Applying Concept of Resilience in Laboratory Safety : A Case Study from Research and Development Laboratory, National Energy Company

Transcription

1 Applying Concept of Resilience in Laboratory Safety : A Case Study from Research and Development Laboratory, National Energy Company Ivan Havosan and Pamungkas Rinengku University of Indonesia

2 Background The socio-technical systems are so complicated, that they can not be analyzed by traditional risk analysis dividing system into parts and by identifying not wanted chains of events (Hollnagel, 2007). The multidimensional and interactive activities can not be controlled by pure traditional way which is aiming to restrict errors. A new systemic approach called resilience engineering is being developed for safety management.

3 Objectives and Methodology The main research questions were: 1. What are typical features of resilience engineering and how it differs from traditional way? 2. What practical manifestations of resilience engineering we can find from present working methods? Triangulation Principles: 1. Direct observation (physical conditions walkthrough) 2. Interviewing laboratory practitioners, researchers in the field of human behavior. 3. Literature review.

4 Typical features and difference between traditional safety and resilience engineering

5 What is Resilience Engineering? Resilience engineering as the intrinsic ability of an organization (or system) to adjust its functioning prior to or following changes and disturbances to continue working in face of continuous stresses or major mishaps.

6 Resilience and Other Safety Approach

7 Resilience and Traditional Safety Engineering : Why only look at what goes wrong?

8 Manifestation of Resilience in current laboratory safety practices

9 Resilience Aspects Hollnagel, 2008

10 Learn Organizations or developed several means by which their suppose to anticipate, monitor and respond. Since the systems and environment are continuously changing, the adequacy of the means should also be continuously evaluated and improved especially because the current means not yet necessarily take the resilience viewpoint into account. Another kind of organizational learning: -development of safety culture and climate a basis for the resilience of the organization. -The active visible leadership by line management and concrete safety interventions

11 Response Ability to respond can be defined as, how well unexpected variation or expected variation at unexpected moment can be handled in order to minimize harm. The motivation to respond or responding culture may be utterly important in situations, when it is not clear, whether or not (and how) it should be responded. One example on how to enhance rapid response, is the practice to reward everybody, who stops the production line to prevent an accident (Stop Working Authority / SWA).

12 Attention (Monitoring) Organizations monitor their safety situation and development by many different means, e.g.: injury and incident statistics (NOA and TRIR), incident investigations, safety observations and audits, technical inspection, health examinations, benchmarking etc. Are these what they should look for? the systems are dynamic and complex, the monitoring focusing on gathering and using information about the situation at the moment should be more resilience enhancing, than looking backwards (e.g. injury statistics). Safety observations and audits (including near miss reporting), when they are carried out extensively by employees, (may) enhance resilience at floor level by focusing employees attention on hazards and current situation on site.

13 Anticipation The classical way of risk assessment ( traditional anticipation ) is criticized as an inefficient tool in modern systems which are complex. On the other hand, a clear model of resilient anticipation has not been introduced. However, an availability and use of hazard identification and risk assessment tools can be seen at least as a starting point for anticipation. Since resilience engineering points out the complexity and dynamic nature of systems, it can be argued that the more real time and local the risk assessment is, the more resilience enhancing it is. For example, in laboratory this means several different risk assessment activities during daily basis and task by task. Understanding of system s behavior and hazards can be seen as preconditions to anticipation.

14 Conclusions New safety management solutions and practices based on RE concept still are quite few in practices. Resilience enhancing features were identified in existing general and safety management practices (ignoring its quality as an aspect of resilience). Resilience seems to require a new approach to develop instructions and rules, which traditionally have been the corner stone s of safety management. It can be argued, that the RE already partly includes in existing management practices, but the RE concept requires more dynamic, continuous and comprehensive explanations and practices.

15 References Carvalho, PVR., et al Micro incident analysis framework to assess safety and resilience in the operation of safe critical systems: A case study in a nuclear power plant. Elsevier, Journal of Loss Prevention Dinh, Linh T.T., et al Resilience engineering of industrial processes: Principles and contributing factors. Elsevier, Journal of Loss Prevention Hollnagel, E., Resilience Engineering: Why, What and How. In Tampere, Finland: Työterveyslaitos. Available at: BC7D- 0FD515 EA4BB7/0/Erik_Hollnagel.pdf (October 14, 2009) Hollnagel, E. & Woods, D.D., Epilogue: Resilience engineering precepts. In Resilience Engineering: Concepts and precepts. Ashgate Publishing Hollnagel, E., et al., Resilience Engineering: New Direction for Measuring and Maintaining Safety in Complex System. Lund University

16 Thank You

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