CONTINUATION TRAINING

Transcription

1 HUMAN FACTORS CONTINUATION TRAINING Q3 & Page 1 of 7

2 CONTENTS: 1 INTRODUCTION 2 REVISTING THE PEAR MODEL- ENVIRONMENT 3 DISTRACTION 4 FATIGUE Page 2 of 7

3 1. Introduction Human Factors is the application of what we know about human capabilities and limitations in order to maximize overall system performance. By giving careful consideration to the interactions between humans and technological and organisational elements of a system it is possible to significantly increase the system s productivity and reliability. Human Factors addresses the interaction of people with other people, with facilities and with management systems in the workplace. These factors have been shown to have an impact on human performance and safe operations. Human Factors provide practical solutions to reduce incidents while improving productivity. In the aviation industry Human Factors is an essential component in the effort to operate in a safe and efficient manner. Areas where Human Factors has a key role include: Design of tools, equipment and user interfaces in a way that augments the user s work performance Human and organizational factors in risk assessments and emergency preparedness planning Human behaviour and cognition in accident causes Efficient decision making and teamwork in stressful or critical situations Safety culture and safety behaviour improvement programmes Organisational reliability The aviation industry has a major accident potential. All aspects rely on advanced humanmachine interfaces, and are activities with a complex organisational structure. Increasingly, the work is performed by distributed teams all around our network. Human Factors has become an important and integral part of the industry s approach to safe and efficient operations. Page 3 of 7

4 2. Remember PEAR (part 2)? It stands for: People who do the job. In this case maintenance engineers and support staff. It includes not only our capabilities and limitations, but also our interactions with others. Environment in which they work. Both physical and organisational. Actions they perform to complete the job efficiently and safely. Resources necessary to complete the job. Physical, such as tools and technical manuals, as well as the number and qualifications of the people necessary Page 4 of 7

5 E is for Environment: Physical and Organizational There are at least two environments in aviation maintenance. There is the physical workplace on the ramp, in the hangar or in the workshop. In addition, there is the organizational environment that exists within the company. A human factors program must pay attention to both environments. The physical environment is obvious. It includes ranges of temperature, humidity, lighting, noise control, cleanliness and workplace design. Companies must acknowledge these conditions and cooperate with the workforce to either accommodate or change the physical environment. It takes a corporate commitment to address the physical environment. This topic overlaps with the Resources component of PEAR when it comes to providing portable heaters, coolers, lighting, clothing, and workplace and task design. The second, less tangible, environment is the organizational one. The important factors in an organizational environment are typically related to cooperation, communication, shared values, mutual respect and the culture of the company. An excellent organizational environment is promoted with leadership, communication and shared goals associated with safety, profitability and other key factors. The best companies guide and support their people and foster a culture of safety. Environmental matters are every bit as critical as the other elements in PEAR. 3. Distraction When we look at aviation accident reports or read articles on accidents we find that from time to time a distraction affected the judgment of maintenance technicians, supervisors or managers. What is a distraction? It is the act of distracting or the condition of being distracted. It can also be an extreme mental or emotional disturbance. Distractions are a common occurrence in all of our lives, both at home and at work. But if distractions occur in a critical phase of our work, they can have disastrous consequences. Psychologists have identified distraction as the number one cause of forgetting. We humans are always thinking ahead, both consciously and subconsciously. For example, if we are distracted to the point of interruption during the performance of a task or procedure, when we return to the job, we often think we are further ahead than we actually are. This is a natural tendency which Page 5 of 7

6 occurs frequently. Often after an error has occurred, the engineer will be at a loss to explain how it happened. Again, in addition to distraction, if other factors are present such as fatigue and stress, then the likelihood of an error occurring will be increased. One safety net that we must keep in place is to always work to maintain the rational state of mind as professionals. All distractions cause us as individuals to shift from the rational state to the emotional state of mind. Then before we know it, the distraction that we encountered may set us up to create an error and we have forgotten an important step to prevent an incident. Safety Nets We have to rely on each other when it comes to distractions. A few easy to follow safety nets can go a long way to preventing both minor and major incidents. These include: Support each other and work together as a team. Plan the tasks and stay focused. Put it in writing. The written word is a valuable safety net especially for the distraction of shift changeover. Follow the work cards and check sheets. Document the work you have completed as you progress through the task. When you come back to a job take three steps back and evaluate what is done and what is not done. Do not let complacency reduce your standards. Take pride in your work. We face many distractions every day which can affect our judgment. If we work together, help each other, and use the safety nets identified in this article, then distractions will not be a big factor in our lives. Debris in Main Wheel a distraction Incident? During the pre-flight walk round being performed by the Captain, a piece of metal was found embedded in the top of the tyre of the #2 wheel assy. The aircraft had been subject to a daily inspection earlier that day, and the aircraft had not moved since that check was performed. During daily inspection performed earlier on the event day, the presence of the metal was not identified. The metal had been picked up from the ramp surface, and was traced eventually to the failing #2 brake unit on the same aircraft. During the daily inspection, the engineer stated that the fuelling company attended the aircraft. The engineer considers that he omitted the Left MLG element of the daily inspection due to distraction of the arrival of the fuel truck and subsequent fuelling operation. The engineer stated during discussion that the daily inspection sheet was not used during performance of the daily inspection as he had a level of familiarity with it, such as to cause him not to use it. Not following a logical sequence of check items meant that other than from his memory, there was no reference point to return to after breaking off from the daily inspection to attend to the fuelling Page 6 of 7

7 4. Fatigue Shift workers who work at night, late evenings or early mornings will experience some degree of sleep deprivation leading to a fall in alertness during the duty period. For night workers, this is exacerbated by naturally falling performance that is driven by the circadian rhythm. With the exception of permanent night workers, there is unlikely to be any improvement due to adaptation. The degree of sleep deprivation varies with the individual and becomes more pronounced with aging. The consequence of a fall in alertness leads to slowed reaction times and reduced vigilance, poor decision making and lack of communication. In extreme cases this may contribute to incidents and accidents. It is believed fatigue contributes between 30 and 90% of all serious incidents across industries. Working hours are controlled by a variety of prescriptive schemes in most countries in the world. The European Union introduced their working time directive to guide all workers apart from military personnel and aircrew. In any prescriptive rules set, there may be anomalies and in the aviation industry there are examples where less fatiguing schedules fall outside the rules yet more fatiguing alternatives are permitted. Self-help tips to fight fatigue Eat often to beat tiredness A good way to keep up your energy through the day is to eat regular meals and healthy snacks every three to four hours, rather than a large meal less often. Perk up with exercise You might feel too tired to exercise, but regular exercise will make you feel less tired in the long run, and you ll have more energy. Lose weight to gain energy If your body is carrying excess weight, it can be exhausting. It also puts extra strain on your heart, which can make you tired Sleep well It sounds obvious, but two-thirds of us suffer from sleep problems, and many people don t get the sleep they need to stay alert through the day. Reduce stress to boost energy Stress uses up a lot of energy. Try to introduce relaxing activities into your day. Cut out caffeine The Royal College of Psychiatrists recommends that anyone feeling tired should cut out caffeine. Drink less alcohol Although a few glasses of wine in the evening helps you fall asleep, you sleep less deeply after drinking alcohol. Drink more water for better energy Sometimes you feel tired simply because you re mildly dehydrated. Page 7 of 7