BowTie in Aviation SMS The Message to Management. Bob Dodd Senior Director Risk Management The Aloft Group

Transcription

1 BowTie in Aviation SMS The Message to Management Bob Dodd Senior Director Management The Aloft Group Dublin September 2015

2 + What the CEO Wants What they get the safety deluge Taming the deluge Strategic, Tactical and Event Management BowTie and Strategic Management High Level s, Learning Engines and Data Engines Management Accountability Outline Tactical Dashboards Continuous Data Feeds Management of Change Based Audits Event Priorities Event Investigation The Regulators View Conclusions

3 + What the CEO wants Clear picture of risk status and performance trends Resources target right risk Keep the regulator(s) happy No surprises Balance is right

4 + What Do They Get?

5 Safety Reports Flight Data Audit Reports Confidential Reports Safety Committees Investigation Reports Major Global Events External Audits Corrective Actions + The Deluge! Flight Safety Trends B737 Flight Data Engineering Audit March SMS Audit June Confidential Reports Flight Safety Committee Minutes Ramp Safety Committe e Minutes Investigation Report XXX Major Event involving YYY Airlines Regulatory Compliance Audit Safety Action Closeout Trends Ground Safety Trends And So On...

6 Safety Reports Flight Data Audit Reports Confidential Reports Safety Committees Investigation Reports Major Global Events External Audits Corrective Actions Taming The Deluge!

7 + A Strategic Approach to 7 Strategic Management Timeframe annual Major s Update BowTie Models Tactical Management Timeframe months Dashboard Trends Focussed action Event Management Response investigate or add to data? What does this event add to the picture?

8 Key risks are well studied Runway Excursion Loss of in flight CFIT Mid-Air Collision Turbulence Injury In-flight fire Runway Incursion

9 + BowTie and Strategic Management

10 + Tactical Monitoring of Threat Vulnerability Precursor Hazard Threat Consequence Threat Undesired Operational State Consequence Consequence Threat Consequence System & Culture System Weaknesses 11

11 + Sorting the data

12 Threat Threat Threat Undesired Operational State Consequence Consequence Consequence Consequence + 13 Continuously updated risk picture Vulnerability Assessment Precursor Threat Rates Failures UOS Activation Consequence Rates Based Classification Safety System and Culture Threats Safety Data

13 + based audits focus and assessment

14 + Event Classification 15

15 + Incident Investigation using BowTies

16 + BowTie Management 17 Strategic Management Timeframe annual Major s Update BowTie Models Tactical Management Timeframe months Dashboard Trends Focussed action Event Management Response investigate or add to data? What does this event add to the picture?

17 + The Regulator s View 18 Comprehensive risk process BowTie provide evidence of a systematic and thorough examination of risk Follow through on actions Linking actions to the control framework with managerial accountability for all activities associated with controls. Proactive identification of risk Integrated risk process with BowTie models as learning and taxonomy engines ensure the best risk value from both internal and external experiences SRM performance monitoring dashboards that are simple and visually show senior managers and regulators where SRM is working and what needs to be fixed

18 + Conclusions 19 BowTie models are intuitive and give senior managers a deep understanding of risk in their operation. Applying BowTie at the strategic, tactical and event levels ensures consistent and effective management of risks. Using high level BowTie models of the key risks provides both a means to integrate all of the safety processes and effective incorporation of lessons learned both internally and externally From the CEOs viewpoint this approach makes sense of the safety deluge in a businesslike manner.

19 + CONTACT US AMERICAS Adare Manor Square, Suite 1 Ashburn, VA USA Phone USA : INTERNATIONAL Coliemore House, Coliemore Road Dalkey, Co. Dublin Ireland Phone Ireland : info@aloftaviationconsulting.com