CAJ | 학술논문

复杂社会技术系统的安全绩效取决于技术层面因素与组织管理层面因素的相互作用关系，而非个体要素。事故被认为是复杂系统中各个要素之间相互作用所产生的一种涌现现象，需要用系统安全思想进行研究，建立相应的系统安全模型。本文简要回顾了事故致因与系统安全理论的发展趋势，将事故致因与系统安全理论依据研究范式划分为三代，即规范性理论与模型、基于系统状态偏离标准程度的描述性理论与模型、以及基于系统实际行为的描述性理论与模型，在此基础上，总结了建立系统安全模型的现状、必要性和挑战，强调建立系统安全模型需要从近端因素到远端因素、从静态分析到动态建模、从还原论到整体论进行转变，将安全分析重点从找寻事故原因转移到事故发生机理上来。
복잡사회기술계통적안전적효취결우기술층면인소여조직관리층면인소적상호작용관계，이비개체요소。사고피인위시복잡계통중각개요소지간상호작용소산생적일충용현현상，수요용계통안전사상진행연구，건립상응적계통안전모형。본문간요회고료사고치인여계통안전이론적발전추세，장사고치인여계통안전이론의거연구범식화분위삼대，즉규범성이론여모형、기우계통상태편리표준정도적묘술성이론여모형、이급기우계통실제행위적묘술성이론여모형，재차기출상，총결료건립계통안전모형적현상、필요성화도전，강조건립계통안전모형수요종근단인소도원단인소、종정태분석도동태건모、종환원론도정체론진행전변，장안전분석중점종조심사고원인전이도사고발생궤리상래。
The safety performance of a complex socio-technical system is determined by the interaction between organizational and managerial factors and technical factors, rather than the single element within the system. The accident can be viewed as an emergent phenomenon arises from the interaction of different agents, which requires a system safety perspective and the related system safety model. The development of accident causation and system safety was reviewed. The theories and models were classified into three generations according to the research paradigms, namely prescriptive theories and models, descriptive theories and models in terms of deviations from norms, and descriptive theories and models in terms of actual behaviors. Based on the review, current trends, motivation and challenges of establishing a system safety model were summarized. The importance of shift from proximal factors to distal factors, from static analysis to dynamic modeling, and from reductionism to holism has been emphasized that the focus should be transferred from causes to mechanisms.