the defects of behavioral control, the multiple case study method is adopted to empirically analyze the causes of accidents in Chinese coal mines. The results indicate that the accident causation can be accurately located within one or more stages of the ＂2-4＂ model, thus the organizations can take active and clear measures to effectively oreventaccidents.