Human Factors in Latent-Print Examination
Written by Kasey Wertheim and Melissa Taylor   

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FINGERPRINT EXPERTS never make mistakes right? A better question might be, “Are fingerprint examiners human?” The answer to that question of course is, “Yes.” The reality of all human endeavors is that errors happen, even among the best professionals and organizations.

The field of human-factors research focuses on improving operational performance by seeking to understand the conditions and circumstances that prevent optimal performance, and to then identify strategies that prevent or mitigate the consequences of error. Understanding how human-factors issues impact latent print examinations can lead to improved procedures.

Human-factors research offers a variety of models used to detect and identify errors. Many of these models focus on a systems approach where errors are often viewed as consequences of a person’s working conditions—the work environment, for example, or institutional culture and management. Rather than focusing solely on an examiner when an error occurs, a systems approach would look at underlying conditions—such as inadequate supervision, inappropriate procedures, and communications failures—to understand what role they play when errors occur. Using a systems approach to understand why errors occur will help agencies build better defenses to prevent errors or mitigate their consequences.

In September 2010, the National Institute of Standards and Technology Law Enforcement Standards Office (OLES) recognized the need for further study on how systems-based approaches—such as root-cause analysis, failure mode and effects analysis, and the human factors and analysis classifications system (HFACS)—could be used in forensic settings. OLES initiated a contract with Complete Consultants Worldwide (CCW) to investigate the HFACS framework and develop a web portal to help forensic managers collect and track error-related data.

HFACS and Swiss Cheese

Dr. James Reason's 1990 Swiss Cheese Model human error

Dr. Douglas Wiegmann and Dr. Scott Shappell developed HFACS in the United States Navy in an effort to identify why aviation accidents happened—and to recommend appropriate action in order to reduce the overall accident rate. The HFACS framework was based on the Swiss-cheese model of accident causation, the brainchild of Dr. James Reason.

This Swiss-cheese model gets its name because Reason proposed that highly reliable organizations are analogous to a stack of Swiss cheese, where the holes in the cheese represent vulnerabilities in a process and each slice represents “defensive layers” that have the potential to block errors that pass through the holes. Each layer has the opportunity to prevent an error from impacting the outcome or to keep the error from leaving the system undetected.

Applying HFACS to Forensics

Working at the request of the OLES, CCW has developed an online tool that provides latent print managers and supervisors with an easy and efficient way to determine and document the factors that led to human error in a latent print case. The web-based portal is now live and ready to receive input from the latent print community. Users will be able to use this tool to identify “root causes” of errors (or near-misses) by reviewing a list of domain-specific issues and selecting the ones that are applicable to the incident in question.

The website will remain live to allow enough time to develop a database with a variety of sufficient entries. These responses will then be studied in the hope of gaining further insight into the nature of human error in latent print examination. The reporting process is anonymous, and no data will be collected on human subjects. The portal was also designed so that it does not collect any law enforcement sensitive data.

Perhaps the best way to gain insight into the HFACS system for latent prints is to take a look at the HFACS outline. For our purposes, the four “slices” in the original Swiss-cheese model have been renamed Examiner Actions, Preconditions, Supervisory, and Organizational Influences.

If you are a latent print examiner or supervisor, consider making our data collection efforts pay off by entering incidents into the portal. Without input, this effort will not have the impact that it could. And there is a benefit to those who enter their information: upon submission, a report is generated that details the factors the user identified as contributors to the incident being entered. This could be a valuable printout to obtain for the file, detailing those factors you deemed important in a particular latent print error event.

Log on today to check out the latent print HFACS portal and consider contributing to the project.

Factors that Can Contribute to Human Error in Latent Print Examinations

1. Examiner Actions that Can Contribute to Error

A) Errors

  • Skill-Based Errors
  • Decision Errors
  • Perceptual Errors

B) Violations

  • Routine Infractions—“Bending” of the rules, tolerated by management
  • Exceptional Infractions—“Isolated” deviation, not tolerated by management

2. Preconditions that Can Contribute to Error

A) Substandard Environmental Factors

  • Substandard Physical (operational and ambient) Environment
  • Substandard Technological Environment

B) Substandard Conditions of the Examiner

  • Adverse Mental States—mental conditions that affect examiner performance
  • Adverse Physiological States—medical or physiological conditions that preclude safe examinations
  • Physical / Mental Limitations—situation exceeds the capabilities of the examiner

C) Substandard Personnel Factors (Practice of Examiners )

  • Communication, Coordination, & Planning (Examiner Resource Management) Failures
  • Fitness for Duty

3. Supervisory Issues that Can Contribute to Error

A) Inadequate Operational Process

  • Problems in Operations
  • Problems with Procedures
  • Inadequate Oversight

B) Inadequate Supervision or Leadership

C) Supervisor Planned Inappropriate Operations—unavoidable during emergencies but unacceptable during normal operations

D) Supervisor Failed to Correct a Known Problem

E) Supervisory Ethics or Violations—intentional actions that are willfully conducted by supervisors

4. Organizational Influences that Can Contribute to Error

A) Inadequate Resource / Acquisition Management

  • Problems with Human Resources
  • Inadequate Monetary / Budget Resources

B) Problems with the Organizational Climate

  • Problems with Structure of the Organization
  • Problems with Organization Policies
  • Problems with Organization Culture

About the Authors

Melissa Taylor is a management and program analyst with the Law Enforcement Standards Office (OLES) at the U.S. Department of Commerce’s National Institute of Standards and Technology. Her work within the Forensic Science Program focuses primarily on fingerprint-related research and integrating human-factors principles into forensic sciences. Taylor currently serves as a member of the INTERPOL AFIS Expert Working Group, associate member of the International Association of Identification, and co-chair of White House Subcommittee on Forensic Science’s Latent Print AFIS Interoperability Task Force.

This e-mail address is being protected from spam bots, you need JavaScript enabled to view it is an IAI Certified Latent Print Examiner and a Distinguished IAI member. He serves on SWGFAST as their webmaster and also hosts, the largest web resource for latent-print examiners. He publishes the Weekly Detail, an electronic newsletter focusing on latent-print examination, to nearly 3,000 examiners every Monday morning. And he is Co-Chair of the NIST Expert Working Group on Human Factors in Latent Print Examination.

Note: Mention of commercial products or services does not imply approval or endorsement by the National Institute of Standards and Technology, nor does it imply that such products or services are necessarily the best available for the purpose.

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