Happy New Year and Good Luck

When I see people in top hats and pigs, my first thought is not new beginnings or good luck.  In Germany, they symbolize those things and can be seen in most stores at the end of the old year.   I hope that 2011 is a great year for you, and you are as prosperous as a pig.  I hope you climb high on the ladder of satisfaction in all areas of life and that if you are a chimney sweep, you remain safe in your job.

Let’s apply these old practices to 2011.  Pigs represented prosperity for agricultural families because they provided food, fertilizer, and more pigs!   A pig displays its ability to convert what it consumes into energy.  Therefore, the gift of a candy pig on New Year’s Eve could symbolize good wishes that the recipient prosper, using one’s strengths and forgetting past failures.

The chimney sweep cleans the chimney and the hearth, and lots of people will be cleaning homes, offices, psyches this week and next.  It’s out with clutter and unhealthy practices.   It’s a new beginning, and that requires a clean slate(and chimney).

Look around your workplace.  Would it benefit from a thorough cleaning and purging of old materials?   Could it be a valuable exercise to identify what would make 2011 a more excellent year in managing the risks of your business, including the risks of human factors.  Look at the organization, the job, the individual.  What habits or practices cause problems?  What things, big or small, could improve the work environment?

Pipeline control centers face a big challenge in 2011.  They have to develop and implement a control room management and human factors plan.  This is going to require a mindset, a paradigm shift, in changing practices that may have been followed for many years.   Although the rule requires that changes affecting pipeline safety be correctly managed, the development and implementation of this rule also needs to be managed well and timely.

Sweep clean, be as prosperous as a pig, implement all changes safely, and happy new year!

Posted December 29th, 2010 in Human Factors, Observations, Operational Excellence

The Elephant in the Control Room: The People Who Work 24-7-365

You’ve heard that saying about the elephant in the room, that enormous issue that few people want to acknowledge.

Pipeline control rooms in the USA have been discussing, debating, preparing, procrastinating, and thinking about a new pipeline safety regulations that require their control rooms to develop a human factors management plan by August 1, 2011.   The major concerns at the moment seem to be fatigue mitigation and alarm management.  We’ve been working with several companies on these issues this year.

Alarm management is a labor intensive task, but it is more manageable than fatigue mitigation.  Once all the alarms are documented, categorized, rationalized, and made part of a plan, the alarms do not change unless a manageable change is performed.  Alarms are not human.

Humans are the elephant in the control room.  There may be 20 controllers in a control room and I can document them, categorize them, and provide a rational basis for why we must manage fatigue.  I can develop a rigorous fatigue management plan that includes training and limits hours of work per day and per week to allow time for sleep and recovery rest through days off.   But people might not follow the plan.  Some will not follow the plan.  Anyone who is a human being knows that.

If I want to manage or lessen the risks of a fatigue related pipeline accident, I will take a risk based approach.  For my particular control room, I will identify the potential hazards, figure the consequences and probabilities, and develop preventative measures that include several layers of protection.  I will not rely solely  on training, policies, and procedures.  that is not wise.

I will make a presentation on this subject at the American Petroleum Institute Control Room Forum  November 18, 2010.  Please see below.

There’s an Elephant in the Control Room

Posted November 14th, 2010 in Human Factors, Managing Fatigue, Observations, Operational Excellence

“Someone Somewhere Sees IT Coming”

IT is problems. Have you ever read Managing the Unexpected?   If you work in a hazardous industry, it should be required reading.  Karl Weick and Kathleen Sutcliffe state, on page 74, that “with every problem, someone somewhere sees it coming.”  Think about what people say after a problem, an accident, an error occurs. “I knew that was going to happen.”  If we suspect something is going to happen, why don’t we do something to prevent it from happening?

Weick and Sutcliffe say that the people who know “tend to be low rank, invisible, unauthorized, reluctant to speak up, and may not even know that they know something that is consequential.”  Does that describe you?

I have participated in hundreds of incident analysis and lessons learned sessions. Most could have been prevented with simple steps.  Almost always, a near miss had occurred before the incident, but was not reported or the cause wasn’t addressed.  A corrective action from a near miss will prevent an accident.  Organizations, even those who perform incident analysis, may not develop good corrective actions.   Our memories are short, and the pace of work seldom lessens till it comes to a screeching halt with an accident.

Speak up about problems, report near misses, correct hazards before they hurt you or others.  Do not be afraid to stop work if it is unsafe.

Posted October 19th, 2010 in Human Factors, Leadership, Observations, Operational Excellence