Post on 18-Jan-2016
FPTA/CTD Annual Conference
October 2015
FTA Bus Safety Oversight Program
• Voluntary program but moving to an oversight role
• Developed in collaboration with industry partners (APTA, CTAA, AASHTO)
• Objective – improve safety for passengers, employees, and all that share roadways with transit buses
• Initial focus on small urban and rural bus transit systems
• Now includes large urban bus transit systems
FTA Bus Safety Program Background
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• Resource website
• Voluntary onsite reviews
• Orientation seminars
• Ongoing outreach
Major Bus Program Elements
Voluntary Onsite
Reviews
State DOT Orientation
Seminars
Bus Safety Program Website
Industry Coordination
and Outreach
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Safety Management Systems (SMS)
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• Make a safe industry even safer• Foster sound safety policy• Develop and share efficient practices for
risk management and safety assurance• Help grow a strong safety culture within
every transit system
What FTA wants…from a safety perspective
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• Accountability is properly placed• Agency-wide reporting and
communication of safety issues• Proactive investigation of hazards• Tools to monitor safety performance• Effective and efficient assurance activities• Balanced decision-making regarding
safety risk within operations and planning
What should change look like?
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• At the transit agency, state and federal levels– What are our most serious safety concerns?– How do we know this?– What are we doing about it?– Is what we are doing working?
…and importantly…how do we know what we are doing is working?
Questions we all need to ask that SMS helps answer
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• Ensures timely information about safety risks so executives can make informed decisions about allocating resources to prioritized risk
• Actively seeks to identify and mitigate hazards so we can prevent accidents and manage change
• Fosters system-wide communication about safety issues up, down and across the agency
• Improves safety culture by empowering employees and involving them in decision-making
What SMS does
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• Two critical safety related concerns that demonstrate the need for SMS are:
– The Organizational Accident – Practical Drift
Critical Concerns
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The Organizational Accident
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• Individual accidents– those resulting from the actions or inactions
of people
• Organizational accidents– those resulting from actions or inactions of
organizations
Two Types of Accidents
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“Organizational accidents have multiple causes involving many people operating at different levels of their respective companies.”
– James Reason, Managing the Risks of Organizational Accidents
Organizational Accidents
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Organizational Accidents Involve Active and Latent Factors
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DefensesPeopleWorkplaceOrganization
SafetyBreakdown
Some holes due tolatent conditions
Hazards
Some holes due toactive failures
Identifying and analyzing latent organizational factors that may contribute to accidents and incidents is a critical tool in the transit risk management process.
Organizational Accident and SMS
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“The discovery of human error should be considered the starting point of the investigation, and not the ending point.”
- ISASI Forum
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Practical Drift
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Practical Drift
System and Tasks as designed and engineered
Local Reality
Why? What happened?• Service delivery
pressures• Procedure no longer
practical• Short cuts are more
efficient• Supervisor allows it• Informal processes• Training inadequately
conveyed risk
“Work as imagined”
“Work as actually done”
“Uncoupling of practice from procedure”
Practice
Procedure
Over Time
Imperfect Systems – The Practical Drift
Start of Operations
Slide 17
Practical Drift
Operational Performance
Baseline Performance
Organization
The difference between “where we are” and “where we thought we were”
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Navigating the Drift – The Need for Data
Individual and organizational safety performance monitoring allows a transit agency to identify if, how, and why practical drift has occurred and assists in assuring safe operations.
Practical Drift and SMS
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SMS Overview
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SMS is the formal, top-down, organization-wide, data-driven approach to managing safety risk and assuring the effectiveness of safety risk mitigations. It includes systematic policies, procedures, and practices for the management of safety risk.
What is SMS?
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1. Safety Management Policy
2. Safety Risk Management
3. Safety Assurance
4. Safety Promotion
SMS Framework Components or Pillars
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How the Pillars Interact
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Safety Management Policy
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Safety Management Policy Pillar and its Subcomponents
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SafetyManagement
Policy
• Establishes necessary organizational structures, roles, and responsibilities
• Ensures safety is addressed with the same priority as other critical organizational functions
• Provides direction for effective: Safety Risk Management Safety Assurance Safety Promotion
• Helps ensure sufficient resources are provided to meet safety objectives
Safety Management
Policy Statement
Safety Accountabilities
& Responsibilities
Integration with Public Safety &
Emergency Management
SMS Documentation
& Records
The Safety Management Policy Subcomponent
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SafetyManagement
Policy
• The safety management policy statement is the charter of an SMS
• It must clearly and succinctly frame the fundamentals upon which the transit agency SMS will operate
• A safety management policy statement may not exceed a page or two
Safety Management
Policy Statement
Safety Accountabilities
& Responsibilities
Integration with Public Safety &
Emergency Management
SMS Documentation
& Records
Safety Accountabilities & Responsibilities Subcomponent
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SafetyManagement
Policy
• Safety is not the sole responsibility of the Safety Manager or the Safety Department
• Critical to detail the safety accountabilities and responsibilities for:
Accountable Executive Safety/SMS Manager Managers and supervisors Front line employees
• This is where organizational structure and arrangements are defined
Safety Management
Policy Statement
Safety Accountabilities
& Responsibilities
Integration with Public Safety &
Emergency Management
SMS Documentation
& Records
Integration with Public Safety & Emergency Management Subcomponent
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SafetyManagement
Policy
• Ensures integration of programs that have input into, or output from, the SMS
• Identifies and describes the interface with external organizations
• Ensures coordination in plans for dealing with emergencies and abnormal operations and the return to normal operations
Safety Management
Policy Statement
Safety Accountabilities
& Responsibilities
Integration with Public Safety &
Emergency Management
SMS Documentation
& Records
SMS Documentation & Records Subcomponent
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SafetyManagement
Policy
• Agency ensures that it formalizes and documents key elements of SMS such as:
Safety management policy statement SMS requirements SMS processes and procedures Accountabilities, responsibilities, and authorities for
processes and procedures
• Documentation is scalable, but must be sufficient to help institutionalize the processes within SMS
Safety Management
Policy Statement
Safety Accountabilities
& Responsibilities
Integration with Public Safety &
Emergency Management
SMS Documentation
& Records
Safety Risk Management
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SRM Pillar and its Subcomponents
Slide 31
• Vital to the success of SMS• Before an SMS can be effectively
built or improved, safety hazards must be identified in your operation and mitigations need to be in place to manage the safety risk
• Safety risk management is a continuous process
Hazard Identification &
Analysis
Safety Risk Evaluation &
Mitigation
SafetyRisk
Management
Hazard Identification & Analysis Subcomponent
Slide 32
Hazard Identification &
Analysis
Safety Risk Evaluation and
Mitigation
SafetyRisk
Management
Hazard Identification & Analysis
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Safety Risk MitigationSafety Risk Evaluation
OperationalSystem
Description
HazardIdentification
HazardAnalysis
Hazard Identification & Analysis
State the generic hazard(s)
Identify hazard components
Identify specific consequences
Collect data / info
1
2
Hazard Identification & Analysis
• The only way to know your safety risk prior to an accident
• Provides the foundation for your safety risk evaluation activities
• Must be agency-wide and fully supported and promoted
Safety Risk Evaluation & Mitigation Subcomponent
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Safety Risk Evaluation and
Mitigation
SafetyRisk
Management
Hazard Identification &
Analysis
Safety Risk Evaluation Process
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Safety Risk Mitigation
Index safety risk
Evaluate current mitigations
Evaluatethe Safety Risk
Safety Risk Evaluation
Express probability of consequence
Express severity of consequence
3Hazard Identification & Analysis
Safety Risk Evaluation• Provides a way to measure the
potential consequence of identified hazards
• Evaluates how existing defenses could mitigate the consequences
• Helps determine whether certain safety risk is acceptable, while others require risk mitigation
• Data driven - safety resource allocations are more logical Acceptable
level of mitigations?
Safety Risk Mitigation Process
Slide 36
Safety Risk MitigationSafety Risk EvaluationHazard Identification & Analysis
Safety Risk Mitigation
• Enables us to “manage” our safety risk
• Our aim is to reduce safety risks to an acceptable level
• Provides our course of action to be monitored by Safety Assurance function
Mitigate SafetyRisk
4
Safety Assurance
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Safety Assurance Pillar and its Subcomponents
Slide 38
Safety performance monitoring & measurement
Managementof
change
Continuous improvement
SafetyAssurance
• A continuous process, constantly interacting with Safety Risk Management
• Where safety performance data is collected and analyzed
• Systematic and ongoing monitoring and recording of an agency’s safety performance
• Helps verify an agency’s safety performance is in line with safety objectives and targets
Safety Performance Monitoring & Measurement Subcomponent
Slide 39
Safety performance monitoring & measurement
Managementof
change
Continuous improvement
SafetyAssurance
Safety management requires feedback on safety performance to complete the safety management cycle
Management of Change Subcomponent
Slide 40
Safety performance monitoring & measurement
Managementof
change
Continuous improvement
SafetyAssurance
Continuous Improvement Subcomponent
Slide 41
Safety performance monitoring & measurement
Managementof
change
SafetyAssurance
Continuous improvement
Safety Promotion
Slide 42
Safety Promotion Pillar and its Subcomponents
Slide 43
SafetyPromotion
Competencies and Training
Safety Communication
Safety Communication Subcomponent
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SafetyPromotion
Competencies and Training
Safety Communication
• SMS is dependent upon ongoing management commitment to communication
• One of management’s most important responsibilities under SMS is to encourage and motivate others to want to communicate openly, authentically, and without concern for reprisal
Competencies & Training Subcomponent
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SafetyPromotion
Competencies and Training
Safety Communication
• Executive management responsibility because of allocation of resources to training
• Safety training development process• Relationship between safety training and
Safety Risk Management and Safety Assurance
Employee Safety Reporting
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Slide 47
SMS and Safety Reporting: Facts
• SMS does not work without data• Nobody knows actual system performance
better than the employees delivering the service
• Power of safety reporting– Safety data capture on previously
unanticipated safety deficiencies– Safety data to confirm the effectiveness of
existing safety risk mitigations
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Effective Safety Reporting - Attributes
• Training the messengers– People are not “natural messengers”
• Ease of reporting– Simple requisites
• Timely, accessible, and informative feedback– No feedback; program crumbles
• Protection– Information only used for the purposes it was
collected
• Vehicle for change– Issues reported are solved
FTA SMS Framework
Resources
Training
Events
SMS Information
Blast emails to registered users
FTA’sSafety Training and Resource Website
http://safety.fta.dot.gov/
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